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Fixing the Exterior and What Lies Beneath

From the time the first breast augmentation surgery was performed way back in 1895, people have been looking for ways to correct nagging physical flaws and improve their appearance. Fortunately, the field of cosmetic surgery has come a long way from those days in the 1800s when primitive implants were cobbled together using what the American Society of Plastic Surgeons (ASPS) describes as a concoction of paraffin, beeswax, and vegetable oil.

Compared to those materials, today’s advances are the stuff of science fiction—stem cells, growth factors, CT scans, and digital imaging—and they are helping patients get better results from less invasive procedures.

While many cosmetic treatments and procedures have historically focused on smoothing and tightening the skin and the outer layers of the body, experts are starting to realize the importance of what lies beneath, and the relationship between appearance and physical health.

Understanding Facial Beauty
Attractiveness is largely determined by your facial skeleton. The prominence of your facial skeleton, the height of your cheekbones, the shape of your jaw, and the placement of your eyes, can determine how attractive you are to others. More prominent bones underneath the skin also mean better aging—good structure helps prevent the dual curses of middle age, sagging eyelids, and hanging jowls.

While experts once thought only the skin aged, they now know that the bones also change over time. This finding helped explain why in some patients a facelift doesn’t instantly make them look like they did when they were a fresh-faced 20-year-old.

This increased understanding of underlying facial structure has led to increased attention on augmenting the facial skeleton, says Dr. Michael Yaremchuk, a Boston-based plastic surgeon. “Based on CT scan data, it is now possible through Computer Aided Design (CAD) and Computer Aided Manufacture (CAM) to create implants made specifically for individual patients,” he says. “These customized implants can improve facial features with individuality and great precision. Recently it has been shown that there is some deterioration with loss of projection of the facial skeleton with age; skeletal augmentation has become part of the facial rejuvenation algorithm along with the traditional facelift, neck lift and blepharoplasty procedures. I believe that alteration of the facial skeleton will be increasingly recognized as important in cosmetic surgery.” While new information about facial structure is gathered, experts are also focusing on developing other new technologies, which many hope will one day be as effective as surgery in achieving results. Today’s offerings still fall short of surgery when it comes to results. “Without cutting you’re not going to be able to make someone look ten years younger,” says Dr. Leonard Miller at the Boston Center for Facial Rejuvenation.

However, this may change in the future, and in the meantime, it certainly hasn’t deterred patients from seeking out minimally-invasive procedures that come with less downtime and a lower price tag. In fact, these procedures are booming, fueling the growth of this $13.5 billion industry, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Botox procedures provide a strong anchor in this corner of the market with 6.7 million procedures performed in 2015.

“Patients are using Botox, fillers, and aggressive skin-care regimens starting in their 40s or even younger to fend off Father Time,” says Miller. According to Dr. Jeannie Chung, a Wellesley-based facial plastic surgeon, though sometimes a seemingly quick fix, these skin care therapies can take time. “Looking your best is important for many men and women in the Boston area,” she says. “However, it is important to remember that proper skincare and rejuvenation therapies can be as time consuming as an invasive surgical procedure. I always suggest coming up with a plan a few weeks in advance of when you would ideally like results by.”

Body procedures like breast augmentation, liposuction, and tummy tucks are also on the rise. Non-invasive fat-removal techniques are challenging  liposuction, a tried and true method of fat removal, which grew four percent between 2014 and 2015. In the long run, the popularity of liposuction has actually dropped nearly 40 percent since 2000 as new technology comes on the market.

Not Just for Looks 
While most patients seek cosmetic enhancements to improve their appearance, often they may get other physical and emotional benefits from these procedures as well. For example, The American Society for Aesthetic Plastic Surgery points out that certain procedures also carry with them physical benefits. These include:

  • Breast-reduction procedures or those that address asymmetry can help improve posture and reduce back, neck, and shoulder pain. They can also make it easier to breathe and reduce skin irritation.
  • Tummy tuck procedures can reduce stress incontinence, reduce diabetes risk, and in some cases, help relieve back pain.
  • Eyelid procedures can remove skin that may impair vision.
  • Rhinoplasty can help correct structural problems inside the nose to improve breathing.

