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2 Aesthetic Science Institute: The War Against Aging

How to
in the
How to Win in the Youth Game 3



The world’s first televised makeover took place in 1971,

performed by Dr. Kurt J. Wagner.
Kurt J. Wagner, M.D. and Jason N.
Pozner, M.D.
Aesthetic Science Institute
4 Aesthetic Science Institute: The War Against Aging
How to Win in the Youth Game 5

“You’re beautiful.” There, I said it. That’s the
compliment you’ve been waiting for.

“You’re pretty, you’re lovely, you look so young

for your age.”

If you’re a guy, let’s say, “You’re in good shape,

you look great.”

There, that should be enough to make you feel


What?!? You want more?

Of course you do. Compliments aren’t enough. People can say nice
things, but if you don’t believe it, it’s not enough.

The reality is that we are our first and harshest critics. We ask for
cosmetic procedures and we fight aging for ourselves and not for
others. We are in the Youth Game because we want to feel better and
look better than we do today.

The Youth Game is about more than looks. It’s also about that “get up
and go,” that “joie de vivre” that you remember having in your
twenties… and now you want it back. Compliments and plastic surgery
won’t help if you don’t have the energy you’re missing. Where can we
find the magic bullets and the special formula to get back our joy of
living? Popeye the Sailor had spinach to get a boost of energy – where
is our spinach?

The Youth Game is about what you put into your body: vitamins,
hormones, antioxidants, CoQ10, fish oils, smart pills, amino acids….
It’s about exercise and relaxation.
6 Aesthetic Science Institute: The War Against Aging

The Youth Game is also about the knife and the laser. When you have
your energy back, then it’s time to think about how you want to change
your appearance.

We are cosmetic surgeons – artists, sculptors, renovators. We offer a

wide variety of services at the Aesthetic Science Institute in Boca Raton.
This book describes virtually every procedure, treatment and nutrient
used today to help ourselves stay vital and healthy.

“Mom, I think you’re good for a little

while longer.”

Why is there humor in this book?

Because if you laugh more you live a lot longer.
Look for hints as you read on.

Your Self-Image and Plastic Surgery

Improving your self-image with plastic surgery...

How to Win in the Youth Game 7

Each of us has a "self-image," a perception of how we believe we look

to others. People who are happy with their self-image are more likely to
be self-confident, effective in work and social situations, and
comfortable in their relationships. Those who are dissatisfied tend to be
self-conscious, inhibited, and less effective in activities.

Plastic surgery -- whether cosmetic or reconstructive -- encourages and

promotes a strong, positive self-image. Even a small change on the
outside can create an extraordinary change on the inside, allowing an
individual's self-confidence to flourish.

Because the changes resulting from plastic surgery are often dramatic
and permanent, it's important that you have a clear understanding of
how surgery might make you feel-- long before a procedure is
scheduled. http://www.plasticsurgery.org/public_education/
... ... ... ... ...
Do looks matter?
Dr Kate Gleeson, a psychologist working at The Centre for Appearance
Research, conducted a study among university students, and discovered
that they all carried with them the barbs of childhood. “Nasty comments
that other people had made about their appearance when they were only
five or six had stuck firmly in their psyche. One girl wore only black
because she believed she had pudgy legs, even though her body was
now very slim,” says Gleeson.
The American Society for Aesthetic Plastic Surgery reports an increase
of 23 per cent in cosmetic procedures. A recent survey showed that half
of all Americans approve of cosmetic medical procedures.

In the USA, the television series Extreme Makeover gives ordinary

people the chance to have movie-star reconstructive surgery. Some get
a complete new body and face. This season, ten million viewers applied
to appear on the show. All contestants report that they can’t live with
their – often quite ordinary – looks because society places such a high
value on physical beauty. Susan Walls, juniormagazine.co.uk

Let’s start the journey.

Before considering plastic surgery, let’s cover what you should be
putting into your very special body.
8 Aesthetic Science Institute: The War Against Aging

Chapter 1 10

Chapter 2 12

Chapter 3 15

Chapter 4 38

Chapter 5 51

Chapter 6 67

Chapter 7
How to Win in the Youth Game 9

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13
TOES 144
• SMILE, Even if you’re not on Candid Camera 157
• BREAST SURGERY – Get it on or off your chest 161

Chapter 14

Chapter 15 APPENDIXES 203

Chapter 1
The Magic of Rejuvenation
Doesn't time fly when you're having fun? It seems impossible that over
30 years have passed since I first put down my thoughts and they were

We have entered a new century on the information highway. What was

science fiction 100 years ago has become reality. Computers, lasers,
supersonic transport, the Atkins Diet, aerobic exercise, cloning,
nanotechnology the list is endless.

Our concept of aging has undergone a drastic overhaul. Who is

middle-aged? Was Strom Thurmond middle-aged - a Senator at 100? I
used to tell my patients, "Old is dead." It seemed true when I was 40
and much more plausible as I pass 70.

Being in private practice in Beverly Hills for over 30 years has given
me a great deal of interpersonal experience with over 20,000 patients. I
consider every one of them as a star. I thought that retirement would
enable me to leave the hectic arena of daily stress, but as much as I love
Kathleen (my wife of 38 years) and the occasional 250-yard drive off
the tee, it's hard to keep this racehorse in the paddock.

What about the practice of plastic surgery? My dream was always to

offer the patients not only a better-looking exterior, but also to give
them the tools to enjoy their illusion of beauty and turn it into reality.

That brings us to today's options and opportunities. Not only do we

know more about technical improvements in the mechanics of surgical
intervention, but today's expanding frontiers in hormonal replacements,
exercise options and healthier diets offer us a chance to enjoy life to the
fullest. It’s all worth just a little more effort on our parts.

There are a myriad of offerings bombarding us on a daily basis: A one-

hour face lift; lose ten pounds in two days; have an erection that lasts
forever. What is a person to do in today's world? What is truth? What
is reality?
How to Win in the Youth Game 11

My associates and I propose to give you a guide to help you along the
way encompassing many phases that will avoid the pitfalls of
superficial hype. After all, the more things change, the more basic
truths remain the same!

Read on and enjoy the journey. Maybe the magic of rejuvenation can
really get you and your loved ones fit for life! So far, it has worked for

Author Kurt J. Wagner with his wife Kathy (2001).

Chapter 2
Must we get old so quickly?
What is old? Must we equate chronological age with metabolic aging?
In 1960 there were about 3,000 people over 100 in the USA. Today
there are over 100,000 centenarians and that group is increasing at a
geometrical rate. In fact those individuals living to reach 85 or over are
the fastest growing segment of our population.

You don't have to look in the mirror to see the signs of aging. Every
day gradual changes in every cell and organ contribute to the effects
that we see and feel.

Is there any way to slow down the process? More and more scientist
and physicians seem to think so. Let's go into a brief system review of
the changes that the calendar brings.

Cardiovascular (Heart & Blood Vessels)

Cholesterol builds up in the artery walls causing inflammation and
calcium plaques. The result - blood pressure increases because of the
loss of elasticity and the danger of heart attack and stroke goes up along
with it. In addition the heart muscles weaken as well.

After the age of 20 it starts getting smaller, losing firmness and with it
some of the memory capability and thought processes as well.

In women menopause is feared by some almost as much as malignancy,
because of declining levels of estrogen , progesterone and testosterone
(more about this later).

In men, testosterone levels start their descent after the age of 30, with a
progressive decline in sexual desire and performance. While the
testosterone level goes down, the prostate increases in size affecting
over 90% of men by the age of 70.
How to Win in the Youth Game 13

Cartilage wears away and the cushion between the bones disappears
resulting in osteoarthritis. Flexibility decreases as well, but not the pain
associated with movement.

Normal joint A Joint with osteoarthritis

Somewhere between the ages of 20 and 80, lung capacity may fall by as
much as 40% even with exercise and no smoking.

All of the glands including adrenal, pituitary and pancreas decrease
their output resulting in a myriad of digestive, sexual and thinking
problems. Almost 50% of woman and 33 % of men over 45 experience
various types of sexual dysfunction that are the basis of a burgeoning
worldwide industry.

Muscle Strength
If you exercise, you won't lose 5 to 10 percent of your muscle mass
each decade after the age of 20 (like your couch potato friends), but lose
some you well.

Acuity diminishes, cataracts increase, the retina degenerates.

Hearing, Smell and Taste

Needing to listen more closely begins after age 30. Although we may
think that we savor food and drink, our ability to taste and smell also
14 Aesthetic Science Institute: The War Against Aging

If you have the right genes, you may keep your hair, but the strength
and color gradually fade.

If you’re reading this far, you know that wrinkles, sagging, spots and
sun damage are near the top of my level of interest, but improvement
can not happen by the knife alone!

Not a pretty picture, is it? Maybe we can’t stop the inevitable, but why
make it easy for Father Time? Let’s get started and see what we can do
to make the most of what we have and even improve on it?

"You name it, we'll frame it!"

"If your face or body is unbecoming to

you, you should be coming to me!”
- Kurt Wagner

LAUGH TIP: For Your Lips

Full open-mouthed laughs increase breathing.
Immunoglobulins (which fight diseases) have been
found at higher levels after a belly laugh, showing
that comedy can improve our immune systems.
Norman Cousins, a famous editor and writer,
watched the Three Stooges and sitcoms to help
fight a cancer.
Chapter 3
Face the facts!
That’s what we examine when we wake up and again before bedtime.
Our face. When did those lines appear? And all those spots, the crow's
feet, the bags under my eyes? I didn't even have a drink last night.

Numerous psychological studies, not to mention personal experience,

attest to the fact that when we look our best, we feel and
do our best! Let's start by seeing what's available to help restore
the "Beauty that was Greece and the Grandeur that was Rome.”

To Cream or Not to Cream?

That is The Question
An age-old one at that! Anthropologists and researchers found a
makeup kit in a royal tomb in Babylon. We know that Cleopatra had
the following items in her possession: brow and hair dyes, bleaches,
powders and rouge and, yes, even moisturizers, wrinkle cream, freckle
cream, sunburn lotions, depilatories, lubricants and cleansers. A
motivational researcher summed it up on national television over 40
years ago, "When a woman applies cream, there's a sort of feeling of
something magic happening.”

Nowadays we can add men to the quotation as well.

Before we get into what's new, let's pay homage to the physician Galen
who first developed the basic formula for cold cream: oil, beeswax and
water. And it happened in the 2nd century AD. Added ingredients can
come from the sea, from animal, vegetable, fruit or mineral, ever
expanding the multibillion dollar business that shows no signs of
bursting at the seams. It is more and more apparent that there is nothing
superficial about the connection between a person's looks and the way
they feel.

Let's look at some of the real changes that these chemicals cause.

Skin - What would we do without it?

16 Aesthetic Science Institute: The War Against Aging

Cole Porter's immortal classic "I've Got You Under My Skin” couldn't
be a more appropriate way to start this phase of our journey, because
part of staying young is mirrored by the surface.

Skin is the largest organ in our body, accounting for over nine square
feet of surface area and 20 percent of our weight. It is complex
stratified into three compartments, epidermis, dermis and subcutis (or
hypodermis), and contains hair follicles, sweat glands and sebaceous
glands (oil producers). Its functions are many:

1. Barrier - Keeps our fluids in and external fluids out

2. Temperature control –
Cooling through sweat and dilation of blood vessels
Heating insulation and constriction of blood vessels
3. Sensory Input - nerve ending between the top 2 layers tell our brain
what we're touching or feeling
4. Site of Metabolism - Melanin and keratin absorb ultraviolet light to
protect cellular DNA, Vitamin D synthesis
5. Immune response - role in antigen identification by special cells to
initiate or regulate antibody response.

The various layers of the skin are the targets of constant irritation (e.g.,
sun exposure, smoking) or therapeutic relief by topical or surgical
methods. As we shall see, there's much more than meets the eye.

Since a visit to any store will provide us with an immediate

bombardment of liquid creams, pills and potions promising to help us
How to Win in the Youth Game 17

stay young and beautiful, let's see what's for real and what’s just “pie in
the sky.” Sorry, but a little science is necessary, at least to become
familiar with the labels. There are several skin cells that are vital in
maintaining the properties of the skin.

Keratinocytes (ke RAH ti no sight) make up 80 to 90 percent of the
epidermis, the top layer of the skin. Their entire life cycle is 30 to 40
days as they journey upward to the surface to be shed. They are very
sensitive to exposure to ultraviolet light, which, when unchecked,
causes damage to their DNA, the gateway to
cancerous changes. They are the targets of chemical peels, laser
resurfacing and topical agents, which we'll discuss later.

Melanocytes - These are the second major group of cells. By

producing melanin in varying amounts, melanocytes determine skin
color. When exposed to ultraviolet light in limited amounts, we can
tan, but too much UV and all hell breaks loose. Hormones,
inflammations, medications, injury and genetic factors all can affect the
cells of response that extend from inactivity to overproduction to death.
Have you ever seen a bad skin peel?

This thin layer is made up of cellular and extra-cellular elements that
interact within a scaffold. This scaffold maintains the integrity of the
skin as the barrier to damage.

Collagen is the main structural element in the extra-cellular matrix and

is composed of sequences of amino acids. They are responsible for the
smoothness and youthful appearance of the skin. Type I collagen, the
most common, is produced by fibroblasts cells, which are constantly
remodeling the skin. They can be stimulated to produce excess amounts
after an injury. Type III to VII have varying roles in the maintenance
of a health or regimenting matrix.

Elastin - These fibers are necessary for the skin and all other organs to
stretch and recoil (like a rubber band). They occupy only one to two
percent (by dry weight) of sun-protected skin. Materials like hylaronic
acid, glycosamine, and fibril are becoming household words due to their
increasing presence in creams, pills and fillers. All of these and others
are necessary parts of the dermal framework.

The cells of the dermis also include:

18 Aesthetic Science Institute: The War Against Aging

Fibroblasts, which are responsible for imitating the healing response

after injury.

Mast Cells stimulate the healing response.

Macrophages are the street cleaners, removing damaged tissue to pave

the way for regeneration. In addition, they initiate granulation tissue in
healing wounds, by promoting the formation of new blood vessels.

Dermal photo aging

That's what we are most concerned with, but what exactly are we
talking about? It is the combination of two parts: chronological and
sun damage. Much as we try, we can't halt Father Time (but we're sure
going to slow him down). Outdoor life seems to be the major culprit.
My mother was allergic to the sun, so she made considerable efforts to
stay in the shade. Although her skin sagged, her first deep wrinkle
appeared only at age 80.

The subtle gradual changes of chronological aging are much more

marked and prominent in people who have endured chronic sun
exposure. The fine wrinkles and sagging are replaced by deep furrows
and leathery skin under the microscope, a condition called solar
elastosis. A hodgepodge of broken, disorganized tissue replaces the
neat array of youthful dermis.

What's out there?

Here are some guidelines: skin feels good when it is soft and pliable,
depending on the quality of the stratum corneum (top layer) and the

Alpha Hydroxyl Acids (AHA)

These are organic acids primarily found in fruits. From the first report
of the therapeutic benefits of AHA almost 25 years ago, its use has
increased exponentially. These compounds have been shown to
increase skin thickness without wounding the dermis. They act by
removing the superficial layers and stimulating collagen growth to give
the skin a smoother appearance. Some histopathological studies have
revealed an increase of epidermal thickness of up to 60 percent. (As we
age, our skin becomes thinner. AHA makes the skin more elastic and
“younger.”) The level of glycosamine compounds has shown a similar
increase. In some concentrations, glycosamine binds water to the
superficial cells, enhancing skin softness, but when we stop AHA
treatment, after two or three weeks, it's back to square one.
How to Win in the Youth Game 19

Beta Hydroxy Acids (Salicyclic Acid)

BHA kills keratinocytes (which harm the skin) and induces smoothness
of the skin, but at a price. It is irritating, it increases skin sensitivity and
it can cause allergies in daily use. If you have warts or some form of
acne, “beta” away, but for wrinkles or scars, forget it!

Trentinoin - Retinoic Acid (TRA)

This is a retinoid that has also been shown to increase skin thickness
and glycosamine levels. TRA creates increases in procollagen (the
precursor to mature collagen) just under the outer skin layer. Increased
moisture and softness last for as long as four months after discontinuing
its use.

This pure form of vitamin A probably becomes metabolized into
retinoic acid in the skin. Since it is less concentrated, retinol is less
irritating than retinoic acid, but less effective.

A newer product that some people compare to trentinoin, although it
probable is more of a moisturizer.

Vitamin C - (Ascorbic Acid)

Some recent evidence shows that the topical form may act as a potent
antioxidant, reducing ultraviolet effects on skin aging. It might be a
really potent sun screen.

Vitamin E
This antioxidant works the same as Vitamin C by protecting the skin.

Take your pick. They work by supplying the stratum corneum with
liquid protection from the extreme elements - wind, cold, heat. To
some investigators, moisturizers do more harm than good on the
cosmetic scene. Does "dry skin" have to be nourished? Must moisture
be restored? Why don't children and men need moisture as well?

Adverse effects?
Some well-known practitioners in the field (Dr. Obagi) have linked the
habitual use of moisturizers to dependencies, increased skin sensitivity
and possibly accelerated aging. I and many other surgeons who have
spent countless hours washing our hands have never needed assistance
to overcome dry palms. Moisturizers can actually aggravate some
dermatological problems, such as acne rosaceae, seborrhea, and clogged
20 Aesthetic Science Institute: The War Against Aging

pores, while tending to reduce the efficiency of other agents such as

Retinoic Acid and AHA. So what do we do about really dry skin? It is
probably due to a decrease in the dermis of glycosamine production,
which affects its capacity to combine water. If you reverse these
changes (maybe with trentinoin), then the dryness lessens or disappears.

So what does this mean to us? Before we start any programs to

improve or maintain our outward appearance, we must aim for certain
1. Improve the quality of all layers of the skin.
2. Increase skin circulation.
3. Improve hydration and tolerance against the elements with 2 goals.

How to do it? Let an experienced professional lead you.

Topical application of some products can work

How to Peel Without Getting A Sunburn

So far, we have discussed many ways to rejuvenate the skin with
various modalities. However, a discussion would be incomplete
without summarizing the various peeling agents, some of which should
only be used by an EXPERIENCED practitioner.

Light Peels for Common Use

How to Win in the Youth Game 21

Alpha - Hydroxy Acid (AHA)

Already discussed above. They are derived from such common
substances as citric acid, milk, tomatoes, apples and mangoes. By
varying the concentration from less then 10 percent to 70 percent, they
can be purchased over the counter or can be applied by professionals. It
acts by removing the superficial layers and by mild irritation, thickens
the skin.

Beta Hydroxy Acid

BHA comes from salicylic acids. In low concentration, it causes mild
peeling, with limitations discussed earlier.

Let’s go to the doctor! He has some serious solutions for all kinds of
skin problems!

Stronger solutions
Trichloracetic Acid (TCA)
This is the most commonly used agent in strengths ranging from 20 to
50 percent. By destroying the outer layer of the skin, it stimulates the
dermis to produce more collagen and elastin, resulting in fewer
wrinkles. This is the mechanism for all chemical peels. The deeper you
go up to a point, the better and longer lasting the result. But, as the
saying goes, "no pain, no gain." The increase in discomfort must be
dealt with by varying degrees of sedation and anesthesia.

I discussed this at length over 30 years ago and nothing has changed my
mind about it. Phenol is the most effective method of skin rejuvenation
with the possible exception of newer lasers IN THE PROPER HANDS!

After it enjoyed soaring popularity in the sixties (stolen from lay

practitioners by the medical profession), its use died down quite a bit
because of the inability of some doctors to master its measure.
Unskilled use resulted in reported cases of scarring and disfigurement.
Once applied to the skin, phenol is immediately absorbed and its effects
can not be neutralized (however, TCA can). It is metabolized through
the liver and kidneys, so its application must be gradual and regimented.
It is painful, so sedation is a must. It results in depigmentation in
varying degrees because of its ability to penetrate deeper layers, so there
will always be some lightening of the skin. After 40 years of use, I still
marvel at what a proper treatment can do. While a day may not make
the difference (you're bandaged for a while), a week can evoke a
22 Aesthetic Science Institute: The War Against Aging

Before the phenol peel One month after the peel

(without a peel, she’s (plus face and neck lift – now
without appeal) that’s “appealing”!

TIP: Laugh your blood sugar down

Diabetics should read joke books and
watch America’s Funniest Videos.
Glucose levels in your blood actually
stabilize when you laugh heartily.
The Brilliance of Botox
A prominent medical dictionary published just twenty years ago defined
botulism as "an intoxication due to the ingestion of clostridium botulism
toxin in improperly preserved or canned food; mainly affecting man,
sheep, horses. etc. It is characterized by paralysis in all species."
Remember that word “intoxication.”

The disease is caused by a neurotoxin that is produced by a bacterium,

clostridium botulinum. This bacterium can live for a long time as a
spore wheel, which is a reproductive stage of certain bacteria or fungi.

Place it in a moist low-acid setting without oxygen and the spores

quickly grow into adults and give off their nerve-damaging toxin that
can cause death if not checked.

Let’s not get too medical. The neurotoxin blocks an important enzyme,
acetylcholine, which signals muscles to function by contracting. The
botulism toxin can stop your muscles from functioning, so therefore it is
a potential powder keg.

But here modem science has come to the rescue. Take a poison, refine
and purify it, use it in small amounts on specific parts of the body and
the results are truly INTOXICATING. By the end of 2004, botox
injections were the most popular cosmetic treatment in the world. They
provide happiness to countless millions, not to mention to the TV
stations, magazines and newspapers that have run the ubiquitous
commercials on a daily basis.
24 Aesthetic Science Institute: The War Against Aging

What Botox can do

Frown muscles

Between the eyes

In the forehead
Around the eyes

Before After

Before After

The late 1980's marked the first time a purified botulinum (trademark
Botox) was used in humans to treat certain ocular disorders. While
treating crossed eyes and eyelid spasms by temporarily weakening the
How to Win in the Youth Game 25

muscles responsible, an ophthalmologist noticed that the wrinkles her

husband (a dermatologist) was filling with collagen were easily erased
with Botox and improved for a longer period of time. In addition, her
patients seemed more relaxed and appeared younger.

