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More than fiber in whole grains - YOU DOCS | Protectors include nutrients and cancer fighters


Q. I feel misled by "whole grain" breads. I'm trying to eat foods with a low glycemic index, but I've noticed that many whole-grain slices have less than 3 grams of fiber per serving -- about the same as some white breads. -- Bert

A. Checking that bread has 3 grams of fiber per slice is smart shopping, since fiber-filled foods often are lower in calories and they help you feel full. But it's not just fiber that counts for your health. The key is to avoid simple carbs that aren't related to fiber, which just turn to sugar very fast. So continue to avoid buying bread or any food made from "refined" flour. Whole grains deliver important health protectors beyond fiber:

> People who eat more whole grains gain protective nutrients, including magnesium, and that helps you to stay healthy and your arteries to stay younger.

> Whole grains are also cancer-fighting heroes: In an important recent study, people who ate the most whole grains had a 20 percent lower risk of colorectal cancer than those who ate the least (and it wasn't due to the grains' fiber content).

So keep your grains whole, and aim to get 25-35 grams of fiber a day. When it comes to the glycemic index of breads, you probably know two things: Scientists don't know how each gram of fiber affects a food's glycemic index, so don't obsess over that, and what's on your bread greatly influences its glycemic index. Jam sends it soaring, while vegetables and a little walnut or olive oil or even avocado oil bring it down.

A. All of your fat cells get bigger when you gain weight. But you have many more of those cells in your genetic fat-gathering spots, which is why you develop a "muffin top" over your jeans rather than a flabby forehead. The layer of fat cells beneath your forehead skin or on your ears is pretty thin, so they don't get the inflatable-mattress effect. Your genetics also determine whether excess calories preferentially end up on your hips or in your omentum (belly).

Scientists think that by the time you're a teenager, you have all your fat cells. When you eat too many calories, the fat globules in those cells increase and the cells expand; cut back on calories, and the cells shrink.

Even if your forehead won't get fatter, it's smart to eat healthful food, enjoy it and do enough physical activity to see your six pack.

Q. I developed eczema, and it's difficult to do normal tasks -- not to mention exercise -- since it's on the palms of my hands and the soles of my feet. I've been to a dermatologist and an allergist, but nothing they've done helps. Who else can I see? --Marta

A. Eczema is really an allergic reaction. Hand eczema is the most common type, with names like "dishpan hands" used to describe this condition in women. Your description of hand and foot eczema is typical of a disease called "pompholyx." No one knows what causes this, but stress may be a factor. Some people think it is caused by eating trace elements such as nickel, cobalt and chromium, even if an allergist's patch test is negative for these.

New Jersey plastic surgeon Dr. Arthur Perry says people with pompholyx sweat more than twice the normal amount, and creative docs have injected Botox into hands and feet to decrease sweating. You can try steroid creams or pills, avoid nickel-containing foods (canned foods, foods cooked in nickel-plated pots and asparagus, beans, mushrooms, onions and others). If it becomes debilitating, you might use methotrexate, and if life becomes intolerable, radiation therapy can be used.

The Best Wrinkle Fighters - Look for these ingredients the next time you purchase an anti-aging product.

By TED SPIKER, August 2008

The skin-care aisle is packed with antiaging products and claims. Here are the topical ingredients clinically shown to help diminish the fine lines and wrinkles that appear when collagen fibers break down.

Vitamin A: Often listed as retinol, it penetrates skin to increase collagen production, eventually smoothing lines, says Flor A. Mayoral, MD, a South Miami dermatologist.

Vitamin C: It can stimulate collagen to help build up your skin and smooth and fade lines. It works best when you apply it at night, says Arthur W. Perry, MD, a clinical associate professor of plastic surgery at Robert Wood Johnson Medical School.

Vitamin E: Look on the label for DL-alpha-tocopherol; it blocks the cancer-causing effects of UV light and slows the production of wrinkles. And E enhances the efficacy of sunscreen, decreasing redness and swelling after sun exposure.

Alpha hydroxy acid (AHA): Used as an exfoliant, it's also listed as glycolic acid. By peeling off the top layer of dead skin, it gives you a more youthful appearance.

Vitamin B3 (niacin): It helps shield skin from toxins and decreases brown blotches. Bonus: It helps ease the irritation that can be a side effect of vitamin A creams.


