A2 Aesthetic and Anti-Ageing Magazine

A commemorative recollection of times gone – and an account of one man’s passion for his chosen profession. Robert Fysh depicts the art of Rhinoplasty… as described by Dr Pieter Swanepoel.

Glamorous television ‘make-over’ programmes and ‘feel good’ magazines, have turned plastic nose surgery into a ‘must have’ commodity. Photographs and footage of ecstatic patients embracing a new life reinforce this tendency. Once a luxury form of surgery, the skills of a good Rhinoplasty surgeon are now in popular demand.

Yet, according to Dr Pieter Swanepoel, principle Rhinoplasty surgeon at the Nose Clinic, in Pretoria, Rhinoplasty remains a complex field of surgery; a form that constantly challenges a surgeon’s skill, training and experience.

To remind patients of this, Swanepoel sometimes quotes the American surgeon, Dr Jack Anderson, an early mentor. “Rhinoplasty is the pinnacle of surgery”, Anderson once told me. “It is the most demanding surgery a cosmetic surgeon can undertake. No other surgery is as complex or as rewarding as nose surgery. It’s a fact,” says Swanepoel, “in my case, it entailed years of advance training.”

Dr Pieter Swanepoel "The Nose Man"

Nose surgery, unlike general cosmetic surgery, he explains, requires 3-dimensional, aesthetic skills. “For a surgeon to succeed in this field, you need four things. You need advanced training. You need to ‘super’ specialise. You need to focus, and you need experience,” he says. “There are no short cuts.”

The pay-off, he adds, is the reward, when seven days after surgery, the surgeon removes the splint from the patient’s nose. “You can see a good result reflected in the patient’s eyes. There is no greater satisfaction than this,” he explains, remembering more than 20 000 patients he has assisted over 30 years.

He started out, he recalls, a medical student born into a family of three surgeons. “One of them, my uncle Frans Swanepoel, was a surgeon in Johannesburg. He would sometimes drive to my father’s farm – a 200 odd kilometre drive over mostly gravel roads – to attend an emergency case. Once or twice he performed surgery on my mother’s kitchen table. He would then drape it with a white sheet. I would creep under the table, and then just as they started surgery, sneak out and watch.”

Swanepoel completed his medical studies at the Stellenbosch faculty of medicine, specialised in London, and later travelled – many times over the years – to the United States where he studied under several of the world’s most respected facial surgeons.

“In those days American surgeons set the international benchmark for nose surgery. They were, and still are, the best in the world. They’re always discovering a better way to achieve a good result.”

“I remember watching Dr Russell Kridel (another mentor) demonstrate ‘open’ nose surgery on one of my trips to America. Open surgery, at that time was completely unknown in South Africa (we used the closed, intranasal approach). But seeing Dr Kridel perform open surgery changed my outlook overnight. I flew back to South Africa and started using the ‘open’ approach. Depending on the type of surgery, it enables a surgeon achieve a better result.”

By 1995, Swanepoel had pioneered another technique for Rhinoplasty, ‘regional nerve blocking’ (conscious sedation), until then, used mainly by dentists.

“Regional nerve blocking is painless and much safer than general anaesthesia”, Swanepoel says.

“You don’t have to hospitalise patients. At the Nose Clinic, we simply admit them for an out-patient procedure. They go home after surgery. Patients like it. They recover more quickly, and, in any case, it costs less.”

Swanepoel later published a paper on regional nerve blocking in the prestigious Archives of Facial and Plastic surgery in America.

Today, working from his specialised state-of-the art theatre in Pretoria, he feels proud that his dedication paid off. “I work with a specialist Rhinoplasty team. We focus on nose surgery and because of this, achieve consistently good results.”

He points to another recent innovation, solar power. “We’re probably the first clinic in the world to have installed solar-generated power for our clinic. All the life-support equipment in our theatre is now driven by solar power (backed up by batteries)”, he says. “We can justifiably claim to be one of the world’s first green clinics.”

Swanepoel still subscribes to a motto ingrained into him during training – ‘Primum non nocere’, (Latin for, ‘primarily, do no harm’). “If you can’t improve on something, do not make it worse”, he says.

“Unfortunately, we don’t often see this. About 46% of our work entails Revision Surgery; an operation to repair the disappointing results of surgery performed elsewhere by other surgeons. We regularly encounter patients who arrive at our rooms with the plea, ‘Doctor, can you please fix my nose?”

Revision Surgery - Before and After

For this reason, Swanepoel displays a selection of ‘before and after’ images on his website. “Seeing a good selection of ‘before and after’ images offers potential patients the assurance that specialisation in this field generally yields consistently good results. Our website is probably one of the most informative sources of information on Rhinoplasty in the world” he says.

For more information, visit www.thenoseclinic.co.za

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Since the recent news broke about supernova Hollywood star, Angelina Jolie’s double mastectomy, it has highlighted once again the importance of preventative care in the fight against breast cancer. Plastic Surgeon, Dr Willem Erasmus reports on the significance of early detection.

Hollywood actress, Angelina Jolie shocked the world in May this year when she announced she had a double mastectomy to prevent breast cancer.

She made the drastic decision after learning that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast and ovarian cancer.

According to the star, her lifetime risk of developing breast cancer before having her breasts surgically removed was 87%. Having the BRCA1 mutation also means a 50% lifetime risk of ovarian cancer.

Jolie’s mother, Marcheline Bertrand, died of ovarian cancer on January 27th, 2007 – therefore Jolie elected to have a double mastectomy to minimise her risk of breast cancer. She has also intimated that she may consider having her ovaries removed (Oophorectomy).

In an article in the Opinions section of the New York Times, titled “My Medical Choice”, Jolie writes about her mother who died of cancer at the age of 56 - and held out long enough to hold one of her grandchildren in her arms. Her other grandchildren will never have the opportunity to know her, she added.

Jolie emphasised that the risk of breast and/or ovarian cancer in women with the BRCA1 mutation varies from case to case – as soon as she realised what her odds were, Jolie decided to be proactive and reduce her risk to a minimum.

Jolie wrote:

“I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex. On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.”

Early Detection is Key

A double mastectomy is no doubt a frightening prospect - even if the benefits are weighed up for high risk patients. However, be rest assured that there are alternatives.

One in ten women will develop breast cancer in their life, and the highest risk factor will be age.

Fortunately most of these will be detected early and treated effectively, but the key is to detect early – which is why it’s important for young girls to start self-exams from a young age. Ladies should also do it on the same day of the month post menopause, and a week after your menstrual cycle.

Just like brushing your teeth, divide each breast into quadrants and examine with your palm – feeling for any unusual lumps and bumps.

Additionally, women between the ages of 35-40 years should start considering mammograms and ultrasounds on an annual basis, and those that are at a higher risk, should start these examinations even earlier.

High risk means you have a positive family history - and the closer the relative, the higher the risk. If you have had a few close relatives who have developed breast cancer before the age of 60, then you should consider genetic testing for the BRCA 1/2 gene mutations.

BRCA gene mutations are fortunately rare (1 in 500), but the risk of developing breast cancer if you are positive is 50% - hence why Angelina Jolie opted for a double barrel removal. “My chances of developing breast cancer have dropped from 87% to under 5%,” Jolie said. “I can tell my children that they don’t need to fear they will lose me to breast cancer.”

Although the Oscar winning actress has been applauded and commended for her decision to have both breasts removed, a double mastectomy was not her only option. Remember, not everyone with the gene mutation automatically will develop cancer and not everyone needs to have a double mastectomy to prevent it.

However, increasing your surveillance by doing regular self-exams, ultra sounds or mammograms is of utmost importance.

Reconstruction

Nine weeks after her mastectomy, Jolie had surgery to rebuild her breasts. She disclosed in the NY Times piece that she’d completed the reconstruction of her breasts with implants and is very pleased with the results.

It appears too that her physicians were able to save her nipples, a procedure that’s become available only recently, according to ABC News.

Implants are the most popular option when it comes to a breast reconstruction procedure - and it’s referred to as an Alloplastic Reconstruction.

However, they must be bigger than the usual breast augmentation implants because it has to compensate for the total lack of breast tissue. They’ll also weigh a lot more, which may be uncomfortable for certain patients.

Another option for breast augmentation is an Autologous Reconstruction i.e. your own tissues.

Most commonly we use fat and skin from a tummy tuck procedure – and use this to recreate a breast.

Lastly, for women who choose not to have surgical reconstruction, there’s always an option whereby one can wear a bra that is filled with an implant to give the impression of breasts, an option that we actually find to be not all that uncommon.

In light of August being Women’s Month, and the coming of October (Breast Cancer Awareness Month) – I urge all women to start self-examining early in your life and if you haven’t yet, then there’s no time like the present.

References: News Background on Angelina Jolie republished from Medical News Today

www.mednewstoday.com

Written by A2 Expert Panel member: Dr Willem Erasmus MBChB FCS (SA)
Dr. Willem Erasmus is a Cape Town based Plastic Surgeon at RBSI – visit the website for more info www.plasticsurgeoncapetown.co.

