A new device promises fat loss without surgery, diets or exercise. FOF investigates.

When we first heard about Coolsculpting at the FOF offices, there was one resounding response from our staff: “Sounds too good to be true.”

A new device promises fat loss without surgery, diets or exercise. FOF investigates.

When we first heard about Coolsculpting at the FOF offices, there was one resounding response from our staff: “Sounds too good to be true.”

• Before you start recommending products, can you explain why there is so much confusion around this issue? How can so many different products, at such different prices, all claim to work?
  
  
  
  • It's very hard to know what "really works.” To understand why, it's helpful to understand what a "cosmeceutical" really is. Riding the gray area between cosmetics, which only claim to alter the appearance of skin, (think bronzer or eyeshadow), and pharmaceuticals, which alter the body's biology (think Botox), cosmeceuticals try to have it both ways. Companies that make these products want the public to believe they actually do change skin scientifically, but they don’t want to spend hundreds of millions of dollars and many years going through FDA drug trials to prove it.
  
  
  • The result: most anti-aging creams, both in the drugstore and in the department store, avoid the FDA entirely, which means they can make lots of claims without the need to prove anything. They just have to pass muster with the Federal Trade Commission, which requires that they maintain a level of safety. (Even this is difficult to rely on, since most safety issues come up only after the product has been out on the market and caused enough trouble to get attention.)
  
  
  
  


• Wait, so are you saying that none of these products work?
  
  
  
  • It's possible some anti-aging products really do work, but there is currently no independent group that is testing and validating these products’ claims. A company may advertise that it's put a product through "clinical trials," but that only means it has been tested on actual humans--as opposed to cells in a dish. Clinical research is vital, but when it's presented by the company that's selling the product, you need to take it with a grain of salt. Often, results are reported such as a reduction in the "appearance" of fine lines or dark spots. That does not mean that the lines and dark spots have been reduced, only that it looks better.
  
  
  
  


• What ingredients have been tested so that we KNOW they have benefits? Are there inexpensive products that contain these ingredients?
  
  
  
  • The most proven anti-aging ingredient on the market is the only one that has gone through the formal FDA-approval process. This is tretinoin, a vitamin-A derivative known as a retinoid. The most recognized brand name is Retin-A. Tretinoin is the gold standard for anti-wrinkle treatments. It's also proven to reverse other signs of aging, as well as help to reduce the risk of skin cancer by keeping skin cells growing in a healthy, ordered way. Because it is irritating to skin if used improperly, hard to get because it requires a prescription, and expensive, we look for other anti-aging options.
  
  
  
  


• So are there other ingredients that have been shown to work?
  
  
  
  • Several ingredients on the market are known to have real results in basic science research--the science behind them looks good, even if they haven't been formally tested by the FDA. These include over-the-counter retinoids (retinol, retinyl palmitate, and retinaldehyde), antioxidants such as soy, green tea, feverfew, licorice, mushrooms, vitamin C, coffeeberry, and other formulations proprietary to different companies. Finally, glycolic and salicylic acid and their relatives are also useful ingredients in many anti-aging formulations.
  
  
  
  


• What affordable products do you recommend to your 50+ patients and why?
  
  
  
  • For drugstore brands, I tend to stick with some of the most tried-and-true companies and products that I do believe have ingredients with real evidence behind them. For retinol products, most will work, but my favorites are Neutrogena's Ageless Intensives Retinol SA line ($18.99-$20.99) , which contains various formulations for different skin types (from serum to night cream), and Roc's Retinol Correxion line ($19.99-$22.99). For patients with age spots and general skin dullness, I recommend Aveeno Positively Radiant Triple Boosting Serum and the SPF 30 day moisturizer ($21), to take advantage of its antioxidant and spot-fading soy. For sensitive, rosacea-prone skin I recommend Aveeno's Ultra-Calming cleanser and moisturizer($7.49, $16.79) which contains anti-inflammatory and antioxidant feverfew.
  
  
  
  

• In choosing anti-aging products, try to go for the most emollient (moisturizing) versions tolerable, such as heavier night creams. This allows the skin's top layers to absorb creamy moisture which allows it to be plumped up, giving more of a translucent glow as well as swelling tiny lines and wrinkles full of moisture so they smooth out temporarily. In fact, this is how some of the most expensive anti-wrinkle creams do their best work.


• Is there a benefit to spending more to get a prescription anti-aging cream?
  
  
  
  • The benefit of using tretinoin by prescription is that it has the most research evidence behind it; it's rigorously evaluated and proven in an unbiased way; and it not only reduces the "appearance" of fine lines (which plain moisturizers also do), but actually does reduce the fine lines. A tube of tretinoin, which is sold under various brand names as well as the generic, does cost a bit more than some drugstore creams, but less than some department store creams [editor's note: a prescription for a 20-gram tube of tretinoin could cost anywhere from $40 for a generic to $75 for a name brand]. However, a little goes a long way, and it may be the best bang for the buck, if one knows how to use it properly to avoid issues.
  
  
  
  


• Do you recommend any expensive anti-aging topicals--department store brands? Are there any that you think have interesting science behind them?
  
  
  
  • Physician-dispensed anti-aging topicals and some of the more expensive department store brands claim to have higher concentrations of active ingredients, formulated in more expensive ways, to justify their higher prices. This may indeed be true, but since formulas are often proprietary, it is hard to know exactly how much more of the ingredient you're getting. Some of the more reliable brands are SkinCeuticals, which has highly researched antioxidant serum formulations; Revaleskin, which is a line containing active coffeeberry extract that performs multiple anti-aging functions; Neocutis, a company whose product line is based largely on their proprietary PSP (purified skin protein) formula, which aids wound healing—a finding they extrapolate to claim anti-aging effects in intact skin; Obagi, a line which contains many well-tested products; and Neova, a line which contains many copper peptide and antioxidant products.
  
  
  
  


• What anti-aging products and services are, in your opinion, worth a “splurge?” In other words, they may be more costly, but they make a huge difference in the longterm? 
  
