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HOUSE CALL WITH DR. SANJAY GUPTA

A look at Plastic Surgery

Aired October 23, 2004 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


BETTY NGUYEN, CNN ANCHOR: Want to tell you about a developing story in Afghanistan. Three blasts on the streets of downtown Kabul have killed or wounded a number of people. Peacekeepers say the explosions were aimed at a group of Westerners on the street. We, of course, will update you on those details just as soon as they become available to us.
Several powerful earthquakes shake northwestern Japan early this morning. The strongest was magnitude 6.8. Damage and casualty reports are still preliminary. A live update coming up in about 30 minutes.

Meanwhile, in Western Iraq near Haditha, a suicide bomber killed at least 10 Iraqi police officers near a U.S. Marine base. Another suicide attack in Samarra killed one Iraqi security member.

And in the capitol, six U.S. soldiers were wounded when their Bradley fighting vehicle was hit by a roadside bomb.

Back here in the States, President Bush is campaigning in Florida today, where his brother is governor. He has four events scheduled across the state. John Kerry is stumping today in Colorado and New Mexico. Polls show a statistical tie with just 10 days to go to the election. Live reports from the campaigns are ahead next hour.

But right now, it's on to weekend HOUSE CALL.

ELIZABETH COHEN, GUEST HOST: Good morning, and welcome to HOUSE CALL. I'm Elizabeth Cohen in for Dr. Sanjay Gupta.

Checking medical headlines, the CDC reports the flu has shown up in only seven states so far this year. Those are the ones in green on this map. This is below normal for this time of year. And health officials say more flu vaccine is on the way. An extra million doses of the nasal spray Flu Mist will start becoming available next month.

And a new study shows women who take birth control pills for more than a year can reduce their risk of heart disease and some cancers. This is the largest womens' health study ever done and contradicts other research on the pill.

Now to our top story. We're talking about Americans battling to look younger. More Americans than ever before are flocking to plastic surgeons, nearly nine million last year. But the face of plastic surgery is changing from facelifts to less invasive options.

(BEGIN VIDEOTAPE)

COHEN (voice-over): Forty-five year old Laura Coco wasn't quite ready for a facelift, but she was ready for an eye lift.

LAURA COCO, PATIENT: I felt it was time. I was getting to a point where I'd look in the mirror and I'm like I look tired, even though I wasn't.

COHEN: Tightening up sagging skins above and below the eyes is now one of the most popular cosmetic surgeries. Eye lifts are being marketed as a pick-me-up for body and soul that's less invasive than doing the whole face.

Z. PAUL LORENC, DR., PLASTIC SURGEON: I think the eyes are the window of the soul. And it's true. When you meet someone, when you shake their hand, you look at their eyes.

COHEN: In addition to the eye lift, Laura's plastic surgeon, Dr. Paul Lorenc, did laser resurfacing under her eyes to help get rid of wrinkles.

The procedures took an hour and a half in Dr. Lorenc's office, and then Laura spent another hour in the office recovering, and then she went home. She visited the doctor four days later.

LORENC: You're still a little swollen.

COCO: Right.

LORENC: Which is normal on day four.

COHEN: The pink under her eyes is from the laser. Dr. Lorenc removed the stitches and predicted a full recovery in six weeks. While Laura's had a smooth recovery, there are risks.

LORENC: The risk of infection, even though it's very unusual, but it can happen. Risk of what we call a hemotoma, which is bleeding underneath the skin. Again, it's very, very rare, but possible.

COHEN: And some wonder why are people in their 40s or even younger having plastic surgery?

LYNNE LUCIANO, SOCIAL HISTORIAN: And if we're targeting people to start worrying at in their 20s about their faces and their frown lines, where is this going to go in 10 or 20 years? Where does it stop?

COHEN: Laura doesn't know when her plastic surgery will stop and says she's considering other procedures for the future.

COCO: I'm not working to change myself, just take a few years off.

COHEN: And she hopes that a bit of scalpel work around her eyes was a step in that direction.

