Women's health and cosmetic care

By
From the August 2010 edition

We’ve all heard the facts. Coronary artery disease is the No. 1 cause of death in American women. About one in five women develop osteoporosis. Hormone changes in menopause can cause hot flashes, sleeplessness and depression.

Thanks to thorough coverage in the media and educational efforts by those in the medical field, American women know about the big risks. But there are other issues that women may come to face as the years go by. These issues may not be the topic of quite as much discussion, but facing them and trying to be prepared can increase quality of life.

Gynecological issues

It’s a mystery why it’s easier to talk about colorectal cancer than it is to discuss gynecological issues. But for some reason, issues pertaining to women’s reproductive health are sometimes not given the attention they deserve.

Dr. Terry Grogg of Southwestern Obstetrics and Gynecology says uterovaginal prolapse is a concern many women may face. “It is a very common problem where the uterus, vagina or both may start to drop, or prolapse, through the vagina,” he says. Because they must stretch to accommodate childbirth, a woman’s reproductive organs are very elastic. As women age, these structures may weaken, allowing the uterus to drop down into the vagina, and in some cases, even protrude. In other cases, the uterus is not involved, but the walls of the vagina themselves may shift from their original positions.

“There are a number of ways to fix these depending on the person and specific defect,” Grogg adds. He uses robotics for a number of procedures in his practice, and among those is sacrocolpopexy, in which a mesh sling is used to re-suspend the vagina.

“Traditionally, this was done through an abdominal incision,” Grogg says. “But the robot has allowed us to perform this laparoscopically.”

The small robot used to perform these procedures also can be used in some hysterectomies, and may even be utilized in the treatment of some gynecological cancers. The robot is a tiny device that represents huge strides in medical technology.

In procedures done with robotics, rather than traditional abdominal surgical techniques, patients may experience significantly less blood loss, shorter hospital stays and quicker recoveries.

“Depending on the type of surgery, most (procedures done) with the robot only require an overnight stay as opposed to several days in the hospital,” Grogg says.

Face time

Our physical health is the greatest treasure we have, and we are concerned when it is compromised. But on a day-to-day basis, most of us spend a lot more time thinking about our outsides than our insides.

Women spend considerable amounts of time and money on their faces. Humans are programmed to notice the face and to read the many cues it reveals about age, health and personal habits. It gives the world subconscious information about whether we sleep enough, what we eat, whether we exercise and whether our lives are easygoing or complicated.

Eventually, our skin tells our secrets.

Dr. Carol Clinton of Timeless Skin Solutions says as a woman enters her 50s, more evidence of our past indiscretions will begin to show. “By this age, we all have noticed lines and sun damage and possibly veins, unevenness of skin tone and maybe even recurrent acne,” she says. “Neck skin and lower face skin are sagging and the quality of the skin feels thinner.”

Many of the signs of aging come from past exposure to the sun. Dr. Bivik Shah of the Columbus Institute of Plastic Surgery says almost everyone has some sun damage, and most people will notice the results beginning to appear between the ages of 45 and 55.

“A lot of people go through their 20s and 30s and even into their 40s without seeing the downside, so they keep tanning,” he says. “Then they’ll start to see age spots on their faces, then lines, and they’ll begin to notice that their skin isn’t as supple or soft.”

The first rule is not to do additional harm, Shah says.

He recommends sun block, and sitting in the shade when on the beach. Clinton recommends wearing a hat when spending time outdoors. Keeping the sun from causing the damage will prevent the need for remedial measures later and protect the skin from developing deadly cancer cells.

A daily skin care regimen is something women should follow no matter what their age. Skin care products provided by physicians always will be more effective, because over-the-counter products just aren’t as strong, doctors say. A skin care regimen should include three components: a cleanser, a toner and an exfoliant. Don’t skip that last step, Shah says, because exfoliation is essential.

“Men often have much better skin because they shave every day,” he says. “They are scraping away that top layer of skin and exfoliating.”