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We have all heard of breast enhancements, tummy tucks and face lifts… but not many of us have heard about plastic surgery done to reduce toe size. Dr Reejah Tharu reports.

With an increasing obsession for a perfect body, it comes as no surprise that requests to cut a fat toe to size has escalated over the years. This is confirmed by New York-based Dr. Oliver Zong, a podiatrist who has assigned the term “toe-besity” to the new trend.

Apparently some people are so embarrassed with their obese toes that they have hidden it from their intimate partners. Dr. Zong says that he didn’t have to deal with people making this request before he started practice 10 years ago – and now he has been taken by surprise at requests for fat toes to be shaved off.

In some cases, toe deformation could indicate that the individual could be suffering from other health problems such as arthritis, bunions and hammertoe. If so, then surgery may be required in order for it to be rectified.

In such cases, the surgery is more to restore comfort to the suffering individual than for cosmetic reasons.

However, there are other podiatrists who think that ‘toe-besity’ is unethical and do not support the idea of foot surgery purely for cosmetic reasons. They believe that such surgeries must not be conducted if there is no pain or other functional impairment, as a surgery usually puts a person under several risks.

These risks range from anaesthesia and deformity – to infection and other general risks associated with surgery.

But Zong himself believes that toe surgeries are just like any other cosmetic surgeries - and that the surgeries restore self-esteem and confidence in ‘needy’ individuals. He believes that the procedures may be carried out as long as they are safe.

Cosmetic toe surgeries are considered elective and are therefore, not covered by insurance companies. The cost of the procedure is entirely dependent on the nature of the procedure and the degree of complication involved.

Source-Medindia www.medindia.net

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Ever since I was a little girl I dreamed of having long luscious hair that would tumble over my shoulders and reach the middle of my back, but for some reason I have never been able to get it past ‘just over the shoulder’. Which is why I was super pleased to have stumbled upon Nisim, herbal hair products that are scientifically proven to help your hair grow fast as well has reduce excessive hair loss.

Nisim was developed in Canada and is available in over 60 countries worldwide. Since their launch to consumers in 1993, their popularity has grown (excuse the pun) largely due to the fact that they cater for hair loss in men and women, as well as those looking for rapid hair growth. Something else that makes them special is the fact that their NewHair Biofactors are based on safe and natural ingredients gained by extracting the active herbs used in their products.

Amped to get started, I browsed through their range, and decided to go with the 360ml Nisim F.A.S.T (Fortified Amino Scalp Therapy) Shampoo and Conditioner.

F.A.S.T is packed with all sorts of organic herbs and essential amino acids that promote quicker hair growth in less time and is suitable for chemically treated or coloured hair. Having had a Brazilian blow wave two months ago, I also opted for the sulphate free version.

According to Nisim, if you’ve had a bad haircut and want to grow it out quickly then F.A.S.T is the product to use!

The day before I started using F.A.S.T, I coloured and trimmed my hair to make sure that I was starting with a base length (I take myself way too seriously sometimes.)

The first thing I noticed was the lovely smell. I've always placed a huge importance on the smell of my hair products, and you’ll often see me in the hair care section of any store smelling each and every product I'm thinking of buying. It’s one of those weird things I have.

After about three weeks of using the product, I was somewhat doubtful because I couldn’t see much difference, but I soldiered on.

It has now been six weeks and I am beyond impressed with the results. There is about a 5cm growth spurt that I have never been able to achieve in six weeks.

On the left is Week 1 (before I started) and to the right is Week 6.
I'm wearing the same jacket, so use the line pointed
out by the arrows as an indication.

As you can see, my results are not astounding, and I'm glad. I think it’s a true testament to a product that shows realistic results. Any product that tells you your hair is going to grow 10cm in one month is lying to you. This is a process, not a one-month fix.

Now my next statement is very important. Stop what you're doing and read this: if you want to get the full benefit of F.A.S.T, you must follow every direction on the bottle.

That is:

1. Wash your hair every day – I won’t lie, I found this to be difficult and time consuming, but worth it in the end.

2. Shampoo, rinse and repeat (do not skip this part!)

3. Conditioner must be left on for no less than one minute (you can leave it on even longer if you wish, for a deeper condition).

4. Shampoo and conditioner must be massaged deeply into the scalp, which helps to increase blood circulation.

I cannot stress enough how important these direction are, if you don’t follow them, then you're wasting your time and money.

Some other pointers from me:

- You don’t need use more than a 50c coin size of shampoo. And your conditioner, maybe a R5 coin size. This way you don’t waste any product and it can last you up to seven or eight weeks.

- You can use other products on your hair after washing, like gel or a mousse (I used Moroccan Oil on my ends after every wash just for a bit of extra moisturisation, and then blow dryed/styled my hair as normal.)

- Once you stop using the product, your normal hair growth rate will resume.

All in all, my hair is in great condition - I found the products to be superbly moisturising and softening. Better yet, I'm delighted to finally have found something that works for me and plan on using Nisim until I get to my “Dream” length.

Price-wise, as you can imagine, it’s not cheap, but will also not cost you a lung and half a liver. You are paying for only the best quality at the end of the day!

The F.A.S.T sulphate free combo pack with shampoo and conditioner (360ml) will cost R450. While you can also get a jumbo size (1000ml) shampoo and conditioner for R585 each.

They also have a few other products available like: hair loss shampoos and conditioners (suitable for men and women), as well as tablets for hair loss, an organic body and skin care range and a hair removal product suitable for the face and bikini line.

Nisim is available at selected salons, but you can also buy direct from them.

Check out their website www.nisim.co.za for the full range and prices.

Written by A2 Magazine Blog Editor: Rochelle Friedman

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Bipolar disorder is a much misunderstood mental condition. It is marked by extreme mood swings between depression and mania and takes its toll on both the sufferer and he/she they come into contact with. There is no cure, but it can be managed.

Source: www.mayoclinic.com

Megan’s* battle with bipolar disorder recently came to a tragic end – not because she was cured, but because her 75-year old mother, a lifelong sufferer, decided she’d had enough and committed suicide by jumping out the bathroom window of her 11^th storey flat.

“Of course it was a shock,” says Megan, brushing away a tear, “but it wasn’t a surprise. My mother spent her whole life taking herself off her medication when she felt better. Her excuse this time was that she’d grown out of her bipolar disorder. Clearly she hadn’t, and this is the result.” Megan says her mother’s bipolar was a constant worry.

“I spent a lot of my time at varsity rushing home unexpectedly because my mom would go off her meds and take to walking the streets at night in her nightie. My brother and I would then have to drive around until we found her, have her committed so they could re-medicate her, and the whole cycle would start again. My dad died when we were kids, so it pretty much dominated our upbringing.”

Bipolar disorder– also known as manic-depressive disorder – is a much misunderstood condition. It is marked by extreme mood swings between depression and mania – a feeling of extreme euphoria and energy. In some sufferers, the mood swings happen a few times a year, while in others, they can happen a few times a day.

Bipolar takes its toll both on the sufferer and those she/he comes into contact with. The difficulty with it is that there is no cure, simply a management plan, and as long as you stay on the treatment, you are fine.

In most cases, bipolar disorder can be controlled with medication and psychological counselling (psychotherapy). The trouble is, as soon as sufferers start to feel better, they often take themselves off treatment, and that’s when the trouble starts – as Megan can testify.

What are the symptoms?

The exact symptoms of bipolar disorder vary from person to person, as does the severity of mood swings. So, for some people, depression might be more of a problem, while for others, manic symptoms are a worry. You can even suffer from both at the same time, which is known as a mixed episode.

If you’re in a manic phase, the symptoms can include the following:

- Euphoria,

- Inflated self-esteem,

- Poor judgment,

- Rapid speech, racing thoughts, and aggressive behaviour,

- Agitation or irritation, increased physical activity and risky behaviour,

- Spending sprees or unwise financial choices,

- Increased drive to perform or achieve goals, increased sex drive,

- Careless or dangerous use of drugs or alcohol

If you’re in a depressive phase, however, symptoms can include:

- Sadness and hopelessness,

- Suicidal thoughts or behaviour,

- Anxiety, guilt, sleep problems and low or increased appetite,

- Fatigue and loss of interest in activities that was once considered enjoyable,

- Problems concentrating, irritability and chronic pain.

And as they say in those annoying TV ads, that’s not all!

Other signs and symptoms of bipolar disorder can also include seasonal changes in mood, and rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.

And finally there’s psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations).

So, what causes bipolar disorder?

Unfortunately, no-one really knows, although there do seem to be a number of factors that trigger bipolar episodes.

First, people with bipolar disorder seem to have physical changes in their brains. Also, an imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.

Imbalanced hormones might play a role, and there’s also a genetic component – bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition.

And then, your environment can also play a role – stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.

Diagnosing bipolar disorder

Diagnosing bipolar disorder is multi-faceted because doctors have to be sure they have ruled out other causes for the disorder - and they need to check for any complications. A proper diagnosis, therefore, should only come after the following:

1. A physical examination to check your vital signs and general health.

2. Laboratory tests like blood and urine tests, to rule out any physical causes.

3. A psychological evaluation where a doctor or mental health provider will talk to you about your thoughts, feelings and behaviour patterns. Close family members or friends might also be asked to contribute information (with your permission).

