Cutting Edge

Posted by The Editorial Desk / Monday, December 8th, 2008

The Real Deal in Cosmetic Surgery Advancements

By Marilyn Moss, M.D.

Ben Franklin astutely said, “All would live long, but none would be old.”

This inherent desire in people for youthfulness has fueled the field of cosmetic surgery, which has continued to grow at a dizzying rate. According to statistics released by The American Society for Aesthetic Plastic Surgery (ASAPS), consumers spent $12.2 billion on plastic surgery in 2006 to pay for 11.5 million procedures. Although the number of women who undergo plastic surgery far outweighs the number of men, there has been a steady rise in the number of men who seek cosmetic procedures.

Non-surgical
Non-surgical procedures have proliferated in the cosmetic surgery field, making aesthetic surgery even more appealing. According to Dr. Foad Nahai, president of ASAPS, “What’s really new in the field is the tremendous growth in non-surgical treatments.”

Non-surgical cosmetic therapies are safe and fast, requiring very little downtime for the patient. The procedures can be done in an outpatient setting, commonly in the doctor’s office. Recovery time is much shorter, allowing patients to resume normal activities almost immediately, in many cases.

Fillers
Over the last few months, the FDA has approved several new non-surgical treatments for the face to add to the armament against aging. These newly sanctioned therapies involve the use of “fillers” for facial wrinkles. The injected substances add volume to reduce wrinkles and lines.

Most fillers are composed of a substance found in the body, such as hyaluronic acid, which reduces the risk of allergic reactions. In the past, collagen derived from animals was often used as the filler, and the incidence of allergic reactions was 3 to 4 percent. Nahai said, “These products are not permanent, but they are safe and free of side effects.”

Laser
Another relatively new procedure to reduce wrinkles or other signs of aging involves tightening the collagen underlying the skin. Tightening the sub-surface collagen gives the overlying skin a tighter, younger look. The treatment spares the overlying skin surface. Skin tightening procedures can be used on the face, the neck, the eyelid, the abdomen and the thighs.

The results of skin tightening, however, are less pronounced than surgical interventions, such as face lifts. “The changes are not that dramatic. But this is a promising technique that needs to be refined,” Nahai corroborated.

Surgical

Breast Augmentation
Breast augmentation surgery is the most popular cosmetic surgery among women. There are some new initiatives in use, as well as some on the horizon. To begin with, the FDA recently re-approved, again, the use of silicone breast implants, after withdrawing its approval because of health concerns.

Silicone is reportedly more “natural” appearing, but the implant can rupture without the patient noticing, allowing the silicone to seep out into the breast tissue. Medical texts have suggested that exposure to silicone may be associated with connective tissue diseases. Although that remains controversial, it is undisputed that the ruptured silicone can lead to hardening.

Saline implants have a safe health profile, and ruptures can be easily detected. These implants, however, are more prone to wrinkling or rippling at the edges. Dr. George Bitar, medical director of Bitar Cosmetic Surgery Institute in Virginia and a visiting lecturer at the plastic surgery department at the University of Virginia, said, “I like saline. And I insert the implant from the armpit and place it below the breast muscle to keep the implant separate from the breast tissue.”

According to Bitar, this method offers several advantages: no nipple nerve damage, no scarring of the breast tissue to confuse mammograms and little interference with breast-feeding.

At the cutting edge of breast augmentation is the promise of stem cells. Researchers are evaluating the use of stem cells derived from fat to increase the size of the breast. Dr. Adam Katz, an assistant professor in plastic surgery at the University of Virginia, explained that for years, fat transplants have been used in the cosmetic field, although not with breast surgery. Fat taken out by liposuction has been injected elsewhere to add volume. According to Katz, “This kind of transplant may have some beneficial effects for surrounding tissues.”

Those studying fat grafting feel that the stem cells within the adipose tissue are responsible for such additional benefits, along with the increased volume. Katz said, “There is emerging evidence that suggests the stem cells enhance vasculature [arrangement of blood vessels] and also affect the overlying skin.”

Blepharoplasty
Patients who seek eyelid surgery present different causes for their complaints. Some have loose skin, while others have a droopy brow. And others have experienced skin changes that make the eyelid surface look like crepe paper. Treatment for the individuals, therefore, must be tailored to their specific needs. According to Dr. Victoria Suh, a board-certified plastic surgeon at Victoria Plastic Surgery and Laser Skin Care Center in Fairfax, laser therapy may work well for crepe paper skin, but “sometimes you just have to do surgery.”
Brow and eye lifts can be done endoscopically, giving the surgeon visual access to the tissues. The fiber-optic scope is inserted through small incisions, rather than a large incision like that used in traditional lift procedures. Suh often uses a small, biodegradable device called an endotine. The endotine hooks the sagging skin from below the surface, lifting it up. The other end of the endotine is then anchored to the bone. Over time, the healing process causes the skin to adhere to this new position, and the device dissolves within seven to eight months. The anchored skin gives the face a younger, rejuvenated look. Suh said the endotine is an improvement over the use of threads, which do not dissolve. “The threads have not been all that successful,” Suh said.