By Leslie Garisto Pfaff, Nov-Dec 2007

"Wow." That's how Carol Beck reacted this year to her first treatment with Restylane. The 55-year-old office manager from

Montclair had been feeling, in her words, "droopy and drawn" and was looking for a nonsurgical way to smooth out the smile lines that bracketed her mouth. Like an increasing number of patients, she opted for one of the popular so-called lunchtime procedures, which are quick and noninvasive and involve minimal or no downtime. After injecting Restylane "” a cosmetic filler used to plump up wrinkles and facial depressions "” into one side of Beck's mouth, the doctor held up a mirror. The difference, Beck says, "was powerful."

With the holiday party season just around the bend, many of us are looking for ways to get a brighter, younger look, and lunchtime procedures promise just that. But which ones really deliver and live up to their quick-and-easy reputation? We asked three of the state's finest cosmetic surgeons to describe what the procedures accomplish, what they entail, and what kind of upkeep they require. Read on to see if one or more could light up your face.


Until four years ago, the only filler in town was collagen, and it carried an assortment of unpleasant risks, not least of which was an allergic reaction. Then along came Restylane, a synthetic filler with fewer side effects and greater effectiveness, and the boom was on. Today, patients can choose from a selection of fillers, among them the brands Restylane, Juvederm, Radiesse, and Perlane. Is there a filler in your future? For nearly 800,000 Americans, the answer to that question last year was a resounding yes, and the number is likely to rise as new products make their way onto the market.

What they do
Restylane and Juvederm, made by different manufacturers, are two takes on the same substance, hyaluronic acid. They're used to fill in and plump up surface lines and wrinkles, particularly the smile lines around the mouth and the so-called sag pleats that run from the corners of the mouth toward the chin. "They do the job really, really well," says Arthur W. Perry, M.D., a plastic surgeon with practices in Franklin Park and Branchburg and author of Straight Talk About Plastic Surgery. They also can be used underneath the eyes in the tear trough (the hollow where the lower eyelid meets the cheek), in the cheeks (again, to fill in hollows), along the border of the lips (to give them a crisper, more youthful look) and, to a limited extent, along the jaw line (although serious sags here still require surgery). Increasingly, hyaluronic acid is being combined with Botox to smooth out stubborn creases between the brows. For deeper folds, doctors turn to Perlane (another formulation of hyaluronic acid) and Radiesse (a different chemical altogether, calcium hydroxylapatite).

What they're like
Most treatments begin with either a nerve block to numb the face, which takes effect after about 20 minutes, or the application of a topical anesthetic, followed by a series of small injections. Depending on the area being treated, injection time varies. For smile lines or the nasolabial folds "” the wrinkles from the nose to the lip "” it takes about 20 minutes; for filling in a cheek hollow, about two hours. With a proper anesthetic, they should feel just slightly pricklier than Botox injections.

Although most doctors include fillers in the lunchtime category "” and many patients do return to work afterward "” you may want to take the rest of the day off. "We have people apply ice compresses to the area for 20 minutes a couple of times an hour for the first two hours, but that's about it," says Valerie J. Ablaza, M.D., a partner in the Plastic Surgery Group in Montclair and co-author of Beauty in Balance: A Common Sense Approach to Cosmetic Surgery and Treatments. You can expect a little swelling and soreness for a few hours after treatment.

When you see results
This is where the "wow" effect comes in. "The results aren't just instantaneous," Dr. Perry says. "They actually improve over the next couple of days."

How long they last
Like Botox, fillers dissipate slowly in the tissues, but you can expect results to persist for a minimum of six months. "Some patients say they last up to a year," Dr. Ablaza says. In parts of the face where there's more movement "” the mouth, for instance "” results might not last as long.

Side effects
"Fillers owe much of their popularity to the fact that there are so few risks involved," Dr. Perry says. The most common side effect is bruising. A rare complication, when the filler is injected near an eye, is vision loss.

Restylane and Juvederm sell for about $650 per syringe, enough to fill in the nasolabial folds. Perlane gs for about $750 per syringe, and Radiesse for about $1,000 per syringe.

Fractional Laser Resurfacing

A decade ago, serious laser treatment meant months of redness and discomfort, "and if the laser wasn't used by an experienced practitioner, it had a high complication rate," says David Goldberg, M.D., director of Skin, Laser, and Surgery Specialists of New York and New Jersey, which has offices in Hackensack, Westwood, and Manhattan. Fractional resurfacing has changed all that, offering laser treatment that achieves dramatic results with minimal downtime. The effects, however, are cumulative: If you start treatment now, you might not see results in time for holiday celebrations. Instead, consider it a present to yourself you can open by Valentine's Day.


What it is
The fractional laser removes or minimizes fine lines and brown spots and improves the skin's overall appearance, giving it a more youthful texture and glow.