And so we can thank Drs. Alastair and Jean Carruthers of Vancouver

for opening the flood gates due to a bit of serendipity and alert

From this auspicious beginning, Botox has risen to Number One with
no obvious contender in sight, and now with the complete approval of
the FDA. Even the tyro has heard of the increase in the number of
Botox parties where a group of patients gather together to save a little
time, a little money and share a camaraderie.

Like the title of a popular song of the late 1950's, "Little Things Mean a
Lot,” Botox is sealed in small vials and packaged in 100 units. The
lethal dose is 3,000 to 3,500 units. The average treatment ranges from
30 to 100 units, leaving a large safety margin. Thus a poison has
become a pleasure.
But wrinkles are not the only target for which botox is intended. The
medical improvements of cosmetic surgery are legion, ranging from
achalasia (esophageal spasm, a spasm in the esophagus) to athlete’s foot
to migraine to hyperhydrosis (sweaty palms and armpits) to other forms
of muscle spasm that are beyond the scope of our discussions. In
addition, new uses seem to be springing up on a monthly basis.

Before we go overboard on this new miracle, let’s look at the

downsides, albeit they are few and far between, and thank goodness
only temporary.

Side Effects
(Usually due to poor administration by someone inexperienced.)
1. Eyelid and eyebrow drooping
2. Difficulty in swallowing
3. Muscle weakness (too much too soon)
4. Antibody production - no results (fortunately less than 5 percent)
The pessimists with their philosophy of “the glass is half-empty” will
pick up this banner of negativity. However, the legions crying for
continued treatment stand ready to crush these objections.

Around the eyes

26 Aesthetic Science Institute: The War Against Aging

Wrinkles near the eye, before and after Botox.

What's Available?
Aside from Botox, a form of Botulinum A manufactured by Allergan
(the number one in use), there are several other medical toxins
available. Myobloc is the newest and is made from botulinum B. It has
the advantage of being more stable in liquid form and works on those
patients who have developed a resistance to Botox.

That product may be used alone or in combination in certain diseases

such as hyperhydrosis (sweaty palms). In addition there is a newer
contender, Dysport, which is manufactured in Europe and is essentially
the same as Botox but in a lesser concentration.

Before we become completely INTOXICATED, let’s go over what

botox can do in the constant fight against the ravages of age. What's
possible? Do you have wrinkles caused by muscle tension or muscle
action (such as neck bands or forehead grooves)?

Do you have spastic muscles? Need to soften the signs of aging such as
jowls? Do you want to turn a frown into a smile? Get out the needle.

What's not!
Do you have spots or blotches?
Do you have lizard-like skin?
Is your collagen in need of tightening?
Do your neck and cheek areas remind you of a bloodhound?

Don't worry because we are here to help with laser, the surgical knife,
chemical peels and hormonal adjustment. Our own Dr. Jason Pozner is
one of the foremost administrators in the art of Botox treatments and
has contributed to several books on the subject.

For those avid researchers who need a more thorough exploration into
other uses of Botox, I would recommend The Botox Book by Lautin,
How to Win in the Youth Game 27

M.D. and Levine, D.C.M. as a possible primer (note Dr. Pozner's


So we add another package to our travel bag on the road to

rejuvenation. Let's continue on our trip to the fountain of youth. We've
only just begun!

Is Botox forever?
No. Three to six months.
Does it make sense to keep paying for fewer
wrinkles? Is there a more permanent
Sure -- Light laser. It’s expensive, but paying for
a one-time procedure might work better than
multiple visits to the bovine injection station.
In fact, Jason Pozner, the Light Saber expert on
the ASI staff, takes a pay cut two days each
month to teach other doctors the finer techniques
of this delicate procedure. Some doctors travel
28 Aesthetic Science Institute: The War Against Aging

Fill to Your Heart’s Content --

with Caution and at a Price!
When I was a young plastic surgeon, people were still looking for an
ideal filler for wrinkles or necessary tissue. It should be non-toxic, non-
allergenic, long-lasting, easily introduced, relatively affordable and free
of mistakes.

The search began in the late 19th century when a Dr. Neuber used a
person’s own fat to correct facial depressions. There is even a reported
case of the successful implantation of a fatty tumor (Lipoma) taken
from the buttock of a patient to replace breast tissue removed at the
same time. In the early 1900's, the paraffin injection craze swept the
world until, alas, almost every patient developed foreign body tumors
with resulting disfiguration and infections.

In the 1940's injectible silicone became available as a dermal implant

and it seemed the search was over!

This substance could be transformed into liquid gel or solid by the

simple addition of a catalyst. What could be simpler?

A potent house of horrors was released that occasionally continues to hit

the headlines to this day. Pure liquid silicone can migrate because there
is no tissue cohesion. How many patients was I to see with swelling in
their nose, checks, or jowls? There have even been reports of deaths to
accidental injections of silicone into the blood stream.

When combined with other material (would you believe even snake oil
in “The Sakari Formula”?), silicone injections can give patients terrible
experiences. In some cases, there were granules, infection, tumors,
sometimes resulting in the removal of massive amounts of face and
breast tissue. Attempts to stop its discriminate use resulted in only
seven centers in the USA being authorized to use minimal amounts by
the American Society of Plastic Surgery and the FDA for 20 years.

There have always been other alternatives, some of which require

surgical intervention. But the real thrust came about 20 years ago with
the introduction of collagen, a product derived from denatured cow
protein. So let's go into a brief summary of what's available for a quick
fix for varying periods of time.

Collagen occurs within the skin and its loss secondary to aging causes
sagging wrinkling and decreased smoothness. At first it was
manufactured from animal (cow tissue) and required sensitivity allergy
How to Win in the Youth Game 29

testing via a skin test. Now it is derived from human collagen

(foreskin) and has a much lower incidence of problems. It is effective
in minimizing facial lines, grooves creases and scars. It was the first
injectible to be used to plumb lips on a common basis. However, the
body digests the animal-derived collagen, requiring refills at 3 or 4
months’ intervals even with the human form. It may be an injector’s
delights - very safe with a need for a constant replacement like tooth
paste, but what about the patient?

Here are some of the newer injectible fillers: Inamed, Zyplast, Zyderm,
Restylane, Perlane; they are comprised almost primarily of hylaronic
acid molecules. The latter is a natural structural element occurring in
the skin, subcutaneous connective tissues, and synovial fluid. Since
hylaronic acid is identical in all living tissues, there is less chance of
reaction, although occasionally a few reactions in humans have been
reported. It has the advantage of lasting over twice as long as collagen
and has enjoyed popularity, particularly in Europe.

Articoll - according to articles appearing in the newspaper including

Wall Street Journal this material is soon to be approved by the FDA If
this made up of tiny beads of polymethacrylate suspended in bovine
collagen (à la zyplast) and lidocaine (anesthetic). When injected the
tiny beads cause the body to produce its own collagen to wall off the
foreign droplets. Of 200,000 patients treated in Europe, the
manufacturers reports only 15 developed the most serious complication
(granuloma) tests in the US have not been as positive and there have
been reports of late problems. Since the results may be permanent, we
should proceed with caution. In addition, a skin test is also indicated
before onset of treatment.

Radiesse - this product has burst into the rejuvenation scene with a roar.
The principle component of this material is synthetic calcium
hydroxylapatite a biomaterial with over 20 years of use in orthopedics,
neurosurgery, otolaryngology (ear nose and throat) and ophthalmology.
Calcium hydroxylapatite is the main mineral constituent of bone and
teeth. It is suspended in a gel carrier for injection. After instillation,
the gel (carboxy menthyl cellulose CMC) is replaced by soft tissue
growth, while the carbon crystals remain at the site of injection. The
result may be one to three years of improvement compared to 3 to 4
months with collagen at a bargain price of $600/cc (cubic centimeter).
While the initial expense may seem high, there is less need for repeated
injections, which is the case with other fillers. Longer-lasting results
suggest that this may be a way to go at the present time.
30 Aesthetic Science Institute: The War Against Aging

Reviderm-Intra (Treviderm)
This material is made up of dextran beads suspended in a non animal
hylan gel. The proposed mechanism of action is similar to articoll,
causing a foreign body reaction that results in new collagen formation
on a permanent basis. It is used to treat wrinkles, skin defects, and in
Europe for lip augmentation. A preliminary study of 300 patients
seems to confirm its permanence but no FDA approval as yet.

Endoplasm 50 - Another European product made up of soluble elastic

particles naturally occurring in the skin suspended in cow collagen. It
needs 2 skin tests and may last 1 year.

New Fill a.k.a. Sculptra - A European contender made of a non animal

polylactic acid supposedly biodegradable, bio-compatible and non-
allergenic, good for everything including massive tissue replacement in
the cheeks and hands and post liposuction deformities. It is distributed
freeze-dried, has a long shelf life and like instant coffee only needs
water to make it ready for use. It has been approved in the USA as
Sculptra; early results are promising.

Hylaform Gel - This is made from hylaronic acid taken from rooster
combs of domestic stock. A more concentrated from called SYNVISC
is used to treat osteoarthritis of the knees with FDA approval. It is used
world wide for wrinkles, scars and lip fills, with an effect lasting up to
three times as long as collagen it also is easier to inject. Who's chicken

Biopolymer - Before we leave the injectible fillers, we should mention

the questionable availability of liquid droplets of silicone (that's what I
said) on a limited basis. In the hands of some practitioners it may be
ideal for acne scars and fine lines.

Filling The Surgical Way

So far we have discussed augmentations with materials from a
manufactures that only require an injection. There are a number of
other products or procedures that require an incision for placement or
harvesting of material.

Fat Injections
What a great idea! Why not make a small incision in hidden areas like
the lower abdomen or buttocks, use a careful liposuction or harvesting
technique to gather fat cells, and then inject them into the lips, local
folds or other crevices as needed? We usually offer fat injection as an
adjunct to facial surgery, but in our hands and in the experience of
How to Win in the Youth Game 31

many others, the results are equivocal. Fat cells do not take as readily
as skin grafts, but the use of fat injection continues.

Dermal Fat Grafts have been used with success for decades with
varying degrees of success. The proclivity for dermis (deep layer to be
accepted makes it an ideal choice for deeper folds between the eyes and
the nasolabial (nose and lip) lines. However, before implanting these
grafts through a small incision, the surgeon must remove the entire
layer of outer skin (epidermis). If just a few cells are left, subcutaneous
cysts with infections may result. Therefore, the use of dermal fat grafts
is limited.
32 Aesthetic Science Institute: The War Against Aging

The Wonders of Fillers

Some of the many uses of fillers (before and after).

There are a number of synthetic products in popular use, such as Gore-

Tex (that's the same material used for ski wear, bathing suits and the
like). It is inserted under the skin to act as a filler and is stabilized by
the growth of natural tissues into it. My wife has had it in her nasal
reconstruction for over a decade with excellent results, but a few
patients show a reaction. In passing there are two other materials in
limited use.

Alladerm - Human skin with living cells removed - used like Gore-Tex
in folds or rolls and acts as a matrix for tissue growth. Cynetra is the
injectible form.
How to Win in the Youth Game 33

Lip Enlargement and Eye Liner

Before One month later – Wow!

Soft Form - A hollow tube of synthetic material inserted in the proper

tissue plane to fill grooves or depressions. The tissue growth fills the
tube for a permanent improvement, but (like the Three Bears) it can't be
placed too high to be noticed or too low to be a waste, but at just the
right below the skin.

A word of caution before we continue our exploration. As you have

probably guessed by now, these procedures are not like putting in a
padded bra. There are some risks!

1) Bleeding or bruising - No aspirin-like medication or Vitamin E

before or after surgery for at least a week.
2) Allergic reactions - Keep in touch with your doctor
3) Local skin death.
4) Bacterial or viral infections - A predilection for cold sores should
be reported before treatment.
5) Irregularities of the overlying skin - Your doctor can usually
correct them.
6) Shock, stroke, death, blindness - But don't worry! You have a
much better chance of winning the lottery or becoming an astronaut.

So what's a person to do? Know your options, know your doctor and
listen to his advice. I do!
34 Aesthetic Science Institute: The War Against Aging

Name Composition Uses Length of FDA
effectivenes Available
Zyderm Animal Fine lines, 3-4 months Yes
Zyplast Collagen wrinkles
Rest lane Hylaronic Acid Fine lines 6 - 12 Pending
Perlane Present in all wrinkles, lip months
Species enhancement
Radiesse Calcium Same as above 3-5 years Pending
Hydroxyl +Cheekbone
Apatate +Chin
(Synthetic) +Soft Tissue
Main enhancement
constituent of
bone and teeth
Cosmoderm Human Same as above 3-4 months Yes
Cosmoplast Collagen Zyderm and
(no skin test Zyplast
Articoll Methacrylate, Wrinkles and 2-3 months No
Microspheres Scars
Bovine Collagen
Hylaform Hylaronic Acid Wrinkle, Scars 3-6 months No
Gel (from rooster lip
combs) enhancement
Reviderm Dexran Beads in Wrinkles, Permanent No
Intra Hylan Gel Atrophic scars
and lips
Silicone Silica (man Wrinkles and Permanent Only
Biopolymer made Scars but difficult Ophthalmic
polymer) to keep Use
Ectoplast 50 Soluble Elastin Wrinkles and 1 year No
and Animal Scars
(skin test)
New Fill Polylactic Acid Soft Tissue Two years Yes
(Sculptra) Hands, Cheeks,
Chapter 4
Keep Your Heart
Ticking On Time
You don't have to be a genius to know that a young heart is the key to
remaining vibrant and energetic. With the amount of information
pouring into our awareness highway, perhaps a brief summary of where
current thinking stands is in order.

In October 2000 the New England Journal of Medicine published three

articles linking the presence of blood indications of inflammation to
those people more prone to develop coronary heart disease and stroke.

One of the culprits is a protein called fibrinogen, which causes the

blood to thicken and clump and clotting. Those with higher levels of
fibrinogen showed twice the chance of succumbing to a heart attack.
Another marker is C Reactive Protein, which stimulates the
destabilization of atherosclerotic plaques, freeing them to flow freely in
the blood stream. The result is three times greater likelihood of death
from a heart attack.

The third indicator is hemocysteine, a protein marker. This substance

may cause lesions on the arterial walls that enable cholesterol (low
density lipids or LDL = bad, think “low is no”) and fibrinogen to
accumulate and obstruct blood flow. It is a potent free radical that can
work its damage even with normal cholesterol levels. While we're at it,
let's look at the levels acceptable in helping to prevent cardiovascular
36 Aesthetic Science Institute: The War Against Aging

Blood Test Standard Optimal

Acceptable Level Where I want to be
and so should you

Fibrinogen less than 460 mg/dl less than 300

C Reactive Protein less than 4.9 mg/dl less than 2

Homocysteine 15 micro mol/l less than 7

Glucose less than 109 mgm/dl less than 100

Iron less than 180 mg/dl less than 100

Cholesterol less than 199 mg/dl 180-220

LDL less than 129 less than 100

HDL more than 35 more than 50

Triglycerides less than 199 mg/dl less than 100

DHEA female 35 mcq/dl 350-430

Low density cholesterol is bad (L for Less, bad)

High density cholesterol is good (H for Happy)

There are some differences of opinions about the level of healthy

cholesterol, but currently it is important to keep the LDL (bad) below
100 and the HDL (good) over 50. If overall cholesterol levels are too
low, this may increase the chances of spontaneous hemorrhages.

So what can we do about it? Pharmaceutical companies are making a

small fortune (watch TV) with statin drugs (Lipitor, Zocor) that lower
cholesterol dramatically. But, in what doses? The proper combination
of supplements outlined in the following pages will help. If ever we
needed a gatekeeper, we need one for nutrition.
How to Win in the Youth Game 37


From the very first we have all been told to drink our milk, clean our
plate and take our vitamins. One-A-Day made its mark over 50 years
ago but alas, unless it's the size of a boulder and time-released, I'm
afraid it just won't do the trick anymore. More and more exploration
leading to information and at times misinformation has led to the steady
increase of products lining the shelves of almost every store with
counter space. Let's try to make sense of it.

Part of the aging process is due to the production of “free radicals” by

the cells of the body. These are called pro-oxidants and in reality are
damaging chemicals which have been shown to contribute to the
development of arteriosclerotic heart disease, cancer vision impairment,
and arthritis.

We manufacture our own antioxidants, but in quantities insufficient to

counteract the ever-increasing enemy. Supplements containing certain
vitamins, minerals, amino acids and enzymes should theoretically
neutralize a great deal of the circulating antagonists.

Vitamin A - Fat soluble improves the normal process of enhancing the
immune system and promoting eye and liver health.

Vitamin C - Cold and cancer preventative (according to Dr. Pauling)

which has antihistamine, anti-viral and anti-bacterial properties.

Vitamin E - Positive cardiovascular effect, decreases LDL (bad

cholesterol), enhances skin health and protects cell membranes and
blood cells from breakage.
Vitamin B6 - enzyme activator which promotes B-12 absorption,
immune system function and antibody production.

Vitamin B12 - aids in food metabolism, necessary for red blood cell
formation, prevents cataracts, acts in cell reproduction and growth.
38 Aesthetic Science Institute: The War Against Aging

l-cysteine, taurine, 1-methionine, important in all phases of cell
metabolism including muscle building, fat metabolism, liver, eye and
brain protection.

Minerals are catalysts for many biological reactions and are important
in maintaining and no nutrition would occur. Hormones, enzymes and
cells metabolism are intimately associated with these trace elements. So
is the proper functioning of the central nervous system, muscles and
heart. Without these minerals, no skin would heal, no muscle would

Zinc - Part of 25 enzymes associated with digestion and metabolism, a

complement of insulin and necessary for wound healing.

Selenium - Destroys free radicals and is necessary for tissue elasticity.

Manganese - Necessary for the central nervous systems, for synthesis

of fatty acids and cholesterol, blood sugar and central bone growth.

Copper - Aids in bone fixation, hemoglobin and red blood cell activity,
works with Vitamin C and zinc to form elastin, increases healing, and
plays a role in hair and skin coloring and taste sensitivity.

Enzymes are energized protein molecules, necessary for life which are
found in all living cell. They catalyze and regulate every biochemical
reaction in the human body. The food we eat, the energy we use all
need enzymes for utilization. There are three enzymes types. Two
(digestive and metabolic) are produced by our body when needed.
Food enzymes are introduced into the body through the raw foods we
ingest. Some of these enzymes have antioxidant properties.

Catalase - builds up the immune system

Super Oxide Desmutase - the destroyer of the most common free

radicals, SOD aids in the proper utilization of copper zinc and
manganese, and it revitalizes cells.
How to Win in the Youth Game 39

DHEA - dehydroplandrosterone - Introduced about 20 years ago and is
currently enjoying an increasing popularity. In addition to possibly
controlling the levels of fibrinogen and c-reactive protein it has the
ability to improve many of the symptoms attributable to both andro-
and menopause. This is due to the fact that it is metabolized to produce
both testosterone and estrogen, a bonus for many and a curse for a few
such as men with prostrate cancer or severe prostatic hypertrophy
(“large size”). Women with estrogen-dependent cancers should also be
aware. Better to be under a physician’s care!

DHEA has been shown to prevent obesity, diabetes, cancer and heart
disease, stimulate the immune system and even extend longevity.
These observations led investigators to theorize that some of the
degenerative changes associated with human aging could be linked
to a progressive deficit in circulating DHEA. Thus, DHEA may
represent biomarkers of healthy aging.
-- Dr. Brizell

This is a time-keeper hormone secreted by the pineal gland and is
regarded by some as holding the secret to aging. It seemingly works in
harmony with growth hormones to maintain tissue health and promote
sleep. It’s implications in being a possible anti-cancer therapy are being
explored. A recent study in Europe showed a statistical improvement in
the one-year survival rate of advanced metastatic (spread) cancers. To
use the words of many a Jewish grandmother, it couldn’t hurt to take
melatonin. Besides, it helps you sleep.

CoQ 10 - A Most Important Vitamin

About 20 years ago this new compound was introduced to the North
American market. Coenzyme CoQ 10 is a powerful antioxidant and is
instrumental in protecting the mitochondria and the cell membrane from
free-radical damage. It’s also an essential part of the cellular
respiratory cycle, since it generates ATP, the cell's energy. In addition,
recent research reported the role of CoQ 10 in preserving the
antioxidant property of Vitamin C, possibly preventing atherosclerosis,
causing improvement in advanced heart disease. There may be a link to
brain disease due to insufficiency of this nutrient. Orally administered
CoQ 10 works by helping the mitochondria (energy powerhouse)
regulate the transformation of fats and carbohydrates into energy.
40 Aesthetic Science Institute: The War Against Aging

A biogenetic theory of aging was introduced by an Australian scientist,

Linnane, which linked the relation of oxidative stress in a vicious cycle
to cellular DNA defects, bioenergetic decline and aging and
degenerative disease. If this is partially correct, the role of CoQ 10 as
an integral part of any anti-aging regimen can not be overlooked.

Alpha Lipoic Acid - The Universal Antioxidant?

A leading expert in the field of free radical research is Lester Parker,
who heads a prestigious department at the University of California at
Berkeley (where else could you find someone making free radicals?).

In his review article, Dr. Parker analyzed the biochemical reasons and
other important criteria for evaluating the potential and therapeutic
applications of an antioxidant.
• Is the antioxidant able to neutralize free radicals?
• Does the antioxidant have a chelating effect on metals?
• Does the antioxidant interact with similar components?
• What are the effects on gene activity?
• Availability and how well is it absorbed?
• Does it concentrate in tissue cells?
• Is the antioxidant active in fat and water metabolism?

To be effective, an antioxidant needs to fulfill only a few of these

criteria. For instance, Vitamin E acts only in fat metabolism, but has
been shown to be a very important requirement. After reviewing
several studies. Dr. Parker came to the conclusion that ALPHA
LIPOIC ACID may be the closest substance to an ideal universal
antioxidant - Why?