Hair Transplantation
Cosmetic surgery offers micro-hair transplant surgery to treat baldness in individuals.

The micro transplant is a significant improvement over transplants offered 10 years ago. Hair follicles are harvested in mini-strips from the back of the neck. Individual hair follicles are prepared as follicular units for transplant, unlike the older method that transplanted multiple hair follicles together.

Dr. James Vogel, an associate professor in plastic surgery at the Johns Hopkins Hospital and a private practitioner with an office in Owings Mills, Md., said the new individual method produces a very natural appearance. Vogel commented that the procedure is much more demanding for the physician because of the size and number of the transplants. “This is very labor-intensive,” Vogel said.

He added that the effort was worth it, however, saying, “There should never be any physical evidence of a transplant.”

Liposuction
Although many modifications to the basic procedure have been introduced, none seem to have significantly improved on the old-fashioned method. According to Bitar, “These new devices are just a new twist on regular liposuction.”

Bitar, who has been performing plastic surgery for more than 13 years, remarked that the new approaches, such as liposuction with ultrasound or laser, had some advantages but also some downsides. The new procedures can often be done under local anesthesia, reduce blood loss and tighten skin. These benefits, however, are offset by a loss in precision, which might result in poorer outcomes.

Even the newest intervention, which involves injecting a fat dissolver under the skin, does not overly impress Bitar. He explained that the procedure causes fat cells to burst, and then the body absorbs and excretes the debris; no suctioning is required. The physician, however, cannot control which fat cells get targeted. Bitar said, “This can lead to lumps and bumps or require multiple treatments.”

Rhinoplasty
The most significant change to cosmetic nose surgery has been the use of an open technique instead of the former closed technique. Dr. George Weston, a partner with the Austin-Weston Center for Cosmetic Surgery in Reston, explained that the nose is opened at the junction with the upper lip. This allows the surgeon to open up the nasal area and view the structures. “It’s a huge advance,” Weston said.

Before any surgery occurs, Weston has the patient view a computer simulation of the result. This gives the patient a glimpse of an approximation of what to expect. “Every nose is different. You want to give the patient what they want, but you want to balance that with what is possible,” Weston said.

No matter what cosmetic procedure is done, Bitar cautioned patients to do their homework: Research both the procedure and the physician. To Bitar, the outcome depends largely on the provider. “It boils down to the operator. The procedure is only as good as the operator.”

Bitar advised consulting a board-certified plastic surgeon, saying, “These doctors are fully trained and have a lot of experience.”

Additionally, the best outcomes result when patient anticipations are well-matched with realistic expectations. Dr. Gary Price, a plastic surgeon affiliated with Yale University, stressed the need for communication about the different options and their expected results. He said, “Counseling the patient is very important. The patient needs to have realistic expectations.”

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Saline vs. Silicone
By Carissa Sutherland

Because of safety concerns, the Food and Drug Administration restricted the use of silicone breast implants 15 years ago, making saline implants the only option for American women. Then after years of research, in November 2006, the FDA lifted the ban to the cheer of plastic surgeons and patients nationwide. 
One has to wonder: If saline proved so safe and effective, and thousands of women continued to receive implants, why was the ban lifted? If silicone is the better type of implant, have thousands more women raced to their nearest surgeon now that the FDA changed its mind? Three Northern Virginia board-certified plastic surgeons—Drs. Anne Nickodem, Christopher Hess and David E. Berman—weigh in on which is better: saline or silicone.

Size Matters
Many surgeons and patients widely accept that silicone implants look and feel more natural than saline implants since silicone has texture similar to breast tissue.

Well, not necessarily, according to Nickodem. “It’s really based on the patient and how much tissue she has already. Saline can equally feel like a breast in a patient with more tissue. The more fat she has to start with, the more likely saline will feel just as natural.”

Hess echoed Nickodem’s remarks. “I recommend the silicone if women have smaller breasts to begin with. There is a point that saline and silicone will feel similar if the patient has a decent amount of tissue to start with.”

However, according to Berman, there is no question—silicone is better. He said, “It’s not even controversial; one feels like jelly, and one feels like water.”

Safety First
When it comes to safety, it would seem nothing rivals saline implants. Since water composes every human body, salt water causes no harm. But recent advances in the production of silicone implants make them safer than ever before.