What it's like
After the application of a numbing cream, the doctor makes repeated hits to the skin with the laser. "Because of the cream, most patients feel next to nothing, though some describe a prickling sensation," Dr. Goldberg says. The cream takes about a half hour to take effect, and the procedure itself generally lasts no longer than 15 minutes.

You may feel and look a little flushed, as if you'd just finished a good workout, but you can cover up with foundation and go right back to work.

When you see results
Fractional resurfacing works by hitting a tiny spot on the face with a micropixel of light energy, then skipping a spot, then hitting a spot "” over and over again throughout the area being treated. That means it requires several treatments to get results. Most doctors recommend four to six sessions, about a month apart.

How long they last
"That's the million-dollar question," Dr. Goldberg says. "Fractional lasers have been on the market for two and a half years, and we haven't redone anyone yet." But because damage from sun and aging takes years to appear, the treatment probably needs to be repeated at some point.

About $1,600 per treatment.


"It's the icing on the cake," Dr. Goldberg says, offering as good a description as any for the frothy procedure, which gs down with a minimum of fuss. The effects are strictly temporary, and you don't see the kind of miraculous results delivered by Botox or Restylane. But if you want a quick fix, microdermabrasion may be just the treatment for you.

What it is
Microdermabrasion removes the surface layer of dead and damaged skin cells while eliminating dirt from deep inside pores. Despite claims to the contrary, it doesn't erase wrinkles or scars, but it is "clean the skin better than any other technique "” it's a kind of superfacial," Dr. Perry says. If you're looking for softer skin and a more youthful glow, you're likely to be pleased with microdermabrasion.

What it's like
The treatment is usually administered either by a doctor or, more frequently, a licensed aesthetician. It involves abrading the face, generally with a crystallized cream on the head of a battery-operated wand. Once the face is fully "blasted," the wand is used as a vacuum to suck up the cream and skin debris. The procedure can be uncomfortable, but it's rarely painful.

There's some mild redness but nothing a dab of makeup can't hide. Involving virtually no downtime, microdermabrasion is the quintessential lunchtime procedure.

When you see results
You notice improved texture as soon as the redness recedes, usually within 24 hours. But you can get more dramatic results with a series of procedures "” the average is six, done at two- to four-week intervals.

How long it lasts
After the first series of treatments, patients generally return every four to six weeks for refreshers.

About $150 per treatment.


It's the most popular cosmetic procedure in the country "” 4.1 million treatments last year in the United States alone "” and it has revolutionized the field of plastic surgery. "We used to treat wrinkles between the eyebrows by surgically removing the muscle there, but Botox has rendered that procedure obsolete," Dr. Perry says. Botox treatments have become a cosmetic staple for millions of women, and an increasing number of men as well.

What it is
Botox works its wonders on deep wrinkles caused by muscle contractions: the so-called bunny line between the eyebrows, the horizontal muscles of the forehead, and the crow's feet at the outer corners of the eyes. It can also smooth out the vertical bands of muscle in the neck, and more and more doctors are using it to control excessive perspiration under the arms.

What it's like
Treatment begins with the application of an anesthetic cream, followed by a series of small shots of Botox into the muscles being treated. Because of the anesthetic, most patients don't feel more than a slight pricking sensation. Given the potential results, the procedure itself is surprisingly quick. "For new patients, whose appointments typically begin with a consultation, it's usually less than 30 minutes, from start to finish," Dr. Ablaza says. "For patients who've already had the procedure, it can probably be done in under 20 minutes, maybe 15."

After a treatment, you rest for 10 minutes or so to make sure that the Botox doesn't migrate to other muscles in the face. Once the Botox has "set," you're advised not to engage in vigorous physical activity for 24 hours. But with that single caveat, you can pretty much return to normal life after you leave the doctor's office.

When you see results
Don't expect an instantaneous transformation. Most patients can see a small change in a couple of days, but it takes up to two weeks for the effects to be fully realized.

How long it lasts
"It's different for everyone," Dr. Ablaza says, "but for most people, results last for a minimum of three months. And some of my patients think they even last for six months." Doctors are finding, too, that results are cumulative "” that is, the more often you've had Botox, the longer the effects seem to persist.

Side effects
The most common side effect is a droopy eyelid, which can occur when Botox disperses from its original site; this problem generally dissipates in a week or so.

Expect to pay about $400 for each area treated.

Keep in mind that none of the aforementioned procedures offers the dramatic long-lasting changes of a surgical face-lift. On the other hand, most of them really can be accomplished in the time it takes to down a sandwich and a cup of coffee. And at this hectic time of year, that should be miracle enough for most of us.

