Your Face and Your Food

Warning: this post contains opinions and a lot of personal anecdotal information.  It is not meant to promote anything. 

There are diets everywhere. Obesity is at epidemic levels. I get surprised when my patients actually aren't diabetic. It's sad and really difficult to watch.

I've been obese for much of my adult life. Several years ago, at my wonderful wife's urging, I did a fasting blood glucose level. It was too high. I didn't want to suffer what has plagued my patients and family members, so I took my knowledge of human physiology and tried to simplify those principles to see if I could improve things. I identified several problems.

1) most diets look at weight loss as a gauge of success. The problem here is that diabetes can affect those who aren't obese, and a normal BMI doesn't mean you're healthy
2) most people have no immediate feedback as to whether a food is good or bad for you. How many of us have stepped on a scale and been unhappy, only to think "I shouldn't have had that ____ last night!" That's not how the human body works.
3) most doctors get abysmal training in medical school regarding nutrition. What training they do get amounts to someone standing up and either reciting food pyramid nonsense or telling you that carrots contain vitamin A. That's not helpful.

I took the advice of William Davis, a cardiologist, regarding real time feedback. In my eyes, insulin secretion was the root cause of my problems. Over the years, my bombardment of my pancreas with bread, rice, and pasta in addition to sweets caused tremendous amounts of insulin secretion in an effort to drive that resultant sugar/starch into my tissues for storage for the marathon that will never be run. With time, my tissues became insulin resistant and the sugars remain in my blood. Boom, I'm diabetic. Additionally, insulin is a growth factor. In an almost offensively oversimplistic thought, I considered anything that caused excess insulin secretion as a direct cause of what was keeping me fat.

  

What did I do? I would check my blood sugar before a meal, then eat, and then check 1 hour later. If my blood sugar went up by 15 or more, I analyzed my meal and eliminated the cause. Slowly, over time, I whittled away at the problem. With my wife's help, I was basically eating a paleo diet. I began reading blogs like this one and this one and this one and this one.

I hesitate to call it a diet, however. I prefer to call it "eating". It's not a diet anymore. 60 pounds lighter, amazing lipid profile, lower BP, no more sleep apnea, and a really low A1C level. 

What did I cut out?

• Grains. All if them. Like bread (and it was easy). While the focus is on gluten (Latin for poison), I don't think there is a single health benefit to grains. Even "heart healthy" nonsense like oatmeal and whole grains are empty and don't fulfill a biological need.
• Rice (as a descendant of Persian parents, this is a feat)
• Corn
• Legumes
• Dairy
• Artificial sugars (with time, as I became insulin sensitive, I added back unprocessed forms of sugar, but still minimally)

What do/did I eat?

• Meat/poultry (ideally from pastured animals)
• Seafood
• Eggs (until I realized I was allergic)
• Veggies (not enough of them)
• Fruits
• Nuts and seeds
• Healthy fats/oils (coconut, avocado, olive oil are healthy. I don't eat canola/processed vegetable oil etc). Much to many people's surprise, I eat animal fats from pastured animals as well (like bacon fat)

So how does this link up with your facial appearance? First, losing weight becomes most noticeable in the face. It's the best way to get rid of jowls, folds and shadows caused by excess fat. Gluten elimination (even if you're not celiac/sensitive) makes your skin look better. I've personally seen how eliminating gluten can reverse skin conditions like dishydrotic eczema. I've experienced fewer breakouts since removing gluten.

Admittedly, this post was more about my journey than it was to advise you about how to try to lose weight. The basic premise is that if you're unhealthy and are suffering from what you're putting in your body, it doesn't make a lot of sense to spend money to try surgery or invasive procedures. Taking care of your body will result in improved face and skin health, plain and simple.

Farm to MedSpa Sustainability

Giving back. Tis the season, right?

The Wrinkle Whisperer cares about everyone, whether or not they come in for a whispering session. It's why I serve Organic Botox. It's for the people.

It's also why I give back. Simply stripping the earth of Restylane and Juvederm? I think not.

This holiday season, I'm taking facial rejuvenation a step further. For every vial of filler purchased through January 31, a matching vial will be planted in a sustainable fashion. In years we will have the ability to harvest that filler and continue the process.

I'd like to see YOUR medspa do that.

It's All About Cheek Fat

As a patient, if you went to your doctor for a gall bladder problem or chest pain, and your doctor simply told you "This is the treatment that will help you" without explaining what the CAUSE of your problem was, you'd be upset. That's paternalistic 70's era medicine.