“All implants get encapsulated naturally by the body, even pacemakers. Therefore, I could go in and easily remove ruptured silicone,” Hess said. Unlike their ancestors, newer silicone implants resemble Jell-O, are easier to remove and aren’t sticky or runny.

Cost Comparison
Aside from safety alone, patient concerns also lie in the differences in cost and post-op scarring when making the choice between silicone or saline implants. For example, silicone may cost twice as much as saline but won’t deflate if it has a leak. Hess said, “I offer both, but there is the cost factor. Silicone does cost more. But, when saline ruptures, it’s like a tire going flat.”

Leave a Mark
Berman added, “Silicone implants come pre-filled, so you have to make a bigger incision on the lower part of the breast and can’t hide the scar as well.” Alternatively, saline implants require a smaller incision and are filled once placed inside the body. Therefore, saline implants offer the least amount of scarring on the breast.

In the debate over silicone versus saline, weigh the costs, consider the starting breast size and ponder the issue of scarring. All the doctors agreed that each patient’s personal situation varies but that both options prove safe.

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Five After Five
Cosmetic Surgery Patients Share Their Reports Five Years Later
By Carissa Sutherland

Plastic surgery practices won’t be closing shop anytime soon.

The American Society of Plastic Surgeons (ASPS) reports that nearly 2.5 million people in this region of the country received surgical cosmetic procedures in 2006. In other words, 25 percent of all plastic surgeries throughout the nation happened on the East Coast last year between Delaware and Florida. The West Coast’s plastic surgery popularity may take the cake, but the numbers don’t lie—our area of the country holds a close second. And, perhaps even more shocking, that number has more than doubled from just a million patients in 2002.

Of those million people who went under the knife five years ago, five of them from our area share their stories.

Vanessa Marulli Baltimore, Md.
“I was always insecure about the size of my chest,” Vanessa Marulli, 25, remembered. She wasn’t alone; 42,000 other women in the region opted for breast implants in 2002 as well.

Marulli’s surgeon, Dr. Adam N. Summers of Glen Burnie, Md., required two consultations. “At the first consultation we talked about the incisions, risks and complications, the long-term effects and the eventual need for implant replacements,” Marulli said. At the next consultation, swept up in excitement, she scheduled her surgery date.

But after the procedure, Marulli wasn’t out of the woods. Her left breast healed properly while her right breast stayed hard and high. Marulli had developed scar tissue under the implant. Three months after her original surgery, she had another surgery to remove the scar tissue. Though she was numb from local anesthesia, Marulli could feel the tugging, scraping and pulling. “It was very uncomfortable and at times painful, but in the end it was worth it because my breast healed correctly, and now it looks and feels great,” she said.

For others considering breast implants, Marulli advised, “Think about every complication possible and ask yourself if it’s worth the risk.”

Vicky Decker Sterling
The number of people receiving Botox nationwide quadrupled since 2002. Like millions of other women, Vicky Decker, 44, seized the opportunity to look younger. She hated maintaining her body with exercise while her face revealed her age.

After researching online and talking to friends, Decker chose to treat her brow furrow and horizontal forehead lines. She felt pleased with her results, which took only a day to kick in. “There’s a joke about Botox—that you become expressionless. I still make facial expressions, but they don’t involve my forehead. And that’s just fine with me!”

The effects of Botox eventually fade, requiring ongoing injections. Though many people swear by Botox, Dr. Christopher Hess, a board-certified plastic surgeon in Northern Virginia, warned against using Botox as a substitute for face or brow lifts. He said, “Injectables do good for a lot people, but they’re no replacement.” Future face lift or not, Decker intends to continue her quick Botox injections. “I look younger and I feel better,” she concluded.

Dylan Scholinksi Washington, D.C.
Since Dylan Scholinski’s childhood, he felt uncomfortable in his own body. Scholinski, 40, was born a female and endured years of agony for having masculine traits. At 18, he decided to begin living as a man. However, his breasts made this transformation difficult.  “Every time I looked at my body in the mirror, nothing fit or made sense,” he remembered. After years of hunching his back and wearing several layers of clothes, Scholinski chose to undergo chest reconstruction surgery.

Scholinski picked his surgeon, Dr. Michael L. Brownstein, based on reputation. “Dr. Brownstein is one of the best in the country,” he said. “He’d done this type of surgery many times and understood what I wanted.” Within an hour of flying from Washington, D.C. to San Francisco, Calif., where Brownstein is based, , Scholinski completed his initial consultation and had the procedure the next day. During the two weeks he spent healing in San Francisco, Brownstein addressed all of Scholinski’s concerns. His lengthy healing process prevented Scholinski from raising his arms over his head for over a month.

Looking back, Scholinski wished he’d dedicated himself to fitness before surgery to expedite his healing. In addition to exercise, he recommended “having a support system in place for physical and emotional recovery.”