4. Mood charting – you might be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.

Getting it under control

If you understand nothing else about bipolar disorder, understand this: it requires lifelong treatment, even during periods when sufferers feel better. Adjustments to treatment might be made as your psychiatrist works out what treatment is better for you and your symptoms, but you will be taking mood-balancing medications every day for the rest of your life.

If sufferers are behaving in a way that endangers themselves or others, they might be hospitalised at first, just until their moods stabilise and their symptoms are under control. Thereafter, maintenance treatment will keep their symptoms stable in the long term.

It’s vital that sufferers follow their treatment plan and report any problems and side-effects. People who skip or stop treatment are at a high risk of a relapse. And if you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Without that, it’s very difficult to manage bipolar disorder.

A number of medications are used to treat bipolar disorder. If one doesn’t work well for you, there are a number of others to try. Your doctor may even suggest combining medications for maximum effect.

Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilisers) and medications that help with depression or anxiety.

Finding the right medication(s) will probably take some trial and error, which will require patience, as some take weeks or months to reach full efficacy. And normally, only one medication is changed at a time so that your doctor can identify which medications are working.

Psychotherapy is also an important part of bipolar disorder treatment, both to help you to come to terms with the disorder, as well as to help with impulse control.

There are also some lifestyle changes that sufferers need to make, as certain cycles of behaviour can make the condition worse. Support from family and friends will also make it easier to cope. Some of the lifestyle changes that will need to be made are:

- Quit drinking and/or using illegal drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behaviour and drug or alcohol abuse. If you’re struggling to give them up your own, get professional help.

- Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won’t encourage unhealthy behaviour or attitudes that can worsen your bipolar disorder.

- Get regular exercise. Moderate, regular exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins). It can also help you to sleep and has a number of other benefits. But do just check with your doctor before starting any exercise programme - especially if you’re taking lithium, just to make sure that exercise won’t interfere with your medication.

- Get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your psychiatrist about good sleep hygiene practices and other interventions that can improve both the quality and quantity of sleep you get.

It’s not an easy condition to live with – there’s no doubt about that. But there are some additional strategies that will help you to cope.

First, ensure you learn as much as possible about your disorder. Educating yourself about your condition can empower you and motivate you to stick to your treatment plan.

Likewise, help educate your family and friends about what you’re going through.

Also look for healthy ways to channel your energy, such as hobbies, exercise and recreational activities - and learn ways to relax and manage stress. Yoga, tai chi, meditation or other relaxation techniques can all be helpful.

Finally – because it cannot be stressed enough – stay on your treatment plan and communicate with your psychiatrist if the medication doesn’t seem to be working.

Remember, you can’t be cured, but if you manage your condition well, you can live a full, productive, fulfilling life.

* Names have been changed to protect their identities.

Written by A2 Magazine Contributor: Mandy Collins
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Despite conflicting data in support of the practice, some overweight Americans looking for an easy fix have turned to gastric Botox injections in order to help them lose weight.

In the Clinical Gastroenterology and Hepatology Journal, researchers from the Mayo Clinic published a definitive study, finding that Botox doesn’t promote weight loss.

Injecting Botox into the stomach had been believed to delay emptying of the stomach, increase feelings of fullness and reduce body weight.

Researchers enrolled 60 obese patients in a 24-week trial to compare the effects of BTA to placebo. They found that although the injection slowed movement of food through the stomach, it did not cause weight loss.

“On the basis of our findings, I would not recommend gastric Botox injections to people who want to lose weight. There are some risks with this treatment and we found that there was no benefit in terms of body weight loss,” said Mark Topazian, lead author of the study and professor of medicine at the Mayo Clinic, Rochester, MN.

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I have just turned the big 4.0 last month. While I’m in relatively good shape (I exercise regularly and try to maintain a healthy lifestyle), I have unsightly, sagging skin above my kneecaps… which bothers me to no end! How do I treat this?

Good question, with many possible answers… Firstly, well done for looking after your diet and lifestyle, you won’t regret taking care of your body. The reason for the ‘sagginess’ is the loss of elasticity of your skin over time with age.

The simplest solution is to increase the bulk of your thigh muscles to ‘stretch’ it out, however this is seldom a long term solution. Medical treatments to ‘tighten’ skin offers hope, but the results are variable.

Surgical options include liposuction, which will be useful if there is moderate fat to remove and may provide skin adherence and retraction. A thigh lift offers a good chance of correction, but it’s fairly extensive and an awkward surgery. There are also a wide variety of non-invasive procedures and skin tightening treatments to help

I’m in my early 50’s and I’m seriously considering a face-lift. I have sagging skin in my jowl area, fine lines around my mouth, and horrible crows feet. The only problem is I’m scared to go under the knife. So are there any other procedures that don’t necessitate full surgery? I’ve been reading a lot about laser treatments. What is the difference between a regular facelift and a laser facelift? Would I benefit from a laser treatment?

A facelift is a powerful procedure involving intricate dissection around complicated, important facial anatomy. There is mobilisation of, and variable pull applied to the different layers to achieve results.

It also routinely involves the neck, eyelids, fat filling, brow and chin. It can be used to address the midface, jowls, laugh lines, eyelids, sagging neck, brow etc. There is no alternative that can offer all this permanently.

Laser is a good modality for skin tone, texture and wrinkles and there are a multitude of minimally invasive options including botulinum toxin, fillers and skin treatments that can definitely help to provide improvement without surgery.

I have a couple of spider veins around my ankles – as well as a few thick ones on the top of my legs. While it’s not really painful, I’m quite self-conscious of them (especially when I wear shorts in summer). What is the best procedure to remove them?

Spider veins are a difficult problem, because they are a long term consequence of walking and standing upright.

Unfortunately it also has the propensity to occur in all of us over time. Some correctable abnormalities can be the cause, such as varicose veins from valvular incompetence.

Treatments like sclerotherapy (injection of a sclerosant to scar the area) and laser offer short term results, but in most cases the veins will recur, because the cause remains. Prevention of pressure and swelling in your ankles is the best form of management.

Can repeated use of Botox be bad for you in the long run? I’ve been going for my Botox injections every six-eight months to treat my fine lines – and it works like a charm. But now a friend of mine has told me that if I carry on using Botox, it can be harmful over time. Is this true?

Botulinum toxin has been used for millions of treatments around the world over the past 20 years - and has never been shown to have any long term harmful effects.

Aesthetic matters on the brain? Our expert panel will gladly answer your aesthetic questions. Email your query to: info@lewebmedia.co.za

Written by A2 Expert Panel member: Dr Anton Potgieter, MBBCh (Wits), FC (Plast Surg) SA
Johannesburg based Dr Potgieter splits his time between his Sandton private practice and Baragwaneth Hospital, where he forms part of the plastic surgery team that runs Smile Week. He performs other reconstructive surgeries as well, including breast reconstructions, craniofacial procedures and cancer surgery. www.sandtonplasticsurgery.co.za

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According to a new survey from the University of Notre Dame, women who engage in “fat talk” (the degrading remarks girls and women make in relation to eating, exercise or their bodies), are less liked by their peers.

In the study, college-age women were presented with a series of photos of either noticeably thin, or noticeably overweight women engaging in either “fat talk” or positive body talk. They were then asked to rate the women on various dimensions, including how likeable they were.

The women in the photos were rated significantly less likeable when they made “fat talk” statements about their bodies, whether they were overweight or not. The women rated most likeable were the overweight women who made positive statements about their bodies.

“Though it has become a regular part of everyday conversation, ‘fat talk’ is far from innocuous,” says Alexandra Corning, a research associate professor of psychology. “It is strongly associated with, and can even cause, body dissatisfaction - which is a known risk factor for the development of eating disorders,” he adds.

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Having healthy cells is vital to slow the ageing process, reduce the risk of cell dysfunction and prevent illness and disease. Aesthetic and Anti-Ageing Practitioner, Dr Sly Nedic discusses PEMF – a therapy that is used as an integrative and supportive treatment in anti-ageing and health.

With about 70 trillion cells in an adult body, cell injury is common and repair is on-going. Wherever there is pain, suffering or dysfunction, there is a cell injury. Therefore patients usually seek a doctor’s help once disease is full blown.

Cell injury results when:

• Cells can no longer adapt to stress

• Have unrecoverable exposure to damaging agents (toxins, pollution, virus, etc)

• Suffer from intrinsic abnormalities, whether genetic or nutrient-based

• The limits of adaptive responses of cells are exceeded

The major causes of cell injury are:

• Oxygen Deprivation

• Physical Agents

• Chemical Agents and Drugs

• Infectious Agents

• Immunologic Reactions

• Genetic derangements

• Nutritional Imbalances

• Ageing

Cell injury can progress from milder reversible states, through to more severe irreversible conditions. This leads to tissue or organ failure of varying degrees, and finally senescent apoptotic or necrotic cell death.