As I've said before, I treat my aesthetic patients like I treat my general ENT patients: I approach a cosmetic concern seriously and try to educate my patients about WHY something is happening. Many of the blogs out there focus on the before/after pictures that are depicted after a specific treatment is rendered and completely ignore the analysis of the underlying cause.

One of the most common cosmetic treatments I perform is the application of facial fillers. Restylane, Juvederm, Radiesse and other variations are common choices in my office. 

The most common locations for use of facial fillers are:

• the nasolabial folds around the mouth
• the marionette lines (lines from the corner of the mouth downward)
• cheekbone augmentation

Is there a common cause for the need to treat these 3 facial areas? I think so. I think it's all about the midface fat (cheek fat). In youth, that cheek fat pad is sitting near the lower portion of the orbital bone under the eye and near the cheek bone. As you age, that fat pad descends. What happens as a result?

• Hollowing around the eye (you see eye fat, then a groove, then the descended cheek fat)
• a line between the cheek and the upper lip (the nasolabial fold)
• the marionette line

This is why "high cheekbones" are considered to be youthful. Generally speaking, the facial skeleton itself doesn't change much. What has changed is that the soft tissue over the bone has descended, so some of the volume is lost and the cheekbone doesn't look as high.

There are generally 2 treatment options to revitalize the midface: a surgical midface lift where the fat pad is resuspended OR adding volume to the areas where volume has been lost to camoflauge the hollowing that has happened. Which treatment you decide on has many factors to consider: cost, downtime, risk and longevity.

Overdoing It

I've written before that I consider myself to be a conservative cosmetic surgeon. My ultimate goal when it comes to approaching a cosmetic issue is to achieve a desired result without giving the outward appearance that something has been done. It's not hard to completely freeze a face -- just use a lot of Botox. The nuance and difficulty of cosmetic rejuvenation is doing it in a subtle fashion.

I practice in Portland, Oregon.  By nature, our population isn't going to be like what you see in Beverly Hills or Miami. So I think my approach works pretty well.

So what happens when a patient comes in and says ""Well Dr. _____ put in 3,400 units of Botox every 3 months and that's what I want you to do."? I usually respond by saying:

• No responsible doctor with any amount of formal training would do such a thing
• I suggest you go back to that doctor.

If you are coming to see me, it's not because I serve organic free-range Botox. It's not because my chairs are more comfortable or I have hip Euro-disco music in my waiting room. You're coming to see me for my expertise. I will always err on the more conservative treatment because I can always do more later. If I overdo it, I risk losing you as a patient and, more importantly, I risk tarnishing my reputation as someone who knows that they're doing. 

Differences in Skin Tones

Since its inception, this blog has been focused on trying to point out the science behind methods of facial cosmetic rejuvenation techniques. That being said, I've fallen into the trap of assuming that the information I've tried to provide can actually apply to anyone who is reading. While treatments like Botox, Dysport, and the various facial fillers can really be applied to any adult, the treatment of the skin itself with the intent of skin tightening or scar (especially acne) treatment varies depending on the color of your skin.

Skin classification is often done using the Fitzpatrick classification:

So what procedures am I most concerned about? Basically, anything that violates the epidermis (outer covering of the skin) and gets into the dermis beneath. This includes procedures like microdermabrasion, chemical peels, ablative lasers (like CO2 resurfacing), non-ablative lasers (like those used for laser hair removal) and any procedure that needs a formal skin incision.

I am most concerned with skin types IV through VI. In those patients who desire a procedure, I always perform a test spot to see how they're going to respond. For some desires, like laser hair removal, there are options.  Our office, for instance, has a YAG laser that can help with hair removal without touching the normal surrounding skin.

What is the concern? I worry about post-inflammatory hyperpigmentation (PIH), which can look like this:

Once it develops, it can take a long time to resolve. Often, the affected skin never returns to its original character. There are numerous available topical treatments that can help, but it is far better just to avoid the problem in the first place.

For the patient with darker skin who wishes to have a more youthful appearance, I won't perform any peels or fractional CO2 treatments because of the potential for PIH. Those patients are typically surgical candidates, which can affect the tightening that they desire. Unfortunately, however, many don't want to resort to surgery. I also don't offer less invasive laser treatments that claim to cause skin tightening without damaging the skin. In my opinion, these treatments just don't work.