Five years later, Scholinski remains pleased with the results of his surgery. “When I hug people, all of a sudden I can feel myself touching another person without all the layers covering up my body. That’s nice,” he said.

Jill Russell Alexandria
“I had heavy bat wings, like most of the women on my mother’s side of the family, and it was difficult to find clothes to fit over them,” said Jill Russell*. Both men and women have difficulty defeating upper-arm fat. Since diet and exercise sometimes aren’t enough, some people opt for an upper arm lift, called brachioplasty.

Russell and only about 1,000 other people in this area chose to have brachioplasty in 2002. Fed up with how she looked and felt, Russell, 50, surveyed several area doctors and chose Dr. Dean Kane. Kane’s high ratings in Baltimore Magazine as well as the size of his practice sealed the deal.

At her initial consultation, Russell and Kane discussed options for the best possible results. Russell already knew the traditional way to have the procedure, along the underside of the upper arm. However, Kane suggested a different way, through the armpit. “By coincidence, his wife had the same surgery and showed me her results,” Russell said. She was immediately pleased with what she saw and scheduled her surgery.

Though Russell remains pleased with Kane’s work, looking back, she might have done things differently. “Everyone should consider both the traditional and the armpit procedure. I might have had the traditional, even with the long suture, because the results are more even,” she said.

Elizabeth Gunthert Washington, D.C.
“I hated it when I smiled because one of my eyes would completely close,” Elizabeth Gunthert remembered. Gunthert, 25, suffered from a weakened eyelid muscle, and it not only affected her looks and self-confidence, but also her sight. “My eye drooped so much at the point of the surgery that it was affecting my vision.”

Gunthert’s eye especially drooped when she was tired. “My eyelid would become very heavy and uncomfortable,” she said. A specialist identified her issue immediately. Luckily, since Gunthert’s drooping eyelid affected her sight, her insurance company covered the costs of her procedure.

After the surgery, her sight immediately improved. “My eye no longer bothered me when I got tired, and I noticed a difference in pictures immediately.”

Now, five years later, she reflects upon the extended follow-up required for her particular situation. “For medical reasons, I couldn’t have waited any longer.  In a few years, I will probably have to do it again.”

Hess recommended visiting a few surgeons before selecting one. And, he noted, ensure the surgeon is a board-certified plastic surgeon. Dr. David E. Berman, a board-certified plastic surgeon in Northern Virginia, also noted that the best candidates for any type of plastic surgery maintain emotional stability, good health and realistic expectations. Dr. Anne M. Nickodem, another board-certified Northern Virginian surgeon, agreed. “It’s still a body image change, even if you’ve wanted it for years. What I do will make you feel more confident, and then you’ll feel stronger overall.”

(October 2007)

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It’s a Spa World, After All

Posted by The Editorial Desk / Monday, December 8th, 2008

By Sarah Markel

Day spas, those havens from the stresses of modernity, are no longer the preserve of the pampered few. Yet with new spas opening weekly in Northern Virginia, it is easy to become overwhelmed by selection. So we waded through the spas, non-spas and wannabe spas to find places where we would send our girlfriends, our mothers, our daughters and even the guys in our lives—Who knew research could be so relaxing?

The criteria were two-fold: the spas had to offer full-service facials, massage and waxing, and also be hip to the latest trends in detoxification, anti-aging and wellness. So here is the run down on the rub down: Twenty great spas. You choose which is right for you.

Healthy Aging
More than wrinkles come with age. As collagen in the skin breaks down, cells regenerate more slowly and the result is dull, sagging, often mottled skin. All spas provide anti-aging treatments these days, but these spas elevate growing old gracefully to an art form.

Fountains Day Spa
422 South Washington St., Alexandria
703-549-1990; www.fountainsdayspa.net
This Old Town spa is easy to miss if you are not looking—and their high-profile clientele prefers it that way. Owner Susanne Olsen keeps the faces of area celebrities camera-ready and advises on everything from nutrition to relaxation techniques. The Guinot Hydradermie facials are often combined with reflexology for what amounts to a full body intervention. Loyal customers bring their teens for skin care education and treatment. Boys have been known to sneak in the back door for their facials. They know Susanne won’t exfoliate and tell. Acupuncture and craniosacral therapy are also available.

Circe
123 North Washington St., Alexandria
703-519-8528; www.circedayspa.com
If you can’t get what you need at Circe, it is because you haven’t asked. Circe is a gem of a spa with a hip, but attitude-free, staff. The atmosphere is sociable. Owner Sheila McGurk is hugely into building relationships and teaching clients about the importance of mind/body wellness. The spa offers just about every form of massage therapy, including osteopathy, in addition to a full menu of anti-aging facials. Circe also provides creative extras such as a mobile spa for brides. This is the only area spa that uses the KineLase Non-Surgical Facelift, the photo-rejuvenation system that keeps Oprah and Jennifer Anniston looking gorgeous.