(END VIDEOTAPE)

COHEN: This is the first week in a series of shows we're calling "Bodyworks," about America's quest to look and feel younger. Today we're talking about lifting and tucking the face. Next week, it's all about the body from lipo, from butt lifts. And our last week, we'll take the less invasive route, talking about creams, injections, and scrubs that can help keep you looking younger without going under the knife.

Helping to answer all of our questions about plastic surgery about the face is Dr. Marc Yune. Dr. Yoon is a specialist in facial plastic surgery based here in Atlanta.

Welcome, doctor. Now there seems to be this trend, where people are talking about less invasive procedures. Are you seeing that as well in your practice?

MARC YUNE, DR., FACIAL PLASTIC SURGEON: Absolutely. And thank you for having me on the show, Elizabeth. What we're seeing is an improvement in technology, better training, and younger patients coming to seek procedures. So because of that, we have a working force of people coming. And they don't need downtime. They're asking for minimal downtime. And therefore, we're having to respond by giving them less invasive procedures.

COHEN: Well, let's take a look at some national numbers. Last year of the top five plastic surgery procedures, three of them involved the face. Facelifts, nose reshaping, and eye lift surgery. We received a lot of questions about the eye area. So let's go to one now.

Cameron in Texas asks, "I have dark circles under my eyes that seem to be worsening as I get older. Is there a way to surgically correct this?"

Doctor, I think you have some pictures that sort of illustrate how this could work?

YUNE: We have brought some pictures of patients of mine. So this is one example of a patient who had a very similar complaint. And as you can see, the pre-ops are on the left and the post-ops are on the right.

So here's an example of the area, excuse me, here's an example of the area that we're referring to. In the lower eye lid, you can see that shadowing. Many people call it a dark circle or bags under the eyes. And it happens typically from a combination of things.

Most commonly, it's fatty protrusion, something you're born with. As you can see in this lady, she's very thin and fit. You can't ask her to lose weight to get rid of that. So there's a membrane that holds that fat back. And as we age, it protrudes. Sometimes you see it in a very young age. It's your genetic predisposition. So that's the primary factor for the bags under the eyes. Secondly, the lower eyelid has rounded and come away from the eyeball. So the skin is creasing, causing additional shadowing. So in this particular individual's case, we removed the extra lower eyelid fat by using an incision on the inside of the eyelid. And then because of the fact that we had skin relaxing, we had to lift her lower eyelid with what's called a cantapaxy (ph). Then a small amount of skin was trimmed right below the eyelash line to hide the scar. So that was what I did to enable her results.

COHEN: So for baggy, puffy eyes, you can blame your parents?

YUNE: That's a very good point.

COHEN: To a large extent?

YUNE: To a large extent, it's genetic. That's right.

COHEN: Well, we have another question now from Aly in Connecticut who writes, "I have puffy bags under my eyes, and I want to remove them. What's the best way and how much would it cost?" Doctor, what do you think? Puffy eyes?

YUNE: Puffy eyes are related to that last question we handled. It sounds like she has more of a focus problem. And that would be again most likely the fat. The reason it shows as a puff is because the fat protrudes. And in a typical lighting situation, like what we're seeing here today with frontal lighting, ambient lighting comes from overhead and it casts a shadow around that fat. So it creates...

COHEN: You have a picture of that?

YUNE: I do have a picture of that. Here's another individual. Young man, who again is thin and fit. And he has a -- what this lady is referring to as a puff under the eyelid.

So this crease, this shadow right here is created by lighting cast over that fat path. I removed that. And that was done with an incision inside the eyelid. And then we also did a small amount of skin removal under his lashes. And then we did an upper eyelid surgery, as well. So very similar to that last question.

COHEN: And that can happen, I mean, even at a relatively young age. You can have those kind of bags under your eyes?

YUNE: That's right. In fact, you see that sometimes in teenagers. I have babies. And you can already see in them that they can have a tendency towards that.

COHEN: With that puffiness?

YUNE: Right.

COHEN: Well, we've got time for another quick question. Beverly in Washington wants to know, "How safe is eye lift surgery on African- American skin? I haven't found a doctor in my area with much experience on darker skin tones." Doctor, African-Americans have a higher risk of scarring. What can folks like Beverly do? I guess she should seek out someone with experience with darker skin?

