Hole in One

Child dentistry procedures tackle more than cavities

By Tracey Edgerly Meloni

Seven-year-old Maya doesn’t even have permanent teeth yet, but she has spent much of her life at the dentist. Born with a rare, lifelong condition that causes brittle bones and fragile teeth, Maya has experienced extractions, fillings, crowns, infections and fractures. She plays happily in the waiting room and looks forward to her reward sticker—and she is grinning.

This is not your mama’s childhood dentistry. Area dentists for kids are highly trained specialists, able to handle it all from the usual, like fillings, fluoride and impacted wisdom teeth, to conditions like Maya’s. From too many teeth to too few, cleft palates to facial anomalies, any need has a matching set of specialists.

Early Canine Impactions
Ashleigh Ferguson is active and bubbly, looking forward to her 12th birthday with a confident smile. “She gets many compliments about her teeth and how pretty they look,” says her mother, Tammie, of Lansdowne. But that might not have been the case without orthodontic intervention and a sound relationship with Dr. Rana Barakat, the Sterling-based orthodontist first consulted when Ashleigh was 8 years old. Early diagnosis revealed Ashleigh’s severely impacted upper canines, or “eyeteeth,” as well as a crossbite.

The American Association of Orthodontists recommends an initial orthodontic evaluation around age 7, when permanent first molars have erupted. Barakat determined that Ashleigh’s teeth “did not fit together properly, that she had severe crowding in her upper jaw, and she had impacted upper canines.” Ashleigh’s narrow smile and misaligned jaw presented problems, “and the upper permanent eyeteeth were positioned such that they would not erupt on their own.”

At the first consultation appointment, Barakat determined that it was too early for treatment, and recommended waiting for further dental development and growth. “A year later, I re-evaluated Ashleigh, and she was ready for treatment. Ashleigh’s dental development determined the timing of treatment, and hers was more advanced than her peers,” she adds.

“Dr. Barakat used X-rays, photos and models,” Ferguson says. “She used a computer-simulated program as a visual aid and explained the pros and cons of doing this treatment at a young age compared to waiting until Ashleigh was a teenager. Barakat made sure I understood every aspect of this treatment. I felt as if she was truly doing what was best for my daughter.”

Barakat’s office is not only state of the art, but also fun. Parents like the distraction of computer games in the reception area as much as kids, and Barakat’s exciting contests make for great rewards.

Barakat says Ashleigh’s treatment consists of two phases. Phase I lasted 18 months and concentrated on widening her upper jaw using a palatal expander, limited braces to manage her impacted upper teeth. “Once the expander process was complete, we referred Ashleigh for removal of her upper baby canines and exposure of her impacted upper permanent canines. This procedure lasted around 30 to 60 minutes, during which the impacted teeth were exposed, attachments were placed on the teeth, and the incision closed,” Barakat explains. “After healing, I began bringing both of her impacted canines into position, using the attachments. Once the teeth were visible, I changed the attachments to braces, and aligned the canines.”

After about 18 months of treatment, Ashleigh was given a retainer to wear at night “to maintain new tooth alignment, while the remainder of her permanent teeth erupt.” The outpatient exposure procedure was done under local anesthesia. “Some patients elect to be put to sleep or given a sedative,” Barakat says. “Healing from the procedure is about two to three days, during which the patient generally sticks to a softer diet and stays away from vigorous physical activity.”

To complete her treatment, Ashleigh will be required to go through Phase II in order to fine-tune her bite and get the final tooth alignment. “She is now in a position to have a much shorter time in full braces,” Barakat says.

Brittle Bones, Fragile Teeth
“Seven-year-old Maya Simbulan has Osteogenesis Imperfecta [OI], along with Dentinogenesis Imperfecta [DI],” says her mother, Jennifer. These are going to be “lifelong problems for Maya, and so we take care of her teeth with good dental care and hygiene.” Fairfax-based pediatric dentist Dr. Sherry Sharif was Jennifer’s choice.

“Dr. Sharif has a great staff, with gentle hands, happy faces and a kid-friendly office with TV and toys for distraction,” says Simbulan, who has a good understanding of Maya’s condition thanks to Sharif.

OI is called brittle bone or fragile bone disease. “Patients are prone to bone fractures. They have short stature, triangle-shaped faces and blue sclerae [whites of eyes],” Sharif explains. “They have hypermobile joints and vertebral collapse. Their teeth have yellow/translucent color. They may also have congenital heart defects.”

Maya’s treatment is ongoing, with regular recall visits. “Also, she develops dental abscesses due to her weak teeth and needs treatment such as extractions or stainless-steel crowns. She does not yet have any permanent teeth, but her primary teeth are yellow-amber/translucent color particular to DI Type I. Her permanent incisors should come in with normal length and contour,” Sharif shares.

Asked about the risks involved, Sharif says, “risks are very minimal if proper infection control protocol and minimally invasive technical procedures are adapted. General anesthesia nowadays administered by pediatric anesthesiologists at Fair Oaks Hospital is very safe and effective.” She adds that it provides peace of mind for the families of an apprehensive child.

Jennifer is satisfied. “Maya has dental visits every three months for checkup and fluoride treatment. She also has cleaning every six months. She has been on antibiotics on several occasions for abscesses and currently has one root fracture, which we are just observing for now.”

Teeth Extraction
Children and adolescents with special needs find a perfect fit with Dr. J. Daniel LaBriola of Fairfax Station. While not primarily a children’s dentist, the Northern Virginia oral/maxillofacial surgeon and his associates can put their unique talents to work in special circumstances. They are able to uncover teeth out of position for orthodontists to follow up, and they use case-specific anesthesia techniques for many types of special-needs patients.

Laurie Moore of Goldvein happily traveled some distance to take her autistic son, Chase, to LaBriola’s offices. “Chase is a gentle giant,” explains the proud mother. But the 18-year-old, standing 5-foot-9 and weighing some 240 pounds, needed just the right practitioner when it came time to remove his wisdom teeth.

“We had some pretty negative experiences before finding Dr. LaBriola,” she goes on to explain. “Right away, he knew just what to do, and to do it fast. The rapport was wonderful. He understands Chase’s needs and anxiety.”

Moore adds that LaBriola will be her pick to work with Chase again on anesthesia for any potential future dental needs.

“We like to have a consultation visit to get a feel for the needs of a child with a routine tooth removal,” says LaBriola, adding that knowing the child’s anxiety level helps determine how to proceed: “Local anesthesia, sedation with nitrous oxide, or is there a need for a general anesthetic.”

Consultation, however, isn’t always a possibility. In cases of emergencies, where the child is in severe pain or has an acute infection, “then we proceed, maybe starting with laughing gas.”

“Most children’s procedures are over in a matter of minutes—the treatment is short and sweet.”

LaBriola adds that dental risks in kids are notably different from those of adults. “They can get in trouble fast. An infection can become life-threatening quickly in a child.”

Risks of bleeding and post-op infection are also greater in children if proper precautions are not taken.
Further, “children have difficulty communicating their needs,” LaBriola notes, especially when a hospital day or night visit is involved. “We make sure they are properly hydrated, taking in calories, able to go to the bathroom, and have pain control” before releasing them, although usually the hospital stay is no more than a single night.

All agree that the best way a parent can ensure lifelong dental health for a child is to invest time in conducting the appropriate amount of research, find a dentist in your region with the right rapport, office and training for you and your child, and to start visits early.

Our Dental Experts

Rana Barakat, DDS
45745 Nokes Blvd., Dulles; 703-433-9330; www.barakatorthodontics.com
DDS, University of Tennessee 1994
Diplomate, American Board of Orthodontists
12 years in practice

Sherry Sharif, DDS
3700 Joseph Siewick Drive, Fairfax; 703-620-9122
DDS, Howard University 1993
Diplomate, American Board of Pediatric Dentistry
12+ years in practice

L. Daniel LaBriola, DDS
5619 Smoke Rise Lane, Fairfax Station; 703-978-7013
DDS, Georgetown University 1976
Diplomate, American Board of Oral and Maxillofacial Surgery
28+ years in practice

(November 2008)

Tags: child dentistry, Dentist, Health & Beauty

Skin Deep

Vanity takes a backseat to necessity when cosmetic skin surgery saves lives

By Pam Lettie

For Sgt. Robert Bartlett, reconstructive plastic surgery allowed him to speak. He can feel his wife’s kisses. He doesn’t drool.

Bartlett is a calvary scout sniper who was riding in a truck in Iraq when a bomb hit the truck, taking off half his face. Bartlett was missing almost all of his bottom lip and lower eyelid, the front of his nose, plus his left eye—to say nothing of the injuries to the rest of his body. For three weeks, the soldier was unable to communicate. He died and was revived three times.

Bartlett regained his ability to talk and even speaks to large groups, making sure that the war—and our soldiers—are not forgotten. He’s lost count of the number of surgeries to fix his face; 15, maybe
20 operations.

For most of us, plastic surgery will not make such a dramatic difference in our lives. Still, many of the procedures are more than skin deep, some offering life-saving treatments for cancer. Technological advances may grab the headlines, but solid centuries-old techniques remain the doctor’s regular tools. When analyzing sun damage, removing cancerous moles, reducing the appearance of scars and using skin grafts, physicians combine old and new technology to serve patients.

Sun Damage Reversal
Board-certified dermatologist Dr. Nicole Hayre of the Cosmetic Dermatology Center in McLean says old-fashioned evaluation works best to analyze sun damage. She looks at the patient’s skin. Brown spots, freckles, dilated blood vessels or red marks, large pores, poor skin texture and wrinkles are signs of damage.

For a solution, she often turns to a device called “Portrait.” Hayre is cautious about new technologies. She doesn’t bring anything into the office that she wouldn’t use personally.

“It’s better to have a wait-and-see attitude. You really want to know what the probability is of having a side effect.”

Portrait looks like a handheld laser fired at the skin, but uses plasma, an energized gas.

Through a controlled heating of the upper layers of skin, Portrait induces the lower layers of skin to build new collagen and repair itself. The intensity can be adjusted for a single high-energy treatment or a series of low-energy treatments depending on the needs of the patient—lifestyle, plans, family, skin quality, extent of sun damage, patient’s age.

It takes about four months after the procedure to start looking amazing, but patients improve for up to a year, Hayre says.

Andrea Orlando decided to have a high-energy Portrait procedure over Thanksgiving 2007. “My chin and around my mouth—the lines around the smile lines—looked really bad to me. I had had moles removed when I was younger, and the scar tissue puckered. I was really self-conscious. The procedure is not like a walk through the park, but it’s not painful. When it’s over, you feel hot, like a bad sunburn, but that goes away after a couple hours. Then you have beautiful baby skin. It’s a little pink. It’s like being a teenager again.”

But the change for patients can be more than skin deep. “I’ve had some really big transformations over the years in the office. I’ve seen people come in with new hair styles; they’ve lost weight, wearing more fashionable clothing,” Hayre says.

“It just makes me feel great. I love doing this.”