In the stages of reversible injury there is:

• Reduced oxidative phosphorylation with depletion of ATP,

• Cellular edema caused by changes in ion and water flows,

• Mitochondrial and cytoskeleton alterations and

• DNA damage.

When our cells are sick and injured, they lose energy. As a result, there is not enough ATP and the voltage of our cells drops down to 40-50 mV. People who are sick often have voltages as low as 20mV (as is the case of cancer).

In fact, every organism on earth lives under the influence of natural magnetic signals. Magnetic fields are important regulators of every living organism, and deficiency of magnetism in the body is like the body running out of oxygen.

Life and metabolism cannot be sustained without the earth’s magnetic field. This magnetic field is growing weaker with time, resulting in a lowering of magnetic potential within the cells of the body. The electrical and electronic pollution we are exposed to in the world today lowers magnetic potential within the cells of the body to an even greater degree.

The result is greatly reduced cellular ‘trans-membrane potential’ (or TMP). Every cell in the body is a tiny battery with a trans-membrane potential (TMP), which is a measurement of the electrical charge of the cell. In order for a cell to bring nourishment in - and let metabolic waste out - the cell membrane potential needs to be fully charged.

Poor nutrition (together with chemical and electrical pollution), causes damaged and diseased cells to have abnormally low TMP – which can be up to 80% lower than healthy cells. This results in greatly reduced metabolism and in particular, impairment of the sodium-potassium pump.

The sodium-potassium pump is responsible for moving waste products out of cells - and nourishment into cells. Therefore, an impaired sodium-potassium pump activity causes unhealthy, inefficient and ‘clogged-up’ cells which results in edema (cellular water accumulation).

It also has a tendency toward fermentation within cells - a condition known to result in a host of chronic degenerative disease conditions (such as cancer). Almost everyone today is operating at far below his or her true potential!

Magnetic therapy restores what earth changes have depleted, the vital electromagnetic energy needed to produce optimal health. There have been several experiments that illustrate the negative consequences of magnetic field deficiency on health. One such illustration is that of the cosmonauts, who lost 80% of their bone density in just over a year in space. That problem was solved by putting an artificial magnetic field into their space capsules.

So, apart from all above-mentioned mechanisms that are injuring our cells, depletion in natural magnetic fields is a major contributing factor. Unfortunately, over time the magnetic field of the earth has lessened considerably. When dinosaurs roamed the planet, the earth’s magnetic field was approximately 30 gauss (a unit of electromagnetic field strength).

Today, the magnetic field on the earth’s surface is between 0.31 and 0.58gauss. Thus, the magnetic field is presently only 1-2% of what it once was. Therefore, supplemental magnetic field therapy may be a powerful weapon in recovering one’s health.

This is the reason that PEMF (pulsed electromagnetic frequency) has become a necessary part of integrative medical approach of virtually any degenerative and age related disease.

What is PEMF Therapy?

Pulsed Electromagnetic Frequency Therapy (PEMFT) originated in Germany and has been used worldwide for over four decades. It is one of the most researched therapies available, with over 2,000 double blind medical studies available. PEMFT provides numerous benefits that support the body as it returns to a state of balance and optimal health.

PEMFT as a technology was approved by the FDA for the healing of non-union fractures in 1979. In 1998, it was approved for urinary incontinence and muscle stimulation - and in 2004 for cervical fusion patients at high risk for non-fusion.

In 2006, it was approved for the treatment of depression and anxiety - and recently in 2011, for brain cancer.

PEMF Therapy restores the body’s natural electro-magnetic build up within your cells. It can oxygenate and alkalize the cells, and improve circulation by allowing the conversion of nutrients and oxygen inside the body to occur at optimum performance.

PEMF device applies an electro-magnetic field to the body, which induces the production of weak electrical currents in the tissues. These weak bio-currents can influence the flow of blood and oxygen to the tissues – as well as the flow of ions and nutrients into the cells.

This enhancement of circulation and nutrient exchange can be beneficial in improving cellular bioenergetics.

Over the past 40 years, scientists from around the world have investigated the effects of Pulsed Electro Magnetic Therapy (PEMF) on nearly every organ and every disease in the body. This results in over a thousand published clinical studies, which show the many benefits provided by PEMF. (Please check references below)

Here are some of the benefits provided by Pulsed Electro-Magnetic Therapy:

• Stimulates pain relieving endorphins

• Repairs damaged and diseased tissue

• Reduces pain, swelling and inflammation

• Improves cell hydration, or water content

• Repairs torn tendons and fractured bones

• Improves energy (ATP production) in cells

PEMF is exclusively available at the 8th Sense Medi-Spa and is used for:

• Chronic pain, chronic fatigue, fibromyalgia, backache, neck ache and arthritis

• Anti-ageing supportive treatment to slow down age related degenerative disorders

• Osteoporosis and menopausal symptoms

• Stress and recurrent infections

• EB virus, coxackie virus , lyme disease (supportive treatment)

• Increasing liver and body detoxification ability

• Supportive treatment for weight loss and cellulite

• Supportive treatment for acne and eczema

• Cancer prevention and energy production.

Written by A2 Expert Panel member: Dr Sly Nedic MBChB (Bel)
Johannesburg based, Dr Nedic is a founder of the 8th Sense Medi-Spa in Sandton, where she passionately combines aesthetic makeovers with anti-ageing medicine, bioidentical hormone replacement therapy and preventative genetic testing.
www.8thsense.co.za

References: Am J Psychiatry 2002Jul;159(7):1093-102Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders.Hoffman RE, Cavus I.Yale-New HavenPsychiatric Hospital, Yale University School of Medicine, LV 108, 20 York Street, New Haven, CT06504, USAJ Clin Psychiatry2001Dec;62(12):981-4Right versus left prefrontal transcranial magnetic stimulation for obsessive-compulsive disorder: a preliminary investigation. Sachdev PS, McBride R,Loo CK, Mitchell PB, Malhi GS, Croker VM.School of Psychiatry, University of New SouthWales, Sydney ,Australia. Bioelectromagnetics. 2003 Sep;24(6):373-9.The effect of exposure to high flux density static and pulsed magnetic fields on lymphocyte function. Aldinucci C, Garcia JB,Palmi M, Sgaragli G,Benocci A, Meini A,Pessina F, Rossi C,Bonechi C, PessinaGP.Department of Physiology, University of Siena, Siena, Italy. Biomed Sci Instrum2000;36:7-13. Experiments showing the electromagnetic fields can be used to treat inflammatory diseases. Nindl G,Balcavage WX,Vesper DN, Swez JA,Wetzel BJ,Chamberlain JK, Fox MT.Terre Haute Center for Medical Education, Bone Miner Res1990 May;5(5):437-42. Bone density changes in osteoporosis-prone women exposed to pulsed electromagnetic fields (PEMFs).Tabrah F, Hoffmeier M,Gilbert F Jr, Batkin S,Bassett CA.University of Hawaii. School of Medicine, Straub Clinic and Hospital, Honolulu.J UOEH 1988 Mar 1;10(1):31-45. The effect of long-term pulsing electromagnetic field stimulation on experimental osteoporosis of rats. Mishima S.Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.

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A plastic surgery procedure that was documented to be on the rise between the years of 2000 and 2012 was the upper arm lift, a new report suggests.

In 2012, over 15,000 upper arm lifts were performed across the United States - an increase from just 300 in 2000. This is according to a report released by the American Society of Plastic Surgeons.

An upper arm lift (commonly known as brachioplasty), is a surgical procedure that changes the shape of the under part of the upper arm - from the underarm region to the elbow.

Weight gain and loss, ageing and genetics can result in the upper arm sagging or drooping in appearance. Exercise can strengthen and improve the muscle tone of the upper arm, however it cannot treat excess skin that has lost elasticity. It also can’t rectify weakened tissues and fat deposits in the arm.

Doctors point out that there is no reason for the recent rise, except that perhaps women are now paying more attention to the arms of female celebrities. According to a recent poll, women desired the arms of first lady Michelle Obama, followed by actress Jennifer Aniston.

An upper arm lift generally costs between R54 000 and R72 000. One drawback to the procedure is that it can leave a scar on the upper arm.

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Coolsculpting by Zeltiq, the revolutionary fat-freezing procedure has become one of the most successful, non-invasive body treatments available in South Africa. The ‘Freeze Your Fat Off’ campaign has had universal appeal and spiked interest across racial and gender divides. After all, who doesn’t have a few centimetres that they want to get rid of forever?

With body-sculpting treatments being the fastest growing of all non-surgical aesthetic treatments worldwide, it is evident that people are becoming more body and weight conscious. The constant images of supermodels and celebrities that we are exposed to in the media, create an expectation that a great body is indeed possible… no matter what our age or how many children we’ve had. Many people are now searching for external help when regular gym workouts just don’t produce the desired results.

Non-invasive body sculpting is a relatively new addition to the stable of non-invasive aesthetic treatments. In fact, the American Society of Plastic Surgery (which releases annual statistics on both surgical and non-surgical procedures in the United States), only has data on these treatments from 2012.

In their most recent annual report, three body-sculpting procedures were mentioned as the most popular treatments in the United States, namely: Coolsculpting, Vaser Shape, and Liposonix.