YUNE: Yes, that's an excellent point. Interestingly, the face heals differently in different areas. And when you're dealing with darker skin types, And I happen to see quite a few of my ethnicity. I see quite a bit of Asians and African-Americans, as well.

So hypertrophic or visible scarring, as well as keloid scarring...

(AUDIO GAP)

YUNE: ...of skin. And it doesn't seem to happen in the eyelid skin.

Historically, through much medical research and in my own practice, I don't see problems with scarring when the incisions are made in the eyelid. It's a different skin type. It's thinner. It doesn't have as much in the way of oil glands. And it's a different type of color.

COHEN: So again, finding someone with that experience is really crucial?

YUNE: Yes.

COHEN: Well, how young is too young to start lifting, tucking and plumping? We'll get that answer coming up on HOUSE CALL.

UNIDENTIFIED FEMALE: From neck lifts to facelifts, people want to get results fast. We'll show you the latest ways to put your best face forward. But first, let's check our daily dose quiz.

What is the most popular plastic surgery? That answer, when we come back. Stay with us.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Checking the daily dose quiz, we asked what is the popular plastic surgery? The answer, rhinoplasty. More commonly known as a nose job.

COHEN: Plastic surgery has the potential to improve many areas of the body, but it also has its limitations. In order to have a successful experience, it's important to have realistic expectations. Don't expect your life to dramatically improve just because you've had surgery. Also, keep in mind you may have to miss a week or more from work. And insurance won't pay most procedures. So it could get expensive.

Lastly, go into this understanding that surgery is like any other and it has risks. Answering our questions this morning is Dr. Marc Yune, a plastic surgeon here in Atlanta. Doctor, we've got lots of questions lined up. Let's get right to Erin in Tennessee who writes, "I'm 44 and the skin between my chin and my neck has fallen and is loose. If I get a lift now, will I need more facelifts as I age?"

First of all, doctor, what does that -- this lift involve? Can you talk a little bit about this lift? I think you have some pictures to show us?

YUNE: I did bring some pictures. And I've got an example of a patient with a very similar age and similar set of circumstances.

Here she is now. You can see that in her situation, what I've addressed is really the area of the cheek, jaw line, and upper neck here. So what I've done is used incisions just around the ear like an U-shape. It extends a little bit into the sideburn and the hair. And hers is more of a version of what we would call a mini lift. That addresses what we were talking about earlier, less invasive procedures.

COHEN: And how would this be different from a full lift?

YUNE: Well, in the full lift, what we're doing is sometimes extending incisions up -- way up into the scalp here to address the temple, this area right in the hair, connecting to the mini lift incision and then back behind the scalp to address the lower neck. So a mini lift, a full facelift is sort of two terminologies, but it doesn't really clearly describe what's happening. There's sort of a whole spectrum.

COHEN: But the scar is clearly less? It's much shorter?.

YUNE: It's shorter. That's right. So frankly, mini lifts in my practice can be done under a local anesthetic.

COHEN: Well, we have another question now. Jennifer from Connecticut wants to know, "I hear so much about the mini face lifts for people in their 30s replacing the major face lift later in life. What's the difference between that and a face lift?"

And we just have been talking a little bit about the mini versus the full. So you get the mini when you're 40 and the full when you're 60? Or how does that work?

YUNE: Such a popular question, Elizabeth. It really has to do with your anatomy. I'm not treating somebody for their chronological age. I'm treating them for their anatomy, their physiological age.

So here's an example of somebody that you might consider more of a full facelift. Now what we've addressed with her is the same sort of areas, the temple, jaw line, and then all the way down to the clavicles on her neck.

But also, she's had eyelid surgery. And let's look on her post- ops here. She had eyelid surgery. She's had a little lip augmentation. We also combined a little liposuction with her lift. And so, what I find is that there's no single procedure that identifies what a full facelift is. It really has to be catered to that individual's needs.

COHEN: So she's a new woman?

YUNE: She feels pretty good about herself. I think she looks great.

