Robert (Rob) M. Freund MD has big dreams.

As a practicing plastic surgeon with a restless, curious mind, he has joined the elite crew of physician inventors with patents and products that actually sell.

Not only does he tinker and invent, but he has also found time to write two books (the second is soon to be published), while ensuring he doesn’t miss his son’s baseball games. I was relieved to hear that he doesn’t sleep much – otherwise I’d have to believe he is super-human.

Listen to this lively 20 minute podcast in which Rob offers a glimpse into his full and creative professional life. Then tell us what you think …

The actual worth of a skin care product implies both the worth of the actual product in achieving the desired goals as well as the worth in relation to the cost versus the actual benefits. Most often I comment on the actual worth of the product in achieving the desired goal – dispelling the myths and unravelling the hype. But for today I would like to talk about good preventative skin care that justifies the cost for the desired effect.The basics of every skin care regimen, especially in a pollution filled city like New York must be;

1. Cleansing the skin of pollutants and dirt. Be careful not to strip away moisture and natural oils during the process.
2. Exfoliation – gently remove the dead layers of skin to uncover the beautiful healthy skin below. Too much exfoliation can leave the skin irritated and red, so limit exfoliation to once or twice weekly.
3. Moisturizers- these products are designed to keep your natural moisture in the skin. Not all parts of your face need moisturizers, and some areas will need lots of it.

Cleansers

Walking through the department store cosmetics section, I am overwhelmed by the large array of products available in a steep price range that promise to cleanse your skin, but which is best. Perhaps more importantly, the question should be, which type of product is best for my skin and How much should it cost? The key to a good moisturizer is that it should be non-foaming and gentle on your skin. You are trying to remove dirt – not a coat of paint on your car! A great example is Cetaphil Cleanser. Cost-$4.79

Exfoliants

As we age, the dead skin cells add up on the surface of our skin. This build-up give a ruddy and less-than-ideal complexion. Exfoliation is the process of removing these dead cells to reveal the youthful you! Extreme versions of exfoliation include microdermabrasion (in your doctors office) for $250 per session or can be easy and cheap. My choices for excellent, inexpensive exfoliation include 1) a Buf Puf twice a week ($3.99) or 2) St. Ives Apricot scrub with 2% salicylic acid ($4.79).

Moisturizers

Now moisturizers take up the most room in the store and perhaps do the least. A couple of key points regarding moisturizers.

the only thing they do is trap moisture in your skin.

2) The Federal Trade Commissions requires that they only need to demonstrate the ability to trap moisture before they can claim that they cure fine lines and wrinkles.

3) Not all people need a moisturizer.

4) For those that need a moisturizer, not all parts of your face may need a moisturizer.

5)Moisturizers designed for different locations on your face or body (i.e. under eyes, neck or hands) are NO different. So don’t spend extra money for multiple products.

6) Different moisturizers will work differently on different types of skin – try several and pick the one that works best for you, regardless of cost or packaging.

7) Forget the phrase “all natural”. There are many natural things that can hurt you. A good moisturizers will have mineral oil, petrolatum, glycerin or some other product similar and very synthetic.

A good starting point for a moisturizers is to try Eucerin for under $100.

In the early 20th century, different and stronger acids were used to enhance complexion in the same way that cleopatra had done 5000 years before. Surgeons then came to realize that patients who had large scrapes or burns to there face (but not too deep) had smoother, less wrinkled skin when the wounds had healed. The surgeons imitation of these injuries was a process called Dermabrasion (not to be confused with microdermabrasion), which uses a rotating sander to carefully remove the top layer of skin. The result is a smoother less wrinkled complexion and it worked great. The only problem with dermabrasion was the technical skills required to perform this in a safe and reproducible manner.