1. It is readily absorbed.
2. It neutralizes free radicals in both fat and aqueous (water)
3. It regenerates other antioxidants like Vitamin C and E, CoQ 10 and
some amino acids.
4. It has metal-chelating properties.
5. It may have an effect on genes and regulatory proteins involved in
normal growth and metabolism.

The downside is small because those patients with B12 deficiency may
cause a worsening of symptoms. But aside from occasional skin rashes
and hypoglycemia in diabetics, no serious side effects have been
reported even at high doses.
How to Win in the Youth Game 41

Fish Oils –
There’s Nothing Fishy about the
If you want to believe the American Heart Association (and you
should), fish oil supplements drastically reduce the risk of sudden death.
They came to this conclusion by studying over 11,000 patients who had
suffered a heart attack within three months before the start of the study.

All of the patients had a diet alteration which included increased

portions of fruits, vegetables, fish and olive oils. One group received an
additional 1000 mg (one gram) of fish oil supplement daily. After three
and a half years, this group had 45 percent fewer deaths from heart-
related disease. They postulated that fish oil helped to prevent
arrhythmias, a condition where the heart muscles beat out of control,
causing the cessation of effective blood flow. In addition, fatty acid
imbalance has been linked to a litany of disorders which have a
common link:

- aging
- hypertension
- arthritis
- memory loss and dementia
- adult diabetes

So, take your fish oil and slip off the hook of these debilitative
42 Aesthetic Science Institute: The War Against Aging

Human Growth Hormone

A key to the fountain of youthfulness?
Whoever gets e-mail must be aware of the ever-increasing
advertisements regarding the availability of HGH products in various
proprietary forms. The hormonal extract, produced by the pituitary, has
been used for many years to deal with delayed growth patterns in
children. It is given by injection and is relatively costly. Within the
past decade there has been an expansion into the commercial market.
Why the interest?

In 1990 a seminal study in the New England Journal of Medicine by a

Dr. Rudman appeared. Although only 12 men, aged 61-81, received
supplements of HGH, it was concluded that 6 months of therapy
reversed 10-20 years of aging on lean body mass and fat tissue

The reports of improvement are almost unbelievable and even if only 25

percent are half-true, supplementation may be worth a try.
Here is a partial list:

l. Increased muscle mass and strength

2. Decreased body fat
3. Decreased blood pressure
4. Increased immunity
5. Decreased wrinkles, smoother skin
6. Increased memory and blood flow
7. Increased joint flexibility
8. Increased sexual function
9. Decreased blood sugar
10. Decreased total cholesterol
11. Increased stamina
12. Increased cardiac strength
13. Hair growth
14. Decreased PMS
15. Stronger fingernails

How do we get a hold on this stuff?

One of two ways - either by injection of the pure extract (expensive,
but it works), or by the injection of HGH stimulants, precursors that
supposedly assist the pituitary gland to release more of the hormone that
declines with age. As far as we know, there has not been a really
definitive study to show that oral growth hormone releasers get the job
done, despite the claims of the manufacturers.
How to Win in the Youth Game 43

The only thing true is that these precursors, a combination of amino

acids and vitamins, can cause a slight rise in HGH, but only a fraction
compared to injections of the hormone itself! But they are eminently
more affordable, although you may wind up taking 20 or more pills a

What else can we do to affect growth hormone levels?

These sound like sensible ideas:

1. Don't be fat. Protein is good (Thanks, Dr. Atkins)

2. Sleep well.
3. Get plenty of exercise (aerobics for sure).
4. Controlled stress. How do we do that? Mental gymnastics, for
one. (Use it or lose it!) Create opportunities to do something different
(drive home a different route, learn another language, speak in public).

But there surely must be a downside to HGH. Of course, there is!

Some people complain of increased blood pressure, others report an
increase in the size of the prostate, others still say that their fat stays.
We owe it to ourselves to taste a little before we swallow it hook, line
and sinker.

Remember the catalysts

In order to absorb many supplements, you need other micronutrients.
There are catalysts that help the absorption. These added ingredients
bring up the costs of most supplements, including the “Forever” pill (that
contains ingredients used to repair chromosomes). Many people think
they are saving money by buying a supplement without these catalysts.
They could get double the effectiveness by purchasing the bottle that
costs $5 or $10 more but includes the needed catalyst. That catalyst
might be an enzyme, a vitamin, whatever. If you don’t have the catalyst,
much of the supplement goes unused and leaves the body. You might
have gotten only $3 value of benefit from a $20 supplement.... Talk about
being pennies wise and pounds foolish!

You need the catalysts -- we all do! So, do the right thing and look for
the catalysts in the pills you take. – Dr. Brizel
44 Aesthetic Science Institute: The War Against Aging

The Four Gs
So what is a person to do? Anyone seriously interested needs
professional guidance. Although there are many claims for adding
certain compounds to enhance health, there are some potential side
effects, particularly for someone contemplating surgery. For instance,
the four Gs (ginger, garlic, ginko biloba and ginseng) have been shown
to have some deleterious effects.
Ginger - It may alleviate nausea but bleeding time is increased (the
time it takes to stop bleeding).
Garlic - Whether your breath is bad or not, garlic can lower blood
lipids and it has antioxidative properties. However, it can also increase
bleeding time.
Gingko Biloba - It may clear your mind a little, but it also increases
bleeding time.
Ginseng - It is used to increase energy, but when combined with certain
stimulants, it can increase heart rate and blood pressure. It may also
cause blood to clot too readily.

There you have it... This information is a mouthful, to say the least,
and it’s an awful lot to swallow, but in divided doses, it may be just the
right medicine for you.

Charge it! (with apologies to MasterCard)

Next Birthday: 57

Cell Age: 32, thanks to Dr. Brizel’s

Chromosome Repairing Formula ($78 per

Mental Age: 28, thanks to “Smart Pills” ($62

per month)

Metabolism: like a 35-year-old, thanks to HGH

($231 per month)

TIP: Drink two cups of coffee or tea a day.

Research can’t explain why, but caffeine appears to
significantly reduce the onset of Parkinson’s or
Alzheimer’s diseases.
Chapter 5
Hormones – Heaven or Hell?
Not a week goes by without a story appearing with conflicting reports
about the effects, good or bad, of hormonal supplements and their role
in our daily life style. If that isn’t enough, we have to weed through the
TV supplications to take everything but the kitchen sink in an effort to
restore or mend whatever ails us or can go wrong! The next pages will
help in finding your way to a clearer understanding of what is, what
isn’t and what could be. Come along.

Why Worry about Hormones?

How does the modern woman differ from her predecessors? In the past,
the female had a shorter life span and was concerned with multiple
cycles of pregnancy and breast-feeding diseases, sanitation deficiencies
or a hostile environment. With luck, a few adults lived to a ripe old age
of 65.

What we have seen is nothing short of miraculous in the past century.

A woman doesn't have to become a mother shortly after the onset of
puberty. She can shape the time and size of her family, if she wants
one. We have birth control pills. Morning-after pills, career
opportunities, the realization that the "Venusians" woman can control
her external and internal environments to an extent never before
dreamed of.

But the stress of daily living brings its own demands. The barrage of
environment, chemicals, stress in the career and increases in newly
recognized diseases and hormonal abnormalities has tempered the joy of
so-called liberation.

As we all admit, most people are confused about aging and the role
hormones play in accelerating the process of slowing it down. And the
media doesn't help. It seems that not a week goes by when some study
is quoted about the erroneous_ information given to the public by
overzealous practitioners.

"Study Links Breast Cancer to Hormone Use" (LA Times)

"HART Causes an increase in Senility" (NY Times)
46 Aesthetic Science Institute: The War Against Aging

Is it a wonder that many women go around in an emotional quandary?

Are hormones the continuation of a good life or the beginning of the

What is the news not telling the public? Can the same hormones that
keep us young and vital for so many years become a slow poison as we
grow old?

According to many practitioners, including our Institute’s medical

director of age management, there is nothing much in common between
the reports and the hormones produced in the body.

The estrogen hormone is not derived from human sources. It owes its
existence to pregnant horses. It’s surprising that more women don't
whinny while they're on Premarin. Similarly, Provera is derived from
petroleum by-products.

So is it possible to find a safer road to a longer, healthier and more

youthful existence? Why have multiple cosmetic procedures to improve
the facade if part of the foundation is eroding and in need of immediate

Natural hormones may be the answer

What are they and where do they come from? The majority of anti-
aging specialists use substitutes made from soy beans and wild yams.
With a little bit of chemical gymnastics these plants can produce
hormones that are IDENTICAL to human production. But, before you
go on a steady diet of these foods, just know that your body can't do
what the chemist does!

There is no shortage of these compounds, available either through

prescription or over the counter. However, to stop the rush to a health
food store, let’s go over a few ground rules. In the first place, each of
us is unique and although we fit into certain groups and categories,
individual responses must be recorded. We know that the presence of
hormones decreases at an astounding rate as we age.
How to Win in the Youth Game 47

Age-Related Decline of Hormones

Estrogen – a 30% drop by age 50 and a continued sharp drop
throughout menopause.
Progesterone - 75% lost from age 35 to 50 then continuing decline
Human Growth Hormone, DHEA, Pregnenoline and Testosterone -
50% decrease between ages 25 and 50, then another 50% decrease to
age 75
Melatonin - Minor decrease between from ages 25 to 40, then a sharp

What can a patient do? Let’s get some hormonal level readings and
compare them to the patient’s symptoms.
1. Energy Level - Sluggishness
2. PMS symptoms - Night sweats hot flashes
3. Mental State - Anxiety depression, memory
4. Weight gain
5. Sexuality – declining interest.
6. Muscle time – soreness, long recovery after using the muscle
7. Bone and Joint problems

Then titrate the supplements to achieve maximum results. This means

that the patient works with the doctor to find the right level of
supplements for the patient. If a woman with low levels is doing fine
while another with so-called normal levels has hot flashes and sagging
empty breasts, then treat the symptoms and not the bad work. As a rule,
start by adjusting the estrogen and progesterone levels.

Unlike pharmaceutical hormones, natural supplements leave the body

within 8 to 16 hours without an accumulation of effects. They are
available in a number of forms.

1. Capsules
2. Vaginal creams
3. Topical creams and gels
4. Sublingual drops
5. Suppositories
6. Lozenges
7. Dermal patches

It is obvious that the dosage will vary with age, the onset of stress,
menopause, but who, why, what, where, and how are questions that
must be answered and asked at periodic intervals. If a person should
take only one or a combination of hormones is a decision that can not
be made without thorough evaluation.
48 Aesthetic Science Institute: The War Against Aging

Remember that taking any hormone is like being part of symphonic

orchestra. Be sure the conductor not only knows the score, but also
gives you the right instruments and pills. If you know how to play
them, with the right choice, you can make beautiful music together.

Now, let’s go on to another often-overlooked source of improvement.

TIP: When you have back pain, don’t listen to

your friends. Most people recommend “bed rest.”
Unfortunately, after staying in bed more than three
days, the back muscles that are in spasm also
begin to weaken. The best way to recover is to
gently walk. Your body was built to walk, so do it.
Even a slow walk while you’re in pain is better than
just lying there because the other back muscles
that are not in pain can be exercised.
How to Win in the Youth Game 49

Testosterone - For Men Only?

We claim to be better informed today in the Information Age, but
maybe we're not. A Yale study in 1997 found out that over 66 percent
of women believe that estrogen and progesterone are naturally
occurring female hormones, while less than half thought that
testosterone had anything to do with their bodies.

Wrong! All female estrogen is produced from androgen male hormones

(including testosterone), which begin to emerge as puberty erupts, In
fact, teenage girls’ interest in boys is the results of the increase in the
libido power of male hormones, which include flights of fantasy and
arousal. While estrogens may make sex more comfortable by
increasing lubrication, don't discount testosterone for getting you there
in the first place.

Where are the male hormones produced? The adrenals and ovaries.
As we age, the output decreases. You saw that between the ages of 20
to 40 the amount of female circulating testosterone decreases by up to
50 percent. With the onset of menopause another 30 to 50 percent
disappears. So, while hot flashes and vaginal dryness may make the
headlines, for some women (not all) the decrease in sexual arousal is
strictly related to the level of testosterone. In addition, some
medications like birth control pills, certain mood elevators and some
blood pressure medications add to a further decrease.

How does a women suspect that she is suffering from a deficiency?

The first sign is when no man, let alone her partner, arouses any
interest. Her nipples and clitoris feel more like dead tissue than hot
spots. There are also the usual symptoms of deficiency - loss of muscle
tone, decreases in genital tissues, dry skin and loss of pubic hair.

So what can the addition of testosterone do for a female? There

have been several studies proving that testosterone can boost desire,
increase psychological well being, strengthen bones, and ease
menopausal symptoms in those patients not responding to estrogens

Sounds too good to be true? There may be a downside. Images of

hairy, acne-faced, muscle-bound women with a clitoris reaching the size
of a penis may sway many women away from the benefits of
testosterone therapy. There have been enough studies to assure us that
physiological doses may cause some hirsuitism (excessive growths) in a
few patients, but little else to cause concerns. In addition, changes in
50 Aesthetic Science Institute: The War Against Aging

cholesterol and liver function studies are equivocal. In the past

testosterone was used to treat breast cancer, so that may be a plus.
However, the body can convert it into estrogen, so a little caution is in

Who should consider taking testosterone? If you have an intention

of having a baby, forget it! We aren't sure about patients with heart and
liver disorders. So, discuss it before you try it and never start using
testosterone on your own. In short, the decision is based upon a
complete work up, an experienced physician and a knowledgeable

Now let's talk to the guys.

How to Win in the Youth Game 51

A Solution to Andropause
(and whatever else ails the men?)
We are quick to recognize the word "menopause" as an integral part of
our treatment program targets to maintain youth and vitality but what
about the male counter part?

For time immemorial, the literature is filled without awareness of the

importance of testosterone in maintaining the image of a "Real Man."
The eunuchs in the harems and the "castrati" in Italy are but a few of the
popular examples of early attempts to modify male development for
special reasons. I even used to laughingly tell my balding male patients
that I could stop their problem with a simple operation - Castration!
Needless to say, no one accepted my suggestion.

In recent years we have become cognizant of a problem that had fallen

between the cracks - ANDROPAUSE. Walk down the street or look in
the mirror, guys - the signs are there.

The waist thickens and the pot belly appears, the muscles begin to lose
their tone and an increasing loss of well being, libido and unexplained
sadness start to fill the air. For awhile it was to be accepted as a part of
growing old, but there's nothing graceful about it.

That was then - this is now! Ever-increasing scientific data is appearing

to prove that most of the symptoms prevalent in men over 40 are
directly related to hormone imbalances. Moreover, these conditions are
now correctable with available drug regimens and nutritional
supplements. One of the contributing factors to the problem has been
drugs prescribed by conventional medicine for hypertension, increased
cholesterol and a host of other diseases that actually can aggravate the
underlying imbalance.
52 Aesthetic Science Institute: The War Against Aging

A major thrust in maintaining a youthful and healthy lifestyle is to

check the blood levels of testosterone, estrogen, thyroid and other male
hormone precursors and restore them to fit the profile of a young adult,
rather than just treating symptoms.

What is andropause?
It is slightly different in meaning than menopause which is derived from
the Greek words menses (periods) and pauesis (stop). Greek words
andro (male) and pauesis (stop) and is appropriately named "when
masculinity ceases" or at least begins to slow down. Malcolm
Carruthers in his excellent treatise Revolution has given us several
check lists for self-diagnosis before running off to seek professional

When we compare the symptoms of menopause and andropause, we

find that they are identical: reduced libido, fatigue, depression aches,
aging, sweating and hot flashes. We can rate these symptoms with
points as None (0), Slight (1), Medium (2), Severe (3), or Extreme (4).

0 1 2 3 4
1. Fatigue – tiredness, etc.
2. Depression- low mood
3. Irritability- bad temper
4. Anxiety- nervous
5. Memory loss - decrease concentration
6. Relationship problems at home
7. Decrease sex drive - libido
8. Erection or potency problem
9. Increase skin dryness
10. Increase sweating day or night
11. Joint or back aches
12. Loss of fitness
13. Heavy drinking

• Add 4 points for each of these - mumps, orchitis, testicular problems, prostate
inflammation, vasectomy and urinary infections.
• Andropause rating 0-9 okay. 10-19 possible, 20-29 likely, 30-39 think about
treatment, 40+ run, don't walk, for help.

Although andropause may overlap and contribute to the well-examined

"Mid-life Crisis," this is another reason to seek professional help in
choosing the right paths to regain a feeling of well being. I had trouble
How to Win in the Youth Game 53

determining when or if my mid-life crisis started and ended. I know

that a song by Peggy Lee (a former patient) called "Is That All There
Is?" struck a chord in my heart and many times in my throat.

TRT (Testosterone Replacement Therapy) is only one of the steps in

dealing with andropause, albeit an important one. By initiating a more
positive outlook, it can induce many men to drink less, exercise more,
lose weight and deal with stress in a positive way. After an exhaustive
work up, you may be ready for a program that may include testosterone
in the form of pills, patches and pellets in combination with exercise
and dieting regimens.

Sounds like a no-brainer. Maybe not. There are natural concerns about
possible problems involving the prostate gland, the liver and heart. This
stems from the fact that the first pill produced almost 70 years ago,
methyltestosterone, was found to cause liver damage (even resulting in
cancer), increased cholesterol levels and prostate growth. It can still be
obtained over the counter in some parts of the world and should be
avoided at all costs.

At the present, there are many safer forms of treatment that should be
obtained from an expert in the field. It pays to do a little investigation,
particularly with the Internet available.

For links to more information, see DrKurtWagner.com and click on

“Hormone Therapy.” Or go directly to www.asimd.com.
54 Aesthetic Science Institute: The War Against Aging

Viagra - Cocked and Ready to Fire!

How many men don't imagine what it would be like to be James Bond?
The similes comparing guns to penises are a source of amusement and
entertainment. If the most serious things are said in jest, what better
examples can we give? Cocked, ready to shoot, pull the trigger –

As we well know, the ideal match would be a teenage boy with a more
mature woman. But aside from a few well-publicized exceptions
usually ending in prison time for the unlucky lady, such is not the case.
What is a man to do when faced with a partner who has a reawakened
sexual zeal after her hormone replacement therapy (HRT), one of the
modern miracles of our time? Thanks to Pfizer, Viagra comes to the

Although most men deny it, impotence, whether occasional or

continual, is one of the most prevalent fears of the male population. A
Massachusetts Male Aging Study in 1993 that included almost 2,000
men aged 40 to 70 revealed that about 50 percent of them had difficulty
in maintaining an erection at some time. That’s truly an epidemic of
increasing proportions due to decreasing proportions.

1998 marked the dawn of a new era with the introduction and FDA
acceptance of VIAGRA. It came about quite by accident because it was
the product of studies testing nitric oxide, a relatively new compound to
be tested within the human body within the last ten years or so. It was
hoped that by playing around with its metabolism, a pill could be
developed that would dilate the blood vessels of the heart and relieve
the pain of angina. A researcher at Pfizer set up a study of a drug call
SILDENAFIL (Viagra). This was known to increase nitric oxide
production, but unfortunately did little to ease chest pain. When he
asked his patients to return their pills, many refused, saying that while
their chest pains remained their erections returned with a BANG! And
so it was that a wonder drug was born with quick FDA blessing.

Like Shaquille O'Neal and Dwayne Wade or Batman and Robin,

another dynamic duo is ready to keep us springing into action in our
search for staying young -TESTOSTERONE + VIAGRA Check it out.
Incidentally it also works for the ladies. We'll talk later.
How to Win in the Youth Game 55

Get To Love Avenue In The Fast Lane

I've devoted several chapters to love and how to feel more attractive.
Let’s summarize what's available to put more bang in the boudoir, or
lust in the living room if you choose.

Ladies, just because male chauvinists have occupied most of the

headlines, there are still any number of avenues worthy of exploration
for the fairer sex.

Viagra - If it's good for the gander how about the goose? Early studies
suggest that it increases lubrication and vaginal engorgement, thereby
increasing sexual response.

Prostaglandin E - Currently used in men by direct penile injection

(ouch) it is well suited to be a vaginal suppository or penile gel. The
optimal result- the clitoris and vagina are engorged, the nerve endings
become sensitized, a tingling sensation has been reported. What could
be bad?

Psychostimulants - Sorry, but I must get a little technical again. Many

women are on antidepressants like Prozac, Zolof, and Paxil.
Unfortunately, that's not all they depress due to being Selective
Serotonin Reuptake Inhibitors (SSRI's). I've said it-- remember it for
just a little while. Suffice it to say that it to say that amphetamine
compounds (diet pills) and the like in low dosage enhance sexual
libido, women usually more vigorously than men. However, caution is
in order because of the potential danger of addiction, arrhythmias and
side effects.

Ephedrine - The sympathetic nervous system is an integral part of

sexual response, particularly during height of arousal. It stands to
reason medications and activities that increase peripheral sympathetic
response will have a positive effect on excitations. Studies have shown
that exercise increases vaginal blood flow and physiological response.

Ephedrine should theoretically be a perfect fix. Its plant origin, Ma

Huang, has long been marketed as a sexual nutritional supplement. But
the use of ephedra as a suppressant for weight control has come under
attack, being removed from the market with rapidity and zeal in the
wake of a recent $600 million law suit due to the death of a baseball
player. Maybe we should really shelve this idea and go to the gym
56 Aesthetic Science Institute: The War Against Aging

Wellbutrin - Pay close attention to this one, because not only is it an

effective antidepressant, it's a proven aid to kicking the smoking habit,
it does not work by being a SSRI (now you can forget the medical
reason). Not only does it not affect serotonin metabolism, but while it
is a chemical derivative of ephedrine, it is not metabolized to
amphetamine, is not a scheduled drug and has not been found to be
abused in over 15 years of use. It works by increasing dopamine
reuptake which consistently has been associated with pleasure and
sexual arousal in both male and female animal research studies. It may
take 10 to 14 days to kick in, but it's worth it.