The number of body-sculpting treatments is expected to grow exponentially. With newer treatments offering good results, many patients are shying away from surgical interventions with the associated risks and downtime - and choosing non-invasive body sculpting treatments instead. More and more money is being spent on research and development in this sector of the aesthetic industry.

About Coolsculpting

Coolsculpting uses a process called cryolipolysis to decrease the number of fat cells in a treated area. This freezing process causes irreversible damage to fat cells, which gradually deteriorates and are removed from the body by the lymphatic system.

The process takes about four months, although most patients have 90% of their end result after eight weeks. As fat freezes at a different temperature from skin and muscle, these two organs are not affected by the freezing process.

The Coolsculpting machine also has important safety mechanisms built in to avoid overcooling of an area which could lead to frostbite or fat necrosis. At present, it is the only cryolipolysis machine on the market which has FDA approval - indicative of the thorough clinical trials and safety testing that was done prior to its release on the market.

With over 450,000 procedures worldwide, there have been no serious adverse events reported with Coolsculpting.

However, there have been several cases of serious side-effects (both overseas and here in South Africa) with similar, non FDA approved, copycat machines. These have required surgical intervention and excision of damaged, necrotic tissue.

The company that produces the Coolsculpting machine is trying to have these copycat machines (many which are using similar advertising campaigns) banned.

Laserderm Aesthetic Centreswere some of the first clinics to introduce the treatment to South Africans, and have done thousands of treatments since they acquired their first machine in June 2011.

Patients are initially seen for a medical consultation to assess their suitability for the treatment - and to exclude any contraindications, such as pregnancy; use of anticoagulants; the presence of a hernia or medically implanted device and a history of Raynaud’s disease or cryoglobulinemia.

Patients with a BMI greater than 30or who are not within 5kg of their ideal body weight are not considered good candidates for this treatment as Coolsculpting is not for overall weight loss, but rather to treat a specific problem area.

Typically, these are the abdominal region (upper and lower), love handles, bra bulges, inner thighs, upper arms, inner knees, and gynecomastia (male breasts) in male patients.

The treatment is relatively painless, although the initial suction can be quite intense. Within about 5-10 minutes of the start of the procedure, the area is completely numb and patients often read, work on a laptop, or watch TV. Many actually fall asleep during the procedure.

The hand piece is removed after an hour of treatment, leaving behind an icy, malleable lump of tissue which feels like slushy ice. With massage, blood flow returns and defrosts the area, and it returns to normal within a few minutes - although the treated fat cells have been damaged by the freezing process.

After treatment, a patient can expect numbness and tenderness for approximately two weeks over the treated area, although this usually will not stop them from activities of daily life (including going to the gym).

Mild petechial bruising, abdominal distension and mild diarrhoea may occur but usually settles within a few days. A sharp cramping pain accompanied by nausea may occur as a result of reperfusion of the area, but this settles within a few minutes.

Approximately 1 to 1.5% of patients develop severe, unremitting pain in the treated area. This persists for about 10 days and responds well to regular analgesics. It is thought to be caused by an overactive immune response to the damaged fat cells, and may be indicative of superior long term results.

A patient can expect to lose 20-40% of the fat in a treated area. This usually corresponds to anything from 1 to 6cm over an area such as the abdomen.

Before and after photographs are able to show the differences visually to a patient, and are often more satisfying than a change in centimetres.

We recommend that patients follow a low fat diet, drink at least a litre of water daily, and do an hour of cardiovascular exercise weekly to improve lymphatic drainage. This also increases the removal of fatty acids from damaged fat cells.

Without a doubt, Coolsculpting has been one of the most successful treatments Laserderm have introduced into their practice. Careful patient selection combined with advising on realistic expectations of treatment outcomes, has enabled them to have a patient satisfaction rate of over 95% for this treatment.

For more info visit www.laserderm.co.za

WARNING: Cryolipolysis is a medical treatment that is associated with significant risks if not done properly. The Coolsculpting machine by Zeltiq is the only machine that has FDA approval for this treatment. There are many imitations available in South Africa that do NOT comply with the necessary safety standards. Ensure that you are being treated with a legitimate Coolsculpting machine by your medical practitioner.

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The ‘Cinnamon Challenge, which involves trying to swallow a teaspoon of cinnamon without water within 60 seconds - has led to many teenagers being hospitalised and requiring ventilator support for collapsed lungs.

For those of you in the dark, the Cinnamon Challenge is a dare that has spread throughout the Internet. While most children know about it, very few parents and teachers do. This was reported in the Pediatrics Journal, written by researcher authors from the University of Miami Miller School of Medicine.

The authors said that parents need to be told about the Cinnamon Challenge, and they need to advise their children about the dangers. Parental advice really matters to kids, they added.

Even though most teenagers who choose to do the challenge endure only temporary effects, the researchers wrote that poison centres are receiving an increasing number of calls related to the Cinnamon Challenge. More and more kids are ending up in emergency departments and being hospitalised.

Cinnamon is a caustic powder consisting of cellulose fibers which do not dissolve and are not biodegradable in the lungs. Animal studies have shown that cinnamon can cause inflammation of the airways and lungs (if it is inhaled). It can also cause lesions and scarring in the lungs and airways.

Serious or life-threatening consequences from the Cinnamon Challenge are extremely rare, the authors emphasised. However, “they are unnecessary and avoidable.”

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No-one can deny that losing weight is no easy feat. Even dropping the unwelcome five kilograms one picks up after an indulgent holiday can be a nightmare.

Many of us want instant gratification - so we tend to throw in the towel when our excess baggage doesn’t just magically fall off. The bulge almost always wins the battle. This is true in most instances, but luckily not all.

Introducing Belinda Gad, a 43-year-old mother of two who has achieved the near impossible: losing a whopping 55kg in 18 months through diet, exercise and sheer determination. Here, Belinda shares with A2 Magazine her inspirational journey to health and self-discovery…

“If you don’t change your lifestyle, you will not live beyond 50”. Those were the words spoken by my Gynaecologist a little over a year and a half ago. I had just been for my annual check-up and he had phoned to give me the test results.

My cholesterol was sky high, I was borderline diabetic and my asthma was out of control and my weight was a staggering 140 kilos.

I remember holding the phone, speechless. All the saliva drained from my mouth and I felt tears welling up. My life had spun out of control over the years and now I had to take immediate action. I felt helpless and so disappointed in myself. For days, I pondered over this news - yet I didn’t have a clue on where to start.

I had a membership at Virgin Active gym for the past few years, and while I tried out a few personal trainers in that time – I never saw it through.

I spoke to my brother-in-law (who is a personal trainer himself) and he asked me what I enjoy doing in the gym. I couldn’t think of anything as exercising was impossible at my weightor so I thought. As I enjoy the water and swimming, he suggested that I try aqua aerobics at my gym.

TheBeginning

I went to my first aqua class and remember feeling such shame and embarrassment as I walked to the pool in my costume. That was the first step to my new lifestyle.

I continued with classes a few times a week – and in doing so, got to know one of my aqua instructors, Estne Auret.

She took a personal interest in me, and I learned that she was a personal trainer as well. However, she trains people in the ‘comfort’ (if you can call it that) of their own homes. I signed up with her and was eager to get going. It was initially hard for me to exercise as I was so big - and it was also a learning curve for her as I was her first ‘big’ client. Through the process I learnt to believe in myself and pushed through the hard sessions.

We have now been training together for a year and a half and are still going strong. I changed my eating habits early on, but decided not to follow a specific diet as the pressure can get too much - and I would inevitably give up.

My trainer guided me with what to eat - and the rest I did myself. We all know what to do… it’s just a matter of doing it.

My exercise regime

I train 6 days a week with a rest day on Saturdays. My week is as follows:

Sunday: 45 minute spinning class

Monday: 45 minute boot camp class and 45 minute spinning class

Tuesday: 40 minute home training session with my personal trainer

Wednesday: 30 minute aqua aerobics class and 45 minute spinning class

Thursday: 40 minute home training session with my personal trainer

Friday: 30 minute aqua aerobics class and a 45 minute spinning class

Saturday: rest day

On occasion I vary my routine, but this is what I do in a typical week. I try go for runs in between all of this, especially on the days when I can only do one class.

The sessions with my personal trainer are tough. We do a mix of cardio and weight training, as well as a lot of body strengthening exercises.

My trainer’s equipment consists of medicine balls, weights, boxing gloves, a big stability ball and resistant bands. I also love the fact that I can exercise using my own body weight to make me stronger.

She continuously pushes me, and as a result we up our game all the time and try new things. I always think I can’t do it, but in the end I prove myself wrong – which gives me such a great sense of achievement. The brain still needs to catch up to my body, but at least we are getting there.

My Eating Plan

I used to drink at least two litres of Coke a day, and eat mainly junk food in place of real food.

I could eat a large packet of crisps and a huge slab of chocolate in a few minutes - and then not eat again until supper. I had a stark reminder of this when I cleared out all my fat clothes and found all the empty packets and wrappers at the back of my cupboard.