Portrait Resurfacing
Best candidates: On high energy, patients with significant damage, more laxity in skin and deeper lines benefit most. On low energy, almost any patient could benefit.
How it’s done: Patient sits with hydrating gel (for low energy) or numbing lotion (for high energy) on his or her skin for an hour. After washing gel off, the laser is pointed at one section of skin after another.
Length of surgery: 15 to 20 minutes
Recovery time: Sunburn feeling for one to three hours. Avoid sun for a couple days. On high energy, patients usually stay in for a week. On day five or six, sloughing removes skin that looks like a mask, leaving pink skin underneath. On low setting, there is no downtime.
Cost: $4,000 to $6,000
Potential side effects: Pink coloration, peeling or a sunburned feeling. Scarring is always possible, but uncommon, if patients follow instructions.

Mole Removal
As Hayre works to repair the visible effects of the sun, Dr. Martin Morse, a Great Falls plastic surgeon, attacks the most serious cancers that are products of sun. The American Cancer Society says that most of the more than one million cases of skin cancer are sun-related. Skin cancer is the most common type of cancer, although it is treatable when caught early.

The majority of skin cancers appear as a lesion on the skin, but can grow out of pigmented skin, such as a mole. Most moles are harmless, but certain symptoms—increased size, itching, ulcerated skin, color change and irregularity of shape—might prompt a trip to the dermatologist or family doctor to biopsy and check for cancer. With a diagnosis of cancer, the patient may be referred to a specially trained dermatologist for a Mohs excision or to a plastic surgeon for excision and reconstruction.

Morse usually sees patients on referral from a family doctor or dermatologist after the patient has a diagnosis of cancerous/precancerous cells or after a Mohs surgery for reconstruction. He removes cancerous lesions, including lesions found on moles. Morse warns patients that, while insurance companies will cover mole removal if it is cancerous, paying to remove a benign mole falls on the patient.

For the most common skin cancers, basal and squamous cell, the surgeon removes a small area around the legion. This procedure is often done in the office with local anesthetic. But for more aggressive cancers—melanoma or a larger basal- and squamous-cell legion—a wide local excision would be Morse’s recommended approach. The wide local excision usually takes place in a hospital and requires some reconstruction to put the skin back together, either with stitches, a flap or skin graft. A pathologist reviews four points and the base of the excised lesion to make sure there is a cancer-free margin. A final review of the surrounding tissue takes place within a couple weeks, but usually the margins are free of cancer. If not, another excision may be called for.

While there are new laser treatments, Morse doesn’t recommend those. They destroy the lesion, so there is no way for the pathologist to determine whether the margins are clear of cancer.

Wide Local Excision
Best candidates: Patients referred by a physician who has performed a partial biopsy
How it’s done: Mole or lesion plus an area around it is removed.
Length of surgery: 45 to 90 minutes
Recovery time: One month to heal 90 to 95 percent. Stitches are removed in about a week; avoid sun, and wear sunscreen for six to 12 months.
Cost: $1200 for lesion removal and closing the wound
Potential side effects: Risk of infection; about 5 percent of the facial grafts don’t take; also skin may not match in texture or color.  Infection, bleeding or scarring. Risks specific to this procedure include recurrence and injury to associated blood vessels or nerves.

Skin Grafts
For skin cancer patients, repairing the aftermath of surgery can be as simple as letting a site heal on its own or suturing it. For cases where that isn’t enough, a surgeon can bring a flap of skin from nearby. Skin grafting, moving skin from one part of the body to another, is the last resort.

A number of Dr. Steven Rotter’s skin-cancer patients have benefited from grafting, as have patients of Morse. Of the Center for Skin Surgery, Rotter’s been performing dermatological surgery for 16 years, and has his own outpatient surgical hospital, the Skin Cancer Outpatient Surgical Hospital, where he performs the surgery.

Rotter describes skin grafting as a procedure that’s been around for 100 years and is still effective in helping patients. Skin grafts fall into two types: split and full thickness. Split-thickness skin grafts can cover large areas. The cosmetic result is not as good or as durable, but only leaves a rope burn from the area where the skin is removed. A full-thickness skin graft uses the full thickness of the skin, is best for cosmetic reconstruction and is what Rotter uses almost exclusively.

The surgeon looks for inconspicuous skin that matches missing skin. He numbs the area and cuts out the skin that needs to be moved. From there, the skin is trimmed to fit the area of missing skin, then stitched in place.

Joe Whitaker of Fairfax Station had severe skin cancer on his ear. After having the cancerous legions removed with a Mohs surgery, Whitaker was missing the outside edge and bottom of his ear. After allowing the area to heal two to three months, Rotter did the first of two skin grafts to repair the ear.

Whitaker describes his cosmetic-surgery experience this way: “It’s been two skin grafts, one on the top and front of the ear, and one on the back. I literally didn’t have an ear until he did this. He did a great job, given what the problem was. I was pleasantly surprised. I’ll tell you, look at the picture of my ear from what I left with after surgery and what I have now. It’s an amazing difference. My ear was penned down, but now it looks like a normal ear.”

The most painful part of the process was a local anesthetic used to numb the site, Whitaker says, and the biggest inconvenience was that he couldn’t take a shower for seven days after each graft.

Skin Grafts
Best candidates: Patients whose wounds are too big for stitches or a flap; those with a contracted scar that needs to be expanded
How it’s done: Skin is moved from one area to another by cutting and stitching.
Length of surgery: 20 to 45 minutes
Recovery time: Four to six weeks for area to look good
Cost: Medicare pays $500 or so as a reimbursement, Rotter says.
Potential side effects: Risk of infection; about five percent of the facial grafts don’t take; also skin may not match in texture or color.

Scar Revision
When a patient comes to Dr. Behzad Parva of Leesburg to fix a scar, educating that patient is Parva’s first thought. He wants to be sure that clients realize that a plastic surgeon can’t make a scar go away.
“We are not removing a scar, we’re revising it. We’re minimizing
its appearance.”

Scar revision was the third most common reconstructive surgery in the United States in 2007, according to the American Society of Plastic Surgeons. Parva evaluates the location of the scar and the effect of surrounding tissue and structures. The visibility of a scar is determined by irregularity in skin, shadows cast and the effect of surrounding facial structures. For example, a tight scar might pull on an eye and draw attention.

For some scars, the direct approach of reopening the scar and restitching it could make it into a finer line.
Other scars require more elaborate tissue rearrangement. A skilled surgeon makes geometric incisions to free skin on as many as three sides, then shifts surrounding tissue to minimize scars, to conceal them in a natural skin line or to alleviate tightness.

The scar-revision technology has been around for centuries. The procedure is usually performed under local anesthetic in the office. For more significant scarring, general anesthesia may require a surgical setting.
Patient Roger Aaron of Winchester came away pleased with the results. Cosmetic surgery earlier in his life left Aaron with a large scar on his face. He tried permanent makeup—a form of tattooing—but that only made it look worse in his case.

“It just widened tremendously over the years. It turned white, you know, as it stretched. It got worse and worse. Dr. Parva did a marvelous job. He does it right in the office with a local anesthetic. They make a cut at the scar area and pull the top layer of skin over. I’m just really delighted not to have this scar.”
Parva would be quick to point out that, while the scar is still there, it’s now disguised by the face’s natural structure.

Scar Revision
Best candidates: A scar needs to be at least a year old. Otherwise, it’s still healing.
How it’s done: The physician makes an incision. The freed skin is shifted to make the scar less noticeable.
Length of surgery: For a scar that is a couple inches long, less than 45 minutes.
Recovery time: Stitches and dressing need to be monitored for about a week. Patients need to use sun block and a scar-minimizer, such as a topical silicon or vitamin-E oil.
Cost: Five hundred to several thousand dollars, depending on the size of the scar and whether general anesthesia is needed
Potential side effects: Risk of infection. For extensive scars, the scar might separate or not heal well and require wound care. Diabetics or smokers have higher risk of complications.

Tags: cosmetic, Health & Beauty

Shine On

Because it’s simply easier to make do with the gleam of a beauty do-over

By Susan Anspach / Photography by Jonathan Timmes

Long before we steadied the shutter for the first of the Fall Makeovers “before” shots, we turned to you to find who among your educators, spouses, business professionals, sons and daughters could most benefit from a boost in the form of a fresh look.

The call for candidates went out on a Tuesday. By Wednesday afternoon, we feared the floodgates falling clean off. Suffice it to say, there was no lack of interest, because—let’s face it—hardly any among us couldn’t use a buffer. When it comes time to shine, it seems, all Northern Virginia needs is a glimmer of incentive.

Melissa Sorensen

Age: 39  Location: Woodbridge  Occupation: Owner of Insightful Solutions
Procedures: Vertical mastopexy, six labial porcelain veneers, two porcelain crowns, bite equilibration, outfitting, hair cut and color, makeup

An eight-year ‘roller coaster’ brought nearly a decade of rises and cancerous falls

When prompted to offer an overview of information on the past few years of her life, 39-year-old Melissa Sorensen of Woodbridge only speaks for about a minute before veering the course of conversation toward her husband, retired Army Lt. Col. Scott Sorensen, and the fight against the pulse-threatening attacks on his body the couple’s past eight years have seen.

The dates tracking the progression of his battles with both bone marrow and esophageal cancer—first diagnosis, June 2000; the second, January 2006—she can rattle off in rounds. The progression of a series of setbacks—last-minute transplant match fallouts, aborted surgeries, blocked and leaking chest tubes, bout after failed bout of chemotherapy and radiation—she dictates in as clear and as neatly even a tone as a seasoned broadcast reporter.

Still, when she considers the moment she first heard her husband voice the word “leukemia,” “I get the same feeling in my stomach, like going up and then coming down on a roller coaster, leaving part of yourself behind you … I still get that same feeling looking back that I felt that day.

“He was 38; I was 31. It could not have been more out of the blue.”

Scott passed away on May 1, a little more than one month after having entered his wife into the Fall Makeovers contest, and nearly a decade since the Sorensens first set out to tackle what would prove to be his fatal health setbacks. In a March email to Northern Virginia Magazine, Scott wrote, “I am truly convinced that I would not be walking around today if it were not for her. There may, in fact, be someone out there who is more deserving of one of your makeovers, but I would not know who.”

Open arms,Open mind: A caregiver agrees to a comeback
Upon the April receipt of the makeover win, Melissa said she was “dumbfounded … exceedingly shocked.” She wasn’t the one who’d suffered cancer, she pointed out. She couldn’t describe the physical sensations accompanying a round of radiation; nor could she put into words what a bone-marrow transfer felt like. “I thought [Scott] would submit the letter, and I’d be reading about someone else six months later in the magazine.”

Still, as a caregiver, Melissa admitted to a deep exhaustion underlying her seemingly up-tempo energy. “I’m tired,” she said. “I would just like something new. And by new, I don’t mean new clothes, but just a new, different experience. Something totally out of the ordinary than what I would ever do for myself.”

Before

Melissa, a self-employed certified professional organizer, cited only a few absolutes in terms of off-limits beauty experiments. What she was after, she explained, was something that matched her down-to-earth, no-nonsense personality. “I’d prefer not coming out with a mohawk. I am, so much, what you see is what you get … I feel time is better used elsewhere than primping and preening in front of a mirror.”

