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Melanie Cole (Host):  Welcome to Expert Insights with the Carle Foundation Hospital. I’m Melanie Cole and today, we’re discussing plastic surgery, cosmetic medicine for aging. Joining me is Jennifer Lieb. She’s a Plastic Surgery Nurse Practitioner at the Carle Foundation Hospital. Jennifer, I’m so glad to have you with us today. Give us a little brief discussion on the science of aging and how we’re tailoring care to these changes, some of which we like and some of which we don’t.

Jennifer Lieb, NP (Guest):  Great. Thank you so much for having me. So, it’s important of course, to start with the basics on cosmetic medicine and kind of why we do what we do. So, the pathophysiology of aging face is an important thing to run through. Something that we talk about a lot in conferences is the triangle of youth. So, what that is essentially is a triangle that has the width at the top and it tapers to the bottom and that’s something that we apply to the face. So, that’s typical for like the 20 year old that has high cheekbones, full cheeks and a nice defined jawline. And that’s kind of the goal as far as what our culture defines as beautiful in a face. And something that happens with aging is that triangle starts to invert. So, then you have the fullness at the base of the face and it kind of tapers to the top.

So, what we see as far as what happens in that process is the skin is starting to kind of sag in the face, we are starting to get resorption of bone, we have separation and resorption of the fat in the face. The skin is starting to age. It’s starting to not have as much collagen and elastin and the muscles in the face start to get kind of hyper functional. So it contributes to wrinkles. So, everyone ages differently. And it can be accelerated by different factors such as smoking, UV exposure, weightloss, stress, illness, things like that.

And also another thing that’s important to keep in mind is the hormonal aspects. Women in the 30s, like in the 30s age range women tend to do better with aging than men do. And then once we start to hit our 40s, then it kind of inverts and men start to do better than women. And why is that? Well typically, it's a hormone response in women. We start to drop off out hormone levels. So, there’s a lot that goes into aging facial structure and things like that. So, that’s something to keep in mind that all of the levels age in different ways.

Host:  Thank you for that comprehensive answer Jennifer. So, run through it for us what options we have for cosmetic medicine currently and tell other providers really what you’re doing at the Carle Foundation Hospital.

Jennifer:  Sure so, it’s a really exciting time as far as cosmetic medicine goes. There’s a lot of things that are changing. Things change frequently in our field. As far as kind of like we discussed, there are all kinds of different levels of aging in the face. So, you have your skin, your bone, your fat pads and the muscles. So, those are things that we target in different ways. So, I would say things that we’re using right now currently would be like neuromodulators. The most common one that people know is Botox. Also fillers like hyaluronic acids, lasers and skin care are things that we’re offering right now in Carle Plastic Surgery that are kind of combatting the science of aging.

Host:  Well then let’s talk about some of those. Let’s talk about Botox first for relaxation of wrinkles. Tell us what neurotoxins are. What they are doing really. How long they last. Give us a rundown on it.

Jennifer:  Great. Yeah so, neuromodulators and Botox I reference Botox because it’s the most widely known. It’s one of those medications that’s kind of like Viagra. Everybody has heard of it. So, essentially, they came about, the cosmetic indication for Botox just kind of randomly with a trial back in the 70s for strabismus and blepharospasm in the eye. It was an incidental finding that patients were having improvement in their wrinkles around their eyes. So, that was something that the company had picked up on and they started to seek FDA approval for cosmetic indications which the FDA approval for Botox was back in 2002 for the glabellar rhytids so the central forehead.

So, the way that these are used, they’re injected into the belly of the muscle. It essentially blocks the release of acetylcholine causing a temporary chemical denervation of the muscle. So, everyone’s a little bit different as far as how long it lasts and the effects of how long it lasts and how good of a result you have. It’s based on the muscle mass of the person, if they work out a lot. There is just a lot of variation as far as that goes. So, some people, men specifically, I would say burn through Botox a little bit quicker. Athletes burn through it quicker. It can last two to four months depending on the patient.

So, it’s a temporary thing so that’s something obviously to keep in mind. It’s something that you would continue doing. With that being said, if you do it one time, and you have four months of your muscles not animating in your face, then you’ve stopped that aging with those – developing those deeper lines in the face for that period of time. So, it’s not time wasted. And that’s what I tell patients to keep in mind if they can’t afford it or they just want to try it and they don’t know that they want to do it again. So, that’s just something for patients and providers to keep in mind. It’s a really great treatment for relaxation of muscles preventing those lines around the animation in the muscles of the face, preventing those lines from getting deep and from being there all of the time as opposed to just there with the animation or with smiling or lifting your forehead or things like that.

Host:  That’s so interesting. We’ve all heard so much about Botox but really didn’t know what it does or what it’s intended to do. Now tell us a little bit about fillers for voluminization and fine lines and how are these given, and you could also go into lasers for skin resurfacing. Tell us a little bit about some of these other options.

Jennifer:  Sure. So, fillers, I would say have really boomed especially in the past ten years or so. We’re starting to get more fillers on the market. Right now there are about 14 different hyaluronic acid fillers. They all have different concentrations, different G-primes or different elasticity. So they are used in different areas. So, some of them mimic bone. Some mimic fat. Some mimic the skin. So, it’s important to have the right product in the right area to mimic what is needed. They are naturally occurring. Hyaluronic acid is naturally occurring in the body and the dermal matrix, it provides structural support in the skin. But a lot of other providers also know, I mean it’s just about everywhere in the body, in the bones, in the cartilage and the eyes and things like that.

Depending on the filler that’s injected; it can last maybe six months. It could last up to two years. and the nice thing with filler is there is an immediate result with fillers. So, the patient obviously can see exactly what was done with the treatment. And then lasers is something that I would say a lot of people get kind of confused with just because it’s very high tech. It can be kind of confusing to explain exactly what a laser does. Essentially a laser, depending on what the laser is, it targets different areas so right now, at Carle, we have six different lasers available for cosmetic indications.