  
  
  • In my opinion, any of the products mentioned here are worth a try, remembering that it may take 6 months to be able to tell whether a product is making any difference. The most reliable anti-aging treatments are still tretionin--the prescription retinoid--and some of the more invasive procedures, including peels, Intense Pulsed Light photofacials, laser treatments, and the injectable neurotoxins (Botox, Dysport) and fillers (including Restylane, Juvederm, Radiesse, Sculptra, and others). All of these treatments have risks that are important to discuss in great detail with your dermatologist before starting, to have a clear understanding of the medical risks involved as well as costs and realistic expectations of change and length of benefits.
  
  
  
  

Author
	Dr. Jessica KrantDr. Jessica J. Krant is a dermatologist based out of New York and founder of Art of Dermatology, LLC. She is also the assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City.

• Before you start recommending products, can you explain why there is so much confusion around this issue? How can so many different products, at such different prices, all claim to work?
  
  
  
  • It's very hard to know what "really works.” To understand why, it's helpful to understand what a "cosmeceutical" really is. Riding the gray area between cosmetics, which only claim to alter the appearance of skin, (think bronzer or eyeshadow), and pharmaceuticals, which alter the body's biology (think Botox), cosmeceuticals try to have it both ways. Companies that make these products want the public to believe they actually do change skin scientifically, but they don’t want to spend hundreds of millions of dollars and many years going through FDA drug trials to prove it.
  
  
  • The result: most anti-aging creams, both in the drugstore and in the department store, avoid the FDA entirely, which means they can make lots of claims without the need to prove anything. They just have to pass muster with the Federal Trade Commission, which requires that they maintain a level of safety. (Even this is difficult to rely on, since most safety issues come up only after the product has been out on the market and caused enough trouble to get attention.)
  
  
  
  


• Wait, so are you saying that none of these products work?
  
  
  
  • It's possible some anti-aging products really do work, but there is currently no independent group that is testing and validating these products’ claims. A company may advertise that it's put a product through "clinical trials," but that only means it has been tested on actual humans--as opposed to cells in a dish. Clinical research is vital, but when it's presented by the company that's selling the product, you need to take it with a grain of salt. Often, results are reported such as a reduction in the "appearance" of fine lines or dark spots. That does not mean that the lines and dark spots have been reduced, only that it looks better.
  
  
  
  


• What ingredients have been tested so that we KNOW they have benefits? Are there inexpensive products that contain these ingredients?
  
  
  
  • The most proven anti-aging ingredient on the market is the only one that has gone through the formal FDA-approval process. This is tretinoin, a vitamin-A derivative known as a retinoid. The most recognized brand name is Retin-A. Tretinoin is the gold standard for anti-wrinkle treatments. It's also proven to reverse other signs of aging, as well as help to reduce the risk of skin cancer by keeping skin cells growing in a healthy, ordered way. Because it is irritating to skin if used improperly, hard to get because it requires a prescription, and expensive, we look for other anti-aging options.
  
  
  
  


• So are there other ingredients that have been shown to work?
  
  
  
  • Several ingredients on the market are known to have real results in basic science research--the science behind them looks good, even if they haven't been formally tested by the FDA. These include over-the-counter retinoids (retinol, retinyl palmitate, and retinaldehyde), antioxidants such as soy, green tea, feverfew, licorice, mushrooms, vitamin C, coffeeberry, and other formulations proprietary to different companies. Finally, glycolic and salicylic acid and their relatives are also useful ingredients in many anti-aging formulations.
  
  
  
  


• What affordable products do you recommend to your 50+ patients and why?
  
  
  
  • For drugstore brands, I tend to stick with some of the most tried-and-true companies and products that I do believe have ingredients with real evidence behind them. For retinol products, most will work, but my favorites are Neutrogena's Ageless Intensives Retinol SA line ($18.99-$20.99) , which contains various formulations for different skin types (from serum to night cream), and Roc's Retinol Correxion line ($19.99-$22.99). For patients with age spots and general skin dullness, I recommend Aveeno Positively Radiant Triple Boosting Serum and the SPF 30 day moisturizer ($21), to take advantage of its antioxidant and spot-fading soy. For sensitive, rosacea-prone skin I recommend Aveeno's Ultra-Calming cleanser and moisturizer($7.49, $16.79) which contains anti-inflammatory and antioxidant feverfew.
  
  
  
  

• In choosing anti-aging products, try to go for the most emollient (moisturizing) versions tolerable, such as heavier night creams. This allows the skin's top layers to absorb creamy moisture which allows it to be plumped up, giving more of a translucent glow as well as swelling tiny lines and wrinkles full of moisture so they smooth out temporarily. In fact, this is how some of the most expensive anti-wrinkle creams do their best work.


• Is there a benefit to spending more to get a prescription anti-aging cream?
  
  
  
  • The benefit of using tretinoin by prescription is that it has the most research evidence behind it; it's rigorously evaluated and proven in an unbiased way; and it not only reduces the "appearance" of fine lines (which plain moisturizers also do), but actually does reduce the fine lines. A tube of tretinoin, which is sold under various brand names as well as the generic, does cost a bit more than some drugstore creams, but less than some department store creams [editor's note: a prescription for a 20-gram tube of tretinoin could cost anywhere from $40 for a generic to $75 for a name brand]. However, a little goes a long way, and it may be the best bang for the buck, if one knows how to use it properly to avoid issues.
  
  
  
  


• Do you recommend any expensive anti-aging topicals--department store brands? Are there any that you think have interesting science behind them?
  
  
  
  • Physician-dispensed anti-aging topicals and some of the more expensive department store brands claim to have higher concentrations of active ingredients, formulated in more expensive ways, to justify their higher prices. This may indeed be true, but since formulas are often proprietary, it is hard to know exactly how much more of the ingredient you're getting. Some of the more reliable brands are SkinCeuticals, which has highly researched antioxidant serum formulations; Revaleskin, which is a line containing active coffeeberry extract that performs multiple anti-aging functions; Neocutis, a company whose product line is based largely on their proprietary PSP (purified skin protein) formula, which aids wound healing—a finding they extrapolate to claim anti-aging effects in intact skin; Obagi, a line which contains many well-tested products; and Neova, a line which contains many copper peptide and antioxidant products.
  
