Barb: Dr Stephen Mulholland is here, founder of SpaMedica, one of Canada’s top cosmetic surgeons. Welcome back to the show.
Dr Stephen: Thank you for having me again, Barb. Of course in the summer we are all working on our sun damage.
Barb: That’s true. That’s right. We have to get that sun damage going so you have a lot of business in the Fall.
Dr Stephen: Yeah, I’m a big fan of sun damage. We can treat it. Wear enough sun block so you don’t get skin cancer. That’s the main thing.
Barb: I was saying that you look great. You don’t have to tell us anything, but you’re sort of looking after … You’ve been losing weight and looking good for the last couple of years, but I just noticed you seem to have lost more weight.
Dr Stephen: Yeah, I kind of made a commitment when I looked at my youngest kid and I realized, “Oh, my God, my sixth could beat me up, and he was like 11 years old. I decided to stop drinking for a number of reasons, maybe just to be sharper and work and more effectively. After that I decided to lose weight, and I’m hoping that my wife and I are going to do a Bravo documentary, climbing up to the first or second base camp of Everest.
Dr Stephen: I figured I can’t be logging that 180 pounds with me. I thought I would lose at least the weight of the pack that I’m going to carry, which is 25, 30 pounds.
Barb: This was a couple of years ago. I think you talked about it when your wife was on Real Housewives, but you gave up alcohol. Did that make a major difference in your weight?
Dr Stephen: I have to say, I was a social drinker my entire adult life, since I was a doctor. Sort of a couple of glasses of wine with my wife at dinner, and of course I would have the three glasses, she would have the two. That’s about 150 calories every night. Then some mixed drinks on the weekend. I’ve never missed a day of work. But I was consuming at least 1500 to 2000 calories every three or four days just with alcohol. I didn’t like it all that much. I played professional hockey as part of our culture then, but I just decided that if I want to get in shape I have to make some sacrifices. Alcohol is the easiest one to make.
Barb: And you feel good, too.
Dr Stephen: I feel better, yes, absolutely. And getting ready for this shedding my backpack weight, I then just eliminated simple carbohydrates. I was pretty much a pasta junkie, and I loved bread. I they just gave that up for just protein and leafy green vegetables. I see a lot of patients with liposuction, and when I am talking to them, you know, “You would be best to lose 20 pounds before surgery.” I just walk them through what some options are. You’ve got your radical weight-loss programs like your Bernstein starvation 800 calorie diets. Those are not really sustainable.
Dr Stephen: You want to have behavioral change. You want to remove the emotional cues from eating. And then take your basal metabolic rate. You can do this with your doctor. And you have a certain number of calories based on your BMI that you need to sustain weight, and it is very predictable. It is like a formula. What your basal metabolic rate needs to be and the calories you need to lose weight. And for me it was about 1800 calories a day, which is doable amount if you are just having mainly protein and some balanced leafy green vegetables, making sure you have the multivitamin, I just don’t … I avoid gluten substances; not that I’m sensitive, but they tend to be a flour and simple carbohydrates for gluten, and that’s it.
Barb: Do you ever crave anything?
Dr Stephen: I did initially, and then once my stomach shrunk to that size were …. I’m not a sugar craver. If you really crave simple sugars, they have products now that off label for diabetes called Ozempic, which blocks a certain receptor in your brain that helps with cravings. Although I am not a craver, I’ve had many patients who have got to reputable bariatric physicians, and they put them on this product called Ozempic. It’s an injection once a week, and it takes away the number one reason people fail, which is they can’t overcome the craving.
Dr Stephen: They see a simple carb or a candy and they must have it. These products, which are Health Canada approved for diabetes, help control glucagon and some other complex issues within the body, but the main thing is they take away craving, and they give you an ambient sense of what patients report is a sense of nausea when they are eating foods they used to gorge on. It has been very helpful to have the stable, gradual weight loss. Lose the weight of the time, change your behavior, gradually learn to do exercise because anybody can lose weight. Just go to a Bernstein clinic. It’s the rebound weight gain you get after you crash that really sinks people’s motivation and will go on.
Barb: 416-872-1010. Text us at 7-10-10. We had somebody hanging on and he could not hang on any longer, but he had a question. We;re answering any kind of question people would come to see you for, for a consultation, right?