Sugar House
111 N Alfred St., Alexandria
703-549-9940; www.sugarhousedayspa.com
You feel noble just walking through the heavy doors of this breathtaking 1795 mansion. The Sugar House provides all the amenities of a large spa in a friendly, intimate atmosphere. Clients trust Sugar House to keep them looking polished and feeling peaceful. It is the home away from home for hundreds of women who book standing appointments up to a year in advance. On Mondays and Tuesdays Sugar House holds a medi-spa clinic with Gerrish & Associates, PC. Medi-spa services include Botox, Restylane, Fraxel, laser hair removal and Thermage skin tightening treatments. Sugar House also sells Obaji (by prescription only) and Philip B products.

PR at Partners
2900 South Quincy St., Arlington
703-998-6500; www.pratpartners.com
Need expert skin care—fast? Head to PR at Partners in Shirlington. This salon has two treatment rooms for facials and massages. Lots of salons do that, right? But two things make Partners special: They give lavish G.M. Collin facials, those pudding-like collagen masks that leave your skin baby-plump, and for hair removal they offer sugaring. Sugaring is your only option for last-minute hair removal because it doesn’t leave those embarrassing red streaks on your face (or worse). This friendly spa is a no-brainer for high-quality beauty reparations that won’t take all day.

Medical Spas
These days medi-spas offer a whole lot more than doctor-supervised injectables and peels. They combine compassionate support with centuries-old natural medicine in a soothing setting. Take control of your well-being.

The Medical Spa at Nova
21785 Filigree Court, Suite 100, Ashburn
703-554-1130; www.novamedspa.com
This is what a medical spa should be: Traditional medicine meets alternative therapy in a doctor-owned day spa. Because this beautiful spa is housed adjacent to a medical practice, patients can book services their doctors recommend without having to independently search for a therapist. Physicians and wellness practitioners collaborate in an effort to help patients improve their wellness. What could be more soothing than that? In addition to the usual medi-spa menu, Nova offers acupuncture, photo-rejuvenation and houses a naturopathic pharmacy.

Lofty Salon and Wellness Center
354 Maple Ave., Vienna
703-242-0609; www.loftysalon.com
Thinking of having a little work done, but don’t know where to start? Call Lofty. Owner Mona Harb has partnered with the Bitar Cosmetic Surgery Institute, to create a medi-spa/salon that provides everything from hair styling to massage therapy to surgical consultations. But beauty is more than skin deep at Lofty. This warm-hearted spa has a whole host of wellness services designed to help clients feel happy and healthy, including personal trainers, yoga classes, belly dancing, and life-coach consultations. The hand-holding is free.

Girls Night In—Brides and Showers, Too!
Spas are fun—and what better way to relax than to reconnect with the people you love? One of the biggest trends in the spa industry is the spa party. Most spas accommodate groups, but these spas make it their business to help you party pretty.

Elizabeth Arden Red Door
1101 South Joyce St., Arlington
703-373-5888; www.reddoorspas.com
Now that Tiffany & Co. sells affordable silver, the Holly Golightlys of the world go to Elizabeth Arden for that princess buzz. When they do, they bring their girlfriends. Arden does more spa parties than anyone and they have it down to a fine art. These “sparties” are so seamless that even the hostess can relax. The Red Door in Arlington, a relatively small spa for Elizabeth Arden, has hosted corporate sparties for up to 80 (using mini-treatments). For full-service treatment parties, consider eight to 10 guests. On Monday evenings at this location, sparty guests can have the spa to themselves at no additional charge.

Modern Day Spa
7856 Tysons Corner Center, McLean
703-356-6995; www.modernco.net
For a spa with numerous locations, the customer care at Modern Day Spa is second to none. Don’t let the waiting area deceive you—this is an expansive spa with a huge pedicure treatment room designed to host large groups. Modern serves wine and champagne to guests as they get pretty in comfort and style. They have an equally large relaxation room where tired mall shoppers are invited to sample products, drink tea and relax even without booking a spa appointment. You’ll come out smiling since Modern offers Zoom teeth whitening performed by a dentist in the spa.

Natural Spas
The trend these days is toward natural healing using essential oils, organic products, recycled materials and detoxification. Here are two spas that offer all that and then some:

Natural Body Spa + Shoppe
4100 Wilson Blvd., Arlington
703-243-4015; www.naturalbody.com
Relax with a clear conscience at these earth-friendly spas in Ashburn and Arlington. The Ashburn shop has only been open two months, but is already generating buzz because of its environmentally conscious building design (they’ve applied for LEEDS certification). Everything is recycled. The floors in the treatment rooms were school bus tires in a former life, which keeps the rooms warm and quiet. It’s the only wind-powered spa in the area. The retail shop sells an array of natural beauty products including Jurlique, the bio-dynamic line of rose-infused products from Australia.