COHEN: That's great. Well, there are always new procedures coming out in this field. And we've got a question now from an informed viewer. Tom in Florida wants to know, "What's your opinion of the Featherlift procedure?"

Doctor, this is a new way to do a facelift. It's not yet approved by the FDA. What is a Featherlift and quickly tell us your opinion of it?

YUNE: Well, I would tell you from experience that I'm not the expert on the Featherlift because I don't perform it. I typically stick with procedures that do get FDA approval have a long-term history in terms of research.

But I do know that some of my colleagues use it and have had success with it. I love the fact that some of my colleagues are willing to try new technologies. I've used similar techniques to try and lift -- the cheek area is really what's being addressed here with a suture with a small incision in the temple. And then it grabs the skin and hopefully holds it up.

COHEN: When HOUSE CALL returns, we'll hear what one consultant told me I needed to have done to ward off the hands of time. Stay tuned.

(BEGIN VIDEO CLIP)

COHEN: I'm going to spend almost $10,000 a year to look younger and I'm only 37?

UNIDENTIFIED FEMALE: But Elizabeth, you have one face. Look at it as an investment in your future.

(END VIDEO CLIP)

CHRISTY FIFE, CNN CORRESPONDENT (voice-over): Plus, shocking your appetite to lose weight? We'll tell you about a special pace make tore help you lose those pounds.

But first, more of this week's medical headlines in "The Pulse."

Pfizer Incorporated, the makers of Celebrex, announced this week a new study on whether or not the drug increases a patient's risk for heart attacks. Celebrex is in the same family of drugs as Vioxx, the popular arthritis drug that was removed from the market this month for increasing the risk of heart attacks and strokes.

And seniors may be so... (AUDIO GAP)

...they may forget about another important vaccination. This week, the CDC reminded seniors and those with chronic diseases to get vaccinated against pneumonia.

Although it does not replace the flu shot, the pneumonia vaccine can help to limit the effects of the flu virus in those who get it. Christy Fife, CNN.

(COMMERCIAL BREAK)

COHEN: Welcome back. We're talking about our battle against aging with Dr. Marc Yune, a specialist in facial plastic surgery here in Atlanta.

Doctor now, about year ago, I was working on a special about plastic surgery. And I went to a beauty consultant and asked her what do you think I ought to be doing? So let's listen to what she thought would be some good procedures for me.

(BEGIN VIDEO CLIP)

COHEN: So the botox would be every three or four months?

WENDY LEVIN, IMAGE CONSULTANT: Right.

COHEN: The filler shots would be every six months? And the microdermabrasion would be...

LEVIN: Every month, every When you get around it.

(END VIDEO CLIP)

COHEN: Now that seems like a lot. She actually had even more to say. Do people who are just 37-years old really need to be getting all these procedures?

YUNE: Well, need and want are two different things. I have a lot of young people coming to see me. And they're typically getting minimally invasive techniques, just like she was suggesting to you. So they're all helpful techniques, but you have to choose what bothers you. You know? That's really what it's all about.

COHEN: And then try to fix it?

YUNE: Absolutely.

COHEN: Well, let's get to a question we have about these less invasive procedures. Harshi in North Carolina asks, "How safe are chemical peels?"

Now doctor, there are different levels of chemical peels. Let's talk first about the most intense levels.

YUNE: OK. Well, there's a whole spectrum of chemical peels. And what you're referring to are deep chemical peels that are rarely used because they're only indicated for certain skin types. Frankly, they're really only safe on fairer skin types, such as blonds, redheads with blue, green eyes.

Once you start to getting into darker skin types, you run the risk of either depigmenting them or hyper pigmenting them. Worse yet, even scarring them.

COHEN: So you can make their skin lighter or darker? So you have to be darker?

YUNE: That's right.

COHEN: And you have an example of a medium chemical peel?

YUNE: Right, what I'm doing most commonly in my clinic are the lighter forms of resurfacing. And what you were recommended to have done was microdermabrasion, which is one of the lightest forms.

My aestheticians in my spa do that.