Dr Stephen: Sure. Anything from nonsurgical to surgical. Weight loss is a good entrée into where does liposuction fit? Do we have some non-liposuction technology? We’ve got some really cool stuff. There’s a new technology that, for the first time, works from the inside out. It’s a pulsed high-intensity electromagnetic radiation that results in contraction of your abdominal muscles or your butt muscle or your thigh muscle. It’s like 20,000 super maximal contractions in 30 minutes. You can’t ever replicate that though exercise. It creates about a 20% hypertrophy in your muscle fiber size in number of your abs or your glutes, or thigh, after simply four treatment in two weeks. It kills about 18% of the fat over the top of that. That is totally new. We have had CoolSculpting, we’ve had SculpSure, we’ve had all of these products. This is very, very new to the North American market.
Barb: This is like fat reduction plus a workout?
Dr Stephen: Correct, yes. You’re building tone, building up muscle, and you;re killing the overlying fat. EmSculpt is its name. There is going to be a lot of spillover from media in the US and in Canada. It is very, very safe. There is almost no contrary indications. There is no thermal heat. It’s very comfortable. You get a lactic acid feeling two days later, like you had a good workout, but that’s been very, very popular. You can’t be particularly chubby or overweight. It is in for your bigger BMI patients. The need weight loss, CoolSculpting, SculpSure. It’s for your smaller BMI patients; something like a BMI of 20 to 30. A couple of inches over your rectus abdominis, your muscle, or a butt that’s a bit saggy and you want to tighten up the muscle and lift the fat, that’s who it’s good for. For the very first time, we can now treat from the inside out, from the muscle out to the fat rather than from the outside in.
Barb: When you were doing … When your wife was doing the show, and you were on it … And I loved it. I watched it every week. There was one episode where a number of the Housewives took part in a demonstration, and they had something attached to their abdomens. Was that one of these?
Dr Stephen: Yes. That is one of the outside in products. That was new then. It shows you how quickly our industry changes. That was called SculpSure. That is sustained heat that will heat the fat for 25 minutes and kill a significant percent, or we can do CoolSculpt, which cools the fat from the outside. Those are what I call the outside in technologies for fat reduction, but they don’t affect you muscle at all. This product puts two large electromagnetic field paddles over your rectus abdominis, and you get titanic super maximal contractions. They feel odd, they feel weird, it’s not like physiotherapy EMS. These are like 20,000 in 30 minutes. You can’t replicate them.
Dr Stephen: Yeah, so we get even fairly sculpted body builders coming in to get the 20% more muscle fiber they can’t get in a gym, and kill whatever fat they have over the muscle. For that type of patient that is pretty fit, has a little annoying pot after all the workouts, it is a nice way to rehab, enhance and build your muscle while killing fat.
Barb: And 30 minutes treatments. And how many treatments do most people need?
Dr Stephen: It is really just four treatments over two weeks, and you wait four weeks.
Dr Stephen: Yeah, it’s very quick. Most of our treatments take a long time other than Botox and injectables, like a package of hair removal, a package of photofacial. This works very, very quickly. Some patients will come back and do another two weeks cycle, but the basic program where there’s well over 90% satisfaction, it’s just four treatments over two weeks.
Barb: What kind of difference to people see? I know you’ve talked in percentages. Is there a measure in terms of inches?
Dr Stephen: In general, it is about a centimeter reduction of pinchable fat, and a visible toning and honing of your muscles. You are killing some fat over the muscle. You can see more of your muscle. The muscles, themselves, look more toned, more defined, more polished, like you have just finished a 16-week or four-month bodybuilding cycle to build up your pecs, your arms.
Dr Stephen: Yeah, it’s super amazing. 20,000 contractions in 30 minutes would take you months to replicate. You can’t even do that if you are a bodybuilder. We have many guys who come in and say, “Wow. I have been bodybuilding for years. I cannot do this on my own.” It doesn’t replace exercise or diet. It is when you have got to a stalled position in your body shaping goals where EMSculpt takes over.
Barb: 416-872-1010. Text us at 7-10-10. If you have any questions about any cosmetic procedures you are curious about, maybe you have been thinking about for yourself, or maybe one of your kids, or your spouse has come to you and said, “I’m thinking about having this done. 416-872-1010. Dr Stephen Mulholland is here for the alp, and you are listening to The Night Side.