After Scott passed away, Melissa accepted the terms of the makeover. Consulting family members strongly encouraged her to go through with the beauty treatments. “They said that this is what Scott would want,” Melissa said. “He took the time to write a letter, and I feel like I want to follow through with it.”

A light lift, fresh face and new spin on a color wheel
Melissa’s out-patient vertical mastopexy included a small reduction in a combination procedure that was “virtually effortless,” according to Sterling-based cosmetic surgeon Dr. David Berman. “Every surgery has a risk, but with plastics, there are general formulas to follow.”

Her crowns and veneers, compliments of Sterling’s Protech dental studio, were put in place by Alexandria cosmetic dentist Dr. Charley Varipapa, who also equilibrated her bite. “She had some old bondings, some spaces, some pointy eye teeth we wanted to deal with,” Varipapa explained as he hovered over Melissa’s mouth, installing her permanents as he pointed out the special attention paid to alignment, durability and the “punchy realness” of the halos, or translucent strips rimming the bottoms of the teeth. “At the same time, you’re trying to be as conservative in dental work as possible, to do just the right amount, so that you not only look good, but are able to function … All set?”

Melissa pulled herself upright, studied her mouth in the mirror. “Thank you,” she said, flashing two rows of white.

“They’re you,” he nodded. “They’re your teeth.”
Her ensemble she selected courtesy of J. Jill, whose Tysons branch store manager Reshea Neal fitted her for a “desk-to-dress” outfit, “something I can wear with a client but then if I want to go to dinner, I can go to dinner.”

“I’m in a rut, I’ll just put it out there,” added Melissa, who said she tends to hide behind muted or earthy tones. “When I first met my husband, it took two months before he finally said, ‘Do you own anything other than black?’”

In selecting an outfit, Neal made note of Melissa’s gold and green shading. “Greens and yellows are good for her, and if you can wear yellows, you can wear reds because it’s a complement,” she said, pulling a patterned red top off its hanger.

“This is something that will take her into another season but still be versatile, good for business.”

For purposes of hair and makeup, PR @ Partners’ Fresh Look Director Mary Shaffer Clendaniel first went to work adding volume and movement to Melissa’s strands. “Fine, limp hair benefits immensely from hair color. It is the best tool to get more lift.” Working with a rich, auburn shade with honey-gold highlights that play up Melissa’s eye undertones, Clendaniel fashioned a long pixie style that combined razored edges and sharper textures. “Also, the diagonal lines I used give her the option of parting on either side, and wearing bangs or not.”

Since Melissa typically wears very little makeup, “I wanted to give her some options to work with without making her feel like a painted lady,” the stylist said, ticking off a recipe of primer, moisturizer mixed with a light, diffusing foundation, all topped with loose powder—“the best way to get a summertime face that’s fresh.”

Making time to get to know ‘a more modern me’
Her first word that came to mind was “different: It’s me, but different.” Her first thought: “I want to go home and tell Scott.”

Instead, Melissa, who made the decision to be made over at her mother and sister’s urging, would return home to her neighbor, “who was just awestruck. She was like, ‘Oh, my God. You look fabulous!’ Then she dragged her husband over to see me.”

While Melissa said she has happily acquainted her old self with her new look—“this is probably me with an edge, a more modern me”—the leeway she lent her beauty pros brought about an image she couldn’t immediately identify. “During the shoot at one point I saw myself on the screen, and I kind of had to do a double take,” she laughed.

“I was fine going a little outside my comfort zone, since I was pretty much a hair virgin. In my 40 years, I think I’ve only highlighted twice. And the tray of makeup that [Clendaniel] brought out … I was like, Oh, God, OK, now we’re in trouble.”

Her makeup tips, she took to heart. “It was like, the dot to dot, down to my level.” The hair, she “definitely” plans to maintain—especially in light of a prep time that doesn’t nudge back any little hands. “She cut it so that it was versatile, so I can do it quickly in the morning, dress it up for the evenings.”

Some of which she’s now finding she can now devote to her own person. “I’ve spent two-and-a-half years not doing anything for myself,” Melissa said. “For me, it was very much a treat to have somebody even doing my hair.”

Stefanie Cardillo

Age: 22  Location: Arlington  Occupation: Nanny and college student
Procedures: Chairside teeth whitening, replacement fillings, outfitting, hair cut and color, makeup

Coming home again: Striking out on her own at school brought setbacks
Expectations are something that 22-year-old nanny Stefanie Cardillo tries to keep at arm’s length. In her past four years, split between home at Blacksburg and home in Arlington, hers have veered far from what she once considered par for course.

She began work on her bachelor’s at Virginia Tech in 2004, where “I didn’t have a huge group of friends, but a good, closely knit group that I adored,” Stefanie said. Summers and school breaks between semesters were spent tackling odd jobs at malls; during the academic year, she chipped away at credit requirements for her English major. The downtime always came as something of a relief, she explained, as she was fighting against what her psychiatrist at the time believed to be clinical depression, but was re-diagnosed in November of 2006 as being bipolar disorder.

A dangerous reaction to a revised regimen of medication that fall was then toppled by what her mother describes as the emotional upheaval of having her best friend shot in the hand the day of the school’s violent April 2007 incident. Though she was able to finish out the spring semester, “I didn’t have the knowledge or the tools to handle what was happening, so I let myself fall back down.”
Because of the two sharply negative setbacks, the summer of 2007 proved to be “basically a battle” between Stefanie and her mother and father, both of whom, by this time, were urging her to remain at home for the fall to seek local counseling.

Stefanie won out and moved back to Virginia Tech, where it took her less than a few months to realize what she now considers a mistake. “I got fired from my job, and I crashed.”

Last November, she called her mother in tears. “She asked me, ‘Do you want to come home?’ Yeah. I did … Finally this time, I was like, OK. I’m not good here.”

Waffling energy and wavering enthusiasm mean taking on one day at a time
Patricia Cardillo, who didn’t tell her daughter she was nominating her for the makeover at the time of entering her, sat her down with the news of the win in April. “Wait, am I in trouble?” Stefanie had asked. “No, but I may be,” her mother said.

Before shot

“Initially, it was like, Wait, you think I need a makeover?” said Stefanie, today a Northern Virginia nanny of two. “It was about 20 minutes later that I got really excited.”

According to Patricia, she threw her daughter’s name and story in the ring in the hopes of boosting her energy more than anything else. “I know she’s worn out,” she said. “She says she’s tired of being sick … I’d love to give something special to Stefanie to show her how good things can happen, too.”

Her daily routine before the mirror is basic at best, Stefanie said, and varies based on her morning energy levels. “Some days I do really good … Most days, not so much. Once or twice a week I try and look nice. I shower, actually blow-dry my hair instead of just letting it air-dry, wear makeup. Cover-up and eyeliner, because I don’t know how to work the other stuff.” Her wardrobe she described as “definitely casual.” “I don’t think I have a ‘look.’”

Nor does the lifestyle for which she’s striving. Stefanie said she isn’t sure what the coming years, or even months, hold for her social and professional life. She knows she needs to complete her bachelor’s, and wants to pick up college courses locally in child psychology, but it’s unclear as to when the degree will be completed, or what she’ll do with it once it’s in her grasp. She said she hasn’t quite formulated the image she wants to convey, since she can’t as of yet identify the beholders.

As such, “I’m willing to try anything,” said Stefanie, who added she most wants to simply enjoy the procedural components of the makeover. She suspects that, after all, is the other reason her mother nominated her in the first place. “I think my mom just wants to see me happy … I haven’t been happy for a while.”

Tending to beaming eyes, textured ends and bringing out a smile
Stefanie’s turnaround took the direction of inside, out: She proved to be a candidate for whitening at Gainesville Dental Associates, where Dr. Theo Batistas had a few of her fillings replaced and oversaw the direction of her chairside whitening procedures, the success of which “really depends on an individual patient,” explained coordinator Erin Kehl. “Some people have naturally grayish teeth. She does not; hers will whiten well.” An equally effective alternative, Kehl added, are the take-home trays most dentists’ offices offer, which take more time but cause less sensitivity to teeth and are about half the cost.

The following week’s clothes fitting at Reston’s South Moon Under further lit Stefanie’s face. She allowed herself to smile into the mirror only after lighting upon a cropped white jacket with gold accents—ones that make the piece fall-transitional, sales associate Jill Mejia-Wetzel pointed out.

“I was nervous!” Stefanie admitted, fingering the jacket’s edge.

“Don’t be nervous! Clothes are fun—you can create any shape you want with the right pieces,” Mejia-Wetzel said. “Do you like gold?”

Stefanie gave herself another full-length once-over before breaking into another grin. “I never did before.”
Turning to her tresses, Stefanie met with stylist David Bakir of Springfield’s Jon David Salon, where she was treated to gold and red highlights and crown layers that, according to Bakir, compensated for her hair “being on the finer side.” He styled the new cut with attention to certain sections with a large-sized curling iron to work in a variation of textures. “Not every section—that would defeat the whole purpose,” he explained.
Stefanie’s makeup artist, Mei Shields, swears by the pigment in artistry lines such as Bare Escentuals and Smashbox for her work, which she performs both as a professional for Jon David and a freelancer. “Stefanie told me she’s really very simple in terms of what she does every day, so what I did, and what I’m encouraging her to do, is to focus on her eyes to bring it all together … The most beautiful feature are the woman’s eyes and bone structure.”

Shields, who applied a primer for Stefanie’s “after” shots, explained she wouldn’t require one on a regular basis and that, if people strive to take care of their skin, most have an “underlying natural beauty.” “A little dabble of this or that can enhance plenty from day to day.”

In other words, small steps, but at times steep ones. Stefanie pursed her lips into an “O” before allowing them to curl upwards on their own. “I think this might be the first time I’ve ever worn lipstick.”

Fashioning a look to love (naturally), with room to grow
“I was more than pleasantly surprised,” said Stefanie, who only confessed makeover concerns she’d had from the start of the process after her final post-pose had been shot.

“I was very nervous about the clothes because before I left school I put on some weight and, you know, when that happens, you kind of revert to baggy sweatpants and sweatshirts; you’re not wanting to shop as much. It drains you. It’s hard to do for yourself.”

Beyond the fitting, Stefanie, who from the beauty do-over’s beginning day stressed a desire to strive for a natural look at day’s end, was concerned to place her hair in an unknown professional’s hands. “The hair color was next what I was most nervous about because people have complimented my natural hair color since I was 2.”

She twirled a strand, studied it, smiled. “It really enhanced what I have, and it does, it looks natural … I feel like it looks like me.”

Her cut she said she plans to let grow out a bit—“I like putting it up in ponytails … I do work with kids, so sometimes I have no motivation”—which Bakir emphasized is angled and colored to be able to do. “Maintenance-wise with the color is basically non-existent,” he said. “Maybe every four or five months. It’s just very soft.”

A slew of approving beauty pros and photographers aside, it took a third party—those who first encouraged her to treat herself—for the final effect to sink in. When her parents beheld the finished product, “They actually both complimented me. My mom loves my hair. She’s actually thinking about going [to Jon David Salon] to get her hair done.

“And they said I looked pretty. It meant  a lot.”