Next came the CO2 Laser. In the early 1990’s, this laser was touted as an easy reproducible way to get the same results as the Dermabrasion technique without the risks of scarring. This technique immediately caught on with dermatologists and any other doctor interested in getting a foothold in the anti-aging market. The CO2 lasers virtues included ; 1) Good smoothing out of many skin wrinkles 2) Easy to control the penetration of the laser, so the risk of scarring was minimized for those who were not trained to perform the dermabrasion procedure 3) The hype of using a space age technology – the laser – was an overwhelming reason to sell and use it.

Almost everyone, including myself jumped on the CO2 bandwagon, albeit with a bit of reluctance, since it was not better than Dermabrasion, only more high tech!

But in the end, CO2 lasers were sent to the scrap heap. Why? 1) Almost everyone who had the treatment suffered with hypopigmentation – their skin became pale white. 2) The risk of scarring and burning was not that much different than dermabrasion. 3) the downtime – scabbing and redness was prolonged 3-6 weeks, and 4) the benefits only lasted from 6-18 months.

So where did the dermatologists who created an entire anti-wrinkle industry go from there?First they tried the Erbium laser – this laser did many of the same things as a CO2 laser but with less downtime, less wrinkle correction and less complications. The only problem was that the laser was expensive, the results were minimal and the patient still had redness and downtime.

Then came a slew of non-ablative lasers and intense pulsed light procedures called photofacials. These procedures promised little and gave little but cost a lot. Non-ablative means that they did not remove any skin, like the dermabrasion or CO2 laser so the results were minimal. My biggest disgust with these treatments was not the outcome , but was the hype and questionable photography to demonstrate successful outcomes.

Now we have come full circle and the latest treatments are the fractionated CO2 lasers like Fraxel. This means that the laser is pointed onto the skin in little polka dots , as opposed to the old painting the skin like a painter paints the walls of your house. The minimal injury created eliminates some of the adverse consequences of the previous CO2 laser, the downtime is now only ten days and the hypopigmentation problem is gone. But the results are still less than the o;d CO2 laser – which was only 6-18 months. For my money, I would stick with a cheap skin peel!

So in the end, Cleopatra was way ahead of her time. Here in the 21st century, Acid peels and Dermabrasion are still excellent techniques, unless you still want to sound high tech!

What should you do?

1- Retin-A/ Alpha Hydroxy acids

2- Exfoliate with a Buf Puf once a week.

3-Sunblock

4- Drink lots of water

5-Gets lots of sleep

6-Topically apply anti-oxidants

6-Orally take anti-oxidants

7-Hyroquinone to belach out sunspots

8-Office based skin peels (lactic acid, Jessners, TCA)

9- Surgical based treatments include Dermabrasion and Strong TCA Peels.

What it is good for:

1. Sagging breast where the nipple-areolar complex needs to be lifted 5 cm or less.
2. Breasts with upper or medial hollow. An example is a breast with all the breast tissue distributed below the nipple or when the breast tissue is too wide, or the nipples are too wide.
3. Patients who are sagging and want an augmentation of any volume.

Why is it different then the competition:

1. The lift is from above. The breast tissue is pulled up and re-attached to the chest wall higher up. Other lifts push up from the bottom of the breast.
2. Pulling up the breast tissue fills the upper and/or medial parts of the breast.
3. Pulling the tissue up puts the nipple areolar complex exactly where you place it In other words, the nipples are symmetrical.
4. The implant is used only to add volume, not to help lift the breast, therefore your volume is exactly what you want – not too big or too small.

My general feeling is that the problems focus around one particular filler called Sculptra and that the FDA is likely throwing out the baby with the bath water. In the meantime, I will be careful to describe all risks and benefits with each and every patient.

I would also like to say that Fat injections will not be affected by any FDA reviews of synthetic fillers. More on the Viafill System from Lipose corporation in later posts. But this system increases the viable fat cells that are injected in fat transfers by 500%. Fat injections are great for several reasons;

1. Everyone has some.
2. It is all natural.
3. You can inject lots of it.
4. People complain that it does not last, but even in the worst case scenario, fat last for more than a year.
5. Fat is as soft as the fat it is injected into, therefore you eliminate those hard lumps and unnatural ridges when you smile.