Dephrenyl - It's an adjunction to treat Parkinson's Disease, and a

dopamine activator. Male rats love it and their sexual desire virtually
increases in leaps and bounds. We're not sure but it may have a mild
effect on the ladies and is safe with little side effects. It has enjoyed
some attention because it's main chemical action releases a massive
amount of PEA (PHENYLETHYLAMNE) the chemistry of love
component found in chocolate that has been labeled as an aphrodisiac
(Sorry no research to back this up, so stay on your diet).

Oxcytocin - This is a "touch" hormone secreted during human and

animal intercourse, particularly at climax. It is frequently used to
induce labor contractions and to treat post partum milk letdown. Some
women have reported tremendous increase in sexual response after oral
spray to treat these post partum problems. Since it is intimately
associated with the presence of estrogen, HRT therapy may resolve a
menopausal oxcytocin deficiency. Research continues.

Testosterone, Estrogen
We've discussed it at length, there's no doubt that these hormones are
some of the things you can't do without. Go back and check out the
previous section.
How to Win in the Youth Game 57

Alternative Medicines
Ginko Biloba - The Chinese have loved it for centuries. It may:
1. increase vascular flow to the genitals
2. increase activity of prostaglandins
3. affect serotonin and norepinephrine activity
4. but remember it also thins the blood!

Ginseng - it may increase the efficacy of the body' own sex hormones,
but it also may give hormonally sensitive tumors a boost, so beware!

Ma Huang - We have already panned this one enough.

As you can see there is a marked cross over in potential efficiency and
problems as well. DHEA and testosterone are among the more common
supplements with the limitations duly noted.

The time is here to recognize that both sexes deserve whatever help
they can get to lead a useful life behind closed doors as well. It's
obvious that we need a guide, now more than ever, but the results are
well worth it!
Chapter 6
Food for Thought –
Power or Poison?
Sir Henry Taylor, a 19th century intellectual, made this telling quote:
“His food was glory, which was poison to his mind and peril to his

Truer words may never have been spoken and since Sir Henry lived
from 1800 to 1886, he obviously practiced what he preached and used
his mouth for something besides speaking.

Food, of course, is the fuel for running the human machine. The whole
trouble with eating is the associations it carries. From infancy to the
grave, we use it to satisfy some psychological and emotional hungers.
It is love, a fact established by the nursing or feeding mother, indelibly
etched into our being. It can make up for frustration, rejection, failure,
and a lousy sex life. And when it comes to socializing, isn't it usually a
meal that is set before us with a dazzling display of culinary delights?

It's no mystery why a person gains weight. Some genetic diseases

aside, if we take in more calories than we use up, the scales show it and
the fat bulges don't lie. Here are some basic facts we learned in high

1 gram of carbohydrate = 4 calories

1 gram of fat = 9 calories
1 gram of protein = 4 calories
Take into consideration the basal metabolic rate (BMR), which is the
amount of energy we use to help the vital organs function properly.
Add to it the amount of energy used when we work or play and you
have the number of calories needed to get through the 24-hour day.
Adjust the calorie intake and you're home free. Sounds easy, but there
are mysterious forces at work.
How to Win in the Youth Game 59

Read the papers, watch the news, open the magazines - it's no mystery
at all! Sue McDonald’s, give Burger King and Taco Bell the heave ho,
surely we couldn't have been to blame!

Now, let's get down to the subject at hand. One out every two
Americans is overweight and our children and grandchildren are
heading there at a precipitous rate. How many people have become rich
telling us what or what not to eat, what time and in what combination to
nourish ourselves, what pills or spells to expose ourselves to in the quest
for a better me? We've touched on emotional and binge eating. Before
you throw your hands up in frustration and head for the refrigerator,
we'll give you a compass to help you stay on course.

What is obesity? Simply defined, it is too much fat for your body mass.
As you all know by now, it can open a Pandora's box of problems - type
2 diabetes, high blood pressure, gall stones, and arthritis for openers.
Of course clinicians have a handy table for calculating it - THE BODY

Weight Height
(Pounds) (feet, inches)
5'0" 5'3" 5'6" 5'9" 6’0" 6'3"

140 27 25 23 21 19 18
150 29 27 24 22 20 19
160 31 28 26 24 22 20
170 33 30 28 25 23 21
180 35 32 29 27 25 23
190 37 34 31 28 26 24
200 39 36 32 30 27 25
210 41 37 34 31 29 26
220 43 39 36 33 30 28
230 45 41 37 34 31 29
240 47 43 39 36 33 30
250 49 44 40 37 34 31

Desirable = 19-24
Overweight = 25-30
Over the top = more than 30.
60 Aesthetic Science Institute: The War Against Aging

This table will let you know what your BMI score is, unless you're built
like the Hulk.

So, how do we tip the scales on our direction?

There are literally hundreds of different diets that have been promoted
as the safest and quickest way to lose that extra flab. They usually
involve eliminating or severely curtailing entire food groups for a
limited time or forever. Currently high protein, low or no-carb diets are
in vogue. They include Atkins, Sugar Busters, Protein Power, Low
Carb Living, and the new kid on the block - The South Beach Diet. In
addition, we now have a new table to worry about: the Glycemic Index.
It has been introduced as a variable in some of the aforementioned
How to Win in the Youth Game 61

Possible Choices for Weight Control

Glycemic Index - This was established in 1981 to help people
maintain stable blood sugar levels. It is a rating of foods on a scale of 0
to 100 according to the extent to which they raise blood sugar levels
after eating. Individual foods with a high number release glucose more
rapidly causing a rapid increase in blood sugar levels. Used since then
by diabetics and endurance athletes, it has become a mainstay for
several investigators. However, many experts downplay its importance,
citing its drawbacks in assessing food combinations (peanut butter and
jelly) and high fat products (chocolate).To help a little, a list of
common food indexes is on our web site DrKurtWagner.com.

Atkins - Dr. Atkins opened up the door. He maintained that by cutting

out carbs, our body would naturally lose weight by burning stored fat in
spite of a diet laced with bacon, eggs and Roquefort dressing. Reviled
at first, more and more of his products and copy cats thereof fill shelf
space, even in convenience stores. But even he permits the gradual
inclusion of limited amounts of certain carbs.

South Beach - The latest rage was initiated by a cardiologist Dr

Agatson, who decided that there was not one eating pattern that would
improve the cholesterol and insulin levels of his cardiac patients. It is a
combination of protein intake and good carbs, based on their, you
guessed it, glycemic index. It forbids all the supposed culprits for the
first two weeks - fruit, bread, rice, potatoes, pasta, and prepared
desserts. The same goes for alcohol of any kind. Following this
indoctrination period, high-fiber carbs such as whole grain bread are
added. It looks like South Beach has convinced more than a few to
plunge right in, while many Atkinsonians cry foul!

Zone - If you like the middle of the road and agree that high carb
living can be "dead wrong,” this is for you. Proponents maintain that
40% carbohydrates, 30% fat, 30% protein is the ratio that promotes
youthful energy and vigor.

Eat More, Weigh Less - Dr. Dean Ornish, well known for his
success in reversing arterial heart blockages without surgery or drugs,
takes a different approach. He contends that a high-fiber, low-fat
vegetarian diet will keep you healthy while losing weight. In addition,
he champions exercise and has a different notion of the origins of our
eating habits in prehistoric times. If you can live without meat, all
62 Aesthetic Science Institute: The War Against Aging

sugar and most fat, be my guest. There's no doubt you may live longer
if you don't go crazy at mealtime.

Blood Types - If you believe in genetic predetermination, our

primordial origins may serve as clues to what we should eat. Type O,
the Hunter Gatherers, thrive on a diet laced with meat and berries, while
the Cultivators (Type B) can deal with lots of carbs. In addition, there
are a number of blood tests that base their success on exposing certain
hidden food allergies. It works for some.

Eat Less, Exercise More - That's the philosophy of Dr. Andrew

Weil in a nutshell. He urges his readers to be realistic and not fall for
quick fixes. The weight will come back, one or two pounds a week is
fine. His formula is a little different from the Zone, but includes all
food groups: Carbohydrates 50 to 60% (no prepared carbs, please), fats
20 to 30% (monounsaturated), protein 10 to 20%, preferably from a
vegetable source like soy. And get out those dumbbells!

Weight Watchers - In order to maintain a different eating style,

many of us need constant supervision. Ask any therapist: repetition
and compulsion are hard to overcome. That's why this concept has had
such a long run. Instead of just telling their members what they can or
can't eat, the goal of Weight Watchers is to help them make healthier
choices as part of a different lifestyle in the mental, emotional and
physical arenas. Because you have to crawl before you can walk, their
initial goal is modest - a weight reduction of 5 to 10% with an ultimate
BMI of less than 25%.

"Eat the food you love and lose weight" is their motto and they use the
“point system.” Each food is assigned a number of points on the basis
of its calories, total fat, and fiber content. Depending on your starting
point, you may consume a certain number of points on a daily basis.
For instance, a six-ounce steak = 8 points while a cup of broccoli is 0
points. Stay in your daily range calculated on body weight, earn points
by exercising, have intense group support, and you’ll be successful
enough to get a "point number" on many food labels. It's no wonder
that WW is so popular and the Bible of many.

Pritikin Plan - If you're over 40, you've at least heard of this, a low-
fat diet based on vegetables, grains and fruits. For over 30 years,
thousands of people have gone to Pritikin Longevity Centers, learning
how to eat and prepare meals while reducing stress. Exercise is a
necessary ingredient. At the present time, Pritikin has introduced the
"Calorie Density Solution.” Fill up on foods that have relatively fewer
How to Win in the Youth Game 63

calories per pound and you will stay healthy and slim. If a pound of
chocolate chip cookies has 2140 calories and a pound of cucumbers has
100 or so, which one should the dieter choose?

That's a quick overview: easy to put down on paper, but hard to stick to
in the real world. Some of us turn to prescriptions and herbal assists in
times of need or frustration, so a brief scan of the popular ones is in
order to set the record straight.

TIP: Exercise keeps your brain

alert, too. One of the reasons that
people turn to HGH is to keep the
mind functioning smoothly. But lifting
free weights (dumbbells) in particular
stimulates synapses in the brain to
maintain balance. So do feats of
mental agility: trivia contests,
vocabulary quizzes in Reader’s
Digest, sudoku, crosswords (the
tough ones) and reading complex
articles. Warning: most newspapers
are graded down to a 14 year old’s
vocabulary, so look for tougher
64 Aesthetic Science Institute: The War Against Aging

Prescription Weight Loss Medicine

Physicians like to limit the use of prescription drugs for individuals with
a BMI over 30 and no obesity related problems or a person with a BMI
over 27 with two or more problems.

Most available drugs fall into the "appetite suppressant" category. These
medications work by increasing two brain chemicals, serotonin and
catecholamine, that trick the body into thinking that is not hungry or
full. These include: Didrex, Tenuate, Saganor, Adipex, Meridia, and
Phenteramine. The latter was part of the ill- fated Redux which was
hailed as the ultimate solution in the 1990s until heart valves started to
malfunction at an alarming rate.

Meridia is the only weight loss medication currently approved for long
term use but recently questions are being raised about its safety as well.
Be careful!

Another category of medication is the fat absorption inhibitor-Xenical,

also approved for long term use. It prevents the body from breaking
down and absorbing fats eaten during meals, eliminating them in bowel

Do they work? If you think that a loss of 5-22 lbs over a year is ok-yes!
Some people have lost more than 10% of their body weight, but
effectiveness diminishes after 6 months of use. Potential addiction is
always a consideration, not to mention other side effects like
hypertension, sweating, constipation, headaches, and anxiety, to name a

As far as Xenical is concerned, there's a whole new can of worms to

consider. Open it and you may find frequent gas and oily discharge,
spotting and the need to be near a toilet more often than not. If that's
not enough, because of the blockage of the absorption of fat-soluble
vitamins, we run the risk of getting certain deficiencies if we're not
careful. In spite of what the Internet says, stick to your doctor!
How to Win in the Youth Game 65

Over-the-Counter Remedies
Foolish enough to try it on your own, without some proper medical
advice? We'll go though some of the more popular products, most of
which are appetite suppressants, lately combined with so-called fat or
carb blockers.

• Ephedrine (Ma Huang) - It is an integral component in the

production of "speed" and following the recent death of a professional
athlete it has left the market with the speed of a Blitzkrieg. “Let the
buyer beware!”

• St John's Wort - Primarily touted as an antidepressant, it has so many

problems that now that we've said it - forget it!

• Guarana - It speeds up brain activity and is used to promote weight

loss by its stimulant and diuretic properties. But its 2-5%caffeine
content raises blood pressure not to mention other possible effects like
nausea, nervousness, and dizziness.

• Chitosan - It's the rage now because this preparation made from
starch found in shell fish skeletons does bond with fats in the GI tract
and is not absorbed. In theory, it should work but in practice the
amount you really have to take with a meal is a meal in itself!

• 5 Hydroxytrytophan (5HTP) - Found in some weight loss formulas

Aside from the fact that it contains a contaminant linked to a rare fatal
blood disorder It has no redeeming qualities! Danger, Will Robinson!

• Aloe - It's a major component in balms and cosmetics and a swig of

this will really clean you out! However, sometimes it doesn't know
when to stop and can lead to cramping, diarrhea, not to mention
nutritional deficiencies. If that's not enough it can interact with Digoxin
a drug used to treat heart failure. Forget it!

• Dandelion - It's a diuretic, but some people think it has a link to

cancer. Better left growing in a garden.

• Glucomannan - Watch out for this one! Made from a root, this herb
works by delaying the absorption of glucose from the intestines. It does
seem to promote weight loss by swelling up the gut to create the feeling
of fullness. The only trouble is that somewhere along the way quite a
few people have gotten a little too full , resulting in intestinal and
esophageal obstruction !It's even banned in some countries. So?
66 Aesthetic Science Institute: The War Against Aging

• Guar Gum - It's a thickening agent for food and medications and
works like glucomannan. Same problems plus blood sugar level
fluctuations. Steer clear!

• Herbal Diuretics - Most of these come from caffeine and are found in
many over the counter compounds and herbal products. Various
products can cause renal failure (juniper), brain damage (equistine), or
convulsions (horse tail or shave grass). If that's not enough, they don't
work either!

• Pyruvate - There is at least something positive we can say about this

one. It is a by-product of carbohydrate and protein digestion and may
do some good. Its presence in red wine and apples makes it relatively

I know we've touched a few nerves in this part of the journey, but let's
try to summarize some salient points. To be effective, you must
consider changing a lifelong lifestyle. Besides eating well, you need to
increase and handle psychological problems more efficiently. Make
sure that whatever path is chosen, it must lead to a place that provides
life-long comfort and easy compliance. Don’t look for a quick fix -
slow and steady wins the race. If you need help, don’t be afraid to hold
out your hand. Just make sure that whoever grabs it is the right kind of

LAUGH TIP: For Your Circulation

When we laugh, the linings of the
blood vessels expand and positive
chemicals flow.
Chapter 7
Exercise – What's Enough?
Does this scenario sound familiar? The alarm rings, you wake up full
of energy. Without hesitation you get out of bed and think "it's a great
life, great time to start exercising.” If that was some time ago and not
now or never, perhaps the next few pages can help get you on the right
track (pardon the pun , runners).

It is well documented that a person's maximal strength decreases with

increasing age - why? Is this due to aging or a decrease in physical
activity? The answer is both - but we can dramatically slow the effects
of chronological changes by a steady program of exercise.

The reasons for exercising are so numerous that an entire book would
not be enough. Since I am not an exercise physiologist, but do still
know that every morning is a call to arms (and legs and stomachs), let's
make a list of why everyone should be motivated.

Benefits of exercise on the

cardiovascular system
1. Lose weight, especially fat
2. Increase your body's ability to use oxygen effectively in delivery to
3. Something called V02 max is regarded as the best indication of
physical fitness
4. Lower or help control blood pressure
5. Lower resting heart rate by making each beat more efficient
6. Reduce total cholesterol while increasing HDL, the good kind
7. Reduce the circulating level of triglycerides, the amount of free
fatty acid in the blood
8. Reduce the incidence of stroke, heart disease and type II diabetes
(adult onset)
Not enough benefits? There's more.
68 Aesthetic Science Institute: The War Against Aging

Effect on aging and functional

1. Increase your level of muscular strength although both testosterone
and growth hormone show marked decreases of not treated. The
maximal strength of a 76 year old man can still exceed his 20 year old
2. Increase stamina
3. Maintain bone mineral density; decrease osteoporosis
4. Increase endurance
5. Maintain weight
6. Decrease injury to joints to tendons
7. Improve balance and coordination
8. Decrease incidence of colon and breast cancer

That takes care of your body - now, let’s get on to your...

Mental health and sense of well being
1. Look better
2. Decrease depression
3. Handle stress more effectively
4. Increase self esteem
5. Sleep better
6. Be healthier
7. Learn how to set goals and keep them

As long as we don't get too overzealous and have expectations beyond

our ability to reach them ,what you have to lose is a lot of bad things,
while gaining a potpourri of positives.

The two types of exercise are aerobic and anaerobic. The former
stresses the development of cardiovascular strength by intermittent
increases to the heart rate at periodic intervals. In that way the heart
becomes more efficient by increasing the amount of blood pumped at
each beat. A person with an "athletic heart" has a far slower heart rate
at rest with a marked capacity to instantly rev up when the situation
arises. No mystery to joggers, runners, swimmers, racket ball players
and bikers.

Anaerobic exercise involves short bursts of exercise followed by

periods of rest like weight lifting or pushups. This is designed to
increase the strength and capacity of muscles. Although it does not
burn fat like aerobics, bigger muscles burn more calories, even at rest.
So a combination of the two types are the ideal.
How to Win in the Youth Game 69

What is the ideal synergistic program for the individual? Obviously it

depends on age, health goals and needs but one thing is certain the big
picture. Do it! Start today!

Two Types of Exercise

Exercise that involves oxygenation, stretching muscles
and cardiovascular exertion: running, swimming,
walking, spinning

Exercise that focuses on isometric resistance,
strengthening muscles and weightlifting

If you have a gut or cellulite don’t think that doing

crunches and squats will work off a specific area.
That’s not how the body works. If you want to build
muscle in a particular area you can make it look
younger and firmer but the only way to get ride of a
trouble spot is through a program of exercise and
calorie control diet. You lose it under the chin before you lose it under
the belly.

LAUGH TIP: For Your Belly

There’s another way to get around those sit-ups.
Laugh. Instead of walking for a half hour or
spending ten minutes a day on a rowing machine,
you could be laughing heartily, since belly laughs
increase the heart rate.
Chapter 8
Arthritis – Don’t let it get you down!
You get up in the morning and your back aches. The old piano fingers
are not as nimble on the keyboard. When you're on the tennis court, by
the second set, your knees are killing you. What's going on? The
answer, more often than not, is osteoarthritis (OA).

Arthritis is a general term for inflammation of the joints and

degeneration of the cartilage. OA is the most common form. It affects
over 16 million men and women in the USA alone, and while the
majority of those afflicted are over 60, many younger folks suffer as

What causes OA? Several factors increase your chances such as

heredity, obesity, injury or overuse of certain joints.

Some of us are unlucky enough to have a defective gene responsible for
the production of collagen, a major component of cartilage. This results
in more rapid deterioration of joints, even with common use.

It may have been fun to be "double-jointed" as a kid, but this leads to

more erosion as an adult.

Spine abnormalities like scoliosis or curvature of the spine predispose

the patient to problems in later years as well.

The age old culprit rears its head again. Remember that we are
machines and overloading weight bearing areas increases the risk of
wear and tear, particularly of the back, hips, and knees.

Have you seen a football game lately? They may look like heroes when
they go back on the field, taped and anesthetized, but look at them 20
years later! Broken bones and severe falls don't help either. Overuse of
certain joints such as fingers and knees increases the chances of
developing OA.
How to Win in the Youth Game 71

What is Cartilage?
We've all seen it in its natural form if we've eaten a drumstick. It's that
firm, glistening, rubbery material covering the ends of bones in normal
joints. Its function is to reduce friction and act a "shock absorber.”
Because it contains more than 70% water, cartilage can change shape to
absorb impact with change of position by compressing then rebounding
to its original form. When we walk or stand, some water leaves the
cartilage to coat the joint. When we sit down, the water returns to
restore the lining to its original shape. As we age, the cartilage may
wear down, the water content decreases, diminishing elasticity,
increasing stiffness and susceptibility to damage. Tendons and
ligaments stretch, bones rub against each other without a cushion
resulting in pain and deformity.

Normal Joint Osteoarthritic Joint

Source: medline.gov
When a joint is inflamed, the cartilage breaks down and the ease and
range of motion is compromised.

How do we know we have it?

1- Joint aching and soreness particularly after normal movement
2 - Pain after exercise or after long periods of inactivity
3 - Bony enlargements in the middle and end joints of fingers, with or
without pain.

When a joint is inflamed, the cartilage breaks down and the ease and
range of motion is compromised. OA does not cause fever, weight loss,
or anemia. X-ray examination easily confirms the diagnosis.
72 Aesthetic Science Institute: The War Against Aging

OA is usually treated by medications, supplements, hot and cold

applications, the use of crutches or canes, weight control or a
combination of modalities. Occasionally surgery such as hip or knee
joint replacement is necessary when the damage is irreversible and pain
is intolerable.

1. Pain relievers such as non-steroid, anti-inflammatory drugs (NSAID)
such as aspirin naproxen, ibuprofen, Tylenol and Celebrex.
2. Creams, sprays of many of the above ingredients applied directly to
the affected area.
3. Unfortunately, there is no concrete proof that any of these remedies
reverse or slow down the progression of OA. Patients seeking effective
alternatives have spurred a remarkable increase in the use of

1. Glucosamine - there are several published articles from reputable
sources attesting to its effectiveness in repair and maintenance of joints.
2. MSM (methylsulfonylmethane) - this is a natural occurring
compound found in all living things that acts as an analgesic and anti-
inflammatory agent. It is important in the constant renewal of cell
structure and there are reports of an 80% decrease in pain after 6 weeks
of use.
3. Vitamins - C, D, K, and E all have been shown to play a role in
maintaining joint health and facilitating bone and cartilage metabolism.
4. Minerals - silica, boron, zinc, manganese, selenium, molybdenum,
and copper. More and more of these ingredients are found in
multivitamin formulations or the health food sections.
5. Omega-3 fatty acids - no difficulty in adding this compound,
because even if there were no other advantage, its protection of the
cardiovascular system is well established.