  
  
  


• What anti-aging products and services are, in your opinion, worth a “splurge?” In other words, they may be more costly, but they make a huge difference in the longterm? 
  
  
  
  • In my opinion, any of the products mentioned here are worth a try, remembering that it may take 6 months to be able to tell whether a product is making any difference. The most reliable anti-aging treatments are still tretionin--the prescription retinoid--and some of the more invasive procedures, including peels, Intense Pulsed Light photofacials, laser treatments, and the injectable neurotoxins (Botox, Dysport) and fillers (including Restylane, Juvederm, Radiesse, Sculptra, and others). All of these treatments have risks that are important to discuss in great detail with your dermatologist before starting, to have a clear understanding of the medical risks involved as well as costs and realistic expectations of change and length of benefits.
  
  
  
  

Author
	Dr. Jessica KrantDr. Jessica J. Krant is a dermatologist based out of New York and founder of Art of Dermatology, LLC. She is also the assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City.

A dermatologist to the stars reveals the non-invasive treatments that really work.

• FOF: When it comes to their faces, many FOFs are particularly interested in non-invasive anti-aging treatments--creams, lasers, facials and so on. Which ones work the best?
  
  
  
  • Dr. Sobel: I know we’ve all heard this, but the very best anti-aging regimen starts with prevention. Stay out of the sun and use a sunscreen properly. That means putting a full teaspoon on your face every day and re-applying every 2-3 hours if you’re outside. SPF 30 is probably enough (there’s not a big difference in protection when it goes above 30).
  
  
  
  


• Is there a specific brand that you recommend in your own practice?
  
  
  
  • Well, we created our own line, DDF, which is now owned by P&G. It’s good, but there are a lot of good sunscreens on the market. Just make sure it blocks UVA and UVB rays.
  
  
  
  


• Okay, so what about the woman for whom the damage is done. Now what?
  
  
  
  • Right, so once you have that sun damage, you’re naturally going to lose elasticity in your skin. You get fine lines, wrinkles, and hyperpigmented areas where skin becomes irregular, rough and lumpy. There are amazing lasers for that.
  
  
  
  


• Let’s start with the least involved! Are there any creams that work?
  
  
  
  • There are some topicals that will get rid of the uneven pigmentation--somewhat. The key ingredient is hydroquinone. Some people are a little afraid of hydroquinone because there were studies connecting it to cancer in mice. But we know now that hydroquinone is very safe and there’s nothing wrong with using it. The trouble is, it doesn’t always work.
  
  
  
  


• Tell me about the lasers.
  
  
  
  • The one I like is the Fraxel Dual laser--1927 wavelength. It really removes the sun damage...brown spots, uneven skin, etc. It’s terrific. You’ll need one or two treatments, depending on how much sun damage you have, and there’s no downtime. You might get what looks like a little cat scratch right afterward--you can cover it with makeup.
  
  
  
  


• How much does that cost and how long does it last?
  
  
  
  • Not costly by laser treatment standards. It’s $1500 per treatment, and the results last as long as it takes for you to re-damage you skin through sun exposure. Also, it’s a laser that really works. There are a lot of lasers out there that promise to do everything--and do nothing.
  
  
  
  


• Does that also get rid of wrinkles and sagging?
  
  
  
  • Yes, you can set that same laser to a different wavelength, and it removes wrinkles and fine lines and tightens the skin. I think it’s most effective to get rid of the pigmentation first and then have the patient come back in two or three months to have the wrinkles done. Some doctors will put the laser up to half strength and do a little of each, but I find that doesn’t work as well.
  
  
  • Another great laser for skin tightening is the eMax. It actually goes below the skin and tightens the collagen fibers and stimulates the collagen. It gives the skin back its elasticity.
  
  
  
  


• What are other laser procedures really work?
  
  
  
  • The ulthera laser--it’s actually ultrasound, not a laser--tightens skin and stimulates the fibroblasts to make collagen.
  
  
  • And the C02 laser works well to get rid of fine lines and wrinkles. C02 lasers used to have several weeks of recovery time, but now we have C02 lasers called fractional C02s which have very little downtime--they’re excellent.
  
  
  
  


• You’re known for doing “facelifts” with injectibles. Can you tell me about that?
  
  
  
  • It used to be that if you had a little loose skin, and you wanted to look younger, plastic surgeons were very keen on doing facelifts--earlier than later. But now most people believe that volume creates a younger face. A surgical facelift causes the skin to get pulled, and if you don’t put volume back, you look like you got caught in a wind tunnel. So you don’t have loose skin anymore, but you don’t necessarily look better--you just look like someone who had surgery. Injectables like Juvederm, Radiesse, etc, create volume.
  
  
  
  


• I know that injectables can fill in wrinkles, but if you have sagging skin and jowls, do they really help?
  
  
  
  • Yes, they absolutely lift. For example, I’ll inject filler on top of your cheekbone, and that creates volume that actually lifts the skin on your cheek. It’s like re-draping a shirt on a hanger. I do a very popular procedure called “The Trifecta” which involves three types of injectables--Botox, Radiesse and hyaluronic acid. The results are comparable to a facelift. Wrinkles and lines are smoothed and sagging skin is actually lifted and tightened.
  
  
  
  


• What is the Botox for? That’s not really a filler, right?
  
  
  
  • Nothing works better to get rid of dynamic lines than Botox. Your crows feet, your worry lines, the wrinkles on your chin. No matter how much filler I use on those, they’ll keep coming back because you’ll keep creasing the skin. Botox actually stops the muscle from moving so the creasing stops. Unfortunately, you have to do it every 3 or 4 or 5 months, but, like I said, nothing works better.
  
  
  
  


• So who is a good candidate for "The Trifecta"--or any “injectables” lift?
  