Barb: Great to have you along on this Thursday evening. Special guest in studio, Dr Stephen Mulholland. He is the founder of SpaMedica, one of Canada’s top cosmetic surgeons. He is taking your calls and answering all of your questions on anything related to any procedure you might be thinking about having. Maybe it’s something on your wish list, you are not sure if you can afford it, or maybe what is right for you in terms of a spot that is bothering you. 416-872-1010. We are going to start with Maria. Welcome to the show.
Dr Stephen: Hi, how are you doing?
Barb: Good, thank you. Go ahead with Dr Mulholland.
Speaker 1: What’s bothering me right now is my midsection. For the most part I’m doing very good. For over a year, I’ve been exercising, walking, and doing vegetables and fish, and vegetables and meat. Sometimes you see those [inaudible 00:10:03] at the social… Like, “Oh, my God [inaudible 00:10:05]” I have not done that in a long time. So you binge a little. For the most part I’m doing pretty good, and I am doing my hour walk at least four times a week. Some couple of weeks you get busy, or you miss that, too, but I would just like to ask you, I heard you say that you do protein and veggies, right?
Dr Stephen: Yes, that would be the high-protein approach. There are some different options. Marie, how much weight have you lost of your target weight?
Speaker 1: I have a phobia of going on the scale, but I know because I was a lot of my clothes are very loose on me now. A lot of people say, “Oh, my God, Maria, you are losing weight. You are doing great.”
Barb: How much would you guess you’ve lost?
Speaker 1: I would guess 25, 30 pounds.
Dr Stephen: That’s really good, actually. That is probably over between 10 and 20% of your total body mass, and that’s good. What happens is, I’ve been doing this almost 25 years now. Patients get to a weight where they plateau, but they have a stubborn area like a little pot below their bellybutton or a saddlebag, or an inner thigh, or an upper arm that’s very difficult to target with caloric transitioning, so you can’t say, “I am going to eat this beautiful healthy diet and I want it to only come off my thighs.”
Barb: Yeah. Right.
Dr Stephen: It always comes off where you don’t want it. When you get to a reasonable weight, Maria, like where you are at, this is where sometimes you might meet a cosmetic physician to talk about, “Okay, I’m pretty happy. I will stay on my program, but how do I lose weight locally? How do I shrink fat off my tummy or my pot?” During that first opening segment we talked about some of those options. It doesn’t always have to be liposuction. That is often your best option. If you have loose skin and fat it could be a tummy tuck, but nowadays we have tremendous technologies like CoolSculpting and SculpScure, and this new and EMSculpt I was talking about to kill fat safely, with no surgery, from the outside in, and target an entry to reduction … You don’t want to be unrealistic. It’s not lipo, but it is dead fat, and you can target it locally, without having to change any diet or exercise routine, or going to some crazy amount of carbohydrate or calorie restriction.
Speaker 1: So, it’s the surgery you are talking about?
Dr Stephen: No, I’m talking about nonsurgical. Most patients shy away from surgery, but if you asked me, “Dr Mulholland, what’s the best way to lose my pot?” It’s always going to be liposuction or a tummy tuck, but if you said to me, “Do you have a nonsurgical way where I can kill that permanently, and make a [inaudible 00:12:35] with no risk or very little risk?” Yeah, we have a lot of those things. Over the last seven or eight years we have got technologies like CoolSculpting, SculpSure, UltraShape, Vanquish, EMSculpt; this new one.
Dr Stephen: We can kill fat from the outside in, non-surgically. It may not be the big four- or five-inch reduction you want. If you really want a mass reduction of localized fat under local anesthesia, you have to still do what is the modern version of liposuction, and so you have two options.
PART 1 OF 3 ENDS [00:13:04]
Dr Stephen: -version of liposuction. You have two options, surgical or nonsurgical options.
Barb: What would the downtime be for the nonsurgical procedures?
Dr Stephen: The nice thing about nonsurgical for problem areas like Maria complains about, the pot, you could walk into a center, do your consultation, do your inial treatment and go right back to work.
Barb: Oh wow!
Dr Stephen: There is no downtime-
Barb: You don’t have to wear like a girdle or anything like that?
Dr Stephen: No, I mean you may elect to squeeze into one of those, but I don’t prescribe them or I have no patients. Tummy support is elective, you just have to get under the technology, whatever it might be. You generally can be 25 to 45 minutes, depending if you’re cooling, heating, ultra sounding or muscling. You go right back to your activities and you do a series of treatments that’s going to be between two and four, depending on the technologies. And you can get a significant and noticeable reduction of fat. It’s not lipo, but it’s sometimes pretty darn good.