We should note that chondroitin sulfate, a compound usually combined

with glucosamine in many popular anti-arthritic compounds, is poorly
absorbed from the intestinal tract and is of no essential value in the
treatment of OA.

What better way to improve joint movement and strengthen the
surrounding muscles to diminish the strain of motion? Be smart and
stick to low- impact or non-impact workouts like swimming, walking,
or biking on flat surfaces. Unless you're a masochist and enjoy more
pain, skip jogging and high-impact aerobics.
How to Win in the Youth Game 73

Heat and Cold Therapy

Good for the temporary relief of pain and stiffness. For many, there's
nothing like a hot bath to start or end the day.

Canes and crutches, but let's work hard to never get there!!!!

Weight Control
Hard to digest as we've already discussed, but the benefits are not
necessarily confined to the better looking image in the mirror.

I've had two hip replacements already, thanks to some screwed-up
genes, so here I can speak from personal experience. This procedure,
together with knee-joint replacement, is becoming more commonplace.
There are some limitations of activities (goodbye, tennis), but pain
relief and the promise of relative permanence of the prostheses as the
implanted materials and design improve with each passing year make
this a godsend for countless sufferers. Walking is a lot better than a
wheel chair!

The Future
We have recently seen the introduction of SYNVISC, a hyaline
compound that is injected directly into knee joints, resulting in
remarkable improvement in symptomatology. What doors will stem
cell research open? Our knowledge of genetic structure is another path
to explore. But for now, the best we can do is treat our body like the
temple it is, and maintain it inside and out even if Mother Nature throws
us a few curves.

TIP: When you have back pain, don’t listen to your friends.
Most people recommend “bed rest.” Unfortunately, after
staying in bed more than three days, the back muscles that
are in spasm also begin to weaken. The best way to recover
is to gently walk. Your body was built to walk, so do it. Even
a slow walk while you’re in pain is better than just lying there
because the other back muscles that are not in pain can be
Chapter 9
Cosmetic Surgery –
Cutting Up
Who’s doing what
When I co-authored a book Beauty by Design in 1979, it was clearly
obvious to me that the rapid changes in knowledge and technique were
bound to have an effect on the way we perceived and did things.
Cosmetic surgery is now accompanied by innovations and procedures
that enhance and prolong youth fullness both inside and out. However,
although the roads may have been repaved, the basic routes remain
unchanged in finding the way to a better existence.

I have had two little sayings always get my patients or friends to smile.

“You name it, we'll frame it!”

“If your face or body is unbecoming to
you, you should be coming to us!”
To make it simple we have enclosed a compendium of common
cosmetic surgical procedures well take them one by one and see what's
new or different.
How to Win in the Youth Game 75

An Example of
Before and After:

Face and neck lift,

nose surgery, eyelid surgery
and chemical peel.

Look what a few procedures can do

when skillfully brought together
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Face and Neck Procedures

Face and Neck lift - There are continuing modifications on the depth
of dissection to ensure a longer lasting result. One thing for sure
-removing skin without tightening the muscle structure will not do the
job. The endoscope has also enabled us to do more with fewer cuttings.
More about this later.

Facelift and eye brow lift with liposuction of the neck.

Brow lift

Forehead and Browlift - The endoscope has changed the method more
than any other technique. With proficiency, lines, muscles and wrinkles
can be removed or modified through several small incisions.
How to Win in the Youth Game 77

Eyelid Surgery - There is an increasing awareness of the need to

consider taking up skin and ligaments for a more esthetic result. In
addition the laser makes tightening of the skin much easier without any
excision. We also use incisions inside the lower led to remove extra fat
eliminating the external scar.

Eyelid surgery: East and West (Eyelid incisions)

The Doctor’s drawing (K. Wagner)

The surgical change from Oriental upper eyelids to Western

upper eyelids. This procedure creates an extra upper fold for the
eyes, changing the “Asian” upper eyelid to resemble the Western
upper eyelid.

Left: A 25-year-old woman with congenitally heavy upper eyelids.

Right: Five months after surgery, the upper eyelids are finer and
the eyes appear more alert.
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Nose Surgery - There is an increased use in the open technique. The

roof of the nose is degloved of its skin (sounds a lot worse than it is)
and the surgeon is able to more correctly assess the amount of bone,
cartilage and septum to realign. However, good surgeons still do it well
the old fashioned way.

Open Nose Technique

1. Connect both cuts

2. Start the exposure.

3. Raise the skin

How to Win in the Youth Game 79

A nose job -- Open and shut

Chin and Cheekbone Surgery - Newer implants with different shapes

(I am proud to have initiated many of the changes) in friendlier
materials make for an increasing ability to modify the skeletal structure
on a more natural esthetic basis.

Cheek Augmentation and Otoplasty

This is a 38-year-old man who had congenital hemiatrophy (loss
of half) of the right side of his face and of “dumbo ears.” Had a
siilicone implant in his face and repair of ears.
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Trading Faces
What a good plastic surgeon can do


After: A good start

Incisions for a face lift

Face and eyelid lift

How to Win in the Youth Game 81

Quite a finish…

Before 6 months later

Face lift, eyelid lift and liposuction of the neck
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Facial Implants

Facial implants and grafts: where they can go.

Side view
How to Win in the Youth Game 83

Before After
Chin Implant with a nose job
Quite handsome now!

Double Chin Surgery or Neck Sculpture - Liposuction has made this

an easy procedure in some cases, but direct excision still works very

Chin augmentation with nose job, eyelid lift and face lift.

An example of a chin implant and liposuction on the neck.

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Skin Rejuvenation
Chemical Peel - Tried and true by those who know, but rapidly
succumbing to ...

Laser Face Peel - Latest advances seem to promise results similar to

and in selected cases better than chemical application see the laser

Look at the following tables, I hope you have chuckled at some of my

illustrations, marvel at some of the possibilities, and when you're ready,
let's move on down the road.

Laser peel
Body Procedures
Liposuction - It didn't even exist when I started practice. Now it’s all
the rage, but beware -- know the operation and the operator.
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Tummy Tuck - If only muscle tightening is necessary, endoscopy may

suffice. Liposuction at the same time may obviate the need for a larger

Before liposuction and a tummy tuck….. After.

With a little help, but a long way to go

Body Lift - With the increasing amount of weight loss in some patients
secondary to bariatric surgery, greater amounts of tissue are removed
and moved at the same time to achieve remarkable results.
How to Win in the Youth Game 87

Body Lift (front view) Picking up the front

Body Lift (rear view) Bringing up the rear

Body lift
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Breast Reduction - With newer techniques the traditional anchor

incision may be replaced by smaller incisions around the nipple only or
with a smaller longitudinal excision.

Older Reduction Technique: step by step.



The end result


How to Win in the Youth Game 89

Avoiding the horizontal scar

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Vertical Breast Reduction

Bunching of the scar Two years later

A good result.

Breast Augmentation - After over 40 years of use, this procedure has

survived a decade of controversy and is more popular than ever. While
there is still some debate about the permanence of the implant and the
choice between saline and silicone gel newer techniques allow smaller
and smaller incisions to put in almost any size implant and with the use
of the endoscope, some operations even utilize the belly button as the
entering point.

Breast Augmentation
How to Win in the Youth Game 91

A little of both

Breast Lift plus Augmentation

A different way to measure aging?

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How to Win in the Youth Game 93
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How to Win in the Youth Game 95

If you don’t like to look at charts…

Face and Neck Procedures

Face Lift and Neck Lift
What Doctors Call It: Cervical facial rhytidectomy
What Does It Involve: Excess skin gone from face and neck, muscles
tightened excess fat removed.
Operating Room Time: 3-4 hours
How Long Does It Last? 10 to 15 years
When Are All the Stitches out? 10 to 14 days
Return to Work or School: 14 days

Nose Job (to change appearance)

What Doctors Call It: Rhinoplasty (cosmetic)
What Does It Involve? Bone and Cartilage realigned to reshape
Operating Time: 1-2 hours
How Long Does It Last? Forever
When Are All the Stitches Out? Not applicable
Return to Work or School: approximately 7 days

Nose Job (to improve breathing)

What Doctors Call It: Septoplasty (to breathe)
What Does It Involve? Partition straightened to improve air flow
Operating Time: 1 hour
How Long Does It Last? Forever
When Are All the Stitches Out? Not applicable
Return to Work or School: Approximately 7 days

Eyelid Surgery
What Doctors Call It: Blepharoplasty
What Does It Involve? Fat and excess skin removed to eliminate bags
and pouches
Operating Time: 1-2 hours
How Long Does It Last? 5 to 10 years
When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 7 days
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Sometimes we can get more than

two birds with one operation

Before After
Chin Augmentation and neck lift, plus Rhinoplasty (nose job)

Forehead or brow lift

What Doctors Call It: Brow pexy
What Does It Involve? Lines and wrinkles are modified by relaxing
key muscles; the doctor advances or removes excess skin
Operating Time: 1 to 2 hours
How Long Does It Last? 5 to 10 years
When Are All the Stitches Out? 10 to 14 days
Return to Work or School: 10 to 14 days
How to Win in the Youth Game 97


Ear Surgery
What Doctors Call It: Otoplasty
What Does It Involve? Cartilage reshaped to “pin back” ears
Operating Time: 1 to 2 hours
How Long Does It Last? Forever
When Are All the Stitches Out? Not applicable
Return to Work or School: 7 days

Chin surgery
What Doctors Call It: Mentoplasty
What Does It Involve? Implants to augment receding chin or small
Operating Time: 30 to 45 minutes
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How Long Does It Last? Forever

When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 5 to 7 days

Cheekbone surgery
What Doctors Call It: Malarplasty
What Does It Involve? Often done in combination with facelift or
rhinoplasty to improve profile
Operating Time: 30 to 45 minutes
How Long Does It Last? Forever
When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 5 to 7 days
How to Win in the Youth Game 99

Double chin or neck sculpture

What Doctors Call It: Sub mental lipectomy
What Does It Involve? Fat deposits excised or suctioned out – muscles
may be tightened
Operating Time: 1 hour
How Long Does It Last? If you do not gain weight, forever.
When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 7 days


After the chin and cheek augmentation with rhinoplasty

(nose job) and blepharoplasty (eyelid)

Chemical peel
What Doctors Call It: Chemical exfoliation or facial rejuvenation
What Does It Involve? A caustic solution removes the outer skin layer,
decreasing wrinkles, age spots and pigmentation problems.
Operating Time: 1 hour
How Long Does It Last? Some results last forever, depending on the
When Are All the Stitches Out? Not applicable
Return to Work or School: 10 to 14 days
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Laser face peel

What Doctors Call It: Laser rejuvenation
What Does It Involve? Similar results as in chemical peel, but using a
laser beam.
Operating Time: 1 hour
How Long Does It Last? Depending on depth and type of laser, years
to forever
When Are All the Stitches Out? Not applicable
Return to Work or School: 7 to 14 days

Before face lift, neck lift and eyelid surgery.

One month later Two months later

How to Win in the Youth Game 101

The impact of carefully

chosen procedures
You can take a patient," says plastic surgeon Dr. Arthur Swift,
"who has been a wallflower - who has been sort of sitting back
socially and has been very introverted because she is self-
conscious about a large nose, large bust, or small bust and you
operate. Their personality literally blooms and a parent will
come back and tell me ‘you have had a wonderful effect on
my child. She is so much more self-confident. She’s lost a
lot of those inner inhibitions and she feels she’s out there.’"
February 25, 2002, From an article by Ray Lawson, Look Good, Feel Good: The
link between surgery and emotional health http://canoe.talksurgery.com

The Feather Lift or Thread-Lift

This is the newest facial procedure to hit the scene and capture the
fancy of the viewers of NBC’s Today morning show, among others.

What is it? It is an office-based procedure that uses fine surgical

threads to lift the brow, cheeks, jowls and neck.

What are the threads? They are made of a nylon like material called
polypropylene and have directional cogs. After being inserted in the
skin, they form a support structure for the tissues.

Who are the best candidates? Patients with premature aging, drooping
of the tissues, and a flossed flat face.

How is it done? Under local anesthesia or light sedation, the threads are
placed under the skin using a special needle. After insertion, the tissue
is lifted on the cogs at the desired level.

What are the advantages?

1) No scars to speak of
2) Minimal discomfort for most patients
3) Quicker recovery with patients returning to work in less than a

What do we think? Our enthusiasm for this procedure is not quite as

overboard as some. For me, it is a wonderful adjunct to total and more
102 Aesthetic Science Institute: The War Against Aging

lasting rejuvenation. Combined with a minilift and a full face laser

procedure, it is a welcome addition to our armamentarium.

The Thread Lift

Source: .yestheyrefake.net/feather_lift.htm

LAUGH TIP: For Your Face

Fifteen muscles are involved with
making a smile when we laugh.
Benefits include improved blood flow,
which explains why we get a “healthy
glow” when we laugh (and that’s good
for others to see!).
How to Win in the Youth Game 103

Body Procedures
Breast augmentation (breast enlargement, “bigger breasts”)
What Doctors Call It: Augmentation mammoplasty
What Does It Involve? An implant is added to enlarge the size and
improve the breast’s shape.
Operating Time: 1-2 hours
How Long Does It Last? Forever; you might have to swap inserts
When Are All the Stitches Out? 7 to 10 days
Return to Work or School: 7 to 14 days

Breast Reduction (“smaller breasts”)

What Doctors Call It: Reduction mammoplasty
What Does It Involve? Large breasts reduced and made firmer by
removal of excess tissue
Operating Time: 2 to 3 hours
How Long Does It Last? Forever
When Are All the Stitches Out? 7 to 14 days
Return to Work or School: 10 to 21 days

Breast Lift
What Doctors Call It: Mastopexy
What Does It Involve? Excess skin is removed and breast tissue is sewn
together to increase support and elevate the nipple.
Operating Time: 90 minutes to 3 hours
How Long Does It Last? Forever
When Are All the Stitches Out? 7 to 14 days
Return to Work or School: 7 to 14 days

What Doctors Call It: Suction assisted lipectomy
What Does It Involve? Fat is suctioned from thighs, hips, abdomen,
face, etc.
Operating Time: 45 minutes to one hour
How Long Does It Last? If you do not gain wait, forever.
When Are All the Stitches Out? 5 to 10 days
Return to Work or School: 10 to 14 days
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Tummy tuck
What Doctors Call It: Abdominoplasty
What Does It Involve? Loose skin is removed, muscles are tightened;
the procedure is sometimes combined with liposuction.
Operating Time: 2 to 3 hours
How Long Does It Last? Forever
When Are All the Stitches Out? 7 to 21 days
Return to Work or School: 10 to 21 days

Body Lift
What Doctors Call It: Circumferential Torsoplasty
What Does It Involve? Loose skin is removed from the front, back and
muscles, and lower skin is advanced to higher levels, like a pair of pants
Operating Room Time: 6 to 8 hours
How Long Does It Last? Forever
When Are All the Stitches out? 14 to 21 days
Return to Work or School: 21 days

“Give us two weeks and it just may

benefit you for the rest of your life !”
How to Win in the Youth Game 105

Who is having what done?

Here’s a list of surgical and non surgical procedures, broken
down by gender (performed in 2003). Overall, the ladies account
for 8 out of 9 cosmetic procedures.
Name of the procedure Number of
Procedures on females
(% of procedures requested by females)
Surgical procedure
Abdominoplasty 79,709 96%
(tummy tuck)
Blepharoplasty 192,777 84%
(cosmetic eye surgery)
Breast augmentation 249,641 100%
Breast lift 62,453 100%
Breast nipple enlargement 501 93%
Breast nipple reduction 2,205 87%
Breast reduction 125,614 100%
Buttock augmentation 1,909 91%
Calf augmentation 101 67%
Cheek implants 7,033 77%
Chin augmentation 19,598 83%
Face lift 113,463 91%
Forehead lift 58,653 90%
Hair transplantation 864 5%
Lip augmentation 25,512 98%
Lipoplasty (liposuction) 316,469 85%
Lower body lift 4,378 91%
Otoplasty 16,698 50%
(Cosmetic ear surgery)
Rhinoplasty (nose reshaping) 118,028 75%
Thigh lift 4,026 96%
Umbilicoplasty 1,363 66%
Upper arm lift 6,180 98%

Procedures for men

Gynecomastia, treatment of 16,551 (men only)
(male breast reduction)
Pectoral augmentation 671 (men only)
(male chest)
Total Surgical procedures 1,424,939 85%

Non-surgical Procedure
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Botox injection 1,424,939 86%

Cellulite treatment 46,671 99%
Chemical peel 453,505 92%
Collagen injection 729,075 93%
Dermabrasion 16,131 84%
Fat Injection 67,540 90%
Laser hair removal 588,549 80%
Laser skin resurfacing 68,248 94%
Laser treatment of leg veins 52,271 99%
Microdermabrations 936,228 91%

Sclerotherapy 291,051 98%

Total Non-surgical procedures 4,674,208 88.7%

Total procedures 6,081,857 88.3%

LAUGH TIP: For Relief from Pain

Research has shown that we can tolerate a higher threshold of
pain while laughing. Comedies and funny videos might be part of
everyone’s pain management program.
Chapter 10
The Endoscope –
A Different Point of View
It's a surgical technique that has been used for decades in a number of
different procedures including gall bladder removal, tubal ligation and
knee exploration.

For those of us who own a digital camera, the technology is humdrum.

The endoscope has two basic parts - a long tubular probe fitted with a
tiny camera and bright light capable of being inserted through a small
incision and a view monitor that magnifies the images of the body's
internal structures. This enables the surgeon to watch the screen while
moving the tube through the surgical area.

That's part one - the viewing device. To actually perform the surgery, a
separate incision must be made in a different location through which a
surgical instrument (such as a scalpel, scissors, or forceps) must be
inserted and taken to the tissue to be worked upon. For the younger
generation accustomed to using both hands for computer games, it's a
no-brainer. For some of the more seasonal vets, it takes a little getting
used to.

There are some obvious advantages. With an endoscope the scars are
much smaller, likely to be hidden and the recuperation shorter. Let's go
through a procedure relevant to cosmetic surgery to illustrate.
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Forehead Lift:
Prior to endoscope use it was necessary to make a long incision usually
from ear to ear to do the job. With the endoscope, 3 or more incisions
less than 1" are all that is necessary to disrupt the muscles and raise the
eyebrows. The risk of sensory loss from nerve damage is decreased as
well as the possibility of bleeding bruising or swelling. In addition
many other endoscopic procedures can be performed under local
anesthesia and sedation with out an overnight stay.

 Forehead lift

Under the right conditions it can be

used in tummy tucks, breast
augmentation or evaluation of
existing conditions such as
capsular contraction, and face lifts
particularly med force elevation.

The downside - All surgery carries

a certain amount of risk and every incision leaves a scar. Because,
endoscopy is a relatively new technique in plastic surgery it's more
important than ever to make sure that your choice is the right one.
Nothing can beat training and experience. Our center is the paragon of
the above.
How to Win in the Youth Game 109

A Thought
I’m too young to have a full face lift. I’m thinking of
doing a simple thread lift.
Response: Are you over 40? How long will a thread lift
last? Five years, maximum? Why not think about a
full face lift, which lasts a lot longer?

Why should I go through two procedures? I would

rather get it all over with in one operation.
The general rule is: If you have a choice between a
simple procedure that lasts less than five years and a
more complex procedure that lasts longer, which will
you take? Most people will suggest the more
permanent solution because you don’t have to go
through the preparation for surgery a second time – so

I can’t get over the change in my gums. They used to

bleed. I started taking hormones and now my dentist
tells me that I have great gums… -- Linda M., Fort
Lauderdale, Fla.
Response: Hormone therapy and HGH often help
restore strength in the gums.
Chapter 11
Flash Gordon Arrives –
Or at least his lasers do!
For those of us old enough to recall the thrills of Flash's super ray gun
which stopped Ming’s Merciless Mercenaries again and again, fantasy
may have become reality. No quite like Darth Vader and Obi-Wan
Kenobi, but we're well on the way.

 Scton: one of our favorites

The fundamentals of lasers was first

described by Albert Einstein in the
early 1900s. Not to belabor his work
which defies understanding to all but
the smartest of us, lasers are the result
of electromagnetic radiation reacting
with matter in such a way to produce a
light beam. The beam has been
harnessed to trial a myriad of medical
conditions as well as fording a place in
many commercial enterprises
(aerospace communications) LASER
(Light Amplification by Stimulated
Emersion of Radiation) it took over 40
years to put it into medical practice.

Theodore Marman is given the credit. He created his laser by polishing

a synthetic crystal at both ends and wrapping it in a flash tube. The first
physician to bring lasers into the medical field was Leon Goldman, a
dermatologist who did much of the early work using a ruby laser to
treat childhood birthmarks. He and some brave souls started the
American Society of Laser Medicine and Surgery, which brought
increasing attention to other specialties.

The early use of laser consisted mostly of removing birthmarks, tattoos,

and benign skin lesions. Although there were some problems, (skin
How to Win in the Youth Game 111

pigmentation and scaring), there was enough interest to start research on

the effects of light beams on tissue interaction and reaction. With each
year, newer and more diversified machines were developed and its use
in treating other conditions increased, much like an Orwellian novel.
Various attributes of the light production became obvious. The theory
of SPTL (Selective Photo Thermolysis) was introduced in 1983. This
explained how the benefits of treatment could be controlled or altered
by varying 3 factors: wavelength, pulse duration, and energy loading.
What this means in plain English is that some lasers can treat the
surface like chemical peels, while others can go below and stimulate
cell production.