  
  
  • That’s for someone who wants to look younger and fresher, but doesn’t want surgery. Patients literally can walk out and look ten years younger.
  
  
  
  


• What are the limitations of these non-surgical procedures? In other words, when do you refer a patient to a plastic surgeon?
  
  
  
  • Between the lasers and injectables there’s so much you can do. And I think the biggest mistake you can make is doing too much. But once you get into your 60s and the skin around the neck area starts to hang, you probably will need the knife to get rid of it. Filler won’t be enough. But just cutting, without filler, isn’t enough either. Because these days, the trend is to do a lift and then still add volume back in.
  
  
  
  


• What is the biggest mistake women over 50 make when it comes to their faces?
  
  
  
  • Of course, spending too much time in the sun. The other thing is, women come in and have cutting and pulling procedures a little earlier than they needed to. They wind up with their eyes up near their scalp. Too much surgery is much worse than no surgery at all. Start with the simplest procedures and work your way up.
  
  
  
  


• What non-invasive procedures on the horizon are you most excited about?
  
  
  
  • Injections and topicals that can actually turn on individual cells to increase collagen production and give us back our youth. Or that can inhibit the enzymes that stop collagen production. There are are topicals now with stem cells and dermal growth factors but they don’t work yet. They just don’t penetrate the skin. And this is something you have to be careful with, because any factor that encourages cell growth might encourage a cancerous cell to grow--like a melanoma. I don’t know when it will be ready, but that’s the future.
  
  
  
  

Author

Dr. Howard Sobel, MD Dermatologic SurgeonDr. Howard Sobel, MD, is a Board Certified Cosmetic Dermatologic Surgeon and the first editor-in-chief of the International Journal of Cosmetic Surgery and Aesthetic Dermatology. He is recognized by both New York Magazine and the Castle Connolly Guide on How To Find the Best Doctors in the New York, Metropolitan Area as one of New York's premier cosmetic dermatologic surgeons for eleven consecutive years.

A dermatologist to the stars reveals the non-invasive treatments that really work.

• FOF: When it comes to their faces, many FOFs are particularly interested in non-invasive anti-aging treatments--creams, lasers, facials and so on. Which ones work the best?
  
  
  
  • Dr. Sobel: I know we’ve all heard this, but the very best anti-aging regimen starts with prevention. Stay out of the sun and use a sunscreen properly. That means putting a full teaspoon on your face every day and re-applying every 2-3 hours if you’re outside. SPF 30 is probably enough (there’s not a big difference in protection when it goes above 30).
  
  
  
  


• Is there a specific brand that you recommend in your own practice?
  
  
  
  • Well, we created our own line, DDF, which is now owned by P&G. It’s good, but there are a lot of good sunscreens on the market. Just make sure it blocks UVA and UVB rays.
  
  
  
  


• Okay, so what about the woman for whom the damage is done. Now what?
  
  
  
  • Right, so once you have that sun damage, you’re naturally going to lose elasticity in your skin. You get fine lines, wrinkles, and hyperpigmented areas where skin becomes irregular, rough and lumpy. There are amazing lasers for that.
  
  
  
  


• Let’s start with the least involved! Are there any creams that work?
  
  
  
  • There are some topicals that will get rid of the uneven pigmentation--somewhat. The key ingredient is hydroquinone. Some people are a little afraid of hydroquinone because there were studies connecting it to cancer in mice. But we know now that hydroquinone is very safe and there’s nothing wrong with using it. The trouble is, it doesn’t always work.
  
  
  
  


• Tell me about the lasers.
  
  
  
  • The one I like is the Fraxel Dual laser--1927 wavelength. It really removes the sun damage...brown spots, uneven skin, etc. It’s terrific. You’ll need one or two treatments, depending on how much sun damage you have, and there’s no downtime. You might get what looks like a little cat scratch right afterward--you can cover it with makeup.
  
  
  
  


• How much does that cost and how long does it last?
  
  
  
  • Not costly by laser treatment standards. It’s $1500 per treatment, and the results last as long as it takes for you to re-damage you skin through sun exposure. Also, it’s a laser that really works. There are a lot of lasers out there that promise to do everything--and do nothing.
  
  
  
  


• Does that also get rid of wrinkles and sagging?
  
  
  
  • Yes, you can set that same laser to a different wavelength, and it removes wrinkles and fine lines and tightens the skin. I think it’s most effective to get rid of the pigmentation first and then have the patient come back in two or three months to have the wrinkles done. Some doctors will put the laser up to half strength and do a little of each, but I find that doesn’t work as well.
  
  
  • Another great laser for skin tightening is the eMax. It actually goes below the skin and tightens the collagen fibers and stimulates the collagen. It gives the skin back its elasticity.
  
  
  
  


• What are other laser procedures really work?
  
  
  
  • The ulthera laser--it’s actually ultrasound, not a laser--tightens skin and stimulates the fibroblasts to make collagen.
  
  
  • And the C02 laser works well to get rid of fine lines and wrinkles. C02 lasers used to have several weeks of recovery time, but now we have C02 lasers called fractional C02s which have very little downtime--they’re excellent.
  
  
  
  


• You’re known for doing “facelifts” with injectibles. Can you tell me about that?
  
  
  
  • It used to be that if you had a little loose skin, and you wanted to look younger, plastic surgeons were very keen on doing facelifts--earlier than later. But now most people believe that volume creates a younger face. A surgical facelift causes the skin to get pulled, and if you don’t put volume back, you look like you got caught in a wind tunnel. So you don’t have loose skin anymore, but you don’t necessarily look better--you just look like someone who had surgery. Injectables like Juvederm, Radiesse, etc, create volume.
  
  
  
  


• I know that injectables can fill in wrinkles, but if you have sagging skin and jowls, do they really help?
  
  
  
  • Yes, they absolutely lift. For example, I’ll inject filler on top of your cheekbone, and that creates volume that actually lifts the skin on your cheek. It’s like re-draping a shirt on a hanger. I do a very popular procedure called “The Trifecta” which involves three types of injectables--Botox, Radiesse and hyaluronic acid. The results are comparable to a facelift. Wrinkles and lines are smoothed and sagging skin is actually lifted and tightened.
  