My eating plan is based on more protein than carbs. My meal plan for a typical day is:

Breakfast – fat free Bulgarian yogurt with a scoop of whey protein and a handful of cornflakes.

Mid-morning snack – a protein shake

Lunch – two rye bread crackers with a half a tin of tuna and salad

Mid afternoon snack – a protein bar and fruit

Supper – ostrich mince and veggies or salad

Evening snack – Candarel bar

I also drink up to three litres of water a day.

My approach was to change my way of life into something that became sustainable. Recently I started going to a nutritionist, Phillipi Marx, who is helping me fine tune my eating plan.

I used to feel sick all the time, was continuously out of breath and found it difficult to move around. I had a very poor self-image and hated the way I was.

I now feel fantastic; strong, fit and healthy. I can run and jump - and can now look in the mirror and feel good about myself. I am now working with a psychologist who is helping me with the emotional side of things. This has been extremely difficult, but I’m getting there – and I feel stronger every day.

My Surgeries

Due to the weight loss (44kgs at that point), I felt it was now time to focus on the next dimension of my transformation – the surgeries.

On the 28th February, I have had Phase 1 of my surgical plan which consisted of the following:

Brachyplasty – excess skin removed from my arms

Belt lipectomy – removal of the loose skin around my middle

Abdominal plasty – removal of loose skin from my tummy (this was 11kgs alone)

Thigh lift – an entire thigh reconstruction

On the 3rd June, I went back for Phase 2 (the final Phase) of the surgeries which comprised:

Breast mastopexy and reduction – breast re-shape, lift and reduction

Extended medial thigh lift – removal of loose skin from my inner thighs

Downtime

Recovery from the Phase 1 surgeries was a month’s downtime – after which I could start with light training.

A further two weeks down the line, my training was back to normal. I had to wear surgical stockings and a corset - and return to the surgeon every week for fluid drainage.

Due to the physical shape I was in (and the lowered fat content of my body), there was no fluid to drain - which was a first for his patients. My pre-operation level of fitness played a huge role in my recovery, and the speed thereof.

I would like to mention that I did not feel at all like myself after surgery, as my results were so drastic that it took some time to get used to the new me.

I also had to get used to my body weight as my centre of balance had shifted - and as a result I felt like I wanted to fall over all the time.

Success

In total I have lost 55 kilograms and 259cms across my body. I have gone from a size 28 jeans to a size 14 and feel like a whole new me.

My original goal was to get healthy, feel normal and get fit, but I have achieved so much more… I have a new lease on life! I am learning to be happy with who I am and aim to maintain this life style forever.

As a result of the shift in focus, I am not weighing myself anymore. My family and friends are very proud of me – something my children and husband remind me of every day. My girls say “thank you mommy for getting healthy” and my husband says he has a new wife. Their support and love has been a huge part in all this.

My personal trainer, Estne has believed in me from day one. She has been an unbelievable support structure and has become a very close friend to me and my family.

Virgin Active N1 City is my second home and the staff (as well as the members), have been a tremendous support system for me. For that, I am truly grateful. Dawn Loots from Virgin has been very involved in my journey, and her advice has been invaluable to me.

I plan to do a personal training course next year and would like to specialise in larger women. I have walked the walk and now want to help others who are in the position I was a little over a year and a half ago.

The contact details for my team are:

Personal trainer – Estne Auret from Trihealth (Tel: 0846013007)

Nutritionist – Phillippi Marx (Tel: 0827871347)

Plastic surgeon – Dr Jonathan Toogood (Tel: 0218513400)

Psychologist – Sharon

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A new vaccine which is being developed in Chile, will give drinkers an immediate hangover - even if a small amount of alcohol is consumed.

Scientists from the University of Chile have spent a year designing the drug in a bid to tackle the growing problem of alcoholism in the country.

The vaccine (which will be effective from between six months to a year), works by sending a biochemical message to the liver, telling it not to express genes that metabolise alcohol. Normally, the liver converts alcohol into the hangover-causing compound called acetaldehyde - which is then broken down by a metabolising enzyme.

If someone who’s been vaccinated tries to drink alcohol, they will immediately experience severe nausea, accelerated heartbeat, and general discomfort. However, one has to be 100% sure of their decision to have the shot, as once the vaccine has been administered, it cannot be reversed.

A preclinical trial using mice (in order to determine the correct dosing) is due to begin soon - with researchers hoping to begin tests on human subjects in November 2013.

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Skin changes and treatments thereof, Menopause is a time of change – a natural biological process that signals the end of fertility. While women no longer have to worry about pregnancy, they do have to contend with unpleasant symptoms such as hot flushes, night sweats and mood changes. It also accelerates the ageing process, causing skin to wrinkle and sag. Dr Sly Nedic discusses aesthetic treatments for skin in menopausal women…

Menopause causes the skin to age more rapidly, inducing cosmetic changes such as wrinkling and sagging of the skin. Structural changes such as thinning of the epidermal layer and decreased amount of melanocytes are also prominent.

The dermal changes of menopause are generally caused by reduced oestrogen levels. These are worsened by the effects of ageing from hormone decline, as well as a lifetime of UV light exposure.

Oestrogen has profound effects on skin biology and function. It also protects skin from ageing by increasing skin thickness, reducing wrinkling and increasing hydration.

There is extensive supportive evidence that certain structures in the skin have more oestrogen receptors then others, such as: keratinocytes, fibroblasts, sebaceous (sweat) glands, hair follicles and blood vessels residing in the skin.

As such, the functions of dermal cells (including metabolism), are influenced by the reduced levels of oestrogen that characterise menopause.

Oestrogen Effect On The Skin

Collagen, which is the key component of the skin, is very important for facial skin firmness In the initial five years of menopause, a woman may lose as much as 30% of the collagen content of her skin. The rate of collagen loss then declines a further 2% annually in post-menopausal women.

Decreased oestrogen impairs the production of glycosaminoglycans in the dermal layer of skin. Over time, this causes collagen production to decline - thus leading to increased laxity. It is very important to start treatments during these five initial years in order to preserve and stimulate collagen production.

Typical treatments are:

1. Aesthetic procedures to enhance collagen production such as:

• Titan (infrared tailored light),

• Thermage (monopolar radiofrequency),

• Tripollar (tripollar radiofrequency),

• Mesotherapy etc.

2. Anti-ageing treatments such as:

• Oestrogen, BHRT,

• Collagen supplements,

• Vitamin C

Skin Dryness And Wrinkling

The concentration of blood vessels in the dermis also declines around the time of menopause. Reduced vessel concentration is associated with dehydration of the skin, less oxygenation and decreased turnover of the cells.

This contributes to the thinning of the epidermis and a slower cell turnover rate – which is accompanied by a reduction in the barrier function of the epidermis. This leads to increased trans-epidermal water loss and dry skin.

Glycosaminoglycans attract and absorb water, and their concentration directly affects the water content of skin.

Together these changes cause skin wrinkles. Loss of underlying fat tissue that is partly controlled by estrogen levels causes certain folds to become more visible. All of these are worsened by be the decline in growth hormone and lifetime UV exposure.

Typical treatments are:

1. Aesthetic procedures such as:

• Fillers - especially designed fillers for different problems like Voluma (Juviderm) for mid-cheek fat loss,

• Vollbela (Juviderm) for smokers lines,

• Juviderm for nasolabial folds,

• Botox (Allergan) for hyperkinetic lines,

• Fractional laser for skin texture improvement,

• Chemical peels,

• Mesotherapy etc.

2. Anti-ageing treatments with:

• Oestrogen BHRT,

• Multiple hormone replacement therapies for long term results,

• Advanced antioxidants

Menopausal woman age 52 Before & After Juviderm ® - Voluma ™

Susceptibility To Sun Damage And Increase Of Age Spots

The maintenance of Melanocytes is partially under the control of oestrogens. As menopause progresses, the number of melanocytes in the skin are reduced with less melanocyte.

We produce less of the protective melanin and skin appears lighter. Menopausal skin is therefore more prone to sun damage, making it more susceptible to wrinkles. Women normally notice paleness of the skin – and this appears as loss of youthfulness.

There is also a lack of regulation of Melanocytes by oestrogen, which leads to an increase of age spots.

Typical treatments are:

1. Regular and dedicated use of sun block and IPL for age spots

2. Oestrogen BHRT (Bio-identical Hormone Replacement Therapy)

Adult Acne and Increase of Facial Hair

Both of these conditions are mostly caused by an imbalance between oestrogen and testosterone that happens during the early stages of menopause. As oestrogen levels decrease, testosterone (produced by the adrenal glands) is no longer masked in the woman’s body.

Testosterone stimulates the sebaceous glands, which in turn secretes thicker sebum. This reveals itself as adult acne in some women - as well as the development of excess facial hair (particularly in the chin area).

Typical treatments for these conditions are:

• Topical treatments to treat adult acne,

• Laser hair removal,

• Re-balancing Oestrogen: Testosterone ratio with BHRT, Beta –sitosterol, etc.