Comfort and Joy
9514 A Main St., Fairfax
703-425-8800; www.comfortjoy.com
Open the door to Comfort and Joy and enter a restful world of chemical-free beauty. Owner Julie Smalfelt has created a spa that appeals to the general public and is safe for those with immunological issues or severe allergies. Even the water is triple-filtered. This is the place to go for formaldehyde-free manicures (that actually last), henna dyes and detoxifying wraps. Comfort and Joy also offers energy medicine, Thai yoga massage and Ayurvedic healing. Shop here for Suki products, and Amrita essential oils.

Creative Spa Experiences
Experienced spa-goers are always looking for novelty in their relaxation experience. While we didn’t uncover anything as weird as barbecue sauce massage—you’ll have to head out West for that one—there are plenty of local day spas offering unique services. Here are two that wowed us.

Ritz-Carlton
1700 Tysons Boulevard, McLean
703-506-4300; www.ritzcarlton.com
What isn’t great about the Ritz? The decor is stunning, everyone from the doorman up is gracious and the food is terrific. The Ritz-Carlton has long been a destination for brides thanks to their inimitable multi-day bridal packages. But they also have a marvelous spa luncheon. It includes a half-hour relaxation treatment, usually something that won’t ruin your hair, and a gourmet lunch served poolside. Just think how productive you’ll be after that heavenly experience. Members of the Ritz’s new fitness club receive discounts in the spa. On weekends and school holidays, teens love to come to the Ritz for their ice cream pedicures using Me! products.

McLean Face + Body
6707 Old Dominion Drive, McLean
703-761-0100; www.mcleanfaceandbodyspa.com
While most spas are growing, Maria and Randy Gould have decided to take theirs in the opposite direction. This sweet spa is two treatment rooms and a relaxation lounge decorated with Mark Mentzer originals—Mentzer is Maria’s brother. Book the Signature Three Hour Vacation with a friend or loved one and the spa becomes your own private oasis. Bring wine, order a meal—this is a place to uninhibitedly relax and reconnect. The treatments are completely customized. Athletes love Randy’s “tune-up massage,” a combination of Swedish, deep tissue, trigger point and hot stone. Maria’s signature facial is 70 minutes of “pampering with top of the line skin care.”

(May 2007)

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A Frown Turned Upside Down

Posted by The Editorial Desk / Monday, December 8th, 2008

One Woman’s Adventure in Plastic Surgery

By Elizabeth Weiss McGolerick

On the corner of Dr. Csaba Magassy’s desk in his McLean office stands a miniature statue of Venus. The plump, fleshy icon, Roman goddess of beauty and love, is an anachronism in today’s Barbie-doll slim ideal of proportion and beauty. For Ann Boyer, neither the mythological nor societal vision of beauty makes any difference to her. “I want to be who I am,” she says.

The Mind’s Reflection
And who is Ann Boyer? Originally from Britain, she is a 59-year-old educational consultant who lives and works in McLean. She is also a devoted patient of Dr. Magassy, one of the region’s most highly-regarded plastic surgeons.

On the first of November, Boyer indulged in an $11,000 birthday gift from her husband. Her elected surgeries included liposuction of the arms, a facelift, an endobrow midface lift, and a neck lift. As daunting as her adventure may seem, this would not be Boyer’s first time under Dr. Magassy’s precise knife. “My first procedure was in February 2004. I had my breasts lifted and lower eyelids done,” she says. One year later she had liposuction to the tummy, hips, and thighs. “It changed my life completely.”

Boyer says she’s not one of those serial surgery people. “I think there comes a time when you have to say, ‘That’s enough’,” she says. “I knew what I wanted. It was really in order of importance for me. I lost a lot of weight at one point quite quickly and I had really saggy breasts. Very uncomfortable.”

Boyer wasn’t looking to conform to an ideal or to stand out from a crowd, she says. She simply wanted to feel better about herself. “I’m very tall and I’m never going to be stick thin and I don’t want to be,” she says, describing the level of confidence her surgeries have given her. “I know I’m nicely in proportion now. I want to wear what I want and know that I look nice. That’s really what it is.”

Boyer had her lower eyelids done because “everyone kept telling me I had bags under my eyes, and that I looked tired.” And then she decided to undergo facial surgery, because “when I catch myself in a photograph, if I’m not smiling the corners of my mouth go down. People mentioned that I looked so sad and I hate that.”