(September 2008)

Tags: Health & Beauty, makeover

Putting a Cap on Anxiety

New Dental Procedures Aim to Tame Patient (and Doctor) Nerves

By Lindsay Holst

A cold, sterile room that smells of disinfectant and dental floss. Needles, drills and ratchets adorning a creaky tray. A dentist’s head, silhouetted ominously against the harsh, incandescent glow of overhead florescent bulbs. A patient’s white knuckles gripping the arms of a plastic-coated chair. The imagery encompasses the fear that some 95 million North Americans share: going to the dentist’s office. It’s the anxiety-ridden patient’s worst nightmare, and these days, it’s the dentist’s as well.

But it didn’t used to be that way. “Adults that are now older than 50 used to go to the dentist at a time when dentists weren’t so concerned about anxiety control,” says Dr. J. Daniel LaBriola, D.D.S., chief of oral and maxillofacial surgery at Inova Fairfax Hospital and oral surgeon at Northern Virginia Oral and Maxillofacial Surgery Associates (Annandale). “Back then it was, ‘I know you’re numb, sit there, let me do this.’ People started to get fearful that dentists wouldn’t listen to them and would proceed with something without adequate anesthetic.”

After such major milestones in dental care as fluoridated water and toothpaste, tooth decay decreased, and dentists realized that if they wanted to stay in business, they would have to take patients’ total needs into consideration, including anxiety control.

“Most dental anxiety starts when you’re a child,” says Dr. Daniel Cassidy, D.D.S., who has a family and cosmetic dentistry practice in Alexandria. “A lot of it is psychology. Hopefully we’re giving this generation of kids a positive experience so that they don’t have the negative association that some of the older generations have.”

New dental trends that stress anxiety control and pain management are helping doctors tame patients’ nerves better than ever before.

Anxiety control in patients doesn’t have to be rocket science. Sometimes, diverting dentist fears simply requires a different state of mind. In theory, if patients are made to feel as comfortable and calm as possible, they are able to relax to the point where they may even forget they are getting dental work done. Offices are beginning to offer dental work and spa-like amenities, such as manicures, pedicures and paraffin wax treatments, simultaneously.

Dr. Cassidy’s office offers add-on vibrating massage chair components that patients can control and iPods they can use to cut back on the sound of the drill. The Alexandria-based offices of Dr. Kim Kitchen, D.D.S and Associates, offer spa-like cuisine to patients who come in for consultations, further diverting the sterile, harsh environment typically associated with the dentist’s office. “We offer them water, juice, smoothies and freshly baked bread,” says Dr. Clifton Harris, D.D.S, who works alongside Dr. Kitchen.

When patients come in for procedures, they enjoy additional amenities such as hot towels, blankets, and DVD and CD players. “People are simply more comfortable when they have something else to focus on,” Dr. Harris says.

Sometimes patients’ stress can be exacerbated by something as seemingly minor as an office’s lighting. Dr. LaBriola’s office provides eye shades for patients with light problems, and the office also allows patients to bring in their own musical devices, though Dr. LaBriola prefers they keep the volume low so he can talk them through the procedure. If a patient is slightly anxious, he says, an explanation of the procedure can help tame nerves.

“I don’t give them gruesome details, but I let them know what sensations to expect,” Dr. LaBriola says. “With surgery, there can be intense sensations, though they’re not necessarily painful, and we want to be able to explain that to anxious patients. If they can’t hear me, they could develop more anxiety. In a surgical situation, it’s much more advantageous for the patient to know what’s coming.”

Slightly greater patient anxiety stems from a fear of pain, and basic relaxation techniques are not always sufficient in quelling worries. “What actually hurts in an injection is the medicine going into the tissue,” Dr. LaBriola says. “Newer tools can administer the local anesthetic at a slower rate, making the shot more painless; this way, people are more likely to have the procedure done.”

Patients with minor needle phobias can begin to relax, thanks to tools and procedures whose aim is to cut back on the dreaded burning sensation resulting from a too-quick injection. Sometimes, manual techniques alone can effectively divert the patient’s attention and cut back on injection-associated pain. When Dr. Cassidy gives an injection, he begins by numbing the gums with a topical anesthetic. He then applies pressure to and shakes the patient’s lip before administering the injection.

“They feel pressure before the stick,” Dr. Cassidy says. “The theory is that I’m stimulating the part of the nerve that feels pressure. Additionally, the shaking tends to distract the patient. “They’re still wondering what I was just doing, and I’ve already administered the anesthetic.”

The Wand, a tool Dr. Cassidy says has been around for a few years, uses a computer to administer the anesthetic very slowly through the mouth. The machine looks essentially like “a box with tubes coming out of it,” Dr. Cassidy says; out of concern that the machine’s appearance would be off-putting to patients, he trained himself to administer the local anesthetic slowly by hand. Another new tool, the Vibrajet, clips onto the anesthetic syringe and causes it to vibrate gently, which Dr. Cassidy says significantly cuts back on the sharpness of the injection.

For more severe forms of patient anxiety, more and more dental offices are offering sedation dentistry as an option. Kim Kitchen and Associates uses an oral-conscious sedation to put patients into a kind of “twilight zone,” sedating the patient and also acting as an amnesiac, so that the patient will not remember much of the procedure.

“We will have the patients take Valium, a longer-lasting sedative that calms your nerves down the night before,” Dr. Harris says. “They will get a good night’s sleep, and when they wake up the next morning, the drug will still be in their system; they will come into the office already quite sedated.”

When undergoing this type of sedation, the patient must be driven to the office. Upon arrival, the doctor will sometimes give an additional, quicker and shorter-acting drug that serves essentially as a sleeping pill, Dr. Harris says. Once in the chair, the patient is hooked up to a machine to monitor vitals, and the dentist commences the procedure.

Though sedated patients appear to be in a deep sleep, Dr. Harris notes, they are never in a situation where they’re in such deep sedation that they cannot be woken up by the dentist. “I did oral conscious sedation on a patient last week, and gave him 12 or 13 fillings,” Dr. Harris remembers. “He was here for about four hours, and he doesn’t remember the work at all; he just remembers essentially getting here and leaving. He got up twice during the procedure.”

When under oral-conscious sedation, patients are able to communicate to the doctor if they need to use the bathroom or take a drink; Harris says that he gives his patients a little Gatorade to stimulate them enough to get up and walk to the restroom and back. Afterwards, he says, they rarely recall anything.

Increased attention to patient anxiety has popularized another option in anesthesia. Many offices are turning to private anesthesiology practices that send a trained anesthesiologist to a dental office to perform the sedation himself. “People mistakenly think that the length of the procedure should dictate the level of the sedation,” says Don Mauney, M.D., an anesthesiologist at Horizon Anesthesia in Falls Church.

Practices like Horizon have relationships with area dentists or physicians, and anesthesiologists from the practice will deploy to different offices to perform sedation during procedures. The anesthesiologist will meet with the patient beforehand to review medical history, surgical history and other concerns such as medications and allergies.

On the day of the procedure, the anesthesiologist brings a small machine that can sedate patients and provide general anesthesia, as well as a machine that monitors such vitals as blood pressure, heart rate and end-title C02.

The type of anesthesia that Horizon provides is particularly useful for small children, extreme needle-phobics or those undergoing long and complicated procedures. “The alternative is to give the patient an IV with sedating medication, but with our machine the patient is able to breathe medication through a mask,” Dr. Mauney says.

“Safety is of paramount importance. Whether you’re having a 27-minute procedure or a six-hour procedure, you should be comfortable with the level of service.”

(April 2008)

Tags: Dentist, Health & Beauty

Small Patients, Big Treatments

Advancements at the Children’s National Medical Center

By Sarah Markel / Photograpy by Jonathan Timmes

Children’s National Medical Center, in Northwest Washington, is the area’s only medical system devoted entirely to caring for children and infants. Because Children’s Hospital has outpatient centers across the region, including two in Fairfax, those in need of care can better access most of its 367 pediatric specialists, many of them leaders in their respective fields. These doctors never forget that they aren’t just saving lives.
They’re saving families.

Dr. Michael Boyajian
Pediatric Plastic Surgery
Approximately one in 700 children is born every year in the United States with cleft palates. In the Mid-Atlantic region, most of those babies will see Dr. Micheal Boyajian, director of plastic and reconstructive surgery at Children’s Hospital.

Boyajian’s specialty is craniofacial surgery. He rebuilds faces, repairing cleft palettes so well that the scars are barely visible and correcting malformed infant skulls, often within hours of delivery.

Recently, medical advances have changed the landscape for children recovering from plastic surgery. It used to be that doctors fixed bones using titanium screws. Boyajian now uses screws made of absorbable material.

“It takes about a year to be fully absorbed,” he warned. But for growing bodies, this means no leftover materials to get in the way of facial growth, particularly unformed teeth.

Boyajian is always looking for ways to improve upon his work. Children’s was the first hospital in the country to modify the absorbable screws into pegs so they could be pushed into place using ultrasonic waves. This technique saves time and offers a better grip.

Pediatric plastic surgeons earn far less than their adult counterparts, but that doesn’t upset Boyajian. “I love my work,” he said. “To be able to close a cleft lip and bring it to a point where the deformity is small enough that it is below the threshold of what people can pick up, that is a big deal, and it’s privilege for me to be able to do it.”

Dr. Richard Jonas, Dana F. Higdon (mom) and Walter Higdon (patient)

Dr. Richard Jonas
Neonatal Cardiac Surgery
Dr. Richard Jonas, chief of cardiovascular surgery and co-director of the Children’s National Heart Institute, has been a pioneer in the field of early intervention for congenital heart abnormalities. About eight in 1000 babies are born each year with such defects. Formerly, doctors preferred to postpone corrective surgery until the child was older.

Jonas disagreed. “You are better off giving a child a normal circulation as early in life as possible. It benefits the brain, and the child will achieve normal developmental milestones,” he said while stuck in traffic after a day in which he completed three neonatal heart surgeries.

For more than two decades, this Australian father of three has been repairing the hearts of tiny patients, some as small as 2 pounds. He and a massive team of doctors and staff work with clocklike precision, using magnifying telescopes. “We have to work fast. The heart can’t withstand having no blood supply for a couple of hours.”

Some of Jonas’ earliest patients are now college students. The trio of babies he operated on recently? They’re fine.

Dr. John Myseros, Deborah Triggs (mom), Jessica Triggs (sister) and Matthew Triggs (patient)

Dr. John Myseros
Pediatric Neurosurgery
When a CT scan revealed a massive tumor on the right side of 9-year-old Matthew Triggs’ brain, his mother, Debbie Triggs, thought the news couldn’t get worse. But finding a neurosurgeon willing to take on the case proved challenging, as the dangers of bleeding and brain damage were so high.

Luckily, their pediatric oncologist, Dr. Marianna Horn at Inova Fairfax, referred them to Dr. John Myseros, a pediatric neurosurgeon at Children’s Hospital.

At 43, Myseros is something of a surgical wunderkind. He is already one of the leading experts in removing tumors from children’s brains, and he has a reputation for pushing the boundaries of what neurosurgeons can and will do to save lives.

Matthew’s tumor was so tangled in his brain that conventional treatments would have removed a significant amount of healthy tissue along with the tumor. His parents were warned he could wind up on a ventilator for life. That was, if he survived.