Barb: 416-872-1010. Here is Derek. Welcome to the show Derek.
Derek: Hi there, how are you doing?
Barb: Good, thank you. Go ahead with your question.
Derek: Sure, I’m a 49 year old male and I’m in good shape, but I have these little lines that are forming in front of my ear, on both sides and I find that’s like a tail sign that I’m getting older. Is there anything that can be done non surgically for that?
Dr Stephen: Yes. Derek, you’re 49, you sound like you’re probably a big smiley guy.
Derek: Yeah, somewhat I suppose.
Dr Stephen: Full dentate smile. You show your teeth when you smile, you’re not like a smirker.
Derek: Yeah, yeah, yeah.
Dr Stephen: So when you smile, it crinkles a little bit, but what you’re talking about is those very annoying post sideburn, right in front of your ear, wrinkles. It looks like kind of grandpa skin, but you’re a young guy and you don’t want to have that grandpa skin. It’s not uncommon and so I’ll have a number of guys.
Dr Stephen: If you were a little older, I’d say well do a little mini guy lift, we lift the skin up and hide in your ear, but that takes surgery. Your best option, can I ask if you are light skinned or darker skinned, kind of ethnicity?
Derek: Caucasian, Mediterranean skin.
Dr Stephen: Okay. So in general, we have some fractional, non surgical fractional techniques that use either radio frequency energy or a laser, a fractional laser, or a radiofrequency device that can usually take… Those are fairly fine lines there, not like your smile lines, and we can basically do a selective thermal injury, well let’s called what it is, a selective burn and we can burn the wrinkles down. You have to take 7 to 10 days off, like you have a bad sun burn, but if they’re fine lines and you have fairly light skin, you can anticipate 95% reduction of those lines.
Dr Stephen: Of course, you can never smile again Derek. That’s for size amount.
Derek: Okay, I’ll like that. Thank you.
Barb: Alright, Derek. Thanks a lot for the call. I think you were kidding about the last one.
Dr Stephen: No, you can smile, but just you can’t see all your teeth. Full dentate smilers, like Tom Cruise looks great at this age because of all the surgeries. Let’s say, if you watched Tom Cruise and that full dentate smile, you end up with all these lines and wrinkles that go all the way back to your ear. It looks great those big white smiles when you’re young, but you pay the price for all that happiness.
Barb: He looks weird good.
Dr Stephen: Well, he’s always looked a bit weird good, you know? He’s always had that huge full dentating gaging smile going right back to Jerry Maguire and those early shows when he was just in his early 20s and he’s got a lot of charisma. He really captures the screen. I’ve had the chance to see him live when he’s not that far away and not on screen. You’d think “Man, that’s not Tom Cruise, he’s got like the face double.” Some people just light up a camera and he’s one of them.
Barb: He is because he always looks amazing on camera, but then if you see just pictures of him, it’s just not the same.
Dr Stephen: Right, no. Definitely, he’s got that sort of George Costanza look about him when he’s not on air. He’s not under assuming, but wow, he’s got that full dentate smile. My point is his cheeks, if he’s not doing some kind of non evasive laser –
Barb: They would be really wrinkled.
Dr Stephen: Totally. He’d look like Robert Redford by now in some Sundance commercial. Some old guy with a gun.
Barb: We’ve got a couple of callers on the line. Please hang on if you have time because we have to take a break, but this is like great information and I love learning about this stuff too.
Barb: Dr. Mulholland is here. Normally, I think we would have to pay for a consultation, but tonight you’re getting it for free. 416-872-1010. He is the founder of SpaMedica, one of Canada’s top cosmetic plastic surgeons. Give us a call now, you are listening to the Night Side.
Barb: Great to have you along on a Thursday evening. It is a fun night and a busy night. Dr. Stephen Mulholland is here. Founder of SpaMedica, one of Canada’s top cosmetic plastic surgeons.
Barb: I know a lot of you have questions and great that you’re calling in at 416-872-1010. We will get to all of your questions and I’m curious to hear, because it’s always interesting the kinds of procedures people are interested in having done. And downtime is a big one because a lot of times, is it fair to say, people will come to get things done, they don’t really want everyone knowing that they’ve had something done.
Dr Stephen: One of the management discussion is who’s going to help care for you after when you go home? Either that day or the next day. And then, what is your transition plan back into your normal life? Just principally the workplace. We’re much much more open about cosmetics surgery, we talk about it and everyone else who’s had it. But of course no one has had it done.
