YOU on a diet - Appendix B - FACTOID

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FACTOID Anyone who claims they can remove fat cells without surgery is more fraudulent than a credit-card thief. Ads for "mesotherapy" appear in the yellow pages, on telephone poles, and in your in-box-but stay away. They purport to do it by injecting a drug into your skin over the course of ten to twenty session; the drugs in these treatments haven't been shown to be effective. If course, some chemicals-like sulfuric acid-might actually work, but we'd prefer you save these chemicals for clogged sinks. The number of cosmetic procedures performed in the U. S. has reached 12 million a year (that includes both surgical and nonsurgical procedures like Botox injections and lase hair removal). According to the American Society of Plastic Surgeons, the leading surgical procedures are: Liposuction: about 475,000 (up to $2,000 for one area and $10,000 for five areas) Breast Augmentation (implants): about 325,000 (between $5,000 and $8,000). Eyelid Surgery: about 290,000 ($4,000 to $5,500). Rhinoplasty (nose jobs): about 165,000 ($5,000 to $6,000). Face-lift: about 155,000 ($7,000 to 9,000). It's about as easy to remove cellulite as it is to remove a suspect-looking mole with a plastic spoon. It can't be done. About 90 percent of women have some of the cottage-cheese- looking fat in their thighs or butts, and that's natural. Human skin is tethered to the underlying muscle by connective strands of collagen-and that prevents excessive motion. Dogs lack these; that's why

their skin can move so easily. No creams (which mostly use caffeine as the active ingredient), medicine, lasers, or massage will work to remove cellulite marks. One technique vigorously marketed out of France is called Endermologie. It may temporarily reduce the appearance of cellulite. But it's only temporary and not worth the big bucks (or even little ones), in our opinion. It seems that using lotion on skin before it stretches (as in the case of a pregnant belly) may help reduce the chance of developing stretch marks, because the moisture may help maintain the dermis. However, once the dermis tears apart, there's nothing you can do. A lot of people may recommend lotions with alpha tocopherol (vitamin E) or aloe in them to help. No research has shown that vitamin E or its derivatives or aloe will make stretch marks fade. Once that layer underneath the skin is ripped, in theory you can only prevent

it from getting worse. But some of our medical friends swear from patient and personal experience that aloe and/or vitamin E will reduce the size and improve the look of stretch marks. Things that make stretch marks worse: getting fatter and lack of exercise. Steroids and sun damage also weaken the skin's collagen. By the way, one thing that does facilitate skin healing (though not the total disappearance of stretch marks): walking. In one study, identical wounds healed in twenty-nine days for walkers and thirty-nine days for nonwalkers. You'll need to ask your insurance company whether your procedure is included in your plan-that is, whether it's covered and what percentage will be covered. Since many plastic surgeries are health-related and help fix and prevent serious health problems (rather than being purely cosmetic), they may be covered by insurance (such as breast reduction for treatment of

back pain). If you are initially denied, though, you can fight-if you're persistent. One survey showed that patients who appealed denied insurance claims were successful in getting paid in about half the cases. One thing that particularly helps: Enlist your doctor's help. Have him or her write a letter explaining why you need the procedure; submit lab results of your blood work that support the procedure; find information on trends for your particular surgery. The plastic surgeon may be able to help your doctor write the letter. Finally, try to get your case in front of the insurer's medical director; a doctor will usually look at your situation sympathetically and support good patient care. It's best to keep a new surgical incision moist with a gentle moisturizer, but don't over treat it. Our general rule: You shouldn't put any medicine or anything else on your skin that you wouldn't put in

your eye. But get this: One study showed that covering a scar with porous paper (like Steri-strips) for six months reduced the likelihood of an ugly scar-probably because the tape helps keep the healing scar moist. Smoking worsens the tears made in your dermis by interfering with microscopic healing processes and depleting the short-lived gas nitric oxide that preserves the elasticity of you skin. That's why smokers get wrinkles around their lips (plus the inflammation in arteries that cigarettes cause). When you try a new recipe, the proof is in the taste test. When you have plastic surgery, the proof is in the before-and-after photos. Computers can modify anything, so computer-generated images or models of your potential results (morphing) shouldn't be enough to convince you of the benefits of being "cut." They can be used as a method of communication between you and your doc, but

insist on seeing before-and-after photos of other patients as well. Anyone in the field will admit that if a plastic surgeon's home burns, the first thing to be saved would be the before-and-after images, so anyone of the quality you deserve will have dozen samples of folks similar to you. Thick Skin Stretching tears the skin at the level of the dermis-that' s the lower level of your skin that makes new cells, not the outer level of skin called the epidermis. (Unfortunately, the stretch marks associated with weight gain that happens in this deeper level do appear on the outer level.) Get Tucked In In tummy tucks, not only is the excess skin removed, but the

underlying muscle (rectus fascia) is tightened to give patients a buff belly. Vacuum Cleaners With liposuction, the body can be sculpted with a straight instrument that serially churns and sucks out the fat from selected areas.