  
  
  


• What is the Botox for? That’s not really a filler, right?
  
  
  
  • Nothing works better to get rid of dynamic lines than Botox. Your crows feet, your worry lines, the wrinkles on your chin. No matter how much filler I use on those, they’ll keep coming back because you’ll keep creasing the skin. Botox actually stops the muscle from moving so the creasing stops. Unfortunately, you have to do it every 3 or 4 or 5 months, but, like I said, nothing works better.
  
  
  
  


• So who is a good candidate for "The Trifecta"--or any “injectables” lift?
  
  
  
  • That’s for someone who wants to look younger and fresher, but doesn’t want surgery. Patients literally can walk out and look ten years younger.
  
  
  
  


• What are the limitations of these non-surgical procedures? In other words, when do you refer a patient to a plastic surgeon?
  
  
  
  • Between the lasers and injectables there’s so much you can do. And I think the biggest mistake you can make is doing too much. But once you get into your 60s and the skin around the neck area starts to hang, you probably will need the knife to get rid of it. Filler won’t be enough. But just cutting, without filler, isn’t enough either. Because these days, the trend is to do a lift and then still add volume back in.
  
  
  
  


• What is the biggest mistake women over 50 make when it comes to their faces?
  
  
  
  • Of course, spending too much time in the sun. The other thing is, women come in and have cutting and pulling procedures a little earlier than they needed to. They wind up with their eyes up near their scalp. Too much surgery is much worse than no surgery at all. Start with the simplest procedures and work your way up.
  
  
  
  


• What non-invasive procedures on the horizon are you most excited about?
  
  
  
  • Injections and topicals that can actually turn on individual cells to increase collagen production and give us back our youth. Or that can inhibit the enzymes that stop collagen production. There are are topicals now with stem cells and dermal growth factors but they don’t work yet. They just don’t penetrate the skin. And this is something you have to be careful with, because any factor that encourages cell growth might encourage a cancerous cell to grow--like a melanoma. I don’t know when it will be ready, but that’s the future.
  
  
  
  

Author

Dr. Howard Sobel, MD Dermatologic SurgeonDr. Howard Sobel, MD, is a Board Certified Cosmetic Dermatologic Surgeon and the first editor-in-chief of the International Journal of Cosmetic Surgery and Aesthetic Dermatology. He is recognized by both New York Magazine and the Castle Connolly Guide on How To Find the Best Doctors in the New York, Metropolitan Area as one of New York's premier cosmetic dermatologic surgeons for eleven consecutive years.

By creating pH balance in your body, Dr. Jeannette Graf says you can prevent your cells from accelerated aging, achieve youthful skin and feel fantastic.

• As a dermatologist, how did you discover the correlation between pH and anti-aging?
  
  
  
  • I was doing cosmetic procedures to help women look better, and although the procedures went well, technically, the women still didn’t look great. I’d peel them, and their skin would look a little better, but they were still missing something. On the other hand, I had 80-year-old patients who were just full of life and energy and had a glow, yet they never did any procedures. So I began asking questions. I realized that what’s going on internally impacts what your skin looks like and how it ages, but I didn’t know why. So I went back and began to read old research.
  
  
  
  


• What did you find?
  
  
  
  • A 1931 Nobel Prize Winning study in which Dr. Otto Warburg did a very simple test. He immersed cancer cells and healthy cells in two solutions. The first solution was oxygen-poor and highly acidic. The second solution was high-oxygen, highly alkaline. The cancer cells thrived in the low-oxygen, highly acidic environment but could not replicate well in the high-oxygen, more alkaline solution. The opposite was true for the healthy cells. Essentially, his study shows that when you’re alkaline at a cellular level you can defeat disease. That’s when I realized how important your body’s pH is to your overall health and appearance.
  
  
  
  


• I remember pH from chemistry class, but how does it relate to your body?
  
  
  
  • pH measures the alkalinity or acidity of a liquid. All liquids have a pH. The pH scale is between 0-14. Acids are solutions with a pH lower than 7. A solution is alkaline when it has a pH higher than 7. You may think of the human body as a solid, but it’s made up mostly of water and has a pH. For optimal health and functioning, most of the cells, fluids and tissues in your body need a slightly alkaline pH.
  
  
  
  


• What is the correlation between alkalinity, acidity and aging?
  
  
  
  • Body cells function best in the pH range of 7.35 to 7.45 (slightly alkaline). If your pH falls too low (acidic) the cells in the skin stop dividing, produce fewer enzymes and create less collagen. This leads directly to sagging, dullness and wrinkles.
  
  
  
  


• Does your pH get more acidic as you age?
  
  
  
  • When we are born, our bodies are at their most alkaline, and when we die we are very acidic.
  
  
  
  


• How do you test your pH?
  
  
  
  • The best way to test your pH is by using a pH strip every day. You want to make sure that your mouth is clean. If you just did something like brush your teeth or drink coffee, you’ll want to rinse your mouth with water. Then, you’ll want to take a strip and saturate it with saliva. Saliva is the best indicator of your pH since it is from an immediate organ. After you determine your pH, you can make adjustments to your diet to get it in the 7.35 to 7.45 range.
  
  
  
  


• Where do you get pH strips?
  
  
  
  • Health food stores are selling them more and more. I also have an index of places that sell them in the back of my book.
  
  
  
  


• What can we eat to get our pH in the ideal range?
  
  
  
  • If your pH is too acidic, you need to eat more alkaline-producing foods. If your pH is too alkaline, you need to eat more acid-producing foods. Certain foods are acidic such as lemons and limes, but these are alkaline-producing foods. Other foods that are alkaline, such as milk and dairy, are acid-producing foods. It doesn’t matter whether a food is acidic or alkaline; what matters is if the food is acid-producing or alkaline-producing. After every food is metabolized there’s an ash that is left. The pH of that ash determines if that food had an alkaline or acidic effect.
  