Don’t forget the daily sunscreen, even when you won’t be spending much time outside. “Sun protection is a must for all ages, and an SPF 15 or above is recommended,” Clinton says. Don’t limit the application to your hands, either. The neck and cleavage also are delicate and need protection.

“If you want to know a woman’s age, look at her hands,” Shah says. “Women wear makeup and have lots of treatments on their faces, but you can really see age in the hands.”

One of the most prevalent signs of sun damage is discoloration, freckling or age spots. There are a number of remedies that can undo discoloration and lines that show up after years of sun exposure.

“Retin A and hydroquinone along with peptides, antioxidants and growth factors help with skin texture and color,” Clinton says.

Shah is another proponent of Retin A. He says Retin A is the only substance that is proven consistently and scientifically to reverse signs of aging and sun damage. The solution is applied at night, and while the patient sleeps, the treatment builds collagen, reduces the appearance of age spots, gets rid of fine lines and prevents new lines from forming. For the first month or so, there may be some pinkness and dryness, but then skin adapts and there should be no further reactions, Shah says.

All of these fixes can be done right in the home, but for more severe damage, women may opt for a quick cure that provides greater change much more quickly.

Just like daily exfoliation, chemical peels and lasers remove damaged or dead skin and allow new skin to shine through. But physician-administered peels and laser treatments take off the top layer of skin (the dermis) as well as the second layer (the epidermis). “You are wiping the slate clean,” Shah says.

Such treatments remove fine lines, freckles and even a lot of the deeper lines. The treatments help improve the tone and texture of the skin, as well as improve tightness.

Treatments can undo bad choices we’ve made (remember trying to get burned so you’d have a good “base tan”?), in addition to the things we cannot help. “Many lasers, lights and injectables can reverse some of the damage we have done as well as what is normal aging,” Clinton says.

The Intense Pulsed Light laser, or IPL, is used to reverse brown spots, and it also can help lessen the appearance of rosacea. Lasers with specialized frequencies can erase veins, and the Titan laser uses infrared technology to tighten loose skin and rebuild collagen.

Photodynamic therapy can save not only our appearance, but also perhaps our lives. PDT uses a blue light and a photosensitive topical substance to treat acne on the face, neck, back and décolleté. It also can be used to treat precancerous lesions on the face or body, Clinton says. The light-sensitive drug is activated by the blue light, and an oxygen molecule in the topical solution destroys nearby cells, which prevents those suspicious-looking cells from becoming cancerous in the future.

Lasers vary in their intensity and in their after-effects. With some of the milder lasers, patients can return to work the same day. With others, a week or more of recovery may be necessary before the skin loses its redness.

For deeper lines or areas that have lost their plumpness due to age, Clinton recommends facial fillers and similar products. “Botox and Dysport can help with lines from the forehead through the neck, and fillers like Radiesse, Restylane and Juvederm can plump areas up that are sagging,” she says.

These bioidentical facial fillers, which mimic substances produced by the body, can be used to replace what time has depleted. Using a very thin needle, the doctor injects filler into the desired area—often the lines that run from the nose to the corners of the mouth, lines between the eyebrows or the fine lines that radiate from the mouth and cause lipstick to feather. Fillers also can be used in the mid-face area to plump the apples of the cheeks. The effects of the fillers last between nine and 18 months.

Skin changes

Changes vary from person to person, but Shah says that typically as women enter their 50s, they notice a few systemic changes. One change is that when women take off that five or 10 pounds of holiday weight, their skin doesn’t snap back to normal like it used to.

“The skin is losing elasticity,” he says. “A molecule called elastin helps the skin be tight, and as we age, the body makes less and less of it.” Shah says there is no known medical remedy to replace or replicate elastin, but science is working on solutions.

Another thing that happens as the decades creep by is that the metabolism slows down markedly. “People find that they are eating less, but still gaining weight,” Shah says.

Resting metabolism is the number of calories it takes the body to get through the day with no activity at all except the basic body functions. When metabolism slows down, the body burns fewer calories. Add to this the fact that we lose muscle as we age, and we have a very unpleasant math equation. Muscle burns more calories than fat, and so we need to exercise regularly using weight-bearing techniques to retain and build muscle.