It’s important to note that as soon as the first symptoms of menopause manifests, the majority of other hormones in the body are also declining. They all have different effects on the skin, making the aesthetic appearance more unpleasant - and treatments more complicated.

Growth hormone is another one that is particularly important for the overall look in facial ageing. This is due to increased atrophy and hypotonycity of the supportive underlying tissues and muscles.

Deep forehead wrinkles, droopy eyelids, deep nasolabial folds, lip thinning with retracted gums, jaw bone atrophy and loose skin folds on the neck area are all signs of low growth hormone.

However, IGF-1 is easily documented in the blood and could be treated with growth hormone replacement.

Other Hormone Deficiencies That Increase The Signs Of Ageing Are:

• Aldosterone and Vasopressin deficiencies (sunken eyes in the orbit)

• Cortisol deficiencies (dark circles under the eyes)

• Aldosterone deficiency (sharp wrinkles)

These Deficiencies Need Adequate Hormone Replacement Therapy

Menopausal women are very sensitive to their skin – as well as their physical and psychological changes (which are all caused by the decline of hormones). It’s vital to start with both aesthetic procedures and dedicated anti-ageing treatments from onset of menopause (even in peri-menopausal period).

Combining aesthetic procedures with bioidentical hormone replacement is necessary to achieve long lasting results – as well as to preserve the skin and underlying tissue ageing.

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The magnets in the iPad 2 tablets are capable of interfering with heart implants and pacemakers. This is according to a new, small study presented at Heart Rhythm 2013, the Heart Rhythm Society’s 34th Annual Scientific Sessions.

The research was performed by 14-year-old high school freshman, Gianna Chien of Stockton, California.

They found that the magnetic interference could change the settings - and even deactivate the technology of implantable cardioverter defibrillators (ICDs).

Chien was helped by her father who is a cardiologist. She asked 26 volunteers with ICDs to hold the iPad 2 at reading distance and then, on a separate occasion, to hold the tablets against their chest.

The study showed that magnets imbedded in the iPad 2, as well as its Smart Cover, could interfere and disrupt the workings of ICDs. Specialised magnets are rooted in the heart devices to allow doctors to adjust their settings on a set schedule.

The iPad 2 and its Smart Cover magnets can undermine an ICD’s ability to stabilise sudden rapid heart rates, such as fibrillation and tachycardia. This danger can happen when a person falls asleep with the tablet sitting on their chest.

Of the study participants, 30% had interference with their devices when the iPad2 was placed in that position. However, electromagnetic interference was not seen when the iPad was at a normal reading distance from the chest.

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If you are seriously thinking about bringing your abdomen down to size, (and you require the help of a surgeon’s scalpel), then a tummy tuck might just be the answer.

Dr Vernon Ching gives us the low-down.

The tummy tuck has again come to the fore as a reliable and predictable way to improve extremely overweight abdominal contours.
It gets rid of extra skin and fat in the majority of situations, and restores separated or weakened muscles to reshape a firmer and smoother abdominal profile.

In 2012, ASAPS (American Society for Aesthetic Plastic Surgery) indicated that cosmetic surgical procedures increased more than 3% in the past year, with almost 1.7 million procedures being performed in 2012.

The tummy tuck was the third most commonly performed cosmetic procedure after breast augmentation and liposuction.

With the recent number of non-invasive and minimally invasive treatments for abdominal contouring on the market today, patients have been less keen on the more invasive tummy tuck.

Patients generally prefer non-invasive interventions (such as Liposonix, Coolsculpt or Vaser shape) or minimally invasive liposuction contouring (Slimlipo or Vaser) to avoid a general anaesthetic, pain, an increased risk of bleeding and a longer downtime.

However, due to poor patient selection, patients have often been less than satisfied with the less invasive procedures.

In many patients (especially after pregnancy), lax stretched abdominal muscles, loose skin and increased subcutaneous fat are the main bugbears and become more difficult to treat.

Although the less invasive procedures can remove fat - and to an extent, tighten skin to improve contour - they all have no effect on loose abdominal muscles. They also have a minimal effect on significantly stretched skin (for example – if you’ve lost a great deal of weight, that extra skin left behind becomes increasingly difficult to get rid of.)

When you visit your plastic surgeon, he or she will determine the kind of procedure most suitable for you, based on your individual condition and goals.

The Standard Tummy Tuck operation has a gradual and central lower incision. This procedure is most suitable for patients who have spread-out abdominal tissues that require excision of bigger quantities of skin.

The incision is concealed in the majority of bikini bottoms, while allowing the excision of a considerable quantity of skin and fat from the lower abdomen. The abdominal muscles are tightened, and a new belly button position is recreated after the removal of the excess skin and fat.

The second type of this procedure is called a Mini Tummy Tuck– and it involves excision of the skin from the lower abdomen (also known as the ‘lemon slice’ excision). It does not reposition the belly button and is most suitable for thin patients who have large excess lower abdominal skin.

Contraindications To The Tummy Tuck Procedure

1) All contouring operations (regardless of degree of invasiveness) are only for patients with exercise and diet resistant fatty collections. It’s not for weight loss reasons. Ideally, patients should be fit and healthy with a BMI (Body Mass Index) of less than 30.

2) Patients who have unrealistic expectations from the surgery - or who are unable to handle post-surgical scars - are also disqualified from having the procedure.

3) If there is an abdominal hernia present, this may be corrected at the time of tummy tuck by a general surgeon.

4) Women who intend to have further pregnancies should also delay this procedure until they have completed their families.

5) Those who smoke would need to stop the habit three weeks before the surgery, and for three weeks after the surgery to avoid wound-healing problems.

Recovery

Recovery time differs from patient to patient.

In general, you can expect to be away from work for one to two weeks – with the resumption of normal activities at approximately six weeks.

Tummy Tucks – Is It For You?

A tummy tuck cannot be considered as a replacement for an exercise program or weight loss regimen.

Furthermore, this operation cannot fix stretch marks – though they can be to a degree improved - or even removed if located on the part of excess skin that would be cut away. This is usually the treated areas below the belly button.

To conclude, in that select group of patients with a protruding tummy, a tummy tuck is often needed to remove that excess skin, eliminate that fat and contour those lax abdominal muscles. This is something that VASER or Slimlipo cannot do. In these patients minimal invasiveness = minimal results.

Written by A2 Expert Panel member: Dr Vernon Ching MBBCh (Wits) FCS (SA) Johannesburg based, Dr Ching is a Specialist Plastic Surgeon who has been in Private Practice since 1995. He is the Director of Precision Aesthetics based at the new Waterfall City Hospital in Midrand. It offers the complete aesthetic solution combining non-invasive treatment modalities with Cosmetic Surgery.
www.precision-aesthetics.co.za

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For almost 40 years, a debate has been raging on about whether or not to eat eggs, the number of eggs that can be eaten - and are they as bad for the heart as smoking?

When actually analysed, it was found that eggs don’t make you fat, but they aid in weight loss. Each egg has 70 calories and is rich in protein– this protein causes the body to release glucagons, which helps the body make use of stored fats and carbohydrates.

Eggs are cholesterol increasing villains…fact or fiction? Yes, eggs are high in cholesterol (around 200mg per egg), yet researchers say this dietary cholesterol found in eggs is not as harmful as cholesterol from saturated fats.

Many people also believe that the egg yolk should be discarded and only the white consumed (as egg white is said to be pure protein with no fat). However, the yellow yolk is actually hugely beneficial as it has fat, nutrients and protein – and contains 240mg of leucine (which is an amino acid and helps in muscle building).

When it comes to the quantity of eggs that can be consumed, there is great news for egg lovers. Research has now found that eating one egg a day is not only absolutely fine, but is also very healthy. In fact, even heart disease sufferers can eat about four eggs a week.

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The underworld of narcotics and the devastating effect it has on families, individuals and society are immense. Cindy Le Grange brings us the facts and fictions of addiction, as well as the “wonder drug”, Naltrexone – an implant that boasts a high success rate in the aid to recovery…

Addiction

An obsession of the mind and an allergy of the body. Long have we laboured under the misconception that addiction is a choice. The belief over many years has been that those addicted to mind altering substances - or activities such as gambling, have done so through choice or an inherent weakness within them.

Abuse is a double edged sword; it is a physical compulsion, coupled with a mental obsession with a particular substance or activity being the prime focus.

The disease of addiction, as it is now officially recognised, is progressive, incurable and ultimately fatal.

The good news is that this disease can be arrested at any point. With the assistance of support groups, life restructuring programs and in some cases medication (such as Naltrexone) - survival and recovery are possible.

Naltrexone – The what and the why.

Naltrexone, short for Naltrexone Hydrochloride (C20H23NO4-HCl), is an opiate antagonist.

Naltrexone blocks receptors in the brain that ‘feel’ pleasure when a person uses alcohol or a broad spectrum of narcotics .When these areas of the brain are blocked, a person feels less need for ‘one more drink’ or ‘one more hit.’

There are various forms of the Naltrexone treatment:

1. There is the low dose maintenance tablet.

2. The one month injectable (Vivatrol)

3. And the subcutaneous implant which lasts three months – with slow release.

According to Dr de Wet, a registered doctor from Roodepoort who specialises in the implant procedure, it is not recommended that patients new to Naltrexone opt for the low dose daily tablet.