Dr Stephen: It’s still not that open where you say “Oh, what do you think of my face lift scars? Those look great.” Or you lift up your shirt and say “Whoa, I think my breast augment.” That’s standard non coffee, you know, coffee time chat or around the cooler chat. People have to have a plan on what to say at work. Generally, have a transition plan on “I needed to have some abdominal surgery.” Keep it general. Or if you had facial surgery, “I had some gum surgery, so I’m a bit swollen, you should of seen me last week.” Nobody likes dentists really. So we just blame it on the dentist, wherever possible.
Barb: Alright. 416-872-1010. Kira, thanks for holding and go ahead with your question.
Kira: Hi there. So I had a breast augmentation about a year and a half ago, one of my scars has this small bump on it. Almost like a skin tag. I was wondering one, how do I get rid of that and two, is that something that I have to pay for or does my surgeon cover it?
Barb: Oh that’s a good question.
Dr Stephen: That’s a great question Kira. And this was not a molar skin tag that was there before?
Dr Stephen: This was new. And it was an under the breast incision approach? Not areolar or armpit. It was under the breast?
Kira: Yup. Under the breast.
Dr Stephen: So what happened during the closure, and all probability, there was a little bit of a proud flesh or a slightly uneven incision line or you could of had a little bit of flesh that got buried under the skin and you got an inclusion cyst. Regardless, it’s likely benign, likely nothing to worry about. And most surgeons, if you call the office, it’s in their incision, we take responsibility. We feel badly. Little local anesthetic, a little nip with some scissors, and maybe a little electric cautery or a one stitch and it’ll be gone.
Kira: Okay, perfect.
Barb: Have you talked to the surgeon about it?
Kira: No, I haven’t called yet. I keep putting it off, but it’s been a year and a half so I think I should just call him.
Dr Stephen: Now, it is under the incision, it’s hidden under your breast. The obvious question is, when do I ever see it or who ever sees it?
Kira: That’s the thing. That’s why I’ve been putting it off because you don’t even see it when I’m wearing a bikini.
Dr Stephen: Right.
Kira: But it’s something I know is there and it does bother me.
Dr Stephen: Yeah, it bugs you. You paid for perfection. If you’re still dating it’s kind of creepy if your date’s playing with this little skin tag.
Barb: Oh God.
Dr Stephen: I think that, in the interest of perfection, most plastic surgeons this city are perfectionists. That’s why we go into it. And they’d be quite bothered that you have this and it would cost you nothing. It would likely be part of the post op care.
Dr Stephen: Local anesthesia, literally 50 minutes, nip it off. Just like a skin tag you might have in your armpit or your groin. And it’s gone.
Kira: Perfect. Thank you so much.
Barb: Alright, Kira. Thanks a lot for the call. 416-872-1010. You gave me a visual there that I just don’t want. Marlene-
Dr Stephen: It is radio.
Barb: Yes, of course. Marlene is next. Hi Marlene.
Marlene: Hi, good evening.
Barb: Hi, go ahead with your question.
Marlene: I’ve been dealing with what I’ve been told is melasma for many years and I’ve tried a number of products and nothing’s worked. I’m a light skin black woman and I know laser is not necessarily the best treatment for me. I was just wondering what I could do to get rid of it because even going out for a walk or out on my front porch, you know, it’s just a struggle. I have to slap on a lot of make up to cover, which doesn’t always do such a great job.
Barb: What exactly is melasma?
Dr Stephen: Marlene, thanks for calling and how old are you? How young are you, I should say.
Marlene: I’m 56. I’ve been dealing with this for over 20 years.
Dr Stephen: Yeah. Practicing here in Toronto for the last quarter century, I have to say I go to other cities to lecture and talk to doctors and they might have a few Hispanic patients, but no city I know of is as multicultural as we have. We have Caribbean Canadian, like yourself, we have Guyanese, we have lots of South East Indians, Asians patients and melasma is a big issue though we treat at SpaMedica.