Shave off years without going under the knife

By Geoff Van Dyke, March 2007

When Kenny Rogers appeared on American Idol last year, it wasn't his performance that made headlines, it was his face. He had the trampoline-taut look of a man fresh from an episode of Plastic Surgeons Gone Wild. And if celebs with serious money can't get decent cosmetic work"”think Steve Martin's creepy doll eyes and Elton John's moppet hair"”what does that say about our own prospects? For subtler facial improvements, those in the know are skipping the operating room and opting for nonsurgical treatments instead. According to a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery, the number of men undergoing nonsurgical facial plastic surgery increased 91 percent in the past seven years. Why? "A face-lift involves a long recovery time, and oftentimes the change is more dramatic than guys want" says Peter Hilger, MD, director of facial plastic surgery at the University of Minnesota and president of the American Academy of Facial Plastic Reconstructive Surgery.

Just because these procedures are "minimally invasive" however, doesn't mean you ought to trust just anybody to top off your mug. Many treatments still require a deft touch. To ensure your nip doesn't leave you royally tucked, find a few board-certified plastic surgeons in your area (search, and then interview them and get at least two or three opinions. Ask to see pictures of results; you're looking for patients who appear refreshed, not dry roasted. We spoke with Arthur W. Perry, MD, who is a clinical associate at the University of Pennsylvania and the author of Straight Talk About Cosmetic Surgery, for his no-nonsense take on the five best treatments.

Targets: Wrinkles above the nose
How: Since it was FDA approved for cosmetic use more than 10 years ago, it has gone from being whispered about in doctors' offices to being offered in salons. Last year, 4 million Americans injected the stuff. Its popularity stems from its instant, though temporary, wrinkle-eliminating effect. When injected, it interrupts the communication between nerves and muscles, thus relaxing the facial muscles.
Cost: About $500 per treatment
Lasts: Two to six months
Dr. Perry says: "Very effective, with results in a week. But if you decide to get it around your mouth, be prepared to drool and have a speech impediment."

Laser Resurfacing
Targets: Fine lines and acne scars
How: An intense light beam blasts away skin layer by layer, vaporizing damage and wrinkles and promoting collagen production. The deeper you go, the better the results but the longer the recovery time. The light CO2 treatment is the most superficial, with recovery time of less than a week. The deepest treatments cause oozing and redness, so unless you can take a sabbatical, you'll want to stick to lighter treatments.
Cost: About $2,200
Lasts: A few months to a few years, depending on the treatment
Dr. Perry says: "It definitely tightens the skin. After the procedure, one square inch of a cheek shrinks to seven-eighths of an inch."

Hyaluronic-Acid Injection
Targets: Superficial wrinkles and acne scars
How: This gel-like filler (sold under the brand names Perlane, Restylane, and Juvéderm) is injected to plump up areas with less volume than others. Like collagen, it is biodegradable, but unlike collagen, it is made from nonanimal material, so there is minimal risk of an allergic reaction.
Cost: About $600
Lasts: Six to 12 months
Dr. Perry says: "Hyaluronic acid is very good at filling superficial wrinkles, but I wouldn't go near the eyes with it. If the material gets into the retinal artery, it can cause immediate and permanent blindness."

Calcium Hydroxylapatite Filler
Targets: Deep nasolabial folds, sunken cheeks, and sagging between the chin and jowl
How: When this calcium-based gel (brand name Radiesse) is injected properly, it's not only a filler and plumper but also a strengthener. The stress of the injection causes the fibroblasts (skin cells) to form new collagen and tissue. Calcium hydroxylapatite can also be used to smooth out ridges in the nose because it can create new bone when it comes into contact with existing bone.
Cost: About $800
Lasts: Two years
Dr. Perry says: "Very effective. It acts like the rebar in concrete. You can use this to stave off a face-lift for a few years."

Targets: Entire face
How: Under a microscope, the superficial layers of your skin look like a French pastry. As you age, the upper layers of the skin stop shedding as well as they once did, resulting in flaky patches. During microdermabrasion, aluminum or salt microcrystals are propelled onto the skin"”imagine a miniature sandblaster"”to remove the outermost layer.
Cost: About $260 per treatment
Lasts: Three to six weeks
Dr. Perry says: "Microdermabrasion can't remove scars or wrinkles, but it's the best skin cleaning technique available. It removes dead skin, exfoliates, and suctions out dirt, oil, and debris from the pores."