“The problem with this choice is the inclusion of a significant other that will need to administer the medication at specific times – as well as finding a specific dosage that works.

The slow release implant lasts for three months and has no addictive nature. This means that the patient will only withdraw once – from the drug of choice they wish to abstain from,” he says.

While Naltrexone is prescribed and recommended in the treatment of alcohol and opioid addiction, it must be noted that it’s not a cure.

The patient must be ready to make life changes - and be willing to undertake a comprehensive treatment program that includes counselling, support groups and close medical supervision.

As with all things in life, terms and conditions apply. Addiction in itself is a disease that incorporates the need for quick fixes and short cuts. In order to overcome the falsehoods brought on by life in active addiction, new thought processes should be cultivated while using Naltrexone as an aid to recovery.

Scores of patients with more than two years sobriety have noted that the feeling of obsession and compulsion (which is an intricate part of addiction), almost disappears with the initial use of Naltrexone.

This is perhaps due to the ‘receptor blocker’ properties of the treatment. It has become known by the recipients and success cases of this treatment as the ‘Time freezing drug’ as it allows the user to ‘Live in today – deal with yesterday and look forward to tomorrow’.

Although Naltrexone is FDA approved, it’s not as yet registered in South Africa. It is also not fully supported by some medical professionals - and is opposed by various rehabilitation centres.

Pre-Implant Rules

Before the procedure can be authorised, a full medical history must be given to the doctor. This will ensure that any pre-existing conditions can be ruled out and complications can be avoided.

The patient should essentially be free of all narcotics and certain medication for seven to 10 days before the procedure is performed.

Heroin addicts are often allowed 48 hours of being drug free before the procedure, due to the difficulty of the physical withdrawal from this drug.

The heroin addict receives sedation medication for the first three days after the implant to assist with the detoxification process. Proper counselling should be given and a ‘future’ plan for recovery should be established. If the potential patient shows signs of reluctance to ‘clean up’ the doctor should not do the procedure.

The reason for this is that although Naltrexone blocks all the feel good receptors in the brain (and absolutely no high can be achieved if one decided to use drugs or drink while on this medication), it does not stop the person from trying. In severe cases, addicts have tried to get high while on the implant and have doubled or tripled their usual dosage of a particular substance. Although the mind and body “feels “no high, extensive damage can be done… and this can be fatal.

Tragic super-star Michael Jackson passed away in June 2009 of ‘high intoxication levels’. According to the British tabloid The Sun, the LA coroner found a Naltrexone implant under Jackson’s skin during his autopsy. It’s believed the talented musician had the implant inserted to help him with his addiction to prescription drugs.

This is evident in the case of 26-year-old Alice*, an intravenous heroin addict who received Naltrexone on her family’s insistence. Four weeks after having the implant inserted, Alice started using heroin again.

She did not remove the implant at first, but tried at all costs to get high. Her relapse was discovered when she began to lose weight, the appearance of her skin became red and blotchy and her eyes drooped. A drug test was done and large amounts of opiates were detected. She then proceeded to cut out her implant – and used heroin on the same day. This bout led to Alice being rushed to ICU after a massive overdose.

Luckily not all cases end up in the emergency room. Alice was a poor candidate for the implant as she was not ready to make the life change and treat her addiction. Her decision to have Naltrexone was made under extreme duress from her parents – and not her choice alone. This is why it’s imperative that the patient is 110% committed to recovery before embarking on the Naltrexone implant.

The Procedure

The implant procedure is minimally invasive and must be done in registered doctors rooms. The procedure must only be carried out by a trained Medical professional.

CHECK YOUR FACTS.

A local anaesthetic is required and the entire process takes only 15-20 minutes. When the local anaesthetic has taken effect, a small incision is made in the lower abdomen or posterior. The specifically formulated biodegradable implant is inserted just below the skin and 2-4 stitches then closes the wound. Patients of this procedure confirm that the post procedure discomfort experienced is minimal.

Warning: Naltrexone hydrochloride is well-tolerated in the recommended doses, but may cause liver injury when taken in excess - or in people who develop liver disease from other causes. If you develop abdominal pain lasting more than a few days, white bowel movements, dark urine, or yellowing of your eyes, you should stop taking Naltrexone hydrochloride immediately and see your doctor as soon as possible.” (www.drugs.com)

* Names have been changed to protect their identities.

For more information on the Naltrexone implant, visitwww.naltrexoneimplant.com

Sources

www.naltrexonerx.com

www.naltrexoneimplant.com

www.gazorpa.com

www.lowdosenaltrexone.org

www.eatdrawlive.com

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Everyone hates acne… and everyone hates acne scars even more. There can be nothing worse than your breakout clearing up - only to find scars leaving permanent reminders. Even when you resist the temptation to pick and squeeze you pimples, there is still a good chance they will scar.

Cause and Effect

The inflammation caused by acne damages the skins collagen reserves. Even without picking, this creates the environment for scarring. The great news is that treatments for scars have come a long way - and you no longer need to be affected by this skin condition.

What do your acne scars look like?

The type of acne scar will play a massive role in your treatment option. So too will the quality of your skin, the colour of your skin and the training experience of your doctor.

Acne scars can be categorised into three different appearances:

1. Shallow atrophic scars

2. Boxcar shaped

3. Ice-pick shaped (Narrow and deep)

Other factors that may influence how visible your scars are include redness or darkening of the scars.

What are your acne scarring treatment options?

Treatments in scarring have evolved to include a number of options, and an experienced doctor will be able to treat your skin with specific protocols that suit your specific needs.

In most cases you will require some combination treatments over a service of weeks, and they almost all begin with a good homecare range.

Homecare

As mentioned before, stopping the inflammatory response will lessen the risk of scarring. Should you already suffer from acne scarring; the correct use of anti-inflammatory creams will reduce their visibility – while allowing for greater accuracy when treating the scar itself.

A prescribed homecare range can lessen the pigmentation of the scar and reduce visibility - however they can do nothing to remove the scar itself. For that you have a number of options. These are the options that I use at my practice.

Botox®

Although Botox® is not a traditional treatment option for skin depression (as is the case with acne scars), more and more treatments are being done to lessen the visibility of these scars by utilising the muscle inhibitor action.

This lessens the pull on atrophic scars. When used in conjunction with dermal fillers, Botox® can be an effective scar treatment option.

The Botox treatment eases pressure on the scar by relaxing the muscles beneath it, but it will not be able to fill the pock mark - hence the dermal filler.

Dermal Fillers

Dermal fillers are fast becoming the norm when treating difficult acne scars. This is because good dermal fillers act on two fronts:

First: Dermal fillers are made from hyaluronic acid. This means you are injecting a natural skin volumising molecule. By thickening the skin, you will lessen the visibility of the acne scar throughout the skin as a whole.

Second: Dermal fillers can be injected directly beneath a scar and “filled from the inside out”. This means that deep scars can be treated by placing dermal fillers directly below the acne scar, which softens them from view.

Again, this is a great combination procedure to use in conjunction with Botulinum toxin, chemical peels or mesotherapy. The results are temporary, but there is little or no downtime with this procedure. Most patients combine their treatments with additional aesthetic medicine.

Chemical Peels

Chemical peels have developed a rough reputation due to the downtime associated with the treatment. But as with all things in aesthetic medicine, the procedure has evolved and now we as doctors have choices… and so do you.

Chemical peels are an extremely effective acne scar treatment option. They have been for some time, but the ability to mix chemicals at various concentrations now means that we can treat individual scars in individual people.

The process of chemical peeling basically involves forced exfoliation of the skin. The peel is applied to exfoliate the outer layers of scarred skin. This is then replaced by non-scarred, new skin from the skin layers beneath. You will need to undergo a few treatments to achieve your desired result - but chemical peeling offers high patient satisfaction rates at very affordable prices.

Combining chemical peels with dermal filler injections is a personal favourite of mine - and where I can, I recommend this treatment option.

Mesotherapy

Mesotherapy is a technique whereby vitamins and minerals are injected into the mesoderm layer in the skin. The treatment is a skin rejuvenation treatment by nature. This means that if it’s done correctly, it can reduce the visibility of acne scars by volumising the skin.

However this is not a favourite technique of mine for treating acne scarring - but as it is the most cost-effective method, I have included it.

As with all treatments for acne scarring, there are associated risks and skin prerequisites before we can go ahead with treatments. Always discuss your options and desired outcomes with your doctor, and always work with the most qualified doctor you can find.

Remember, you have a budget and need to work within you limits as acne scar treatments are not covered by medical aid. Yet you can nonetheless achieve fantastic results by working with experienced physicians.

Written by A2 contributor: Dr. Martina v.d. Mescht
Dr. Martina v.d. Mescht has over 20 years’ experience in the medical profession and over 10 years in aesthetic medicine. Based in Roodepoort, Johannesburg, Dr vd Mescht specialises in aesthetic and anti-ageing medicine. For more info, visit www.aestheticssouthafrica.co.za

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