  
  
  


• So what are acid-producing foods?
  
  
  
  • Refined carbs, sugar, cola drinks, meat and dairy. Cola drinks are the number one enemy. Coffee is acid-producing as it sits around and oxidizes, so you are better off having freshly-brewed coffee from newly-ground organic coffee beans. It can actually have a beneficial antioxidant effect when consumed in this way.
  
  
  
  


• What are alkaline-producing foods?
  
  
  
  • The most alkaline-producing food is kale. I cook with it or I make juices out of it. Organic greens, vegetables, garlic, olive oil, lemon, fruit, Brazil nuts and seeds are other alkaline-producing foods.
  
  
  
  


• If your pH is acidic, should you only eat alkaline-producing foods?
  
  
  
  • No, you’ll just want to up your intake of alkaline-producing foods until your pH is back in that 7.35 to 7.45 range. I recommend a Mediterranean diet— fruits and vegetables, protein, but not too much protein (about 20 percent of your diet), olive oil and safflower oil. Instead of table salt I would use sea salt. I recommend Stevia for a sweetener. I also recommend the addition of super alkalinizing green powdered drinks, which can be reconstituted in your favorite beverage, and spirulina tablets to boost pH. Mineral supplements are also a great way to boost alkalinity.
  
  
  
  


• How often should you be testing your pH?
  
  
  
  • Every day. But if you want to play with the pH strips to see the effects that different things have, go ahead.
  
  
  
  


• How long after you eat can you can see a change in pH?
  
  
  
  • After taking a mineral supplement, sometimes you can see results in an hour.
  
  
  
  


• Is there anything else that can affect your body’s alkalinity or acidity?
  
  
  
  • Smoking and stress can also make your pH very acidic.
  
  
  
  


• Some of this sounds like what we already knew about bad behaviors and bad eating habits...
  
  
  
  
  
  • It’s common sense proven by science. What’s unique is that it is simple to be alkaline. You can do it with simple changes each day. What’s appealing to most people is, it’s not prison. Dieting is stressful. Let’s say you went out with your friends and had a couple of margaritas, and then the next day you test your pH and maybe it’s not as alkaline as it was. So that’s the day you beef up your intake of greens and alkaline-producing food.
  
  
  
  

Author

Dr. Jeannette Graf, M.D DermatologistDr. Jeannette Graf, M.D. is a New York-based, board-certified dermatologist and former National Institutes of Health fellow. She received an award for Outstanding Achievement from the National Institutes of Health, for her research on peptides in 1987. Published in Journal of Cell Biology, Dr. Graf is a leading expert on skin cells and anti-aging, consulting for cosmetic and pharmaceutical companies including Johnson & Johnson, Neutrogena and Aveeno. She is author of Stop Aging, Start Living: The Revolutionary 2-week pH Diet.

By creating pH balance in your body, Dr. Jeannette Graf says you can prevent your cells from accelerated aging, achieve youthful skin and feel fantastic.

• As a dermatologist, how did you discover the correlation between pH and anti-aging?
  
  
  
  • I was doing cosmetic procedures to help women look better, and although the procedures went well, technically, the women still didn’t look great. I’d peel them, and their skin would look a little better, but they were still missing something. On the other hand, I had 80-year-old patients who were just full of life and energy and had a glow, yet they never did any procedures. So I began asking questions. I realized that what’s going on internally impacts what your skin looks like and how it ages, but I didn’t know why. So I went back and began to read old research.
  
  
  
  


• What did you find?
  
  
  
  • A 1931 Nobel Prize Winning study in which Dr. Otto Warburg did a very simple test. He immersed cancer cells and healthy cells in two solutions. The first solution was oxygen-poor and highly acidic. The second solution was high-oxygen, highly alkaline. The cancer cells thrived in the low-oxygen, highly acidic environment but could not replicate well in the high-oxygen, more alkaline solution. The opposite was true for the healthy cells. Essentially, his study shows that when you’re alkaline at a cellular level you can defeat disease. That’s when I realized how important your body’s pH is to your overall health and appearance.
  
  
  
  


• I remember pH from chemistry class, but how does it relate to your body?
  
  
  
  • pH measures the alkalinity or acidity of a liquid. All liquids have a pH. The pH scale is between 0-14. Acids are solutions with a pH lower than 7. A solution is alkaline when it has a pH higher than 7. You may think of the human body as a solid, but it’s made up mostly of water and has a pH. For optimal health and functioning, most of the cells, fluids and tissues in your body need a slightly alkaline pH.
  
  
  
  


• What is the correlation between alkalinity, acidity and aging?
  
  
  
  • Body cells function best in the pH range of 7.35 to 7.45 (slightly alkaline). If your pH falls too low (acidic) the cells in the skin stop dividing, produce fewer enzymes and create less collagen. This leads directly to sagging, dullness and wrinkles.
  
  
  
  


• Does your pH get more acidic as you age?
  
  
  
  • When we are born, our bodies are at their most alkaline, and when we die we are very acidic.
  
  
  
  


• How do you test your pH?
  
  
  
  • The best way to test your pH is by using a pH strip every day. You want to make sure that your mouth is clean. If you just did something like brush your teeth or drink coffee, you’ll want to rinse your mouth with water. Then, you’ll want to take a strip and saturate it with saliva. Saliva is the best indicator of your pH since it is from an immediate organ. After you determine your pH, you can make adjustments to your diet to get it in the 7.35 to 7.45 range.
  
  
  
  


• Where do you get pH strips?
  
  
  
  • Health food stores are selling them more and more. I also have an index of places that sell them in the back of my book.
  
  
  
  


• What can we eat to get our pH in the ideal range?
  
  
  
  • If your pH is too acidic, you need to eat more alkaline-producing foods. If your pH is too alkaline, you need to eat more acid-producing foods. Certain foods are acidic such as lemons and limes, but these are alkaline-producing foods. Other foods that are alkaline, such as milk and dairy, are acid-producing foods. It doesn’t matter whether a food is acidic or alkaline; what matters is if the food is acid-producing or alkaline-producing. After every food is metabolized there’s an ash that is left. The pH of that ash determines if that food had an alkaline or acidic effect.
  