Under the Knife
Simon & Garfunkel wafts through the O.R. It’s 9:00 a.m. on a gloriously mild November morning when a not-at-all nervous Boyer enters Dr. Magassy’s surgery center for the third time. For the next five hours, to the tunes of Bob Denver and Frank Sinatra, and with a scrubs-garbed reporter in observance, Boyer gets sliced, injected, suctioned, scraped, compressed, sewn, stapled, and bandaged.

Very few instructions are given during the marathon surgery. Each person knows their role before, during, and after the procedure. An intervenous anesthetic puts Boyer under and the journey begins with liposuction of the arms. A new combination of laser and ultrasound techniques “melt away the superficial fat as well as the deep layer [of fat],” Magassy explains. This breaking up of tiers allows for easier suctioning during the procedure. Together, the laser and ultrasound also shrink the excess skin. Astonishingly, the desired smooth, tightened surface is already visible as recovery nurses work efficiently and with great care to clean and wrap Boyer’s arms after the procedure.

Facing Change
The bulk of surgery time—more than four hours—is dedicated to Boyer’s endobrow midface lift, face lift, and neck lift. Board certified as a general surgeon as well as a plastic surgeon, Magassy says, “I actually pioneered [the endobrow midface lift] here in the D.C. [area]. I’ve done a little over 1,200 so far.”

After injecting local anesthesia into Boyer’s scalp, brow, temples, cheeks, and under her eyes, several small incisions are made in her hairline. Magassy’s intricate endoscopic techniques—meaning minimal-incision surgery done while using a tiny fiberoptic lens for visualization—allow him to separate the skin of Boyer’s face from the skull, muscle, fat, and capillaries, and slide it up and back. This procedure lifts the face vertically rather than pulling the skin to the sides. “The endobrow midface brings out the artistic qualities [of cosmetic surgery],” Magassy says. “You can truly see what the difference is—the hollows are filled in and the whole face is pulled up. Very dramatic results.”

During the surgery, Magassy sears capillaries to reduce blood loss, removes the frown muscles between Boyer’s eyes, separates the periosteum from the skull (making a scraping sound no kinder than fork tines on a plate), and inserts dissolvable implants in the cheek to pull the face up.

Before Boyer’s neck lift, Magassy administers local anesthesia around her chin and ears. He liposuctions her neck and removes extra skin and parts of her lower earlobes, tightening the understructure as well as the exterior. Boyer’s profile is magically altered as Magassy’s quick, exact stitches are set in place.

The difference in Boyer’s face from the start of surgery to the finish is quite distinct. Her cheeks are higher, her forehead smooth, the corners of her mouth turned up, her neck an easy curve. There is no stretching of the skin or strained features. She comes out of surgery well-wrapped and looking a little rough, but Boyer’s procedures have already changed her dramatically.

Handled with Care
For Magassy’s bigger surgeries—and Boyer’s makes the grade—RN Connie Worley visits patients the following day at their home, checks their dressings, reviews instructions, and removes draining tubes. Worley likes to call herself the “Reassurance Agent.” She is the right-hand woman for Magassy’s patients, interviewing them before surgery and seeing them through recovery. “If a patient is going to develop a complication, it happens in the first 24 hours,” Worley says. The home visits are unique to Magassy’s practice and a terrific perk for patients, eliminating the painful step of visiting the doctor’s office a day after surgery.

Recovering the Self
“I feel like an Egyptian mummy,” Boyer says, five days after her surgeries. “My neck is incredibly tight and quite uncomfortable but I’m not complaining. I’m so grateful to Magassy. This is going to give me a new lease on life.”

Magassy keeps close tabs on Boyer over the next few weeks, removing the staples from her hairline and behind her ears, giving her a compression garment for her arms to replace the bandages, and even re-piercing her ears since the original holes were sliced away during surgery.

“They never know how painful [recovery] is going to be because everyone’s different,” Boyer says. One month after the surgery, all the bruising on her face had disappeared, some slight swelling remains on her chin and neck, and she is still experiencing a burning sensation in her arms. “The experience has not been without pain and some days have been easier than others,” she says, “but I believe I have made an excellent recovery and it’s been more than worth it. I am delighted with the changes I see. Very subtle and natural. I have a more youthful neckline suddenly. I can actually see better now that my brows have been lifted.”

Boyer’s advice for potential plastic surgery candidates? “The most important thing is having confidence in your plastic surgeon and knowing that person is going to make you look the way you want to look. You hear about places that give special prices and sales—you get what you pay for. I’ve read about disasters but, if you look into it, you’ll find [the patients] didn’t do their homework. You’ve got to go to someone who is board certified and very experienced. Even if they’re not as experienced as Magassy, you want somebody who has a good reputation. It all sounds obvious, but it’s amazing what people don’t do.”