Myseros spent hundreds of hours studying Matthew’s MRI and conferring with other doctors to develop a novel approach for removing the tumor. He called in neuro interventional radiologist Dr. William Bank from Washington Hospital Center to perform an embolization to block off the blood to the tumor. The procedure reduced the bleeding so Myseros would have time to work.

“I know I can do this,” Myseros had assured Triggs before beginning the 12-hour operation. The surgery, in which he painstakingly unpicked the tumor from the nerves that control Matthew’s breathing and the movement in his face, was an unqualified success. As Myseros put it, “Matthew is now a neurologically normal boy.”

“When you are dealing with a life-or-death situation, you want someone who is confident,” Triggs said. “That man is larger than life.”

(February 2008)

Tags: Health & Beauty, medical, Top Doctors

Death Defying

Patients Who Beat the Odds and the Doctors Who Helped Them

By Jan Linley / Photography by Jonathan Timmes

Eight patients faced with very different life-changing medical challenges discovered that having the best of the best in medical care goes a long way toward survival. While these patients are different in many ways, they have more than a few things in common. Each is inspirational, brave and trusting. And each has a top doctor using cutting-edge medical technology.

Clinton Johnson/Pat Divinnie | Survivor/Donor

The Best Birthday Gifts
Clinton Johnson was diagnosed with sarcoidosis (an inflammatory disease that produces granule-sized lumps of cells in various organs in the body) in 1995. It affected his kidneys. Three years ago doctors told him he needed to prepare for dialysis. The 58-year-old Johnson was opposed to the treatment, but went ahead with dialysis classes. After his last class, he made up his mind to find a kidney.

He understood that putting his name on a wait list for kidney donation would mean just that—waiting. There are 850 on Washington Hospital Center’s list, 2,200 in the area and 70,000 in the country. The wait time can be up to five years. Johnson became proactive and put the word out that he needed a kidney. “I didn’t ask, I told them. I need a kidney.” He had willing donors, but none were a match.

His wife Pat Divinnie knew she was not a match for her husband, but that didn’t mean she wasn’t a match for someone else. She volunteered to go on the list as a healthy donor for another recipient, moving Johnson up on the list as a result.

It was about a month before they met their match. Divinnie, 55, was the match for Young Hwang, a 64-year-old diabetic who had already started dialysis. His organ failure was the result of the diabetes; the kidney problem presented itself while he was on a three-day fishing trip and his face “swelled up like a round ball.” Hwang was on the transplant wait list for more than two years. His 63-year-old wife, Sun Hae, was also on the list as a donor. She never thought she might be the match for Johnson.

Sun Hae/Young Hwang | Donor/Survivor

Johnson chose Washington Hospital Center because he knew about Dr. Jimmy Light, director of transplantation services. Years ago they had both worked at Walter Reed Army Medical Center. Light, 63, has been doing transplants since 1971, almost as long as the field has been in existence. “At the time it was very, very challenging, very new. It was absolutely clear people would really benefit.”

Johnson, who is a former professional football player, insisted on having the operation after the Super Bowl. Four operating rooms were simultaneously prepared Feb. 12, 2007, two days before Valentine’s Day, three days before Sun Hae’s birthday, and four days before Johnson’s birthday.

Reza Ghasemian, 49, director of transplant and urology, was Sun Hae’s surgeon. “Transplant surgeries are very satisfying. You see the results almost immediately. You remove the kidney; it’s transplanted and starts working immediately after the connection. Three to four hours after the surgery, the patient feels the difference.”

The couples stay in touch, but so far have no plans for an anniversary celebration. Maybe because they have all been too busy traveling recently, one of many activities made possible by the transplants.

The Little Girl Who Could
Renay Hannon was 34 and had a perfectly normal pregnancy when she gave birth to her daughter, Caleigh Haverland, in September 2000. So when she went in for Caleigh’s two-week checkup and was told her daughter had a heart murmur, she wasn’t too concerned. “A lot of kids have that. I didn’t think it would be a big deal.”

Caleigh was born with Tetralogy of Fallot, a congenital heart condition in which there exists a hole between the two ventricles of the heart, allowing blood to go from the right to left ventricle and then through the aorta, never passing through the lungs for oxygen as it would normally. Caleigh’s condition was further complicated because her left pulmonary artery was not connected to her lung.

Her first surgery to connect the pulmonary artery took place when she was about 4 months old and her heart was about the size of a plum. At 9 months, Caleigh had surgery to repair the hole in her heart.

In November 2006, Caleigh underwent her third heart surgery. She had outgrown the graft that connected the pulmonary artery to the rest of her heart. After each surgery, Hannon, a flight attendant, told herself everything would be fine and that she would soon be “able to be like the regular moms.”

Caleigh’s first surgeries were performed by the late Dr. Bechara Akl. Hannon was understandably concerned about who would perform the next one. She and her husband met with Dr. Irving Shen, director of pediatric cardiac surgery at Inova Hospital for Children. “He was just amazing right off the bat,” Hannon said. Shen, 45, explained a number of possible scenarios and how they would be handled.

It is common for children like Caleigh to have multiple surgeries as they get older and outgrow their original surgeries. Each time a surgery is performed, scar tissue grows around the heart, which can complicate subsequent surgeries. Shen said, “You have to tease everything up.”

He refers to pediatric cardiac surgery as a team sport. Between him, Dr. Lucas Collazo and a team that includes other cardiologists, anesthesiologists, nurses, interventionists and assistants, approximately 300 pediatric surgeries are performed annually at Inova Fairfax Hospital for Children.

Both Shen and Collazo, 42, spend a great deal of time thinking about the surgeries they perform and the children and families they treat. “We orchestrate the whole operation in our heads. We do it again and again,” Shen said, likening the process to athletes’ mental preparations.

Caleigh, who turned 7 in September, is very social and loves most of the things kids her age do—camp, play dates with friends and especially dance classes. Her mom is thrilled. “It’s the most wonderful thing ever to have Caleigh, and I’m so thankful.”

60-year-old Tom Shaw knew exactly what was happening when he suffered a massive stroke in a nearly empty movie theater in the middle of a December afternoon.

Racing Against the Clock
As the owner of Outcome Communications, Inc., a health care marketing and educational company, 60-year-old Tom Shaw knew exactly what was happening when he suffered a massive stroke in a nearly empty movie theater in the middle of a December afternoon. He also knew he had three hours to get treated before any long-term serious damage set in. “It was the ultimate race of my life.”

A throat cancer survivor, Shaw had a laryngectomy and uses an electrolarynx for speech. He usually uses his right hand to operate the device, but the stroke had incapacitated the right side of his body. He managed to use his left hand and turn enough in his seat to ask one of the two other patrons there that day to get the theater manager.

When paramedics arrived on the scene Shaw was coherent enough to ask to be taken to Alexandria Hospital, where his wife Karen is technical supervisor in the Cardiovascular and Interventional Radiology Department.
Interventional radiologists Dr. Keith Sterling and Dr. James Cooper treated Shaw at Alexandria. Cooper, 46, explained that most people have four main arteries, two carotid that supply blood to the front of the brain and two vertebral that supply blood to the posterior part of the brain. Unbeknownst to Shaw, he had been living with only one functioning vertebral artery, most likely since birth. So when the stroke happened due to an extensive clot in the other vertebral artery, the blood supply to the back of the brain was cut off. “People can live off of three arteries and not skip a beat their whole life,” said 43-year-old Sterling.

Strokes are typically caused by a pea-sized clot in one of the arteries. Shaw’s clot was “extensive,” blocking the entire vertebral passage. When Cooper and Sterling saw Shaw’s CT scans, they weren’t optimistic. Cooper said, “There’s no cookbook for what he had.” Sterling agreed. “We pulled out all the stops.” Interventional radiologists perform minimally invasive procedures to treat a wide range of conditions throughout the body. Using X-rays, MRIs and other imaging, they advance a catheter, usually through an artery to the source of the problem. In Shaw’s case, Sterling and Cooper and their team first performed an angiogram to locate the clot. They gave Shaw tPA, a clot-busting drug, and removed the clot using small catheters to suck it out. They widened a narrowing in the artery by using stents (wire metal mesh tubes) to prop it open. All of this was done through one small incision in the leg and in less than three hours.

Shaw was lucky but also well-informed. Cooper and Sterling stressed the importance of stroke awareness. “The key is to know when you develop symptoms to seek medical attention.”

Choosing Life Over Existence
The first thing you notice about Alice Gaines is her striking beauty. It is incongruent with the Parkinson’s disease she’s had for the past 14 years. Now 49, she was just 35 and pregnant with her second child when first diagnosed. Initially she sought treatment for knee pain, thinking she had arthritis. About six months later her leg began to drag intermittently. Doctors diagnosed Alice with depression and put her on muscle relaxants and antidepressants. When she started experiencing muscle rigidity in the form of a stiff neck, doctors thought it was stress.

It wasn’t until after she gave birth and discovered she couldn’t walk that doctors prescribed Sinemet. A positive response to this drug confirmed Parkinson’s disease.

For five years Gaines functioned on Sinemet, but the Parkinson’s continued to progress. Although driving and handwriting became difficult, she stayed at her job full time. It was about this time Gaines lost her mother, then six months later her 40-year-old husband to a massive coronary.

Eventually she could no longer drive or write. Getting out of bed took two hours, and her vision became so poor it was difficult to watch television. “I was just existing.”

One night she saw a television program that featured Georgetown University Hospital’s Dr. Christopher Kalhorn performing deep brain stimulation (DBS) on a Parkinson’s patient. Gaines phoned for an appointment the next day. To gain eligibility for DBS, patients must undergo detailed motor testing and still be responsive to the Parkinson’s drugs Sinemet or Levodopa.

Kalhorn, the 36-year-old director of epilepsy and functional and pediatric neurosurgery at Georgetown, was first exposed to DBS in the late ‘90s through his medical training at Baylor College of Medicine. “I thought, there’s an operation where you really impact on someone’s quality of life.”

The DBS surgery takes about five hours. Two electrodes are implanted bilaterally in the brain with sub-millimeter accuracy. The patient is heavily sedated and anesthetized, but still awake so they can respond to the implants as the surgery proceeds. Kalhorn singles out neuron-anesthesiologist Dung Q. Tran for keeping patients comfortable during the surgery.

A month after the brain surgery, a pacemaker is implanted underneath the collarbone in the chest. It operates similarly to a cardiac pacemaker, but delivers electrical stimulation to the brain, overriding faulty signals and reducing tremors and some of the other symptoms of Parkinson’s patients. Medication is still required, but usually at lower doses.

Being able to be there for her sons RJ, 14, and Sam, 11, motivated Gaines to have surgery. Now she can enjoy some of the routine mom activities again, like playing board games, going to festivals and even throwing the football around.

DBS is not a cure for Parkinson’s, but it does improve quality of life for those who are able to undergo it. Current data indicates that patients do significantly better with motor movement five years after the surgery than prior to it.

Kalhorn views his “role as a neurosurgeon as a great privilege.”

Gaines sees it a different way. “He gave me my life back.”