  
  
  


• So what are acid-producing foods?
  
  
  
  • Refined carbs, sugar, cola drinks, meat and dairy. Cola drinks are the number one enemy. Coffee is acid-producing as it sits around and oxidizes, so you are better off having freshly-brewed coffee from newly-ground organic coffee beans. It can actually have a beneficial antioxidant effect when consumed in this way.
  
  
  
  


• What are alkaline-producing foods?
  
  
  
  • The most alkaline-producing food is kale. I cook with it or I make juices out of it. Organic greens, vegetables, garlic, olive oil, lemon, fruit, Brazil nuts and seeds are other alkaline-producing foods.
  
  
  
  


• If your pH is acidic, should you only eat alkaline-producing foods?
  
  
  
  • No, you’ll just want to up your intake of alkaline-producing foods until your pH is back in that 7.35 to 7.45 range. I recommend a Mediterranean diet— fruits and vegetables, protein, but not too much protein (about 20 percent of your diet), olive oil and safflower oil. Instead of table salt I would use sea salt. I recommend Stevia for a sweetener. I also recommend the addition of super alkalinizing green powdered drinks, which can be reconstituted in your favorite beverage, and spirulina tablets to boost pH. Mineral supplements are also a great way to boost alkalinity.
  
  
  
  


• How often should you be testing your pH?
  
  
  
  • Every day. But if you want to play with the pH strips to see the effects that different things have, go ahead.
  
  
  
  


• How long after you eat can you can see a change in pH?
  
  
  
  • After taking a mineral supplement, sometimes you can see results in an hour.
  
  
  
  


• Is there anything else that can affect your body’s alkalinity or acidity?
  
  
  
  • Smoking and stress can also make your pH very acidic.
  
  
  
  


• Some of this sounds like what we already knew about bad behaviors and bad eating habits...
  
  
  
  
  
  • It’s common sense proven by science. What’s unique is that it is simple to be alkaline. You can do it with simple changes each day. What’s appealing to most people is, it’s not prison. Dieting is stressful. Let’s say you went out with your friends and had a couple of margaritas, and then the next day you test your pH and maybe it’s not as alkaline as it was. So that’s the day you beef up your intake of greens and alkaline-producing food.
  
  
  
  

Author

Dr. Jeannette Graf, M.D DermatologistDr. Jeannette Graf, M.D. is a New York-based, board-certified dermatologist and former National Institutes of Health fellow. She received an award for Outstanding Achievement from the National Institutes of Health, for her research on peptides in 1987. Published in Journal of Cell Biology, Dr. Graf is a leading expert on skin cells and anti-aging, consulting for cosmetic and pharmaceutical companies including Johnson & Johnson, Neutrogena and Aveeno. She is author of Stop Aging, Start Living: The Revolutionary 2-week pH Diet.

If you think beautiful breasts are a thing of the past, Dr. Carlin Vickery says, think again.

• What happens to our breasts as we age?
  
  
  
  • As we go through childbearing, nursing and menopause, most women will lose skin elasticity. So there is a natural gravitational descent of the breast gland, which can result in droopy breasts, or, as we call them, ptotic breasts. In addition, with a loss of estrogen, the breast tissue will become more fatty, which leads to a loss of volume, especially at the top of the breast, which, in our culture, is the desirable cleavage area.
  
  
  
  


• Do breasts generally get larger, or smaller over time?
  
  
  
  • It depends on the woman. Some women, after having children, experience post-partum involution, meaning the breast tissue just shrinks down. That’s very common; I see it in a number of women in their 40s and 50s. Other women’s breasts get larger.
  
  
  
  


• What are the most common types of breast surgery for women over fifty?
  
  
  
  • Women usually come in complaining of sagginess and a loss of volume. They need breast lifts--and that can be done with or without an implant, depending on whether the patient needs more volume. Breast reductions are the other popular precedure for the over-fifty group.
  
  
  
  


• Do you think most FOFs come in with realistic expectations?
  
  
  
  • I think they do. A lot of younger patients come in wanting something they’ve seen on TV or wanting tons of cleavage. But women over fifty are more mature and realistic. They have a good idea of who they are and many have waited a long time for this. Often, they feel like their breasts are too big and are making them look matronly--fat and top heavy. If anything, they want their breasts to be too small.
  
  
  
  


• Is there such a thing as “too small” breasts?
  
  
  
  • I’m a big believer in proportionality. You never want to reduce breasts so much that your belly is leading your profile. That’s not a desirable look, and it’s going to makes clothes harder to fit.
  
  
  
  


• Let’s start with the breast lift. Does it always require an implant?
  
  
  
  • No--not necessarily. You can lift the breast, but without an implant, you’re not going to get that volume that most women are looking for.
    

    

    
    
  
  
  
  


• Do you have a preference for silicone versus saline implants?
  
  
  
  • I don’t. That’s a decision the patient needs to make, and my job is to give them all the advantages and disadvantages of both. I will say that the gel implant often has a slightly softer feel--but not always. For a while, silicone was under suspicion of causing autoimmune disease, so we all used saline implants, and people were very satisfied.
  
  
  
  


• What’s the biggest misconception about breast implants?
  
  
  
  • People don’t realize that implants require maintenance over time. The FDA has now deemed silicone implants safe, however they need to be replaced every 10 to 15 years.
  
  
  
  


• What’s the most popular procedure right now for achieving a “natural” look with an implant?
  
  
  
  
  
  • There’s not one. To be a good plastic surgeon, you have to be flexible, and you have to have a big bag of tricks. If you’re doing the same procedure on every patient, then you’re not achieving the best results. Two women complaining of “sagging” could have completely different anatomy: is the problem lost elasticity, or are the nipples pointing down, or do they have stretch marks, or do they have great skin with a loss of volume? If a doctor says he has one technique that he always, uses, then . . . I can’t get my mind around that.
  