Strength conditioning will help tone the muscles and burn calories, both of which are important if we expect to visit the plastic surgeon for a little nip and tuck to get rid of that newly discovered nonelastic skin.

Liposuction can get rid of small deposits of fat in delicate areas like the face, but the problem spots most women complain of are the belly and hips, Shah says. Liposuction is not a quick fix, though.“This is not a method to lose weight,” Shah says.

“This is for getting rid of those fat deposits you can’t remove with diet and exercise, and to shape those areas.”

The doctor uses a wand inserted into the fat layer beneath the skin to extrude the fat through a thin vacuum pipe. The remaining fat is shaped and contoured, and recovery is complete within a few days.

Breasts

Many women in their 50s are electing to make surgical improvements to their bodies. It’s not that time has taken such a great toll—sometimes it’s just that they’ve always wanted to make certain changes, and now they have enough financial freedom to spend some money on themselves.

Some women want to increase the size of their breasts, and augmentation is a way to do that. In some cases, an implant is inserted into the breast tissue and inflated with saline solution. Other women may opt for a silicone implant, which comes preformed and has a firm consistency, but feels natural once it is in place. Augmentation increases fullness and gives the patient great cleavage, but it doesn’t reposition the nipple, which may have headed somewhat south of its original position over the years.

For women who want to reduce sagging of the breasts, a breast lift is the procedure of choice. Sagging occurs when women have more skin than breast tissue.

“We cut out excess skin so the skin fits the amount of breast tissue you have,” Shah says. There are three ways the procedure may be done, depending on how much skin needs to be removed. In the first case, an incision is made around the areola and excess skin is removed. This technique results in virtually no visible scar.

For more extreme cases, the surgeon may cut around the areola and down to the crease of the breast, in a lollipop shape. The third technique involves cutting around the areola, down to the crease and along the crease, in an anchor shape.

Shah says it often pays to do the surgery early, so the first technique is all that is ever needed. In the case of the augmentation and the lift, patients can return to a light duty job in about a week and get back to all normal activities in about a month.

Smiles

As the years go by, our smiles can show our age. Dr. Scott Schumann of Grove City Dental says many people neglect their teeth and deny the fact that teeth age just like the rest of our body parts.

Old fillings and crowns start to crack and discolor, marring the smile, Schumann says. As we age and ingest more teeth-staining food and drinks, the teeth will darken. Eventually, old crowns won’t match the color of the darkening tooth enamel.

“We can fix this by replacing the old failed restorations with modern materials that are a lot stronger and more natural looking, and we can whiten the teeth before we make the new restorations,” Schumann says.

According to the American Dental Association, fillings and crowns only last eight to 10 years, so those need to be replaced to maintain the integrity of the teeth. “No one thinks that parts on a car will last forever, but they seem to think that they will in your mouth,” he says.

The most important dental rules to follow are these: brush at least twice a day for at least two minutes each time, floss before bedtime, visit the dentist twice annually and follow the professionals’ instructions, Schumann says.

He says as we age, we can expect gum recession, as well as damage from tooth grinding. Both expose the teeth to added danger. “The exposed root surface is much softer than the other tooth enamel and thus more prone to root cavities,” he says. The remedy for this unavoidable part of aging is fluoride treatments coupled with fillings or crowns where needed.

Schumann says patients shouldn’t expect dental insurance to pay for much. “Insurance pays the same maximums as in the 1960s,” he says. “We see countless sad cases of people who only do what their insurance pays or who don’t go to the dentist because they don’t have dental insurance.”

He likens dental maintenance to car maintenance. “You don’t have insurance to buy gas for your car or change the oil, but you know what happens if you don’t,” he says.

Schumann says with sedation dentistry, the patient can sleep through the procedure and 10 to 15 years of neglect can be remedied in one or two office visits. The patient can finance the work over a period of up to 84 months.

“We see a lot of women who sacrificed for their families,” Schumann says. “We wish they would have kept up with the basics during that time, but we can always help them get the smile of their dreams today.”

Kristin Campbell is a freelance writer in Columbus.