One day while doing a handstand in yoga her teacher told her to close her mouth and breathe through her nose. That’s when Shearer discovered, “I couldn’t breathe at all.”

It’s Not Allergies—It’s Cancer
When 44-year-old Maureen Shearer, also known as Mia, started having trouble breathing, she thought she had a stubborn cold or was developing allergies. Then one day while doing a handstand in yoga her teacher told her to close her mouth and breathe through her nose. That’s when Shearer discovered, “I couldn’t breathe at all.”

She went to urgent care, where she was diagnosed with sinusitis and given antibiotics and later Allegra and Flonase. When nothing helped she saw her family physician, Dr. Michael Rodriguez, who took a look in Shearer’s nose and sent her to have a CT scan with Dr. Betsy Vasquez. Vasquez discovered a mass. Surgery was scheduled, but Shearer remained unconcerned that it was anything serious. The mass was removed and biopsied.

Within two days of her surgery Shearer had lumps on her neck. She and her husband assumed her lymphatic system was crashing. They phoned Vasquez, who told Shearer’s husband David that Mia had nasopharyngeal cancer, a cancer that is rare in Caucasians and much more common in Asian men. Vasquez had already made an appointment for Shearer with Dr. Kin-Sing Au, a radiological oncologist at Inova Loudoun Hospital.

Shearer and her husband had no idea what to expect when they first went to see Au. “He made us feel like everything was going to be OK,” Shearer recalled.

After meeting with her, the 52-year-old oncologist thought Shearer would be a good candidate for intensity-modulated radiation therapy (IMRT). Historically, because there are a lot of critical organs in the area, patients treated with radiation for nasopharyngeal cancer have suffered from long-term side effects including hearing loss, jaw problems, vision problems, brain damage and tooth loss from dry mouth caused by the loss of saliva glands. Au explained that IMRT is a very targeted form of radiation that approaches the tumor area from multiple directions, shooting beamlets of radiation at the unhealthy tissues and avoiding healthy surrounding tissues. Shearer was the first patient treated with IMRT in Northern Virginia.

Au scheduled her right away to get a mask made for her face. The mask is marked so the radiation hits precisely the right spots each time it is beamed at the patient. IMRT was then performed in tandem with chemotherapy.

Au’s team consists of several top-notch people, including a dosimetrist and a medical physicist. The dosimetrist is responsible for radiation dose calculations. The physicist assists with those calculations as well as doing quality assurance calibrations on the equipment. Because the team, including Au, had not done this IMRT before, Au himself stayed well into the night on several occasions and figured out the calculations for Shearer’s treatment.

Shearer’s successful treatment lasted about seven weeks, five days a week. Au said, “That’s the rewarding part of my specialty, a patient like Mia.”

(February 2008)

Tags: Health & Beauty, medical, Top Doctors

Breakthrough Medicine

New Procedures Easing the Aches of Pain

By Sarah Markel and Lindsay Holst / Photography by Jonathan Timmes

Never mind the traffic. Forget the cost of living. When illness strikes, having immediate access to top-of-the-line medical care makes up for many of the stresses of Northern Virginia life.

From Head to Toe: Medical technology that is changing and saving patient lives
Just over half a million doctors are currently practicing in the United States. And right in our own backyard, the latest innovations in the treatment of life-threatening illnesses are increasingly being developed and tested. Here are the doctors pushing the envelope every day in search of minimally invasive, more effective procedures that save lives.

Bank combines a state-of-the-art Bi-plane X-ray, which allows him to see inside the brain from every possible angle, with endovascular procedures to treat aneurysms without traditional surgery.

BRAIN
Dr. William O. Bank
Washington Hospital Center; Bi-plane X-Ray
Until recently, the prognosis had been dire for patients with cerebral aneurysms and tumors in the head, neck and spine. Aneurysms in the brain are notoriously hard to detect and difficult to access. Once they rupture, the brain is flooded with blood, often resulting in death.

For those who did survive, the only recourse was open brain surgery. Dr. William O. Bank, director of neuro interventional radiology at Washington Hospital Center, has a better way. Bank combines a state-of-the-art Bi-plane X-ray, which allows him to see inside the brain from every possible angle, with endovascular procedures to treat aneurysms without traditional surgery.

“The Bi-plane X-ray has been around for 20 years,” Bank said. But only recently has the technology gone digital. “Now it is more precise,” he said. “I can look through two different directions at the same time.”

The digital Bi-plane X-ray instantly transfers brain images to the computers at Bank’s worktable, where he then measures the aneurysm to hundredths of a millimeter. After consulting with neurologists and surgeons, Banks quickly returns to the patient. Using the Bi-plane X-ray as his eyes, he threads tiny platinum coils up through the groin into the aneurysm so that blood cannot enter it.

A lover of the impressionists, he takes inspiration from the works of Monet and Van Gogh. “The practice of medicine and surgery is not an exact science. What I do is an art,” Bank said. “And I have to do it well every day.”—SM

Satler is leading an investigational trial to study the safety of inserting an artificial aortic valve through a large needle puncture in the leg rather than through open heart surgery.

HEART
Dr. Lowell Satler
Washington Hospital Center; Heart Valve Replacement without Open Surgery
The telltale sign of heart surgery, that pale vertical chest scar, may one day become a thing of the past, thanks to Dr. Lowell Satler, director of cardiac interventions at Washington Hospital Center. Satler is leading an investigational trial to study the safety of inserting an artificial aortic valve through a large needle puncture in the leg rather than through open heart surgery.

Currently the study is only open to elderly patients too weak to undergo surgery. “For the higher risk subset, surgery is not a good option,” Satler said. “Many patients succumb to chest pain, are hospitalized and eventually die. This is an alternative strategy.”

Pricilla O’Donnell’s 95-year-old father was one of the first patients to undergo this minimally invasive procedure. The valve replacement has given her more time with her father. More importantly, she said, it has given her dad the freedom he thought he had lost. “He is now able to walk unassisted and without oxygen. He feels like this procedure was nothing short of a miracle for him. He is really loving life now.”

Satler hopes one day that more patients will be able to undergo valve replacement via catheterization. “This has the potential to replace open heart surgery if the valves demonstrate durability.”—SM

VEINS
Dr. Richard Neville
Georgetown University Hospital; Propaten Vascular Graft and Silverhawk
Dr. Richard Neville, chief of vascular surgery at Georgetown University Hospital, has devoted his career to saving legs. Patients, particularly the elderly and diabetics, too often ignore the pain that comes from clogged arteries in the legs. Sometimes they leave it so long that the only recourse is amputation.

Neville will try just about anything to avoid taking a leg, including inventing his own procedures to create systems for blood to bypass clogged arteries. He is currently testing the Propaten Vascular Graft, a minimally invasive bypass that “tricks a vein into thinking it’s an artery,” Neville explained. Neville was the first surgeon to use the graft below the knee. He also helped develop the Silverhawk, a tool used to scrape out the clogged veins of patients too sick for bypass surgery.

“Sixty percent of what we do is endovascular,” Neville said. “That allows us to work through a small needle puncture.” Patients come from across the country to see Neville. Very rarely today does he have to tell them there is nothing he can do to save the leg. “And even then,” he said, “I can often think of something.”—SM

Deaton, who is recognized as the foremost authority in his field, is leading a clinical trial to test a new, minimally invasive approach to repairing abdominal aneurysm by stapling a synthetic vein, or Aptus endograph, to the aorta.

ABDOMEN
Dr. David Deaton
Georgetown University Hospital; Aptus Endograft
Ed Mooney’s abdominal aortic aneurysm gave him no trouble. “I didn’t have any symptoms,” said Mooney, 71, whose aorta, the main blood vessel in the abdomen, had swelled to nearly five centimeters, more than twice a normal size. Left untreated, the chances of sudden death from aortic aneurysm hover at about 90 percent.

In 2006, Mooney’s doctor noticed the aneurysm during a routine ultrasound and referred him to Dr. David Deaton, chief of endovascular surgery at Georgetown University Hospital. Deaton, who is recognized as the foremost authority in his field, is leading a clinical trial to test a new, minimally invasive approach to repairing abdominal aneurysm by stapling a synthetic vein, or Aptus endograph, to the aorta. Mooney became the first patient in the United States to receive the Aptus endograph.

“It took about three hours,” Mooney said. “I was in the hospital overnight. They let me out the next day.” Deaton explained that traditionally aortic aneurysms are repaired through open surgery, followed by several days in ICU and a week in the hospital. “With the endovascular surgery, we replace the aorta with a catheter through a groin incision. There’s no pain and less trauma to the body.”

A native of North Carolina, Deaton’s style is as relaxed and unassuming as his accent. “I like to say it’s like being able to go to California on a jet plane instead of a horse,” he joked.

For Mooney, being on the vanguard of experimental medicine gave him no qualms. “Dr. Deaton is so calm and straightforward. When he explained the procedure to me I thought, This makes sense.”—SM

Dr. Tom Fishbein
Georgetown University Hospital; Multiple Organ Transplant Surgery
When the Washington, D.C. State Health Planning and Development Agency (SHPDA) granted Georgetown University Hospital, in collaboration with Children’s National Medical Center, a Certificate of Need to allow physicians to perform life-saving small bowel transplants, doctors were able to bring hope to many cases that hadn’t seen any for a while.

In small bowel transplantation, a surgeon transplants a portion of the small intestine from either a living donor or a cadaver. The surgery can restore intestinal function when the intestine has failed due to illness or trauma and when intravenous feeding is no longer an option. Only about 100 patients receive a new small intestine each year in the United States, and Georgetown’s program is the only one of its type in the Mid-Atlantic region. Dr. Tom Fishbein, Georgetown’s director of small bowel and pediatric liver transplantation, has done as many as six organ transplants at one time and has performed small bowel transplantations in a wide range of patients, from small babies to older adults.

Fishbein is a nationally recognized surgeon and has performed approximately 20 percent of all intestinal transplants in the United States.—LH

Dr. Ali Fazel
Inova Fairfax Hospital; Endoscopic Mucosal Resection
Inova Fairfax Hospital’s Center for Advanced Endoscopy, which made a spring 2007 announcement that it would use endoscopic procedures on patients with benign and malignant diseases of the digestive tract, pancreas and bile ducts, is the first program of its kind in Northern Virginia.

In the center, a multidisciplinary team that includes surgeons, oncologists and gastroenterologists uses endoscopic techniques to treat Gastroesophageal Reflux Disease and the damage that can result from the disease; remove large colon polyps that would have previously required surgery for their removal; manage digestive cancers, primarily of the esophagus, stomach, bile ducts, pancreas and colon; and treat benign blockages, stones and inflammation in the pancreas and bile ducts. It’s a one-stop center that offers a wide range of cutting-edge endoscopic services.

The doctors use endoscopic ultrasound and techniques such as endoscopic mucosal resection (EMR) to earlier detect and remove digestive cancers. “EMR allows the endoscopist to shave off the inner layers of the digestive tract without causing damage to the deeper layers,” said Dr. Ali Fazel, the center’s medical director. “Because cancerous and precancerous legions of the digestive tract arise from the innermost layer, by shaving it off, you’re able to remove cancerous legions.” Fazel, who was in charge of a similar endoscopy program at the University of Florida, is very pleased with the program’s growth. “This is such a strong medical community, and this is just one service that happened to be lacking. We’re very happy to be able to fill that niche,” he said.—LH

Dr. Ivan Ducic, chief of peripheral nerve surgery at Georgetown University Hospital, has built a devoted following among migraine sufferers nationwide ... he refuses to take a routine approach to migraine pain.