Hoping to not having thoroughly confused you as one might be when

they read about all the machines available and the prices (wow), let's
see what a successful experience can and can't do.

VASCULAR LESIONS (problems with blood vessels)

Port wine stains - One of the earliest conditions to be treated, requires
multiple treatments, starting the younger the better. The improvement
is remarkable and clearing can be complete.

Hemangiomas - This is a condition of abnormal blood vessel

proliferation. If they are close to the surface of the skin, improvement
is considerable. Deep cavernous lesions do not respond because the
efficiency decreases in relation to the depth of penetration.

Telangectasias - Spider veins and superficial deleted blood vessels can

be effectively cleared in one or two treatments.

HYPERTROPHIC SCARS, KELOIDS - Some improvement results

because of the destruction of the superficial blood vessels. In addition,
the laser can flatten scars by releasing collagenase, an enzyme the
decreases scar formation.

TATTOO REMOVAL - What has awakened the dormant genetic need

for self mutilation that dates back to the Stone Age (1200 BC) and
permeated ancient civilization (Egypt, China, New Zealand, etc.)?
Tattooing is still is practiced with a vengeance in parts of Africa and the
South Pacific has provided a boon to some laser specialists. A study in
1991 by Candela Laser Corporation suggested that 9-11% of adult men
in the USA, have tattoos, but 50% regret their decision. Not
withstanding the athletes and entertainers who serve as role models, the
tide will surely turn as every fad runs its course.
112 Aesthetic Science Institute: The War Against Aging

Before lasers we used acids, dermabrasion, and surgery over tattoos

with unacceptable results. Since 1979 laser treatment has become
increasingly effective and is currently the treatment of choice.

Tattoos removed by laser.

Oh, beauty, where is your mark? For some movie stars and models,
their signature, for others an unsightly blemish. There are many lesions
amenable to improvement, but not all. The most common ones treated
by laser are sunspots, usually in the older population (greater than 40).
However, some lesions are a definite no-no!

The ABC rule provided here is for the doctors and patients alike:
Avoid treating a cancerous lesion
Biopsy anything suspicious
Consult a specialist before laser treatment

The key is not to have visions of sugar plums in our heads, when all you
can expect are some M and M's.

LASER HAIR REMOVAL - For all the female hair pluckers and
shavers and the males resembling King Kong, what a breakthrough!
Before lasers, electrolysis was the only Rx available -- with poor
results. At the present time, this safe and effective technology is
How to Win in the Youth Game 113

available. Aside from unwanted facial, trunk and extremity hair, some
follicles pulled behind the ears in men after face-lifts can be zapped as
well as growth in the ears. In addition, removal from flaps used for
reconstruction and pilonidal cysts are some of the other applications.

INCISIONAL SURGERY - (What a cutup…) This started over three

decades ago, fell out of favor because of post operation healing
problems, and has reemerged with the advent of better machines. At
present, its use is increasing in eyelid surgery, with somewhat less
acceptance in face lifts, hair transplantation and endoscopic eyebrow
and forehead lifting. However, its utilization is directly proportional to
the experience of the operator, so a little investigation is in order.

Laser Resurfacing
The modern concept of treating photo aging is to use a combination of
modalities. Before the availability of laser machines, popular methods
for removing the superficial layers of the skin and permitting
regeneration included dermabrasion (scrubbing the skin) and chemical
peels. Unfortunately, many of these results depended upon the skill
and experience of the operator. However, the first popular laser, which
used a continuous wave of carbon dioxide, produced similar results in
the wrong hands. The problems usually were due to excessive damage
to the dermis, inhibiting regeneration and resulting in prolonged healing
times and in some cases severe scaring. To some extent, this has been
limited by the introduction of lasers that bypass the surface and attack
several components of the extra cellular matrix (the under surface
mentioned earlier), resulting in tightening and other signs of
rejuvenation. The combination of preparing the skin by the application
of certain creams (alpha hydroxyl compounds) before treatment,
whether by lasers or by surgery and laser in combination, followed by a
regimen to maintain the benefits for treatment makes one thing clear.
Know your doctor, preferably your entire team of care givers, before
you make your decision! The following tables will help.
114 Aesthetic Science Institute: The War Against Aging
How to Win in the Youth Game 115
116 Aesthetic Science Institute: The War Against Aging

A Further Comparison of Laser

Resurfacing, Chemical Peel and

Use on forehead with simultaneous brow lift

Laser: Safe
Chemical: Unsafe
Dermabrasion: Risky

Use on eyelids with simultaneous blepharoplasty

Laser: Safe
Chemical: Unsafe
Dermabrasion: Risky on eyelids at any time.

Use on simultaneous facelift flap

Laser: Safe with appropriate technique
Chemical: Unsafe
Dermabrasion: Unsafe

Treatment of acne scars and fine details

Laser: Good
Chemical: Poor
Dermabrasion: Good

Precision of depth control

Laser: Excellent (20 micrometer increments)
Chemical: Minimal control of dermal depth
Dermabrasion: Minimal precision: dermal depth

Immediate visual assessment of degree of skin

Laser: Excellent
Chemical: Not possible
Dermabrasion: Not possible

Viral risk from prolonged blood aerosol

Laser: No
Chemical: No
Dermabrasion: Yes
How to Win in the Youth Game 117

Nw 42nd st.
118 Aesthetic Science Institute: The War Against Aging

Potential for Systemic toxicity

Laser: No
Chemical: Yes
Dermabrasion: No

Laser: Moderate
Chemical: Massive
Dermabrasion: Massive

Laser: Minimal to none
Chemical: Severe
Dermabrasion: Severe

Risk of hypopigmentation
Laser: Mild to moderate
Chemical: High
Dermabrasion: Mild to moderate

Reliance on delayed scar contracture for result

Laser: Minimal
Chemical: Total
Dermabrasion: Moderate

A Laser result.
Chapter 12
Anesthesia –
It's not necessarily a gas
No discussion of any operation experience would be complete without
dealing with the nuances of anesthesia improvements that have
paralleled advances in surgical techniques.

When I was younger, I was both cook and server in my operations suite.
The first 7,000 or so of my patients had me at the anesthesia controls.
Although I am more than a little egotistical, in this respect I was not
stupid. Part of residency training included six months of exquisite
experience under the tutelage of some of the best anesthesiologists in
the LA area of the time.

But like everything else, not so subtle changes have occurred. As out
patient surgery has grown, so has the phalanx of anesthesiologists and
quicker techniques that are needed to bring the patient to a state of
normalcy without much risk.

Unless you're capable of throwing yourself into some kind of trance,

some form of anesthesia is required for every kind of cosmetic surgery.
There are four modes of anesthesia that are used:

1. Local anesthesia - the surgeon can do it.

2. Local anesthesia with sedation.
3. General anesthesia - you are unconscious and must continually be
4. Regional anesthesia - the nerves are blocked by injection along the
course of a nerve, numbing an entire area from a distance.

If you've been in a dental chair, you’ve experienced local anesthesia.

For skin lesions or other minor procedures, it's in continual use. You're
numb and aware but you don't care.

For procedures a little more complicated, we add sedatives, sometimes

orally but usually by the intravenous route. Now you're asleep, unaware
and with the proper choice of agents, you don't remember or sense
anything about the operation.
120 Aesthetic Science Institute: The War Against Aging

From Dr. Wagner’s cartoon collection (a gift by the artist)

Regional anesthesia involves the blockage of nerves to the operative

site, most commonly by epidural or spinal techniques. It is also used in
hand surgery by blocking the nerves in the axilla (armpit) this by some
sort of intravenous sedation to ease the anxiety invariably
accompanying entrance into the OR suite.
General anesthesia is becoming more and more common in outpatient
facilities. Technological improvements and drug advances with high
tech monitoring equipment make even the longest procedure practically
risk free. Today's anesthesiologist, using short-acting narcotics and
modem anesthetic gases, can control the level of anesthesia provide
complete amnesia for recall and control post operative nausea. Post
operative recovery can now be measured in minutes instead of hours.

Getting anesthetics is very analogous to taking a trip. The shorter the

trip, the less you need. The longer excursions are like airplane rides -
the take offs and landings require the greatest skill. In addition while
you're in the air, no one should switch to autopilot!

Now we come down to the nitty gritty - choosing the pilot. Taking
local anesthesia aside for a moment when we deal with general
anesthesia techniques we have a choice - nurse anesthesia or
anesthesiologist. Only one is a doctor. It's very much a kin to
delivering a baby. Who would you rather have at the foot of the bed?
A midwife or an obstetrician!
How to Win in the Youth Game 121

I was blessed to have a 25-year relationship with a Dr. Tom Gumas,

whose skill saved me a lot of wear and tear on my coronary arteries. At
our center ASI it seems to me that we have a clone, Dr. Kenneth
Kushner. He is what every doctor should be – kind, caring, skilled and
efficient. And incidentally, he happens to be a great pilot as well.

Now remember, if your decision is to have a surgical procedure in your

quest to stay on the path to Youngstown, make sure that the person with
the potions at the head of the table knows his stuff. He or she shouldn’t
mind a few questions about the depth of his or her skill and your depth
of anesthesia.

TIP: Don’t worry about cracking your knuckles.

Remember seeing who could make the loudest
“click” during those boring lectures in 8th grade?
Well, your mother’s scolding about “you’ll get
arthritis if you keep doing that” was accurate only if
you felt pain while cracking the joint. When the two
bones move quickly apart, the motion causes gas
to be expelled, making the “snap” sound. Keeping
the joints flexible is a standard technique in yoga
and encourages less rigidity in later life.

122 Aesthetic Science Institute: The War Against Aging
Chapter 13

We’ve covered a lot of ground and now

let’s get more specific about some areas
that will affect many of us
in our life journey.
We’ll go down the line
to open some doors or,
at the very least,
open some eyes!
124 Aesthetic Science Institute: The War Against Aging

Baldness: It's no Longer

Hairy Situation
What a difference a generation or two makes, thanks to innovations,
inventions, scientific advances and super specialization. The hair on my
head is a living example of the
success of hair transplantation, and
has stood the test of time for over 35

When I started my practice almost 40

years ago, there were only a handful
of men (mostly dermatologist) who
were skilled in the art of moving hair
plugs from place to place on the scalp
with varying degrees of success.
Today it is a burgeoning industry
with hair transplantation centers
spanning the globe and newsletters
available on the Internet.

Before we get to today's techniques,

let's just review the whip and
wherefores of hair loss. Hair is on a
genetic time table, an inherited trait.
It can come from either side skip a
generation involves both sexes and is One year and 300 plugs later
random in its affect on siblings. It is
totally independent of hair care. If
you're unlucky to have the gene responsible for hair loss, your hair
follicles are being genetically coded to make them sensitive to
dehydrotestosterone (DHT).

As we enter adulthood the follicles begin to shrink the hair becomes

finer and finer and their growth is stunted. Sooner or later thinning
becomes receding, perhaps followed by baldness.
Many years ago we started varying degrees of surgical gymnastics in
order to decrease the balding areas or transfer larger amounts of hair at
one time. We used expanders, flaps, scalp reductions or strips to create
How to Win in the Youth Game 125

a hairline. Not to belabor the point, improvements in knowledge and

techniques have minimized gargantuan surgical efforts in favor of
medication and Micro Surgical procedures.

How it’s done today.

Hair: Where it’s put

126 Aesthetic Science Institute: The War Against Aging

Typical result after six months

Medical Treatments
1988 marked a milestone in the treatment of hair loss, when the FDA
approved the first medication for scalp applications to regrow hair -
Minoxidil (2 to 5 percent). It was obvious that, while it could slow
down or halt hair loss and even regrow hair in the vertex in some cases,
the frontal areas remained unaffected. In addition, daily application is
necessary for the medication to be effective.

In 1997 another step forward was achieved. Propecia (finasteride)

became the first anti-hairloss pill to gain FDA approval. Available only
by a doctor's prescription, over 1 million men in the US take Propecia
daily. In contradistinction to Minoxidil, most users reported an increase
in hair count, a decrease in hair loss, and an improvement in
appearance. This has been joined by Avodart, which is more
effective and treats prostatic hypertrophy as well.

Asteride compounds work by decreasing the formation of the hormone

dehydrotestosterone (DHT), a key factor in the development of male
patterned baldness. Although this is a major step, there are several short
comings. It takes several months up to a year to start seeing some
results. If your hair loss is long-standing (shiny bald), the chances of
salvaging follicles decrease dramatically. Like Minoxidil, it must be
taken forever to maintain any positive results. In addition, a small
percentage of men (greater than 2%) report a decrease in libido while
taking the drug. Thankfully, most wives will like this: the loss is
present only as long as treatment goes on.

So what is hair transplantation? Hair implants are simply taking the

hair from where it does grow and be expected to remain for the life of
the patient and implanting it into thin or balding areas. If you have the
How to Win in the Youth Game 127

Nero fringes and hair at the sides, you maybe eligible for a successful

Hair grafts are compatible composite skin grafts that must include the
root to be successful. The first common method of transplant was the
punch invented by Dr. Orentreich. The current treatment is simply a
variation of the theme, like planting a garden. The implants have
become smaller and smaller, the sessions longer and longer and the
number of implants at one time have increased dramatically.

The "corn rows or doll's hairline" have been replaced by virtually

undetectable hair replacement, thanks to improvements in techniques.
Where I used to do up to 100 plugs at a sitting, it is now common to
implant up to 1,000 and up at one time. The numbers of hairs has
increased in a session at the cost of the size of an implant. It is not
unusual to have sessions last 6-7 hours with the patient awake, watching
TV or even being fed while a team harvests the hair, meticulously
divides them into grafts of 1-3 hairs with the aid of high magnification
and then inserts them into tiny closely arranged openings in the empty
or thinning areas of the scalp. Two or 3 sessions usually finishes the

The results are not immediate. It isn't instant hair. The new follicle
goes into shock and the hair falls out. After 2 or 3 months and a lot of
looking in the mirror, a fuzzy appearance followed by real genuine hair,
that with proper planning is "good to go" for the next 50 years or so.
The permanent genetics trigger is in the follicle and is constantly

What does the future hold?

How about cloning? It's starting to find a home in some European
centers and seems like our next logical step, particularly if Washington
doesn't interfere with future experimentation. Like everything, only the
very rich will be able to afford the first attempts, but as with all
technical advances (remember TV and computer - decreased costs
invariably follow) the 21st century is opening the door to this intriguing
chances of revenue. Who knows- I might even give it a try!

Just a word to the women. In contradistinction to some procedures, the

techniques are unisexual as are the causes and treatments, and although
the patterns of hair loss are slightly different, finding hair to transplant
is usually not a problem.
128 Aesthetic Science Institute: The War Against Aging

Common Drugs That

Cause Hair Loss
It is well known that many cancer chemotherapy medications cause
baldness. Most people are willing to put up with hair loss when
accepting treatments for life-threatening diseases. But a large number
of popular medications can cause hair loss while neither pharmaceutical
industry nor your doctor will tell you about this side effect.

Here we compile a list of drugs that are known to cause hair loss in
some patients:
Cholesterol-lowering drug: clofibrate (Atromis-S) and gemfibrozil
Parkinson Medications: levodopa (Dopar, Larodopa)
Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine
Anticoagulants: Coumadin and Heparin
Agents for gout: Allopurinol (Loporin, Zyloprim)
Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin
(Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate
Drugs derived from vitamin-A: isotretinoin (Accutane) and etretinate
Anticonvulsants for epilepsy: trimethadione (Tridione)
Antidepressants: tricyclics, amphetamines
How to Win in the Youth Game 129

The Eyes Have It or

Here’s Looking At You
By now, our readers are aware of the
numerous cosmetic procedures available to
beautify that area frequently referred to as the
"Mirror of the Soul.” That shy, coy, come-
hither look, the sly wink, the look of
innocence all emanates from the orbs regaled,
honored, sanctified, adored and adulated in
song, verse, prose or in the more banal
advertisements in magazines, movies and

We have spoken about blepharoplasty, botox

injections, forehead lifts, tattooing of lashes,
peels and filler to enhance the beauty that
gazes out while we gaze in. The eyeglass
industry flourishes, providing products
costing up to the $1,000 to frame that part of human countenance.

Here beauty and youth are frequently on parallel paths, but recent
advances in corrective surgery have given us more of an edge in the
fight to improve not only our appearance, but our sight as well.

You've heard about it, seen it advertised, but I bet you didn't know it
stands for: Laser Assisted In Situ Keratomieuses (now you can forget
it). This is a relatively new type of laser surgery for correcting
nearsightedness and astigmatism. LASIK, sometimes referred to as
"flip and zap,” works by making a small flip in the cornea and removing
some of the tissue under the opening. Because of the preciseness of the
laser beam, the offending tissue can be removed without damaging the
surrounding structures.

The benefits are manifold. The procedure takes 10-15 minutes per eye,
it is performed in the surgeon's office or same-day outpatient center and
requires no hospital stay. Pain is minimal and aftercare is
130 Aesthetic Science Institute: The War Against Aging

Home Care:
1. You may need an eye patch or bandage for a few days after the
2. Sometimes vision is blurry for several days, so work and driving are
a no-no for awhile.
3. Eye drops may be prescribed to decrease inflammation or chance of
infection for a time.
4. Vigorous exercise, eye makeup and water activities are put on the
shelf for a bit and that even includes showers. So come clean!

Who should have it!

First of all, let's get one thing straight. This is an elective cosmetic
procedure. If you have mild to moderate nearsightedness and want to
take a chance on giving up glasses, consider it seriously. Since it's a
fairly new procedure, we're not really certain about long-term results,
but with more and more experienced centers opening up all the time,
techniques are improving constantly. Before we talk about the risks,
let's look at some alternatives.

PRK (Photo Refractive Keratectomy)

This was an earlier attempt to use laser technology to correct
nearsightedness. The surgeon uses a laser which emits as "cold"
ultraviolet beam to remove a precise amount of tissue from the cornea.
Using a sophisticated computer program, the exact amount to be
removed is determined that will change its curvature. By doing this, the
focal point is moved closer to the retina, thereby improving distance
vision. Before LASIK, PRK largely replaced the older procedure called
Radial Keratotomy (RK).

Radial Keratotomy (RK)

I guess the longer the acronym,, the better the result and the shorter
time the surgery takes. In brief, RK is a non-laser surgical procedure
using a highly precise diamond blade to make predetermined radial
incisions (like the spoke of a wheel) determined by the degree of
nearsightedness. The cornea can bugle outward, flattening its central
part and bringing the focal point closer to the retina.

The Downside
As with all technical advances once the new kid on the block flexes his
muscles, proves superior again and again and he soon takes over.
LASIK is quickly replacing PRK and RK as the procedure of choice
particularly as its use increases and the risk of complications continues
to decline. But they do exist and should be considered.
How to Win in the Youth Game 131

1. Clouded vision - sometimes referred to as “corneal haze” and is less

common with LASIK, this condition tends to go away quickly.
2. Night vision abnormalities such as "halos" around headlights and
street lamps – LASIK causes fewer halos than PRK or PK.
3. Glare or increased sensitivity to bright light
4. Double vision (diplopia) usually in one eye
5. New astigmatism secondary to flap or poor surgical healing
6. Some loss of correction- overcorrection or undercorrection

Then we must mention the heavy hitters which are exceedingly rare: 1.
infection (keratitis)
2. development of glaucoma secondary to increased intraocular
3. Dare I say it - blindness, but the odds are beyond winning the
lottery range.
Remember this is cosmetic, but after you know the facts and are
satisfied with your choice of surgeon, go for it! You can still wear great
132 Aesthetic Science Institute: The War Against Aging

Can You Hear Me Now?

It sneaks up on you before you know it. The volume on the radio needs
to be turned up. When you are at a party, you have difficulty
understanding what your friends are saying even though you're next to
them. There's a message on the answering machine and you were

About 10% of our population has some

degree of hearing loss. A major cause is
age. One third of people over 65 and half
over 75 suffer from presbycusis,( age
related hearing loss).At the present time
there is no known cure for this condition,
so let's turn to what we can do to improve
our environment.

The biggest single cause of hearing loss is

on the rise- LOUD NOISE Who doesn't
want ultrastereophonic surround the theater
super real sound systems? What about the
boom boxes, the blow dryers, the
personalized walkmen? When was the last time that the whole
neighborhood didn't hear the Rock concert a mile away? I'll tell you
who -the sensory cells in the inner ear that are damaged from loud noise
and don't grow back!!!! It's bad enough that these cells naturally
deteriorate with age so, why should we add fuel to the fire? According
to the National Institute of Health, more than 30 million American
children and adults are exposed to loud noise on a regular basis.

Before you throw your hands in the air or bemoan our fate, there is a
light at the end of the tunnel and it's not an oncoming train. The last
few years have seen some significant advances in the treatment of
hearing loss. The newer hearing aids are digitalized, smaller and
virtually unnoticeable, so wearing them causes less embarrassment.
New surgical techniques are enabling people to hear words and sounds
that were impossible to think of.
How to Win in the Youth Game 133

That's not all. Recent studies have revealed genetic mutations that
predispose people to this malady, preparing the way for experiments in
gene therapy. What can we do in the meantime?

- Protect yourself from loud noises

- Don't blast the music
- Wear earplugs in unavoidable noise-producing situations.
- And most importantly, don't avoid an annual exam and don't
be ashamed to accept help.
134 Aesthetic Science Institute: The War Against Aging

Smile, Even if You're not

on Candid Camera

Before and after a whitening procedure.

For a plastic surgeon not to be concerned with the state of a person's
teeth makes about as much sense as forgetting to pour part of the
foundation of a building. As is the case with other modalities, the
techniques are constantly being refined and expanded, with the
preservation of an alluring smile becoming more and more important.

The field of cosmetic dentistry has spread somewhat more slowly then
surgery, but there is hardly a city or town that doesn't have a cosmetic
dentist in it's phone book.

While I make no presumption of being a expert in the field, my personal

experience with dentists started at age 6 and continues to the present.
Improved techniques have softened my original antipathy and turned it
into a remarkable friendship, frequently working hand and hand with a
colleague (so to speak) to create the perfect smile.