Magassy’s Nurse Anesthetist Debbie Richardson echoes Boyer and encourages patients to investigate their plastic surgeon. “Ask a lot of questions, make sure they have a staff that have been working together for some time, and look for a doctor who does a lot of the procedure that you want to have done.”

A Chat with Dr. Csaba Magassy

Equestrian imagery and memorabilia from Dr. Csaba Magassy’s days as an Air Force Thunderbird decorate his spacious McLean office. The initial consultation begins here, doctor and patient sitting side by side, discussing what bothersome feature brought the patient in.  “I usually draw for them,” Dr. Magassy says. Using only pencil and paper, he’ll demonstrate how he can change the shape of a person’s face or body. Watching him, one realizes the man is an artist at work.

Board certified by the American Board of Plastic Surgery and in practice for 32 years, Dr. Magassy exudes confidence and possesses a gentle demeanor. “It’s a luxury service, cosmetic surgery,” Dr. Magassy says. Even so, “It takes a great deal of courage for a patient to come and see a plastic surgeon. I’m not here to destroy their ego.”

However, Dr. Magassy will tell a patient if his or her wishes are unrealistic, oftentimes suggesting an alternate course of action that, ultimately, gives the patient more “bang for their buck.” There are occasions when he is forced to turn people down. “Someone who is trying to look for nirvana—I know I won’t be able to accomplish that. They’re looking for something that’s unattainable,” he says. “But I would say 90 percent of the patients are fairly realistic in their approach.”

This solid patient base, from teenagers (mostly nose jobs) to the elderly, has helped to build Dr. Magassy’s sound reputation. The majority of his patients come from referrals and 30 to 40 percent are repeat patients. “I have a pretty good feel about what’s going on and a very good rapport with most patients. You just see them through and do the best you can.”

Surgeries begin in early morning—usually one or two majors a day—and take Dr. Magassy into the afternoon when he meets with patients. “After that,” he says, “I usually go and ride. I still compete in horseback riding. That’s my therapy.”

Don’t be Afraid to Ask Your Doctor

We’ve all been there: overwhelmed, in the doctor’s office, thinking we’d remember everything we wanted to ask. Meeting with a plastic surgeon is no time to skimp on questions. Take this list with you to your appointment and realize there is no query too big or too small when it comes to physically altering your body.

Are you certified by the American Board of Plastic Surgery (ABPS)?
What are your hospital privileges?
Is your facility accredited?
What experience do you have in performing this procedure?
What are the possible risks?
What is the expected recovery for the procedure?
What is your policy on surgical revisions?
How much will the surgery cost?

Nonsurgical Procedures

The definition of cosmetic surgery has broadened.  Find out what it takes to shave off a few years and reclaim a more youthful look—without surgery—and how it’ll affect your budget. Here are some of the most popular skincare and nonsurgical procedures available today.

BOTOX (AVERAGE COST: $382 PER PROCEDURE)
Temporarily paralyzes facial muscles and flattens wrinkles, particularly frown lines around eyes and on the forehead. Results: temporary; repeat treatments every 4 to 6 months

CHEMICAL PEEL (AVERAGE COST: $848)
Removes damaged outer layers of skin; smoothes and improves skin’s texture due to uneven pigmentation and damage from sun-exposure, acne, and aging. Results: long-lasting; may require more than one peel

COLLAGEN (AVERAGE COST: $398-488)
Treats fine lines and wrinkles, often around the mouth; creates fuller lips and softens scar tissue. Results:
temporary; repeat treatments every 3 to 6 months

LASER HAIR REMOVAL (AVERAGE COST: $347)
Disables hair follicles while sparing surrounding tissues; light-skinned, dark-haired candidates often fare best. Permanent hair reduction is possible. Results: ongoing; usually requires multiple sessions

LASER SKIN RESURFACING (AVERAGE COST: $2,484)
Minimizes appearance of fine lines and wrinkles; treats skin damaged by sun, acne, and age spots. Superficial burns allow new, smooth, wrinkle-free, living cells to replace dead skin cells. RESULTS: long-lasting; may require more than one treatment

MICRODERMABRASION (AVERAGE COST: $149)
Polishes away dead skin cells; promotes new growth and exposes healthier skin. Can diminish fine lines and wrinkles, unwanted skin pigmentation, sun damage, and acne scars. Results: temporary after multiple sessions in 2 to 3 week intervals

RESTYLANE (AVERAGE COST: $527)
Restores volume and fullness to skin to correct facial wrinkles and folds. Results: temporary; repeat treatments every 4 to 12 months

SCLEROTHERAPY (AVERAGE COST: $326)
Eliminates varicose veins; may remedy symptoms associated with spider veins—aching, burning, swelling, and nigh cramps.  Results: permanent; requires multiple treatments.

(April 2007)

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