NERVES
Dr. Ivan Ducic
Georgetown University Hospital; Peripheral Nerve Surgery
Dr. Ivan Ducic, chief of peripheral nerve surgery at Georgetown University Hospital, has built a devoted following among migraine sufferers nationwide. Patients who have failed one treatment after another come to Ducic because he refuses to take a routine approach to migraine pain.

“In about 25 percent of cases there are strong individual characteristics,” said Ducic, who is renowned for the extensive amount of time he devotes to puzzling out the source of a given patient’s problem.

“When you have patients who have seen a number of good specialists, and they are still continuing to have problems that affect the quality of their lives, you need to start thinking outside the box.”

Accordingly, Ducic, who has a Ph.D. in addition to his medical degree, tries to reconstruct the events leading up to nerve pain so that he can better treat it surgically. “Unless you understand the source of a problem,” he insisted, “you can’t fix it.”—SM

Dr. Keith Sterling, Inova Alexandria’s medical director of cardiovascular and interventional radiology, is combining ultrasound energy with thrombolytic drug-containing catheters that administer medicine into a clot-containing vein.

BLOOD
Dr. Keith Sterling
Inova Alexandria; EKOS Clot-Busting Treatment
Dr. Keith Sterling, Inova Alexandria’s medical director of cardiovascular and interventional radiology, is combining ultrasound energy with thrombolytic drug-containing catheters that administer medicine into a clot-containing vein.

The high-frequency ultrasound enhances the drugs’ ability to quickly dissolve the clot in a procedure that typically takes less than 24 hours. The tool is essentially a catheter lined with tiny transducers whose ultrasound energy pushes the drug into the clot, which the ultrasound also alters.

Sterling said that the ultrasound energy makes the dissolving process quicker and allows the doctor to use a lower lose of the clot-busting agent. The first hospital in the D.C. area to conduct this new therapy, Inova Alexandria has found great patient success with the procedure. “We use the EKOS catheter system for three main areas: blockages in arteries, veins and the brain,” Sterling noted. Sterling said the EKOS ultrasound-enhanced clot-busting procedure provides more safety and efficacy than traditional procedures, and patients are often able to leave within 24 hours “with a Band-Aid.”—LH

When using the Birmingham Hip Resurfacing procedure for hip replacement, the doctor does not cut the ball off, but rather trims the edges and puts a high-carbide cobalt chrome cap on it.

BONES
Dr. Andy Engh
Inova Mt. Vernon; Birmingham Hip
Someone who is 55 years old has a good chance of success with a regular hip replacement—a procedure in which the doctor cuts off the ball and inserts a metal rod into the thigh bone, which holds the new ball, lasting them the rest of their life. However, someone who is younger than 55 or more active than the typical 55-year-old is likely to eventually need a second operation.

“A high-demand, highly active patient is more likely to wear his or her hip out. These are the patients that might want to take a chance on the newer technology, which is why hip resurfacing is so appealing to high-demand patients,” said Dr. Andy Engh of Inova Mt. Vernon Hospital, which features this advanced procedure.

When using the Birmingham Hip Resurfacing procedure for hip replacement, the doctor does not cut the ball off, but rather trims the edges and puts a high-carbide cobalt chrome cap on it. Laboratory research has shown that the metal-on-metal joint may be more wear-resistant than the traditional metal-on-plastic joints, but doctors say only time will tell. “What we believe right now is that the resurfacing saves more bone—nobody will debate that it’s a bone or a skeleton-preserving hip replacement,” Engh said. “So if I do a regular total hip replacement on one 50-year-old and a resurfacing on another 50-year-old on the same day, and they both go bad 15 years down the road, I will have more bone to work with and the operation should be easier with the resurfacing patient than with the total hip.”

Dr. Mark P. Madden
Reston Total Joint Center; Joint Replacement
At Reston Hospital Center’s Total Joint Center (TJC), it isn’t unusual for a joint replacement patient to be walking the afternoon of their procedure, nor is it strange for the patient to be discharged from the hospital in just three days.

The TJC, formed in 2002 and recognized as a Center of Excellence by Mid Atlantic Medical Services, Inc., represents the collaborative efforts of orthopedic surgery, rehabilitation and anesthesia professionals.

Loraine Zolkiwsky, who had her knee replaced at the TJC in January 2007, said that the informational nature of the center made her experience “just fabulous.”

“I think half of the problem with many surgeries is that there’s this mystery aspect; all the patients know is that they have to show up at the hospital that day,” she said. “At the TJC, you had to attend a class ahead of time and everything was broken down almost to-the-minute. Nothing was a mystery when you went in.”
“We’ve got not just one mind or set of eyes looking at a problem, but four or five. It’s an organized plan rather than a hit-or-miss strategy,” said orthopedic surgeon Dr. Mark Madden.

The team Madden refers to consists of physician’s assistants, physicians, physical therapists, nurses and discharge planners. The center has features like “joint camp,” where patients attend a preoperative class with their own coach, learning to mentally and physically prepare for their joint surgery. Camp continues after surgery, as do group exercise and therapy sessions and educational classes on living with a new joint.

“For lots of people, there’s this mental block when it comes to big surgeries. But if you have the information and are mentally prepared, it really works. It can be a really positive experience,” said Zolkiwsky, who has been fully recovered from her surgery for months and feels “15 years younger.”—LH

PROSTATE
Dr. A. Daniel Laurent
Reston Hospital Center; GreenLight PVP
Previous treatment for Benign Prostatic Hyperplasia (BPH), a condition common in males over the age of 50 where the prostate becomes enlarged and puts pressure on the urethra, required patients to stay at the hospital for several days and nearly a month away from work.

“Up until approximately four years ago, the ‘gold standard’ for treatment for symptomatic BPH was the TURP, or transurethral resection of prostate,” said Dr. A. Daniel Laurent, urologist at Reston Hospital Center, which began offering the GreenLight procedure three years ago. Physicians at Reston Hospital Center said the TURP procedure posed a high risk of complications and several unpleasant side effects in patients. GreenLight PVP (photoselective vaporization of the prostate), a laser procedure offered by urologists at the center, is far less invasive than previous procedures, while providing the same favorable outcome.

“The main issue with TURP was the increased risk for bleeding both during the procedure and after,” Laurent said. “Patients were typically hospitalized for two to three days with a catheter, and even after going home were told to avoid strenuous activity and car riding for several weeks to avoid delayed bleeding, which could at times be severe. In rare instances after having a TURP procedure, men developed urinary incontinence and impotence.”

According to Laurent, the GreenLight laser procedure offers an effective treatment without an ugly aftermath. “The end effect of the procedure is identical to that of a TURP, in that a wider urinary channel is created, immediately relieving the blockage. However, the laser energy simultaneously vaporizes the obstructing tissue and seals the blood vessels. This allows an almost bloodless procedure,” Laurent said.

As such, a return to normal life can occur simply after an extended weekend of rest.

“Reston Hospital Center is unique in that it provides the GreenLight technology on a full-time basis, which offers greater flexibility in scheduling. We have had a very positive response to the treatment. The results have been excellent, and the complication rate is very low.”—LH

Carroll and fellow Georgetown University doctor Nadim Haddad are now using endoscopic ultrasound techniques to diagnose the cancer before the disease advances to an inoperable point.

CANCER
Drs. John Carroll and Nadim Haddad
Georgetown University Hospital; Endoscopic Ultrasound
Short of having a family history, it’s hard to say who is considered “high risk” for pancreatic cancer, and it used to be that when doctors had any suspicions of the cancer in patients, they would use a CAT scan to get a better look.

“A CAT scan just didn’t give as good of a resolution. You would just see a density and wouldn’t know exactly what it was,” said Dr. John Carroll, a gastroenterologist at Georgetown University Hospital. “At that point, you could do exploratory surgery in advance … or just watch and wait.”

Carroll and fellow Georgetown University doctor Nadim Haddad are now using endoscopic ultrasound techniques to diagnose the cancer before the disease advances to an inoperable point. In this procedure, the doctors pass an endoscope with an ultrasound component through the patient’s mouth and into the stomach. With the standard endoscope, doctors only see the inner lining of the digestive tract; with the ultrasound imaging, they can see all the layers and surrounding structures, including the adjacent pancreas, getting close enough to look for any masses, cysts or abnormalities. Some patients’ cancers cannot be seen on the CAT scan, but are detectable using the endoscopic ultrasound imaging. “Endoscopic ultrasound has been around for a while now, but the scopes are getting better, and the needles that we use are better as well, so that when we see a small cancer, we can get a biopsy early on,” said Carroll, who began training in endoscopic ultrasound in 1997.

“The accuracy and the reliability—both from the equipment standpoint, our experience and the pathologists’ experience—it’s all a lot better.”—LH

Dr. Gregory Gagnon
Georgetown University Hospital; CyberKnife
Some cancers are inoperable. Ask Joan Schwab. A former smoker, she had already lost part of her right lung to a cancerous growth. Afterward, breathing became difficult.

So when doctors at Georgetown found cancer again, this time in the left lung, 67-year-old Schwab knew surgery was out of the question. Instead, she was referred to Georgetown’s new state-of-the-art robotic radiosurgery system called the CyberKnife. This $6 million machine delivers an intense beam of radiation to tumors from as many as 1400 different angles. For weaker patients like Schwab, or those with inaccessible cancers, the CyberKnife is their last and best resort.

“The first surgery was quite awful,” recalled Schwab, who is now cancer-free and back to walking her dog. “The CyberKnife was different. I lay down, got up and drove home. No pain or anything.”

Dr. Greg Gagnon, chief of radiation medicine at Georgetown University Hospital, leads the CyberKnife team. “This is 10 times more precise than standard radiation, and because the dose fall-off is so abrupt, we can deliver a high dose to a very small area. It’s like a knife, in a way.”

With traditional radiation, patients are exposed to a high degree of excess radiation, which causes damage to surrounding organs. “There are dosage limitations with standard radiation,” said Gagnon. “With CyberKnife, it’s so accurate that you can use a higher dose.”

Perhaps most exciting are the unexpected benefits of CyberKnife. “Some cancers, like prostate, seem to have a radiobiologic response,” Gagnon said. “They are sensitive to this intense radiation.”

For now, CyberKnife is reserved for patients who cannot undergo surgery. But Georgetown University Hospital staff members are ready for the day when they become the first choice for certain cancers; they just bought a second CyberKnife.—SM

(February 2008)

Tags: Health & Beauty, medical, Top Doctors

Saving Smiles

Dentistry Patients Discuss Their Life-Changing Procedures

By Lindsay Holst

In a culture where plastic makes perfect, to cynics the word “cosmetic” conjures images of procedures representing one more costly indulgence, falling somewhere between “lip injections” and “eyebrow lifts.”
A winning smile has always been touted as the secret to many successes.