Cosmetic dentists can whiten teeth, replace missing teeth and repair
chipped teeth through any number of techniques including bleaching,
dental implants, porcelain binders, bonding, dental crowns and bridges.
How to Win in the Youth Game 135

Most common options

Tooth Bleaching - There are two methods available- Laser whitening is
performed in the office. At home bleaching uses take home kits or
newer tooth pastes containing whitening additives (peroxide gel).

Porcelain Binders - A ceramic shell is applied to the front of the teeth

that is whiter than the original .

Dental Implants - Artificial teeth are placed in the gums and bone
structure to replace missing teeth.

Bonding - A tooth colored material is applied to the teeth, polished and

shaped to a conforming size.

Dental Crowns - A cap much like a overcoat used to repair decayed or

damaged teeth, or to replace older unsightly fillings. Before placement
the cap is shaped to look like the rest of the tooth.

Bridges - Just like the name implies. 2 crowns and a dental implant are
used to fill the empty space. The crowns are placed on either side
connecting to the dental implant that replaces the missing tooth.

This superficial magic is in addition to a long recognized specialty

"Orthodontics" which has been around for almost a century (my braces
came off 50 years ago). By using corrective appliances, braces and
retainers, crooked teeth are straightened or an irregular bite is repaired.
Recently newer techniques featuring invisible (transparent appliances)
have enjoyed increasing popularity and the typical orthodontist's office
now includes adults in their 50's and 60's. My own Kathie just finished
a refresher course because she didn't wear her retainers like a good girl.
The course may take several years to complete, but even that time is
decreasing rapidly.
136 Aesthetic Science Institute: The War Against Aging

Braces - This is the active phase whereby continuous pressure is applied
to achieve movement in specific directions. They consist of brackets or
plastic applied to the teeth with wire or a bonding agent. The pressure
is adjusted many times during the course of treatment to guide the teeth
to their new position. Braces can be stainless steel, plastic or ceramic
the latter two substances being chosen for cosmetic reason. Costs are
directly proportional to the type of braces and the length of treatment.

Retainers - This orthodontic appliance is made of plastic and stainless

steel wire and is placed over the realigned teeth after the braces are
removed. They keep the teeth in their new position until the
surrounding bone and gums adjust around them. The length of time
that the retainer must be worn will vary, but on the basis of my
experience keeping them around for a long time is a great idea.

Sounds pretty straight forward. We are lucky to have one or two

associates whose work rivals masterpieces. The choice is easier when
many before and after pictures are available, so if you like what can be,
why not?

TIP for Thinking

The bigger the laugh, the more work your
diaphragm does. When the lungs work harder, the
blood gets more oxygen – which leads to more
oxygen getting to the brain.
How to Win in the Youth Game 137

Breast Surgery –
Get it off (or on) your
Here's the truth - the female breast is a modified sweat gland and skin
appendage, but what a modification!

Incisions for Breast Augmentation

What doctors say What we say

Breast Implants: Where can they go?

Where implants go
138 Aesthetic Science Institute: The War Against Aging

In our society, breasts are a yardstick (more or less) in the sexual and
sensual evaluation of a woman and in her own mind as well. The only
thing comparable in the male is the size of his penis.

No one is unmindful of the importance in maintaining the health, shape,

function and sensitivity of what's up front where it counts. Therefore,
let's have a little review of exactly what we're dealing with.

Essentially the breast is composed of glandular tissue, connective tissue,

fat and blood vessels covered by a skin brassiere. In addition, there is a
rich supply of nerves that account for its extreme sensitivity to pain,
pressure and erotic stimulation. Any procedure, whether it be
enlarging, reducing or modifying the position, is designed to maintain
all of the normal characteristics of an unoperated breast.

The breast is attached to the chest wall almost as an afterthought of

nature. The exchange of nutrients and information takes place through
the nerves and blood vessels that act as conduit between the inside and
the outside environment. Hormones control not only the function of
lactation but cause monthly changes in sensitivity as well. There are no
significant masses of voluntary muscles within the breast, so exercise is
of no use in changing anything but your chest circumference.

In many respects you can consider the breast to be very much like a
weight suspended from an elastic band. For a while the strength and
elasticity are enough to hold the breast in its proper position, but after a
time the band stretches and both the shape and position will change.
For some I don't have to tell you what pregnancies, breastfeeding and
weight change have done to the image you see in the mirror. One of the
sadness of losing extra pounds is that thinner face and smaller hanging
breast show up long before a slim waistline or fashionable butt.

For most of the world's women, it is the inadequacy of the bust curve
that is the problem. I have made quite a reputation by ADDING to
what is in short supply. Consider that upwards of 300,000 women have
augmentation procedures on a yearly basis in the U.S. alone.
How to Win in the Youth Game 139

Before and after breast enlargement

About 10 years ago there was uproar about the safety of silicone
implants and their possible linkage to auto immune disease like Lupus,
Fibromyalgia, and other collagen problems. The original giant in the
implant industry, Dow Corning, went into chapter 14 bankruptcy and
set aside several billions to settle its caseload. Since I was a designer of
a popular implant, I did not escape unscathed.

After years of bantering and controversy, there has not been a proven
case of the direct relationship between the implant and the onset of
autoimmune disease. However, the myth of forever has been shattered.
The implants have to be monitored to check their integrity.
Manufacturers have taken care to strengthen the silicone sac to prevent
early disruption. The majority in use today are saline filled implants
which provide an easy way to replace the problem- much like changing
a flat tire.

What else is new?

I have mentioned the changes in techniques regarding incision,
placement and the use of the endoscope for liposuction in select cases.
The incision under the breast and placement over the muscle has
virtually been abandoned. The problem of encapsulation has decreased
considerably but still may present a problem for some. Remember the
insert is a foreign body and every individual reacts differently.

How about the other side of the coin? Reduction mammoplasty and
mastopexy have been refined (they still are two of my favorites). No
140 Aesthetic Science Institute: The War Against Aging

longer a hospital procedure, the scars are shorter as well as the time of
the operation For most post operative complications are markedly
reduced and awareness of the population has increased, thanks to Dolly
Parton and Oprah among others.

Let me set aside one fear -- any of the procedures has not been shown
to increase the incidence of cancer. On the contrary, in my experience
with over 5,000 augmentations, I think the insertion of an implant may
actually decrease the incidence. Could this be due to the continual
activation of the immune system by a foreign body? And as long as
we're on the subject of cancer, it was almost 40 years ago that I
championed an alternative to radical mastectomy at a meeting of the
American College of Surgeons - a Subcutaneous Mastectomy. It has
fallen by the wayside, but the road to smaller and smaller excisions for
malignancy with better and better immediate reconstruction techniques
has given women hope instead of mutilating despair. It strikes me as
funny because
at that talk I suggested that if cancer of the penis were as common as
breast cancer within 45 seconds the male surgical establishment would
have discovered an alternate method of treatment. It only took us about
100 years!

Just a word to the men: Don't think you're the forgotten sex. Some
plastic surgeons are the advocates of chest augmentation for men. It's a
little tricky, but for those who've had it, most feel good about their new
image, the result of any insert under the pectoral muscle.

Gynecomastia or enlarged breast in men is another avenue worth

exploring. Putting aside the growth of male breast tissue that is
secondary to rapid hormonal changes during puberty, most cases seen in
later years are due to medications taken either to control hypertension,
prostatic disease tuberculosis or psychological imbalances The
feminization in most cases is due to the effect of these compounds on
liver metabolism, resulting in more estrogen circulation.
How to Win in the Youth Game 141

Breast Elevation with an Implant (editor’s choice)

Most of

lipomastia rather than actual breast tissue enlargement. It was not

particularly difficult to deal with before by surgical excision, but with
the introduction of liposuction techniques, it has become a virtual one
day local procedure with no down time to speak of. As the Peacock
Generation is reaching their later decades we can expect more and more
requests as part of over body sculpting repertoire.

Let's head down south.

142 Aesthetic Science Institute: The War Against Aging

Do I Always Have to
Fat, Fat - Make it Go
When this author first wrote about body contouring in the 70's, little did
he realize that we were on the brink of an explosion called liposuction –
or did he?

In the late 60's, I tried to improve body contours by making small

incisions, taking the curette we used for abortions and inserting it under
the skin to loosen the fat and then suction it out by very primitive
techniques. For awhile I thought I had really discovered something
until a careless patient became infected and found her way into the
office of a venerable colleague (now departed). Not being a friend of
mine ( to say the least), he wrote this to her malpractice attorney "Only
a maniac sucks fat out of a body!" After prodding by my insurance
carrier, I put my thoughts into moth balls until it became the sensation
of the 80's, but what the hell! Welcome to the mad house- open for a
booming business!

Contour transformation has been documented since antiquity. Today's

increase in tattooing and body piercing is the latest fad following
centuries of scarification, binding feet and foreheads and the like.
Tattooing for medical reasons and cosmetic enhancement of eyeliners
and eyebrows are in our armamentarium, but let's stick to unwanted

Back Front Legs and Thighs

How to Win in the Youth Game 143

Liposuction is the most popular cosmetic surgical procedure among

women, totaling over 300,000 cases in 2001. It is not a substitute for
legitimate weight loss programs, but for localized or congenital areas
that won't respond to dieting or exercise, it can't be beat. Ask anybody
who had love handles or riding breeches syndrome what a godsend this
has been.

Liposuction techniques have improved, , the equipment is refined and

the post operative results are markedly better due to increasing
familiarity with the operations.

Since it's relatively new to some, we'll deal with the basics. It's
invariably an outpatient procedure done under the gamut of anesthetic
techniques ranging from local to general anesthesia. The most common
technique involves making small incisions, and inserting small tubes
through which a solution containing xylocaine (a local anesthetic) and
saline is introduced into the areas to be treated. This serves to numb the
area and decreases bleeding during and after the operation. Following a
brief wait, a vacuum suction tube is inserted into the incisions and by
carefully measured strokes, removes the offending tissue. Afterwards a
girdle or stocking is applied, which remains for several weeks until the
tissues conform to the new planes. Aside from stopping strenuous
exercise for 2-4 weeks, return to normal activities takes a matter of

We now have:
1) Microliposuction- for those people who want to look good in
miniskirts and cropped shirts.

In addition we have gone from …

2) Ultrasound lipoplasty - the fat is liquefied prior to removal

…and now we’re going to:

3) PAL (Power Assisted Lipoplasty) - a machine amplifies the power
to minimize physical effort to remove fat quickly
4) VAL (Vaser Assisted Lipoplasty). Here sound waves liquefy the

All well and good, but you can't get to Carnegie Hall if you haven't
practiced, practiced, practiced. The same goes for the surgeon you
144 Aesthetic Science Institute: The War Against Aging

A few raindrops to consider: If you're over 35, you may need some
skin removed because your elasticity may be compromised.

In addition, if you gain weight after liposuction, you may be surprised

to find chubbier places in other parts of the body.

Therefore, for some patients, liposuction is not the answer and there
will always be tummy tucks, buttock and body lifts to improve body
curves. A few new doors are opening. It may be possible to harvest
stem cells from the suctioned material. These primordial cells have
shown the ability to differentiate into different types of tissue such as
fat, nerve, cartilage and muscle in the laboratory under proper
conditions. Will it be possible to suspend the cellular aging process in
this way? We're only beginning on this part of the journey, but this
may be a fast track in the future.

Let's go into other avenues of removing fat without surgery. One is

called Mesotherapy, popular in South America and featured on ABC
TV’s 20/20 only recently. This involves injecting the fat deposits
directly with a substance that melts the cells. A similar technique is
called Lipostabil, which involves shots as well. More about this in the
next part of our trip, but since this chapter is being written, mesotherapy
centers are opening up in the major cities.
Be careful!

Don't like injections? How about a device

called the ULTRASHAPE? According to the
inventors and users, it uses ultrasonic impulses
to destroy fat cells without damaging any
surrounding tissue. It's pretty sci-fi sounding
and is new on the market, but if it works, look
for centers to pop up quickly. After all, who
wouldn't go for non-invasive body sculpting?

I bet in a year or two you won't find anyone

who hasn't tried one thing or the other. Let's go

Ultrashape: The future?

How to Win in the Youth Game 145

Before liposuction

The old way

146 Aesthetic Science Institute: The War Against Aging

Liposuction – The New Way

No visible scars

A Little of Both

Tummy tuck and liposuction.

How to Win in the Youth Game 147

I've Got You Under My

The Cellulite Story
Cole Porter wrote the song, but he never mentioned the real problem
that most women have: "Cottage Cheese or Orange Peel" thighs.
Ladies dread it, hoping they'll never get it, but sooner or later, 90
percent will and men shouldn't be so smug either. Not as many, but a
good number of felloes will succumb to this annoying condition.


What is cellulite?
The dictionary says it is lumpy fat found in the thighs and buttocks of
some women. The fat is believed to be trapped in pockets beneath the
skin. Fat cells on the lower part of the body store fat six times more
readily than those on the upper body. They also release fat six times
less readily. This makes weight loss from the lower body almost
impossible without looking emaciated from the waist up. It is not
something which plagues the obese or slightly portly. Anybody, the
skinny kid or the muscle woman at the gym, can fall prey.

One thing to get straight - cellulite is "normal fat" pressed up against or

constructed by the bands of connective tissue which extend from the
muscle to the dermal areas of the skin. Gaining weight can make it
worse because the deeper fat layer may push up the layer to cause more
148 Aesthetic Science Institute: The War Against Aging

dimpling. It is the fibrous septae (connective tissue) bands that force

the fat against the skin.

OK, we know where it is, but what causes cellulite and how do we
get rid of it?
There is no definite cure yet, because there are any number of factors
causing it. Diet and exercise go a long way in helping to prevent it, but
if you've chosen the wrong parents, too bad.

Some physicians believe it to be secondary to weak circulation and

connective tissue. Health healers and some witch doctors blame toxins.
Others say it is too much water, some say too little water. Before you
suffer from water intoxication or unbelievable thirst, let’s see what is
and what isn't and, more importantly, what shows the greatest promise
in controlling it.

Let's start with things that I think don't work or at least recommend that
you show me otherwise.

Body Wraps
You might as well wrap your brains if you fall for this line of baloney.
Sweat it out and, as soon as you drink a glass or two, it's back.

Garments of Vinyl, Latex, Neoprene, etc.

They make you sweat more whether you're working out to a Richard
Simmons or Jane Fonda tape (check out their plastic surgery) or sitting
on a sofa. But it's much ado about nothing.

Cellulite Pills
Don't you think if any of them worked, the producers would be
zillionaires? If they contain stimulants like ephedra or ma huang, you
may lose weight all over, but remember you have to lose a lot before
you see a little down there!

Electromagnetic Treatments (Cellular Electro Therapy)

There are those who would have you believe that changes in
electromagnetic fields would cure anything form arthritis to cellulite.
Proponents contend that movement of stagnant or bound fluid in and
out of cells s caused by changing the electronic charge. Maybe they can
- I haven't been convinced yet! But if you must, get charged up while
you're being charged!

Endermalogue TM (a.k.a. LPG or Liponic Sculpting)

How to Win in the Youth Game 149

This machine was invented in France in the early 80's and after 15 years
of use, it found its way into the USA to be approved by the FDA as a
Class I device. At the time, it was the only machine to temporarily rid
the body of the appearance of cellulite and improve skin texture and
irregularities. How does it work? It is a combination vacuum device
and massage machine that lifts the skin, theoretically stretching the
septa while massaging the tissue to “free the fat cells” from their fibrous
connection. The resulting improvement has been reported to be due to
increased circulation or increased collagen growth that strengthens the
connective tissue to prevent the fat globules from pressing through the
honeycomb, thereby hiding the dimpling.

While I am not a physicist, I suspect that the vigorous massages cause

subclinical swelling that masks the "orange peel" effect. That is
possibly why it is temporary and that maintenance on a monthly or
bimonthly schedule is required. Many treatments are needed in the first
place and it is uncomfortable for some, but many patients report losing
several inches in the treated areas. But, as some say, “What goes up,
must come down!” With this treatment it is vice versa. If you have
deep pockets and like rough massage, try it.

The bottom line is, if there is any way to improve the appearance of
cellulite, there must be a physical interference or contact with the fat in
question. So what's left?

External Ultrasound
This may work, albeit not in larger amounts yet. The sound waves can
cause the outer wall of the fat cells to burst. The body then removes the
debris through its regular waste removal system. No big trials yet, but
promising. Remember, Ultrashape is being tested (warning, warning).

Liposection, Lipolysis with laser assist, Liposculpture

These are all a variation on the theme of sucking the fat out. It's been
around for about 15 years, but if your surgeon has no clue of what he or
she is doing, watch out!! More people can get skin irregularities and
excessive because of the delicacy of the procedure. The closer you get
to the surface, the bigger the chance for permanent deformities.

You have to hand it to the French even if you don't agree with their
politics. In 1958 Dr. Michel Pastor devised a technique to treat
everything but the kitchen sink – rheumatism, infectious diseases,
circulatory disturbances and, yes, even cellulite! Mesotherapy involves
injecting small amounts of homeopathic medicines immediately under
150 Aesthetic Science Institute: The War Against Aging

the skin surface, which somehow breaks down the cellulite and
improves circulation. Each treatment takes about 10 minutes and is
tolerable without much pain being reported. Micro-injections are given
two times a week over a 4-to-8-week period, giving measurable results.
At the present moment, the recommended maintenance is on a yearly
basis over a 4-to-6-week period.

Before and after mesotherapy

What's in it? It's a mixture of solutions including amino acids and

vitamin C and other closely guarded ingredients and you can be sure
that these treatments will become increasingly popular in the years to
come, particularly in combination with the emergence of a relative
newcomer on the scene - Lipostabil.

Lipostabil - phosphatidy Choline

This material is made from a soy-lecithin base. This introduces on
enzymatic reaction into our body that breaks down fat cells. The fat is
dissolved into liquid and eliminated through urine and feces.

Lipostabil not only can treat cellulite, but it can destroy lipomas (fatty
tumors) as well. Side effects are minimal, limited to bruising, and
lipostabil is part of the treatment techniques of thousands of European
and South American physicians. What else is it good for? Minor and
medium sculpting of specific areas of the body like - stomach (want a
perfect six-pack surgery?), upper arms, chin, hips and thighs.

Once again a word of caution: improper techniques may result in

uneven fat loss, but there seems to be little else to be worried about.
For a celebrity endorsement, listen to Roberta Flack, who's singing its
praises. She's sporting a 32-pound weight loss as well as being able to
How to Win in the Youth Game 151

fit into a size 10 (originally size 16). Maybe we'll be able to join the
chorus! One way or another, the audience is hoping that this is a hit.

Look Good, Feel Good

Society places an enormous emphasis on looks. Studies have shown that
better looking people earn more, are promoted sooner and are more
likely to occupy senior positions within corporations. Given the same
qualifications, the more attractive person, male or female, is more likely
to get the job. Similarly, when it comes to choosing a partner or mate,
do looks count?
So when you look better, you feel better. Your productivity is likely
to go up and perhaps you become a more valuable member of society.
If you look like a million bucks, are you worth a million bucks?
-- Dr. Dirk Lazarus, Plastic Surgeon
MBChB (University of Cape Town), FCS (South Africa, Plastic and Reconstructive
Surgery), http://www.plasticsurgery.co.za/news1.htm
152 Aesthetic Science Institute: The War Against Aging

Ways to Lose Weight

When All Else Fails
As plastic surgeons, we have seen people who have lost tremendous
amounts of weight for resculpting and restoration of the body image.
For many, it has been due to diet, sheer willpower and determination.
For those who have become morbidly obese, sometimes a surgical
solution may be the only way to start the ball rolling.

We have touched on BMI in the previous chapter. A person with a BMI

over 30 is considered to be obese. Another parameters are these body

1) BMI between 25 and 34

2) Waist Size
Men = over 40"
Women = over 35"

If you fall into these categories, you are at especially high risk for
obesity-related problems, such as diabetes, high blood pressure and
heart disease. If you have a BMI of 40, your risk of premature death
by any cause will increase by 50% to 150%.

Before the use of the endoscope, operations to decrease the size of the
stomach and intestines were uncommon, but the last ten years has seen
the development of more and more "Bariatric Surgery Centers,” proudly
heralded in newspapers, magazines, TV sports and the Internet.

Bariatics is the name for that branch of medicine that deals with the
prevention, treatment and control of diseases related to obesity. For
most of those people getting there it means surgical intervention sooner
or later.

To be considered for surgery you usually must need certain

How to Win in the Youth Game 153

1) Be 75 pounds overweight
2) Have failed nutritional and medically supervised diets
3) Be willing to make certain necessary changes in eating habits
4) Be between the ages of 18 and 60
5) Have not had previous weight loss surgery
6) Your BMI is over 40 or between 35-39 with life-threatening
conditions (hypertension, etc.) 7) Have no history of alcohol abuse
8) Be willing to go through psychological and medial evaluations to
evaluate all possible causes of obesity other than intake

Since this is a serious decision, it's obvious that an exhaustive

evaluation is the first step. What are the current procedures being done
by the prominent centers?

1) Laparascopic - Roux-en Y gastric by pass

2) Stapling and banding
3) Mini gastric bypass

Roux-en Y
This was the most widely used and successful operation until recently.
By a variety of techniques (stapling, banding and sutures) the size of the
stomach is turned into a small pouch to limit the amount of food needed
to give a feeling of fullness. Next, a Y-shaped section of the small
intestine is attached to the pouch to bypass a significant portion of the
upper parts. This procedure reduces absorption of calories and

Can you find this fellow on the next page?

Lately, a variation of this procedure has caught attention. According to

its proponents, it takes only 30 minutes through the Laparoscope and
requires a 24-hour post-op hospital stay with good results. It involves
154 Aesthetic Science Institute: The War Against Aging

attaching the pouch to the lower jejunum with one less attachment - it is
the Mini-Gastric Bypass.