In some cases improving the physical appearance can also have benefits for mental health and boost self-esteem, bringing the appearance more into line with traits that are valued in American cultureyouth, attractiveness, and fitness.

Orthodontics to Improve Health
Oral health and aesthetics is also getting a lot of attention these days with a rise in the number of cosmetic dental procedures. In many instances changes patients pursue for aesthetic reasons also may play a role in improving their oral or even physical health. Researchers have linked oral health problems to a higher risk of conditions including heart disease and preterm birth, according to the Mayo Clinic.

It’s not surprising that the mouth’s appearance, and oral and physical health are linked,” says Dr. Anna Berik of Newton Dental Associates.  “The mouth is a window for the overall health of an individual. Many diseases exhibit their earliest manifestations in the mouth. It is insurance companies who have disconnected the mouth from the body.”

The mouth is where digestion begins, and the teeth play a critical role not only in breaking down food, but in helping with proper speech. Helping to maintain strong, healthy, attractive teeth into a person’s 80s and 90s and beyond can preserve their quality of life and health. Healthy teeth also play an aesthetic role filling out the lower third of the face.

When it comes to the mouth, a little vanity might actually be very practical. Orthodontics is an example of how an aesthetic investment can pay off in better oral health.  “Orthodontic is first and foremost a treatment of choice for malocclusions (bad bites),” says Berik. “It is an integral part of comprehensive oral care. The value of having a proper bite has somehow been lost to the notion that having “straight teeth” is an elective cosmetic treatment for middle class children.”

Three of every four Americans have a problem with their bite or with overcrowded teeth that can potentially cause their teeth to wear away, become hypersensitive, decay, or cause gum disease and bone loss, she says. For today’s adults, whose bite problems weren’t treated during childhood, there are options to address the problem, such as invisible, clear trays to realign the teeth.

Adults are taking advantage of these orthodontic options in increasing numbers. Between 2012 and 2014 a record number of adults—1,460,000, age 18 and older in the U.S. and Canada—sought out orthodontic treatments which is an increase of 16 percent, according to a study by the American Association of Orthodontists (AAO). Adults now make up nearly 30 percent of orthodontic patients.

In addition to straightening procedures, local adults are also looking for other services to improve their smile.“As a prosthodontist I see many people in their 50s and 60s,” says Dr. Ryne Johnson, a prosthodontist and managing partner at Newton Wellesley Dental Partners. “They are active, vibrant, and very social at this point in their lives.  A great smile projects health and charisma.  However, this generation often has old and tired dentistry that was done 10-plus years ago.  Generally, we’re doing crowns, veneers, and implants to restore function and aesthetics.  If done properly, the work is imperceptible. I can often ‘subtract’ 10-15 years off one’s appearance by invigorating their smile.”

Newton dentist Ted Filandrianos D.M.D., F.A.G.D., says that he sees many older patients who are ready to enter the job market and looking to make themselves more marketable by opting for whitening treatments or porcelain veneers, which provide quick results.  Veneers are custom-shaped slivers of porcelain crafted to bond to the patient’s teeth to instantly reshape them and repair imperfections. Applying veneers typically takes two visits. The teeth are first buffed and shaped to ready them for the veneers and then they are applied to the teeth. “Porcelain veneers are getting better and thinner,” he says. “They’re almost like contact lenses that you can just bond over the teeth. It’s what we call minimally invasive dentistry.” This minimally invasive approach aims to respect and maintain the original structure of the mouth and its tissues as much as possible. Essentially it aims to make the fewest number of changes to the person’s original teeth as possible.  This approach is helped along by new technology that adds new precision, predictability, and ease to old techniques.