  
  
  

Author

Dr. Carlin Vickery, MD, BCPS Plastic surgeonDr. Carlin Vickery, MD, F.A.C.S., has been practicing surgery for over 25 years. Consistently ranked as one of New York City's top plastic surgeons by Castle Connolly Medical, Dr. Vickery has pioneered innovative approaches to breast reconstruction and augmentation. She holds an appointment as Associate Clinical Professor in Department of Surgery at Mount Sinai Medical Center, where she has taught since 1985.

If you think beautiful breasts are a thing of the past, Dr. Carlin Vickery says, think again.

• What happens to our breasts as we age?
  
  
  
  • As we go through childbearing, nursing and menopause, most women will lose skin elasticity. So there is a natural gravitational descent of the breast gland, which can result in droopy breasts, or, as we call them, ptotic breasts. In addition, with a loss of estrogen, the breast tissue will become more fatty, which leads to a loss of volume, especially at the top of the breast, which, in our culture, is the desirable cleavage area.
  
  
  
  


• Do breasts generally get larger, or smaller over time?
  
  
  
  • It depends on the woman. Some women, after having children, experience post-partum involution, meaning the breast tissue just shrinks down. That’s very common; I see it in a number of women in their 40s and 50s. Other women’s breasts get larger.
  
  
  
  


• What are the most common types of breast surgery for women over fifty?
  
  
  
  • Women usually come in complaining of sagginess and a loss of volume. They need breast lifts--and that can be done with or without an implant, depending on whether the patient needs more volume. Breast reductions are the other popular precedure for the over-fifty group.
  
  
  
  


• Do you think most FOFs come in with realistic expectations?
  
  
  
  • I think they do. A lot of younger patients come in wanting something they’ve seen on TV or wanting tons of cleavage. But women over fifty are more mature and realistic. They have a good idea of who they are and many have waited a long time for this. Often, they feel like their breasts are too big and are making them look matronly--fat and top heavy. If anything, they want their breasts to be too small.
  
  
  
  


• Is there such a thing as “too small” breasts?
  
  
  
  • I’m a big believer in proportionality. You never want to reduce breasts so much that your belly is leading your profile. That’s not a desirable look, and it’s going to makes clothes harder to fit.
  
  
  
  


• Let’s start with the breast lift. Does it always require an implant?
  
  
  
  • No--not necessarily. You can lift the breast, but without an implant, you’re not going to get that volume that most women are looking for.
    

    

    
    
  
  
  
  


• Do you have a preference for silicone versus saline implants?
  
  
  
  • I don’t. That’s a decision the patient needs to make, and my job is to give them all the advantages and disadvantages of both. I will say that the gel implant often has a slightly softer feel--but not always. For a while, silicone was under suspicion of causing autoimmune disease, so we all used saline implants, and people were very satisfied.
  
  
  
  


• What’s the biggest misconception about breast implants?
  
  
  
  • People don’t realize that implants require maintenance over time. The FDA has now deemed silicone implants safe, however they need to be replaced every 10 to 15 years.
  
  
  
  


• What’s the most popular procedure right now for achieving a “natural” look with an implant?
  
  
  
  
  
  • There’s not one. To be a good plastic surgeon, you have to be flexible, and you have to have a big bag of tricks. If you’re doing the same procedure on every patient, then you’re not achieving the best results. Two women complaining of “sagging” could have completely different anatomy: is the problem lost elasticity, or are the nipples pointing down, or do they have stretch marks, or do they have great skin with a loss of volume? If a doctor says he has one technique that he always, uses, then . . . I can’t get my mind around that.
  
  
  
  

Author

Dr. Carlin Vickery, MD, BCPS Plastic surgeonDr. Carlin Vickery, MD, F.A.C.S., has been practicing surgery for over 25 years. Consistently ranked as one of New York City's top plastic surgeons by Castle Connolly Medical, Dr. Vickery has pioneered innovative approaches to breast reconstruction and augmentation. She holds an appointment as Associate Clinical Professor in Department of Surgery at Mount Sinai Medical Center, where she has taught since 1985.

A new report claims that only 1 out of every 5 sunscreens is safe and effective.

• FOF: Why doesn’t the FDA ensure that these products are safe?!
  
  
  
  • Nneka: The FDA first released it’s recommended regulation draft for sunscreen in 1978, but, believe it or not, it’s never been finalized. There are certain requirements--for example, sunscreens must list all their ingredients. However they don’t have to prove that those ingredients actually work or are safe for everyone.
  
  
  
  


• How did your study work?
  
  
  
  
  
  • We have a database called Skin Deep where we analyze all sorts of consumer beauty products by comparing their ingredients to the most recent scientific literature on health effects including cancer and reproductive toxicity. For our Sunscreen Report, we take it a step further and also look at the UVA and UVB protection the products provide.
  
  
  
  

Author
	Nneka Leiba, M.Phil., MPH Research Analyst Nneka Lieba, M.Phil., MPH is a Research Analyst with the Environmental Working Group. She received her Masters in Public Health from The Johns Hopkins University.

A new report claims that only 1 out of every 5 sunscreens is safe and effective.

• FOF: Why doesn’t the FDA ensure that these products are safe?!
  
  
  
  • Nneka: The FDA first released it’s recommended regulation draft for sunscreen in 1978, but, believe it or not, it’s never been finalized. There are certain requirements--for example, sunscreens must list all their ingredients. However they don’t have to prove that those ingredients actually work or are safe for everyone.
  
  
  
  


• How did your study work?
  
  
  
  
  
  • We have a database called Skin Deep where we analyze all sorts of consumer beauty products by comparing their ingredients to the most recent scientific literature on health effects including cancer and reproductive toxicity. For our Sunscreen Report, we take it a step further and also look at the UVA and UVB protection the products provide.
  
  
  
  

Author
	Nneka Leiba, M.Phil., MPH Research Analyst Nneka Lieba, M.Phil., MPH is a Research Analyst with the Environmental Working Group. She received her Masters in Public Health from The Johns Hopkins University.