One way to do it
 Notice that the stomach and part of
the upper small intestine have been
avoided by entering lower down the
tube. The stomach is also smaller.

These operations are not without

consequence. Total cooperation is
required and these risks must be

1) Pouch stretching - for some the

stomach gets bigger resulting in more food
2) Band erosion -- the band enclosing part
of the stomach disintegrates.
3) Failure of staples
4) Peritonitis - caused by leakage of contents into the abdominal cavity
since acid is very irritating
5) Dumping syndrome - if the stomach empties too rapidly into the
small intestine, it can result in nausea, weakness sweating, faintness and
occasional diarrhea. In addition eating sweets can cause uncontrolled
6) Gall stones
7) Nutritional deficiencies - decrease in your Vitamin B 12 and foliate
8) Psychological problems secondary to massive changes in body

9) Osteoporosis: Does it work? Most people begin to lose weight and

continue loss for up to one year. Various studies have pegged the losses
at up to 85 percent of excess weight over a period of five years. Does
that give a lot to think about? The amount of food ingested at one time,
the vitamins and mineral supplements, all must be part of a carefully
planned lifestyle.
How to Win in the Youth Game 155

No discussion would be complete without mentioning the Gastric

Stimulator, a device available in Europe for more than a year and
under FDA consideration at the present time (2004). It involves a
device the size of a pocket watch that is implanted into the chest or
abdomen through four small endoscopic incisions with wire connections
to the wall of the stomach (see illustration). The surgery takes less than
an hour. Most patients walk 30 minutes after the procedure is over and
are home the next day. Two weeks after surgery a doctor, using an
electronic wand, turns on the device. Stimulated nerves may send
signals to the brain, affecting food intake, hunger sensations and
hormonal changes. Why the excitement? A study in Europe examined
50 women who were 23 to 62
years of age with a BMI of 30
to 35. The range of weight loss
was 21 to 34 percent after 24 to
30 months. There will soon be
centers in the USA attempting
to duplicate the results. For a
procedure that is reversible and
has minor side effects
(dyspepsia), it is a possible
boon to many.

Who is the fellow on the

right? (Hint: see the photo
on the previous page). Dr.
Pozner is in the center.

So what’s the bottom line? At the present time, maybe Weight

Watchers is your best bet – or you can really learn to watch your
weight. The usual culprits in life are prepared carbohydrates like soda,
milk shakes and sweets. Please be prepared to think before you get
ready to eat. The life you save for a little longer may be your own.
156 Aesthetic Science Institute: The War Against Aging

The Vagina – It's Not

Always a Monologue!
No journey would be complete without talking about the possibilities of
rejuvenation of one of the areas glossed over or embarrassingly avoided
- The Vagina.

The object of man's desire, the ultimate goal of youth, is the victim of
use for childbirth and is, under the best of conditions, not exempt from
aging. In addition to laxity and loss of muscle tone, many women area
displeased with the external appearance of their genitalia. So what's a
woman to do? The answer is plenty.

First let's talk about the outside: the labia majora and menora. That's
right men, women do look at Playboy models, too, and don't want to
look ugly down there. Some women complain about the unevenness of
elongated lips and, occasionally, large labia can be pulled inside during
intercourse (ouch!). Chafing can be a problem as well during everyday
activities. Here a plastic surgeon or gynecologist can come to the
recourse, using either simple surgical or laser techniques. Only local
anesthesia is necessary and, within a couple of weeks, you're ready to
face the world or that special someone.

I became aware of hymenoplasty over 40 years ago to give the patient

that unused look popular in the Far East (it cost $60 when I read about
it in Time Magazine). It's still around for the occasional request.

There are a growing number of patients who have involuntary loss of
urine with sneezing, coughing, laughing, exercising or sex. This is due
to vaginal relaxation as the tone, strength and muscle control
diminishes. The sensual sexual gratification is lost and women have
been the butt of male jokes on more than one occasion due to the
enlargement of their cavity.

Here we have two options: exercise or surgery. My good friend Dr.

Alan Stein of Tampa, Fla., has come up with a device that I feel should
be a household fixture for every woman over 40 or who has had
children. It's called Gyneflex™. What is it? Something like Suzanne
Summers’ Thighmaster™ for the vaginal vault. Made from gentle
plastic to conform to the contours of the musculature, it allows the user
How to Win in the Youth Game 157

to exercise the vaginal muscles akin to using dumbbells to strengthen

the biceps.


If that's not enough, vaginoplasty can be performed. It's a little more

complicated because it requires an excision or laser introduction within
the vault. There's a slightly longer recovery period, but the results are
well worth it.

In passing, there is a new technique call "G-Spot Amplification" being

done at some clinics. It is a safe, painless injection done in the doctor's
office to heighten orgasm. It lasts for up to 4 months and, besides
making both partners feel good right then and there, you can bet they
feel good for longer than that. So what are you waiting for?
158 Aesthetic Science Institute: The War Against Aging

The Third Leg: Lengthen

We've talked at great length about the importance of sexuality in our
perception of staying young. While it is true that increasing awareness
of the various interactions of medication has led to the decreasing role
of surgical intervention in the treatment of penile problems for some it
may be the only way.

Potency is and always has been something special in human culture.

Early common and church law required marriages to be consummated.
Failure to do so was grounds for annulment. If you consider the
infrequency of divorce in those times, you can appreciate the magnitude
of the "offense.”

The joke and asides still exist and although less drastic nowadays, don't
tell that to a man who has lost his ability to perform.
Let's talk about the problems on an anatomical and physiological level.
It's called "erectile dysfunction" or ED for those in the business.

ED is the loss of the ability to produce and maintain a functional

erection secondary to anatomical, psychological or physiological

The causes of ED are multifactorial (lots of things). They are usually

classified as hormonal, neurological, arterial (not enough blood getting
there), and venous (incompetence of valves). Injury to nerves and
blood vessels can result from trauma, prosthetic surgery, and long
standing diseases such as diabetes and hypertension. Neurological
causes include multiple sclerosis, and other degenerative diseases.
Hormonal imbalance can be a major factor, such as depressed
testosterone production, adrenal insufficiency, and diabetes. Increasing
the problem can be the fact that certain medications taken to treat
hypertension and prostate disease (as well as antihistamines and drugs
of abuse) produce ED as a side effect. Peyronie's disease, which is
scarring of the underlying fibrous structure of the penis, may be a

That's it in a nutshell. Considering the fact that up to 50 percent of men

experience ED by age 70, the little guy faces an uphill fight. Thanks to
drugs like Viagra and injection techniques, he's more than halfway there
How to Win in the Youth Game 159

but, how about the rest of us when the magic pills, hormones, or direct
shots fail?

Before 1960, treatment of any kind was rare. People with ED were sent
to the psychiatrist couch with little else to offer not now. Let's talk
about the surgical approaches that are available.

In 1970, an inflatable penile prosthesis was developed. Although it was

the treatment of choice, the device needed to inflate the rod frequently
failed. Because of this, some urologists developed semi-rigid designs to
implant directly into the shaft that are constantly being improved in
function and reliability.
Today there are approximately 20-30,000 devices implanted annually
worldwide. Small in number compared to the enormous success of
Viagra like compounds, but a god send to the rest.

There are problems, of course, as with any surgery such as infection,

erosion, and potential discomfort and unfortunately you can't try before
you buy. However, more than 90% of men who have these types of
procedures are more than satisfied.

Let’s go to another side of the coin: penile enlargement for "Bigness

Sake.” If big boobs are ok for the goose, how about a little more for the
gander to gander at?

We'll start with the ridiculous. In my joke repertoire there is a story

about a little Jewish man who is standing next to Wilt Chamberlain at a
urinal during a Lakers game. He can't help but admire the length,
strength and girth of this fabled 7-footer's member. Not meaning to
pry, he asks Wilt if he was born that way or are there any exercises he
could suggest. Annoyed, Wilt replied, "Sure, put a strap around the
glans, tie it to a 2-pound rock and let it hang there without touching the
ground. You'll see results!”

One week later, the scene is repeated. Our little guy, very pale and
soaked in perspiration, approaches the not-so-gentle giant and remarks,
“It's not any longer, but already it’s turning black!"

Funny, you say? Not for some. How about a current contraption on the
market called the Hangman? It features 10 to 22 ounce weights and the
designer claims that by hanging it from the penis for a few hours a day
you can gain as much as one-and-a-half inches within a year. I'll bet!
160 Aesthetic Science Institute: The War Against Aging

Devices to avoid

How’s this for a crutch?

Proceed at your own risk

There are some operations that make a little more sense, if the concept
makes any sense at all. There is a procedure that cuts some ligaments
that attach the member to the pubic bone. The organ will be almost two
inches longer when not in use (maybe the boys in the gym won't stare?)
but, when called to attention, the increase is virtually negligible. If
girth is a problem, dermal fat grafts or fat injections may make it
thicker, but not longer or stronger.

The fact is that most men had much bigger expectations and are visibly
disappointed. Complaints range from pain to ugly penises, scars and

Here is the real scoop. What is normal? One doctor measured 60

penises to try to come up with what's “okay.” Get ready:

• Flaccid 3.5 inches

• Erect 5.1 inches
• Circumference 3.9 inches
He and other researchers have concluded that anything above 2.8 inches
should be considered normal! So, after you've put down your rulers, if
How to Win in the Youth Game 161

you still suffer from penis envy, make a move toward the therapist's
couch. You may find out that the power of the wand is not measured in

Another Point of View

I have checked into the situation thoroughly, and the sad
fact is that if nature has equipped us with a ding instead of
a dong, well, we must just learn to live with it, and that is all
there is to it. A consulting urologist at the sexual behavior
consultation unit at Johns Hopkins Hospital in Baltimore tells
me that there are no known methods, surgical or otherwise,
of permanently increasing penis size for what we might call
"cosmetic purposes."…
In short, your best bet is to reconcile yourself to your
present equipment. Remember, it’s not the meat, it's the
Cecil Adams, advice columnist

TIP: ED is not inevitable. The more

you can do it, the longer you last.
Follow the guidelines for keeping your
arteries open and blood flowing: diet,
exercise and reducing high blood
pressure and cholesterol levels. This
will keep blood pumping to every body
162 Aesthetic Science Institute: The War Against Aging

Vein? –
What's the Best Course?
If you walk around the streets, particularly during the hot spring or
summer days, you shouldn't be surprised to know that millions of men
and women have varicose vein disorders. According to a national data
bank survey by the American Society of Aesthetic Plastic Surgery,
sclerotherapy (injections) is the sixth most commonly performed non-
surgical procedure in the US, comprising over 500,000 treatments

The visual appearance of veins is a useful but not always reliable

indicator of the health of the venous system, particularly of the legs.
We'll deal with this a little later.

What causes venous disease?

Sex and age has something to do with it.

Varicosities by age and sex

Age Female Male
20-29 8% 1%
40-49 41% 24%
60-6972% 43%
Choose the right mom and dad. If your parents had it, you're twice as
likely, too. Relatives with the problem increase you changes as well.

Pregnancy is an important risk factor, explaining part of the difference

in incidence between boys and girls to a larger extent. It's not hard to
imagine what a larger uterus can do to the venous system of the legs or
the vulva.

In addition, occupations that require long standing contribute to the

problems, and cyclical changes in progesterone secretion can affect
venous wall and valve distention.

Increased age plays a role because, over time, the elastic lamina and the
smooth muscle layers degenerate as well.

What happens if we don't treat it?

Chronic venous insufficiency can cause swelling, discoloration,
dermatitis, cellulitis, skin loss, ulcers and even malignant changes.
How to Win in the Youth Game 163

Aside from cosmetic disfigurement, we can get burning, throbbing,

cramping and leg fatigue. That's just the beginning.

If you're interested in more of the anatomy and the whys and

wherefores of physiology and pathology of the problems, please go to
several articles and books listed in the bibliography section. (Or you
can search on the Internet “chronic venous insufficiency” and “long
term problems with venous disease.”)

Varicose veins
So, what do we do about veins big or small, whether they are on the
face, body or leg? The treatment is either medical or surgical,
depending on severity or location.
The standard for treatment of spider or reticular veins is sclerotherapy.
This involves the careful injection of solution that irritates the venous
walls, causing them to collapse and disappear. Compression by
bandaging is appropriate when indicated. Alternatively, some of the
newer lasers are effective as well.

The diagnosis of complex problems has been greatly facilitated by the

introduction of improving gadgets like the color flow duplex ultrasound
(CFDU). It is quickly replacing magnetic resonance imaging
(expensive) and radio-labeled injections because CFDU is inexpensive
and non-invasive and gives precise information about the breakdown of
structure and function (in color). It takes some time getting to know
how to interpret the findings, so it pays to ask the doctor how long he or
she has been using it (six months is not too long to expect).
164 Aesthetic Science Institute: The War Against Aging

After local anesthesia around the vein, a flexible rod

is threaded to the junction, then it is slowly removed,
destroying the vein.
When I was in medical school (a lifetime ago), venous ligation and
stripping was what we had to offer and was what we did. It seemed
barbaric; thank goodness the patient was asleep. We would put a rod
down the length of the offending vein and yank it out, followed by
sewing up many small incisions and applying compression. It worked,
but often the recuperation was quite painful and long.

The vein showed here after the procedure has

collapsed and will be absorbed.
With the introduction of the ultrasound, the first improvement over
surgery was the guided introduction of sclerosing solutions along the
paths of the offending veins. It made a lot of things much easier for
many patients. A long catheter, threaded carefully, is pulled along the
inside of the vessel as the solution is introduced.
How to Win in the Youth Game 165

The Thermal Catheter at work

Watch how the laser seals the vein (like a zipper).

Left: Catheter inserted. Middle: Vein heated and collapsing.
Right: Catheter withdrawn, closing vein.

A typical result with spider (surface) veins

Before 48 hours later

With the public’s and physicians’ fascination for lasers, could the light
at the end of the tunnel by anything but?

At the present time, there are a growing number of centers offering

endovaricous vein thermal treatments (big words for a relatively simple
procedure). Since I've had sclerosing solutions and compression
treatments myself, I can tell you that they seem the way to go. Under
local anesthetic, a small incision is made to catheterize the vein. An
injection of anesthetic solution is then introduced around the targeted
vessels followed by the insertion of a specialized flexible rod along the
166 Aesthetic Science Institute: The War Against Aging

path to the vein's origin. As the magical wand is slowly removed, the
vein is zapped by turning on the power (laser or thermal). Imagine – an
outpatient procedure, no real downtime and results that are permanent.

Before After

Patient Satisfaction
Symptom Pretreatment After After
6 weeks 2 years
Leg Pain 85% 6% 5%
Leg Fatigue 85% 12% 5%
(swelling) 19% 8% 0%

Any remaining superficial veins can be treated by direct sclerotherapy

or minor surgical removal. As with anything, there is no free ride and,
since many people are older and may have various medical problems as
well, thorough medical evaluation is in order in these cases. The
complications range from dermatitis, pigmentation and creation of new
veins, to skin loss, thronihoplilebitis nerve and arterial injury. Like All
State Insurance, you want to be sure you're in good hands.

Don't let your treatment be labor in vain!

How to Win in the Youth Game 167

Shoo Away the Shoe

Before we come to the end of our journey, let’s not forget an important
part of our anatomy that’s gotten us this far – the feet.

Father Time is a severe adversary and since the average person will
walk the equivalent of four times around the world in the course of a
lifetime, is it any wonder that feet bear the brunt of the burden for many
of us?

Most of the problems that befall us don’t necessarily wait until we reach
the later decades. Flat feet, athlete’s feet and fungal infections surely
can put a crimp in anyone’s step.

As many subspecialties have grown, so has the branch of health care

devoted to lead and foot care: podiatry. Such a doctor is a D.P.M.
(Doctor of Podiatric Medicine) and, as we make it further along the
way, sooner or later a visit to his office is inevitable.

Let’s talk about aging feet first. Corns, calluses and bunions can show
up anytime, thanks to the torturers we laughingly call shoemakers. For
some reason, designs seem to be far more important than comfort and
function. The ladies know what I’m talking about. Add to this fact that
the fat pads that cushion the foot frequently diminish over time, that
arthritis and arteriosclerosis increase with the years and it’s easy to see
why your tootsies are sore.

We’ve discussed the merits of diet, exercise and circulatory repair in

previous chapters and they are as important as ever. Paying as much
attention to your toenails (you too, guys) as your fingernails pays off in
the long run.
168 Aesthetic Science Institute: The War Against Aging

For those of you with specific cosmetic problems, never fear! Surgical
intervention is an ever-increasing reality. Some of you may be upset
because your second toe is longer than the big toe – it’s called Morton’s
Toe. A pretty easy procedure, if you’re so inclined, removes a small
portion of the bone from one of two joints to bring it down to its proper

Toes too short? Like penises, toes can get a little visible length with a
silicone strut. After a two-day bed stay and a month of care, you can
proudly parade your perfect digits for all the world to see.

The bottom line: if your feet are giving you trouble, hike down to the
foot specialist. Relief may be just a spray or a shoe change away. If
not, you’ve landed in the right chair anyway!

Chapter 14
Get Set and Ready to Go
From I to I to I...
In my younger days, I used to joke with some of my
friends and patients and say, “I’m the best left lower
eyelid and right upper eyelid surgeon in the world.”
Although that really was not the extent of my expertise,
perhaps in my mind that was a portent of things to

Superspecialization is rapidly becoming the rule of the

day. In contradistinction to the general practitioner or
specialist of yore, the growing store of knowledge is no
longer capable of being handled by solo practitioners.
While I decry the increase in lack of personal contact
between doctor and patient, it is increasingly important
to explore the level of the doctors’ training and

In today’s world, it is easier than ever to ascertain the

background of almost every person that holds a license,
even without being a member of the CIA or FBI. It’s
called the Internet. Stored with a certain amount of
Information (I know this book will help), a little
Investigation, a personal Inspection, and an
Interview, the level of comfort can be Increased
to make an Intelligent Independent decision about your
treatment. Here are a few questions to help you along the way.
170 Aesthetic Science Institute: The War Against Aging

Questions to ask…
What is the extent of your training and experience in your
Are you board-certified in an accredited specialty?
Can I see some of your results?
Are you published?
Is your facility accredited to handle the procedure and any
unforeseen problems, should they arise?
How to Win in the Youth Game 171

We’ve come a long way…

Your New Beginning

How, when and where do I start?
You bought this book!

The mirror is a good place, a real evaluation of what you don’t like and
a realistic expectation of what you can expect. Separate fact from
Don’t be blinded by the metaphors and come-ons from so many
directions. Recognize that whatever path you take, sometimes you can’t
do it alone. Do your homework and be careful in your choice of
traveling assistants and aides, whether it be exercise or your diet.

Remember, you have a great

role to play in creating your
own “Forever Therapy.”
We’re here to help. Enjoy, live
long and live well!
Aesthetic Science Institute asimd.com
172 Aesthetic Science Institute: The War Against Aging

Suggested Reading
Cosmetic Surgery for Dummies by R. Merrell Olesen, Olesen Marie. B.

Facercise: The Dynamic Muscle Toning Program for Renewed Vitality

and a More Youthful Appearance by Carole Maggio

Change Your Looks, Change Your Life: Quick Fixes and Cosmetic
Surgery Solutions for Looking Younger, Feeling Healthier, and Living
Better by Michelle Copeland

Secrets of a Beverly Hills Cosmetic Surgeon: The Expert's Guide to

Safe, Successfully Surgery by Robert Kotler

The Smart Woman's Guide to Plastic Surgery: Essential Information

from a Female Plastic Surgeon by Jean M. Loftus

Plastic Surgery without the Surgery: The Miracle of Makeup

Techniques by Eve Pearl

The Essential Cosmetic Surgery Companion: Don't Consult a Cosmetic

Surgeon Without This Book! by Robert Kotler

The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple,

Youthful Skin by Nicholas Perricone

Understanding Cosmetic Laser Surgery by Robert Langdon

You Don't Need Plastic Surgery: The Doctor's Guide to Youthful Looks
with No Surgery, No Pain, No Downtime by Everett M. Lautin, Suzanne
M. Levine, Kathryn Lance

Age-Less: The Definitive Guide to Botox, Collagen, Lasers, Peels, and

Other Solutions for Flawless Skin by Frederick S. Brandt, Fredric
Brandt, Patricia Reynoso

Your Best Face: Looking Your Best without Plastic Surgery by Brandith
Irwin, Mark McPherson

Safe Cosmetic Surgery by Dai Davies, Judy Sadgrove

Your Complete Guide to Facial Cosmetic Surgery by Jon Mendelsohn,

William Truswell, Kriston Kent, Kriston J. Kent
How to Win in the Youth Game 173

Complete Idiot's Guide to Cosmetic Surgery by George Semel, Jeff St.

John, Jeff St. John

The Unofficial Guide to Cosmetic Surgery by E. Bingo Wyer,

Macmillan Publishing

Permanent Makeup and Reconstructive Tattooing by Eleonora Habnit

Chapter 15
This book is updated by visiting the web pages of ASI (asimd.com).

Other helpful web sites

Gyneflex.com A web site that gives an animation showing the use of
the gyneflex device.

Medlineplus.gov A web site paid for by the U.S. government and the
National Institutes of Health, providing “trusted health information for

plasticsurgery.org/public_education American Society of Plastic


iom.edu The Institute of Medicine, especially the web page giving

Dietary Reference Intakes (suggested minimum daily requirements) of
various nutrients. http://iom.edu/Object.File/Master/21/372/0.pdf

bluepeel.sandycarter.com/threadlift_looplift.html Thread lift

information; also at: yestheyrefake.net/feather_lift.htm

store.nutecint.com Feather Lift information

Look at asimd.com for other links to useful information.

Special thanks to a special guy

To Stephan McCrea – a brilliant friend
whose encouragement, intellect and
has turned this work into a reality!
How to Win in the Youth Game 175

Old is dead.
Young is what you can be.

Dead is for a long, long time.

Young is now.
And we can help you regain your youth.
Kurt Wagner
Spoken at Gauchos Restaurant
March 11, 2005

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