So, we have hair removal, tattoo removal, removal of colored lesions of the skin, so pigmented or vascular lesions and then we have nonablative and ablative resurfacing lasers. So, depending on what you wanted, these lasers can kind of minimize scaring. They can improve skin texture and laxity and rhytids. So, these are all really great options for patients with combating aging. Essentially, a lot of the way that the lasers will work is they cause some injury, so you trigger a wound healing response, so it increase collagen production in the area.

When we are starting in our 20s, we start to notice that collagen starts to deplete in the skin so you can imagine in your 40s and 50s, you might not have much collagen left. So, stimulating collagen really helps the appearance of the skin.

Host:  So, now tell us a little bit about skincare products because other providers want to be able to recommend things to their patients. But we’re looking to use them ourselves. What skincare products for hyperpigmentation do you advise, and I know that we’re talking about aging, but you can even touch on acne a little bit if you would and the products that you like us to look to and why.

Jennifer:  Absolutely. Skincare is a really easy place for a lot of patients to start as far as cosmetics and aging and things like that go because everybody is using a product on their face. But I would say most people don’t really know what products they should be using. So, I would say if you do nothing else, you have to have a good sunscreen regardless of what you’re doing, regardless of how your skin looks. It’s the number one preventative tool as far as skincare goes that we can use and something to keep in mind with sunscreen is you have to reapply it for it to be effective. So, sometimes we’ll get patients in office and they’ll say well yeah, I put my sunscreen on this morning and it’s like well okay, have you reapplied it at all? And 95% of the time, they haven’t. So, after two hours, you don’t have any protection with your sunscreen anymore. So, that’s a really important tool to tell patients because they don’t know. And they don’t also realize the exposure they get from the sun just while they’re driving their cars.

In America, the left side of our bodies is where we see the most skin cancers in patients because of driving. Patients don’t realize how much sun exposure they’re getting. So, sunscreen is incredibly important. As far as acne and skincare like that goes, some people they just want to dry their skin and that’s important to a degree, but you can’t take all of the moisture out of the skin because you get to a point where you’re drying your skin out. You’re putting – you’re doing salicylic acid face wash which is great. We recommend that but then they are also throwing on benzoyl peroxide and things like this and they get their skin so dry that their skin is like wow, we’re so dry, we need to produce moisture. So, they just start to produce more sebum so it’s kind of counterintuitive. You have to find that balance with patients. We have two skincare lines here. They both have products that help with acne. We have an esthetician here at Carle that can recommend go through a skin analysis and recommend treatments for patients. Same thing with pigmentation issues. You are looking at your skin brighteners like hydroquinone, retinol is something that I recommend almost every patient do at night because it’s great for acne, it’s great for the aging, the sun spots. It increases your cell turnover. It helps with that sebum or that oil production and also helps regulate your melanin or the discoloration that you are seeing in your skin.

So, a lot of people like I said, get very confused about where to start on this. There are so many products our there. At Carle, like I said, we’ve got the esthetician that can go through products that we have here or if you want products from somewhere else, that’s fine too. We have two product lines here. They are both cruelty free. They both don’t have any added oils or things like that. They are fragrance free. They are really great for the skin and staff here at Carle gets a 20% discount and the staff also gets a discount for the other treatments that we talked about as well, the neuromodulators, Botox, filler, laser. We have really great pricing structures for staff for all of these different aging things that we do here at Plastic Surgery. So, it’s definitely something that we want staff to know about so they can come here and take advantage of those discounts.

Host:  Wow, that’s excellent and I’m so glad you pointed that out for staff members at the Carle Foundation Hospital. Wrap it up for us. What’s your best advice regarding skin aging, and maintenance. You’ve given us so much good advice. Summarize it a little bit here for us briefly and really tell us what you want us to know about plastic surgery at the Carle Foundation Hospital.

Jennifer:  Absolutely. Cosmetic medicine is something I’m very passionate about. It’s ever changing. There’s always new things out on the market. It’s something that we’re constantly researching. I would say if providers take nothing else away from this, it’s to use sunscreen. It’s such a big part of aging, photoaging of the skin. It really affects how the skin looks with time. So, sunscreen is incredibly important. And it’s a multilayer approach as far as cosmetic medicine goes. It’s not just one thing. You can’t just do Botox your entire life and then you are going to look great when you are 70 or 80. It’s not just that, it’s thinking about everything as the whole picture. So, thinking about the layers like what we talked about before with the skin and the bone and the fat and the muscles and the hormone and all of those things. They all intertwine. So, there’s no simple fix. It’s a very gradual process. It’s something that you just – it doesn’t happen overnight so a lot of times patients will come in and say I just look tired or my kid says that I look angry all the time. And they can’t quite pinpoint what that is.

It's very helpful to have a cosmetic provider that can help you look at you individually since everyone ages in such a different way and kind of target what it is that the problem is or what you’re looking to improve. So, we’re really excited to have cosmetic medicine here at Carle. Really excited to have staff that can take advantage of the discounts that we’re providing. They are very, very good discounts. So, we’re looking forward to seeing staff and just taking care of yourself, drinking water, sunscreen, having a good diet. I mean these are things that I think a lot of people are really starting to understand and take advantage of more so in recent years, people wanting to have a holistic approach to their body and aging well. So, anyone who wants to come by and see us, we’re obviously happy to take a look and that’s it.

Host:  Thank you so much. What an absolutely great segment. Really good information Jennifer. Thank you again for joining us. That concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at www.carleconnect.com for more information and to get connected with one of our providers. We hope the information gained will be applicable to your work and life.  If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.