Studies have shown that an attractive smile can improve your self-confidence, get you a date and even help land you a job.

Why the obsession  with straight, shiny teeth?

Chalk it up to Darwinism. Blame society’s infatuation with the smiles of veneer-clad celebrities. But ultimately, it’s undeniable: The attractive smile is a coveted fixture, and the field of cosmetic dentistry has gained considerable popularity for its range of services, which include veneers, tooth implants, whitening and tooth restoration, in addition to other traditional dental procedures.

The cynics, as it turns out, are incredibly wrong.

The art of restoring a smile has far-reaching benefits, and the work of cosmetic dentists can drastically improve not only the physical appearance of their patients, but their confidence and sense of self-worth, as well.

No Bones About It
Though patients are ultimately taken by the change in their physical appearance, those who have been experiencing chronic pain can find dual relief in cosmetic dental procedures. Dr. Chong Lee, who practices at Galleria Dental Aesthetics in McLean and is a clinical instructor at the Las Vegas Institute for Advanced Dental Studies, emphasizes the need for cosmetic dentists to take care of the functional aspect of the patient’s problem before the cosmetic aspect. If pain exists, he advised, it must be addressed first.

“I have patients who have been to neurologists and ENT’s because of their headaches,” Lee said. “They can’t function due to migraine headaches, neck pain and back pain. Many times, it’s caused by their bite.” Often, the pain is a result of teeth grinding, which Lee said occurs when a patient’s bite is not in the proper place. The muscles and the jaw work overtime, causing fatigue and pain when they are at rest.

To assess the location of a patient’s bite, Lee uses a machine to measure the muscular activity. A computer helps him locate where the natural bite will be, and sonography—which uses the sound of the joint—helps him with jaw tracking. Once he restores the jaw to its natural position, Lee said patients are shocked that the pain “simply goes away.”

He can recall one patient who came into his office with two pages of medications that she had been taking for her head, neck and shoulder pain. “The pain was affecting her everyday. She couldn’t function; she was missing work, and had to sit in a dark room constantly for her migraines,” Lee recalled. “She took a second trust on her house just to get her teeth done, because she didn’t want to live with pain anymore.”

Meet The Dentist
CHONG LEE, DDS, received his Doctor of Dental Surgery from the Medical College of Virginia School of Dentistry in 1983. As a graduate of Las Vegas Institute for Advanced Dental Studies’ renowned post-graduate aesthetic and neuromuscular dentistry study program, Dr. Lee went on to become an LVI clinical instructor and regional director. He founded the LVI Study Club in the D.C. Metro area, and frequently gives lectures around the county to hundreds of dentists. Dr. Lee is a fellow of the International Academy for Dental Facial Esthetics and an active member of the Virginia Dental Association, American Academy of Cosmetic Dentistry, American Dental Association, Association of General Dentistry and Northern Virginia Dental Society. He practices at Galleria Dental Aesthetics in McLean, where he and fellow Drs. Oh and Mortazie were voted top dentists in the Metro area by several publications, including Washington Consumers’ Checkbook and Washingtonian Magazine. Visit www.smilesva.com.

Picture Perfect
Kellie, a 39-year-old mother of three, had had problems with her teeth for as long as she could remember. By the time she was in her late 20s, she found herself with only a few remaining teeth, and she was fighting to save even those.

“Every single tooth had multiple fillings,” she remembered. “I had had at least six root canals and a bridge in the front where one of my teeth had fallen out while I was eating. I have stories that could make your skin crawl.”

Kellie, who owns a well-drilling business with her husband in Christiansburg, Va., began having such difficulty eating that she lost nearly 45 pounds. Her teeth were decaying so quickly that she found herself at the dentist’s office at least once a week. When she went out to dinner, she could only order soft foods—what she began referring to as her “baby food diet.” And yes, her smile was unattractive, she said, but that was the least of her problems.

“When I decided to get cosmetic dental work done, the vanity aspect was only a perk of the procedure,” she said. “For me, it was, I have to eat again. I have to function again.”

After two consultations at nearby dentistry practices, Kellie remained unsatisfied with the institutions’ credentials. She extended her search to encompass the entire state and found Dr. H.R. Makarita, whose credentials impressed her and prompted her to drive three and a half hours to his Oakton practice for a consultation; later, she would return for a complete smile makeover.

“I now have—no exaggeration—perfectly colored, perfectly shaped Julia Roberts teeth,” she said gleefully, adding that before her dental work, she couldn’t find one picture where she was smiling with her teeth. “Over the years, I had major anxiety issues. Now, everything has changed; the way that I eat, the way that I look, the way that I photograph.” With her new teeth, Kelly is training herself to smile again, controlling her hand from flying to cover her mouth as it used to. “No way am I going to cover these beautiful teeth!” she exclaimed.

Meet The Dentist
H.R. MAKARITA, DDS, MAGD, LVIM, FICOI, FAACD, graduated from the Medical College of Virginia School of Dentistry in 1988. He has been a member of the American Academy of Cosmetic Dentistry since 1995, receiving his accreditation in 2001 and becoming the 39th member of the academy to receive its prestigious fellowship designation in 2006. He is a master of the Academy of General Dentistry, and was awarded mastership status from the Las Vegas Institute for Advanced Dental Studies in 2006; he is also an LVI clinical instructor and regional director. Dr. Makarita has received numerous AACD Smile Gallery awards, and received the AACD People’s Choice Award in 2003. His private practice in Oakton specializes in aesthetic reconstructive dentistry. Visit www.fixasmile.com.

Emergency Makeover
Not all dental damage is the result of gradual deterioration, and on-call dentists must be ready to immediately handle urgent cases as they arise. Dr. Lawrence Singer, who serves as assistant clinical professor of surgery at George Washington University and has practices in Alexandria and Washington, D.C., is on-call for facial fractures and dentoalveolar trauma, including avulsed teeth.

When traumas arise, he goes to the George Washington University hospital to assess the patients’ injuries, and has had many unique cosmetic and reconstructive surgery opportunities. “Often, we will go into the O.R. and reset broken jaw bones, and re-implant and stabilize loose teeth,” Singer said. “This initial treatment is critical to getting the best result so that the tissues are manipulated in the best possible way for ideal healing with little defect.”

He remembered when Tanya, an on-duty Arlington County police officer, came into the O.R. Tanya, who was on foot that night, had been struck by a car traveling at 55 miles per hour. In addition to broken hands and a badly broken leg, she had broken upper and lower jaws. She had lost six upper teeth and had three avulsed lower teeth. While orthopedics reconstructed Tanya’s broken hands and legs, Singer worked on her maxillofacial region with an ENT resident. He re-implanted and stabilized the lower teeth by connecting them to adjacent teeth, and began healing the upper and lower jaw by “reducing” the fractures; that is, putting the jaws back into place with plates, screws and sutures.

“The lower teeth were all treated with root canals and porcelain crowns,” Singer said. “We are replacing the upper teeth that were lost with zirconium implants and zirconium crowns, all porcelain.” Since the initial surgeries, Tanya has had several additional plastic surgeries for her gums. “It has been seven months since the accident, and we expect her to finish up in the next couple,” Singer predicted. “Tanya is a tough gal. She has a big smile, though, and restoring it has been rewarding as any.”

Meet The Dentist
LAWRENCE D. SINGER, DMD earned his Doctor of Medical Dentistry at the School of Dental Medicine: University of Pennsylvania, where he served as assistant professor of restorative dentistry from 1997 to 2000. He currently is the assistant clinical professor of surgery at George Washington University and maintains full admitting and ambulatory center privileges at the GWU hospital. He is a member of the Academy of Osseointegration, the American Academy of Cosmetic Dentistry and American Dental Association, among others. He is a also fellow of the Academy of General Dentistry, as well as the International Congress of Oral Implantologists. His practice, DC Smiles, has locations in Washington, D.C., and Alexandria, specializing in cosmetic, implant, and reconstructive dentistry. Visit www.novasmiles.com.

Best Face Forward
Broken teeth resulting from accidents or abusive relationships can cause emotional trauma that runs deep, and cosmetic dental procedures often serve as one significant step in the victim’s recovery process. Dr. Kevin Ryan is vice chairman of the board of Second Chance Employment Services, a Washington, D.C.-based nonprofit organization that places battered, abused and other at-risk women in jobs free of charge.

“Many of these women obviously need dental work because they have broken front teeth due to an abusive relationship,” Ryan said. “I use veneers to restore their smiles so that they are presentable enough to go and get a job, and I’ve also made temporary crowns so that they can go on job interviews. The main thing is to get them ready and give them enough confidence to go out into the workforce.”

The women, who are typically psychologically damaged, find it difficult to believe that they can actually get a job, and the cosmetic dental procedures often allow them to regain a sense of normalcy in their lives. Contrary to common assumptions, Ryan said that the organization sees women of all educational and social backgrounds. He remembers a marine biologist who had a front tooth knocked out.

“She was unbelievably well-educated,” he remembered, “but she just couldn’t get a job. I made her a temporary crown to improve her appearance, and she got a job right away.”

It seems that it isn’t just the women’s appearances that change with this dental work. Ryan remembered a young French woman whose teeth were incredibly damaged as result of an abusive relationship. He created an entire case of veneers for her, which he said made a dramatic change, not only in her looks, but also in her attitude. “She’s a completely different person now,” he remarked. “She’s remarried, has a baby on the way, and is happy and smiling every time she comes in.”

Although many of the procedures would ordinarily run up to $17,000, all of the dental work at Second Chance is done pro bono. Even so, it seems a small price to pay for a life change.

“We don’t just do dentistry [at Second Chance]. We get them clothes, help with their resumes, and you can always see the difference immediately in the way they hold their heads, the sparkle in their eyes. We have story after story of people who have made remarkable changes.”

Meet The Dentist
KEVIN A. RYAN, DDS graduated from the Medical College of Virginia School of Dentistry in 1981. Dr. Ryan was voted as “highly regarded for cosmetic work” by Washingtonian Magazine, and was voted by his peers as one of the “Best Dentists in America” for 2004-2005. He completed post-graduate training at the Las Vegas Institute for Advanced Dental Studies, where he put in 200-plus hours of continuous education a year. He is a member of the American Dental Association, Virginia Dental Association, Northern Virginia Dental Society and the American Academy of Cosmetic Dentistry. He started his own practice, the Springfield Esthetic Dental Center, in 1985, and has been practicing in the area for more than 19 years. Visit www.springfielddental.com.

(November 2007)

Tags: Dentist, Health & Beauty

Cutting Edge

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.”

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.

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)

Tags: Beauty, Cosmetic surgery, Health & Beauty, Plastic Surgery, Top Plastic Surgeon

It’s a Spa World, After All

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 / Photography by Anastasia Chernyavsky

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.

Spa goers enjoy therapy in tea and treatmentsat Sugar House. Photography by Anastasia Chernyavsky

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 / Courtesy of Mark Wieland Photography/The Medical Spa at NOVA

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 / Photography by Anastasia Chernyavsky

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 / Photography by Anastasia Chernyavsky

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 / Courtesy of Freed Photography

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)

Tags: Beauty, Health & Beauty, spas