When we start getting into deeper levels of peels, the physicians in my office these procedures. So you'll notice in this particular individual, that she's had sort of a diffused freckling around the cheek. And freckling occurs on prominence, because that's where the sun hits. Nose, forehead, cheeks.

And so, what we've done for her is a medium chemical peel. And then I've formulated a bleaching compound. And that helps to clean up the hyper pigmentation. It doesn't take skin and make it overly white. It just helps to clean up the brown spots. Of course, she's had a few other minor procedures as well. So...

COHEN: Well, let's get to another question now. Cynthia from Wisconsin writes, "If someone were to have facial plastic surgery, what are some of the more serious complications? Also, how long do results usually last until another surgery is needed?"

Doctor, let's start with the first part. Plastic surgery, of course, is surgery. Can you talk about some of the dangers involved?

YUNE: Well, that's an excellent question. And anybody needs to take anything they do electively seriously. So any surgery carries the same inherent risks, such as the risk of anesthesia, bleeding, infection, injury to surrounding structures, need for further procedures.

Fortunately, in this particular specialty in and what I'm doing, we have very limited risks because technology has gotten so excellent. And the training has gotten so excellent.

So I would tell you that -- let's backtrack. The risk for anesthesia -- the risk of having a major catastrophic injury...

(AUDIO GAP) ...my anestheologist will say is about equivalent or less likely than for you to drive home and have a major catastrophic problem in the car. Bleeding is controlled by making sure that patient's off of blood thinners and using proper techniques. We now have new instruments that limit that.

COHEN: So -- but it's always important to know when you're going in what the risks are. Nothing is risk free?

YUNE: No doubt about that.

COHEN: Well, if you're looking to have some work done, we'll show you places to start looking after the break. Stay tuned.

UNIDENTIFIED FEMALE: How can you pick a good plastic surgeon? We'll give you some tips when we come back and show you Web sites where you can find more information on procedures we have talked about. Stay tuned.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

SANJAY GUPTA, DR.: You've seen the ads promising dramatic weight loss. No surprise, though, that most of those fancy gadgets don't work.

But Candy Bradshaw said she's lost her cynicism and several dress sizes by shocking her appetite. She dropped from a size 28 to a size 14, something she attributes to controlling the appetite with the weight loss pacemaker.

CANDY BRADSHAW, GS PATIENT: I actually stay full for a longer period of time.

GUPTA: It's called the implantable gastric stimulator or IGS. A device the size of a pager is implanted into the abdomen with a small incision. Two wires send electrical pulses to the stomach at a regular pace. These pulses stimulate appetite hormones and create a feeling of fullness.

Doctors caution that shocking the appetite isn't for everyone.

SCOTT SHIKORA, DR., BARIATRIC SURGEON: Somebody who probably would not do well with this would be someone with a history of binge eating or other eating disorders, because those folks generally don't listen to the signals of fullness.

GUPTA: IGS is currently in stage 3 clinical trials and could be on the market as early as 2006.

Dr. Sanjay Gupta, CNN, reporting.

(END VIDEO CLIP)

COHEN: For more information on the treatments we've been talking about, go to plasticsurgery.org, home to the American Society of Plastic Surgeons or www.facemd.org, site of the American Academy of Facial Plastic and Reconstructive Surgery. Both Web sites show before and after photos and can help you find doctors in your area.

Now there are some questions you should ask if you do decide you want to get some work done. First of all, is the doctor board certified? And if the procedure is done in an office, is the office certified for that treatment?

Also, is there adequate emergency equipment if something were to go wrong? And find out how many procedures like yours the doctor has performed in the past. Those are some important questions to ask.

We're out of time today. Thank you so much to Dr. Marc Yune, board certified, for being with us today and answering all of our viewers' questions about facial plastic surgery. And don't forget to watch next weekend as our "Bodyworks" series continues.

We're talk about plastic surgery on the body from tummy tucks to liposuction. That's next week at 8:30 a.m. Eastern. E-mail us your questions at housecall@cnn.com. Thanks for watching. I'm Elizabeth Cohen. Stay tuned for more news on CNN.

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