Dr Stephen: Melasma is a condition of abnormal production of pigment. It’s a hereditary, hormonal, and an environmental problem. You probably have a mom or a grandma that passed on the tendency of your cells to lay down that melena. It’s often geographic, irregular brown spots. Not small, but large ones. Cheeks, forehead, under eye. They can be very dark and hard to cover. It can be hormonally triggered, so as you enter menopause, it gets worse. After you’ve had a couple of kids, it comes on it doesn’t come back, it never goes away. You can go out and get just a little bit of sun and it darkens and it never lightens again. Melasma is a little bit of a curse. Where is the cult curse tends to be red rosacea kind of faces. The Mediterranean, Asian, Caribbean curse is melasma.
Dr Stephen: Fortunately, even for a light skin Caribbean gal like yourself, we have some good options. First of all, you need a medical prescriptive. You can try hydroquinone and bleaching agents, but you’ve got to get-
Marlene: I’ve tried all of those.
Dr Stephen: Okay. It’s not going to be a cure, it’s going to be the first phase of stunning your melanocytes, the cells that make pigment, into like a coma. It won’t go away, but they kind of quiet down and that allows a center cosmetic dermatologist, myself, other centers that have something called a picosecond pulse duration laser. These are very new, it’s the last four or five years. The picosecond is such a short pulse duration, it doesn’t generate much heat. It shatters the pigment, even in dark skinned patients into tiny bite size more so your immune system can take it away.
Dr Stephen: In general, doing a pico facial with a picosecond laser, maybe 15 of them in the city of Toronto, which is a good number of them, you can get about a 70% reduction in your melasma, which is better than what we’ve ever been able to do and you need to stay on that bleaching cream during the entire process. I’m talking about a medical prescriptive, 8% hydroquinone, 0.5% retinoic acid, a little kojic acid topically in your skin. And you can control that. It won’t be cured and you have to look at melasma as if you have diabetes of your skin. You can never get rid of diabetes.
Barb: It’s managing it.
Dr Stephen: It’s managing it. But you do need a picosecond laser. It’s reasonably affordable. When I say reasonably, obviously it’s more expensive than anybody wants, but generally for $2000-$2500, you can have a 6 to 8 months program that gets 75% reduction of your melasma and then a simple three times a year maintenance program to look after. But you need to avoid sun exposure wherever possible and just avoid those curling iron burns or thermal stimulation that sometimes lead to a brown spot that never goes away.
Barb: You know what’s interesting about that because for some people, they would hear that and say $2000. That may not be manageable every single year, but if you’ve got a big event coming up and this is really important to you or you could do it a fewer times and not have the same level. But for people who have that it sounds like she’s always, always being careful because I guess it just continues.
Dr Stephen: Yeah. It is a progressive, skin disorder that is relentless and amplified by UV sun exposure and post-menopausal or hormonal environment. It is a one single program. Once you’ve got that control, it’s really only coming in two or three times a year. So it’s quite affordable to maintain.
Barb: 416-872-1010. Text us at 710-1010.
Barb: Everybody who is on hold, we are going to get right back to your calls. Just as soon as the night side continues.
Barb: Dr. Stephen Mulholland is here. Founder of SpaMedica, he is one of Canada’s top cosmetic surgeons and he will answer all of your questions. You’re listening to the Night Side.
Barb: Great to have you along, Dr. Stephen Mulholland is here and we are taking your calls on any questions regarding-
PART 2 OF 3 ENDS [00:26:04]
Barb: … and we are taking your calls on any questions regarding invasive/non-invasive procedures. He is the founder of SpaMedica, one of Canada’s top cosmetic surgeons. Let’s go back to the phones. 416-872-1010. Shirley, welcome to the show. Go ahead.
Shirley: Yes. I have a droopy eyelid. What is the procedure for righting that?
Dr Stephen: And it’s just one of your eyes that’s droopy?
Shirley: Just one.
Dr Stephen: And it’s been there your whole adult life or gotten worse since you’ve gotten older?
Shirley: No and I’m getting older all the time.
Dr Stephen: Okay. So what you have is what’s called Ptosis. P-T-O-S-I-S if you’re going to google it. Basically, there’s a special muscle in the crease of your upper lid. As you get older, sometimes it separates from its job, which is holding the lid up, and you get what’s called a Senile, not that you’re senile, it’s just the medical term we use for it, Ptosis or droop and so it needs a little procedure called a ptosis repair.