Autologous fat is the way to go. And now with the new concerns about synthetic fillers around the eyes, fat will be the only way to perform a volumetric correction around the eye.

Early to bed,
Early to rise,
Makes a man
Healthy, Wealthy and wise.

But the saying should add—younger looking too!

I write this after a roller coaster ride on wall street this week. No one I know is sleeping well and everyone is afraid that their job is on the line.

One thing I am sure of: like all cycles, these bad times will end. However, the stress of the times and what it does to your skin may not! You see – every night when you go to bed, the levels of a stress hormone called Cortisol goes down. Conversely, diminished sleep and added stress makes the level in your bloodstream rise.

What does cortisol do to you? Well, Cortisol modulates many bodily functions: it effects your ability to think, to reason, to love, but most importantly it affects your skin and youthful looks. The most important thing to keeping your skin looking and feeling young is to keep the content of collagen and elastin in your skin high. When you were a baby, collagen and elastin levels were extremely high in your skin hence the term “soft as a baby’s bottom”. But if you can read this, those levels are getting lower each and every day. One of the enzymes that assists in reducing the levels of collagen and elastin is called metalloprotease. This bad enzyme which makes you look older, goes up as cortisol rises. Thus, lower the cortisol level and you lower the level of metalloprotease and subsequently collagen and elastin rise – this means healthier, younger looking skin. A great example of what not to do is to become the president of the United States. That sleepless, thankless, stressful job makes everyone age rapidly during their term. I guess the reason presidencies only last 4 years was to give president’s skin a chance to recover.

In the end, the more sleep you get the better you look.That advice is the cheapest advice on beauty that you will ever get on this Blog!

The procedure was performed like this: the old implants were removed, the breasts pockets were closed laterally with my breast splint (previously reported), a tunnel was created from the incision to the breast tissue on the inner breast and then the breast tissue was moved medially and anchored in place. This maneuver moved the breast tissue and nipple toward the center. A new implant was put into and beautiful breasts were the result. After our 1 week follow-up the results were still great! I will show follow-up photos in later blogs – so be on the lookout for The IBM procedure.

My general feeling is that the problems focus around one particular filler called Sculptra and that the FDA is likely throwing out the baby with the bath water. In the meantime, I will be careful to describe all risks and benefits with each and every patient.

I would also like to say that Fat injections will not be affected by any FDA reviews of synthetic fillers. More on the Viafill System from Lipose corporation in later posts. But this system increases the viable fat cells that are injected in fat transfers by 500%.

Forget the surgery and treat your body well.

Here are some of the mistakes that are made in an effort to lose weight:

1. Try to diet. Diets do not work. Everyone who tries them is depriving themselves of food – food is essential to life. In the end, you will bounce around from diet to diet. That is why the diet industry is so big. None of the diets work, but they promise a lot.
2. Try to miss a meal, in order ot decrease calories. Another big mistake. If you miss a meal, you are more hungry and when you finally eat, you eat more calories then if you had two reasonable meals.
3. Avoid breakfast. Another no-no. When you wake up, you are in starvation mode, your metabolism is slow. You need to get out of starvation mode as soon as possible to allow your metabolism to rev up.

Sensible eating habits include:

1. Eat every meal and have a snack 3 and 1/2 hours after the last meal.
2. Eat protein for breakfast. It helps get out of starvation mode, revs up your metabolism and won’t be converted to fat.
3. Avoid processed, bleached or white foods.
4. Eat hot soup for meals. It slows down the eating process. It takes time for the signal of satiety to reach your brain from your stomach. Eating fast always leads to overeating. Hot soup slows down the eating process. Eat with friends and talk a lot.
5. Replace all butter and margarine with olive oil.