When a patient is happy with their smile it can boost their self-esteem.  “When you smile at another person, the physical action releases endorphins in your brain,” says Irays Santamaria, a prosthodontist with Warshauer and Santamaria in Boston. “An instant feeling of happiness will raise your self-esteem. When you smile, you will radiate a positive attitude, creating a positive impact on everyone around you. We see it every day. Whether is a small restoration, teeth whitening, full mouth reconstruction with implants, or a full smile make over, we see the positive impact right away.”

Surface Treatments Also Provide a Boost
For those who aren’t quite ready for the commitment or expense of cosmetic or dental procedures, there are still other options that can provide a quick and significant boost to the appearance. One of the simplest is make-up, which enhances the appearance with less commitment. Today’s hot look in the Boston-area focuses on bold lips, full brows, and dewy fresh skin, says Paula Tierney, owner of Boston-based, A Matter of Face.

While contouring makeup was the big buzz a few years ago, Tierney says she gets fewer requests for contouring today, but still uses highlighting techniques to brighten the face while still allowing for a natural look. “I think in some cases contouring can replace surgery for those who don’t want to take that surgical leap to achieve a smaller nose, prominent cheek bones, or bigger eyes, which can all be achieved with makeup,” says Tierney. Boston-area residents don’t want just any make-up or skin-care products—they want them to be natural. “Fortunately, consumers have created a demand for this and manufacturers are getting better and better about eliminating the harmful ingredients being put in our favorite products,” she says.

Hair Restoration to Help in Healing
Another instant appearance-booster is hair replacement, which may be especially critical for women who have gone through cancer treatments and experienced hair loss. Losing hair can take a toll on a woman’s self-esteem, body image, and self-confidence, according to the American Academy of Dermatology (AAD). Hair integration can help women who have gone through chemotherapy to restore their hair. “Not everybody that goes through chemotherapy loses all their hair,” says Sarah Deutsch of Suisse Natural Hair Salon in Newton. She uses hair integration to restore a natural look and a sense of normalcy and beauty after what is often a traumatic life event. Restoring a woman’s hair can help them heal emotionally, as well as physically, she says. Women typically come in before cancer treatments begin so that Deutsch has a baseline for the restoration after treatments are over.

Zapping Away a Source of Embarrassment and Discomfort
Another procedure that can help boost self-esteem is laser hair removal. While some clients seek laser hair removal because it’s more convenient than shaving or waxing, others come in because they’re self-conscious about excessive hair growth. Excess hair growth sends many women, and men in search of hair removal options. In 2015, 1.1 million laser hair removal procedures were performed in the U.S., according to the ASPS. Laser hair removal uses concentrated light to damage hair follicles to eliminate unwanted growth, and it typically takes between two and six visits to achieve results, according to the AAD.

“For women it’s often dark facial hair on the upper lip and chin or thick hair growth on their arms that’s embarrassing to them,” says Maral Ghahramanlou, Vice President of Operations for CARE Laser U.S. “For men, thick back hair that grows over the shoulders is not only bothersome, but also keeps them from truly enjoying activities like going to the beach or exercising. We also see young clients that have just begun puberty who are already self-conscious about excessive hair growth. We are glad to be able to offer them a safe, easy, and effective way to remove unwanted hair and contribute to their self-esteem.”

As technology continues to evolve, not only for laser hair removal, but for all types of cosmetic procedures, Boston-area residents will have more options to address those nagging physical imperfections that plague them. It may be those drooping eyelids, that extra pocket of fat around the middle, or a misaligned smile that adds years to their faces. In some cases, making those physical improvements they seek may also help them improve their health and well-being.

Resource Directory

Contact these local experts to jump start your life today.

Boston Center for Facial Rejuvenation

CARE Laser

Dr. Ted Filandrianos

Dr. Ryne Johnson
Newton Wellesley Dental Partners

Dr. Michael Yaremchuk

Jeannie Chung, MD, Plastic Surgery, Rejuvenation
781.235.3223 (FACE)

Newton Dental Associates
Dr. Anna Berik

Paula Tierney: A Matter of Face

Suisse Natural Hair Salon

Warshauer and Stantamaria