Dr Stephen: Now, in the old days, like when I trained in the 80s, if it was encroaching on 25% of your visual field, OHIP would cover it. Good luck getting that nowadays and so you would see, start by getting a referral, to a plastic surgeon or an Oculoplastic surgeon. These are ophthalmologist that specialize in this little lid tuck, in a ptosis repair. They actually reinsert the muscle into the crease and tighten up the muscle, so they try to balance, it’s almost like a blind is coming down on your eyelid. It’s closing like a blind on a window and they try and right the blinds, get the venetians right on both sides, and they would leave your normal eye alone and try match the droopy eye to the other side. It’s done under local anesthesia. It takes about an hour. Very successful. It’s probably nowadays, the way OHIPs costs, probably going to cost you about $2500 and up, but generally a good investment because it lasts forever.
Shirley: Well, I was told, I’m a senior. I was told it was covered.
Dr Stephen: Well, you have to get an ophthalmologist then that rights a letter to OHIP and sends you visual field and sometimes they do cover it. It’s been my experience it’s more and more difficult to get covered. They’re not in the business of funding more surgeries. They’re trying to deny us surgery, so I think if it’s encroaching on your visual field, it should be covered and just get an ophthalmologist that just gets behind that concept and submits a letter on your behalf.
Barb: Shirley, thanks a lot for the call. Myrna is next. Hi Myrna.
Barb: Go ahead with your question.
Myrna: I have two questions. First of all, I’m 48 and my skin looks pretty good. I have no wrinkles whatsoever. I’m interested in the collagen induction therapy using a derma roller, I want to know if that actually helps to produce more collagen in the skin? Number two, even though I have no wrinkles my face lost some of the fat layers and it does look like a little bit sagging like not plump and obviously I’m not young but I want to know if there’s anything that can be done to keep that plumper look or is there any procedures?
Dr Stephen: Those are two good question Myrna and they’re two separate topics. Let’s start first with you collagen induction therapy. Basically there are a ton of little micro needling devices available now with or without radiofrequency energy and they penetrate into the superficial layer of your skin and they create a little micro wound and any micro wound that’s not excessive is going to result in new collagen and ground substance production. So micro needling is one of the entry levels into an aesthetic treatment, micro dermabrasion, micro needling. Then you can add growth factors like something called PRP where we draw a little bit of your blood, we spin it down and we have growth factors and stem cells and we can then put it on your skin through those little micro needling injuries to induce even more collagen elastin. However, your skin sounds very smooth just deflated so micro needling’s not a good option for you because as you said your texture’s pretty good, you don’t have many wrinkles. What you lost is volume. Do you have normal menstrual cycles still?
Myrna: I do.
Dr Stephen: Okay, do you work out a lot? Did you get like fit and lose some weight and you’re happy with your body but your face didn’t follow that same plan?
Myrna: Yeah, exactly.
Dr Stephen: So that’s what happens I call it the worker outer face or the jogger’s face. They look great, man their biceps and they’re just ripped on their body, they look awesome but their face looks quite deflated and you lose that facial, you know we call it the fullness of youth for a reason. Those nice full cheeks, that oval shape and then you get these hollow temples, hollowing under your eyes, the cheeks deflate it sags a bit and you look at bit cadaveric. So here you are at 48 looking hot from the collarbone down but you need candle lights and dimmers for the rest and so thank goodness for fillers. Fillers saves the day for worker outers so you can work out to your hearts content and do a little bit of Juvederm and volume maybe once a year to keep the volume up, you don’t want to look like filler face, you know those giant overly filled faces but just enough volume to bring back the volume you had so that you can rock the hot bod from the workouts but your face doesn’t look deflated and old and saggy and cadaveric. So that’s a very, very common problem.
Dr Stephen: So the solution is either put on some weight and it’s been an old adage that goes back way, way back that you sometimes have to sacrifice your butt for your face. But if you want the hot butt your face takes the heat. Nowadays we’ve got volume shapers like Juvederm and Reslin and we can just once a year add a little plumping and it allows you to preserve what you got. Now you could take fat from residual fat pockets spin it down and inject fat and that may give you a longer term result, that’s a little more expensive and a little less guaranteed to give you how much you want where you want but injecting some volume that gives you back that fullness of youth without looking overdone is a secret to being an exerciser as your approaching that peri-menopausal age.
Barb: 416-872-1010, Roseanne, welcome to the show.
Roseanne: Hi, I’ll keep my question really quick. About seven years ago I had a very expensive circumferential body lift. The procedure itself was I believe almost seven hours and what the remainder, they took 17 pounds of skin off. Yeah, no fat from my abdoment but what I was left with was where I had a small in my back, it’s now a bump in my back and it’s kind of in two parts. So I have like an extended line along my spine and two very firm kind of pieces that no matter how much I try and lose the extra fat it’s not going away and I didn’t know if that scar tissue could potentially be surgically removed or maybe liposuction or whatever I was looking at Cool Sculpting or if there’s some way I can get rid of it. I also wondered if it’s normal for areas where you’ve had liposuction, say along the outer thigh where they did a little bit of sculpting on my thighs it’s numb and the feeling has never come back. Is that normal as well?
Dr Stephen: Well those are good questions. First of all congratulations on losing enough weight that allowed you to do that body lift so that’s a big commitment through gastric manipulation or bypassing or just good old fashion fortitude or a combination of everything. Then you know body lifting is a very specialized area of plastic surgery, there’s about three guys in the city that do it really well, Dr. Bray, Dr. Addufar, Dr. Dupree, those are probably the busiest body lifters and almost certainly, I’m not a body lifting guy, I do neck lifts on people who’ve lost a lot of weight but not the body work, I leave that to guys like Dr. Bray. Now once you’ve done a body lift, I do know that all three of them would say there’s almost 100% chance we’re going to come back and we’re going to have to work with the fabric a little bit because when you’ve lost a lot of weight like that your collagen content, your elasticity is not quite the same.
Dr Stephen: So once things have settled and Isaac Newton has weighed in on where this gravity’s going to take the soft tissue there’s often little touch ups that are required. It sounds like you may have a bit of a dog ear which is a little extra fabric when you’re taking the dart out on a dress sometimes you have a little dog ear. A little standing cone of flesh that may have a little fat in it and sometimes you can do a little bit of enhancement lipo and it will sit flat, sometimes you have to do a little bit of lipo and cut out the tissue. But what I would do is I’d go back to your physician, if you still have a good relationship and feel confident with him, if not seek out one of the other two or three guys I just mentioned and say look I was pretty happy with the overall body lift front and back but I’ve got some issues around the scar, what can I do now? Usually it’s a local anesthetic hour and a half procedure max.
Roseanne: It’s a significant space through, it’s like four inches by about ten inches and it’s hard.
Dr Stephen: Okay it may be you have some fibrous scar tissue there and again usually it can be dealt with if it’s enough to be protuberant and your scars have healed well without keloid or hypertrophic scars, it would be very unusual not to be able to deal with a post op [inaudible 00:35:08]. We’re on the air so it’s hard to know exactly what you’re talking about but I would just say that almost let’s say if I was doing a neck lift on you and you’d lost a lot weight I would say there’s two surgeries we’re going to have ma’am. The first one and the second one and pre-plan about a year later just to deal with some of the issues around elastician tone, you had a big surgery, you’re probably super happy you did it, you just want to do a little renovation on the scar basically.
Barb: So we are way out of time but there is a caller, I’m not going to have time to take the call but maybe if Susan can listen. She had to have some surgeries that ended up developing a mild staph infection, now she wants to have a surgery to get rid of bags under her eyes, doctor says no. Is there any way it could be safe?
Dr Stephen: Well, she probably had some methicillin resistant staph and we’ve all heard this in the back of our mind, on the news, the MRSA, very common at teaching hospitals with multiple resistant organisms, it’s carried in the nose and all I would say is as long as she was no longer a MRSA carrier and she was treated for her MRSA and you do a nasal swab and it’s no longer there, then I will offer cosmetic surgery to MRSA patients who have proven to no longer be carriers. If you’re no a carrier, you’re not exposed to these resistant bacteria then you are at no higher risk than anyone else in the population.
Barb: Alright, we couldn’t get to all of your calls this time but thank you so much and Dr. Stephen Mulholland will be back probably in about four weeks time depending on his busy schedule. Thank you very much for this.
Dr Stephen: Thanks as always Barb.
Barb: And people can find you at SpaMedica.com?
Dr Stephen: They can and actually in the building.
Barb: And in the building they can find you, not just on the website. But I know you do podcasts and videos.
Dr Stephen: I do, so we do a lot of stuff. If they want to see what’s cool and what’s new I’m almost every second weekend in the U.S., some U.S. city teaching lasers and invasive devices, always non-invasive of what’s new what’s happening, what’s available.
Barb: Very cool. Thank you very much Dr. Stephen Mulholland, you are listening to the Night Side.
PART 3 OF 3 ENDS [00:37:01]