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Episode 1: Anti Aging Secrets with Steven Struck, MD

Teri interviews Dr. Steven Struck,Stanford-educated, board-certified plastic surgeon from Silicon Valley, CA about the latest in cosmetic surgery procedures. Steven Struck, MD, gets into very helpful detail about face lifts, brow lifts - endoscopic vs. traditional, chin lifts and breast augmentation pros and cons. He also discusses laser liposuction and Fraxel laser treatments. Teri asks him about the options around injectables from Botox and Restylane to Allergan's newest product, Juvederm including covering a new concept called the Brazilian Butt Lift which is where the posterior is filled with injectible product to plump it up without surgery. This show offers the luxury of having an hour-long consultation with an amazingly knowledgeable and articulate surgeon about the many plastic surgery options available. Even better, you will want to listen to it over and over to really understand what's available today in best-of-breed cosmetic surgery practices.

Beauty Now: Episode One

Beauty Now Transcript with Dr. Steven Struck, MD

Teri Struck: Hi, I'm Teri Struck, host of Beauty Now. We're going to talk about Smart Lipo, Fraxel, FDA approval of silicon implants and endoscopic surgery... and, Brazilian butt lifts.

Teri Struck: I'm Teri Struck, host of Beauty Now. I'm the lucky wife of Dr. Steven Struck, who's going to be my first guest for my podcast for plastic surgery, beauty, anti-aging and more.
Welcome, Dr. Struck.

Dr. Steven Struck: Thank you.

Teri Struck: Tell us about Fraxel.

Dr. Steven Struck: Well, Fraxel is one of the newest laser technologies in skin resurfacing. I think the main benefits are that it's extremely effective. And, there are many devices out in this area of non-burning lasers that actually don't work, and people spend a lot of money on them, and they don't do anything for them. This one does deliver in making your skin look smoother, softer, and corrects photo-damage.

Teri Struck: So, just tell us a little bit more about if you're dark skinned, how does that work?

Dr. Steven Struck: Well, Fraxel is a non-burning laser, there are four treatments involved in the process. The process does take some time, about an hour per treatment. You come into the office and we paint your skin blue, you look somewhat like a Smurf, or someone from Blue Man Group. After you've numbed for an hour, we partially burn your skin, that's why it's called "Fraxel" or "fractional resurfacing". We're treating about 20% of your skin surface, and that 20% will grow in new collagen, the pigmentary irregularities in that 20% will be removed and with four treatments we will have treated 80% of your skin and many of the brown spots will be markedly lightened and your pore size should be smaller as well as tighter skin. Teri Struck: Well, for many of our listeners that's kind of confusing. How much downtime realistically, if I came in, what would you say to me?

Dr. Steven Struck: The usual downtime is, after treatment you should be red or swollen for overnight, for sure. If we're being aggressive with the process, which most people want me to be, it may be two days of redness. It's enough that you can go to things, you've gone to soccer games afterwards and been fine, no one looked at you or laughed so, I think you can go out and do most normal things a day afterwards. If you need to go to a family photo shoot, you would probably want to wait two or three days, but I still think it is a no downtime treatment that you can do most of what you normally do the next day.

Teri Struck: Well, as your wife, I will tell you that you need at least three days downtime. Since you're so beautiful, you don't need it. I think it's an amazing treatment, but you do need three days downtime, for most people. I do have friends that could do it in one day, but tell us more about melasma, and that kind of stuff.

Dr. Steven Struck: Melasma is called a "mask of pregnancy", you see it often after people have delivered children. It's that dark mask around the face. It's an extremely difficult thing to treat, and people have tried bleaching agents, people have tried numerous treatments. The reason that you hear a lot of treatments for melasma is that none of them are really particularly effective. And, Fraxel has shown promise in this area, it doesn't eliminate the melasma, and I think that would be an unrealistic expectation, and that you as a patient would be unhappy if you expect it to be eliminated, but it will significantly reduce that mask and make your skin look more one-tone, or one-color.

Teri Struck: Right, but if you go back in the sun, it does come back, right?

Dr. Steven Struck: It does return if you spend time in the sun, that's why we put you on sunscreens and a bleaching agent to maintain the results. Most of my patients that are happy with Fraxel, come back once a year and do one touch up. So they do their series of four treatments, and they follow it up once a year to maintain the result.

Teri Struck: True, and your naughty patients, like me, will go back in the sun, and just get another Fraxel, so that's perfect. Let's move on to breast augmentation. A lot of talk about the FDA approval of silicone implants. Tell us more about that.

Dr. Steven Struck: Silicone implants. I think with silicone it's great that they have been FDA approved again, during that whole time I have been, and numerous doctors have been, on that experiment where we've been using them for 20 years, and I believe in most cases, in people who are trim, and have limited amount of breast tissue, are worried about feeling the implant, that a silicone implant is better. I think concerning the risks that people worry about, with Lupis, that has been disproved by the FDA's protocol, and I don't think you need to worry about that very much.

Teri Struck: What is your best advice for people that have no breast tissue, size A or B, and they come in and they want DDs.

Dr. Steven Struck: Well, I think there's really two parts to that question. I think that the best advice for a AA patient who wants to have a breast augmentation is that, that's the perfect patient for silicone. They have very little breast tissue and very little coverage, so you want the most natural feel in there. The reasons silicone is superior is that it is the most similar to breast tissue in it's density, so it's going to feel the most like breast tissue. Trim patient, A-cup breasts, you want silicone under there so that it will feel most natural. The next point with that is you probably want to go under the muscle, because you want more muscle coverage, more breast tissue coverage. The point in a trim patient is to make it feel the most natural as possible. Now, as far as the idea of going to a DD, they're probably going to compromise their results with that, because if you push it that large, the skin envelope can only stretch so much, and at that point they run the risk of getting tight and hard and unnatural. So I would probably tell them to go to a C first, and if they really want to go to a DD once their skin's been stretched, then they can proceed with the second operation.

Teri Struck: I agree. I find that with a lot of my girlfriends is that they have gone too big and then they have to go smaller because they look like hard eggs. Is that because they have saline or because they have silicone or because they have no tissue?

Dr. Steven Struck: I think that with hardness, implant material doesn't make that big of a difference. There's never really been any data to show that silicone makes more hardness than saline, than any other product that we've ever used. Hardness I think is probably related more to either using too large of an implant, some bleeding into the implant pocket causing scar tissue or some skin bacteria getting into the pocket, which aren't really causing an infection, they're simply causing the body to make scar tissue. So I think those are the main reasons perhaps not truly the type of implant material we use.

Teri Struck: And, last about breast augs, is I hear a lot about, what's above the muscle and what's below the muscle, and what's the reason for both?

Dr. Steven Struck: For me, I do mainly below the muscle implants. I think that the coverage of the muscle in addition to the breast tissue gives you the most natural feel, and that's mostly what people are looking for. The number one problem with implants are hardness and rippling or palpable implant, if you have a muscle on top of that you're going to have less palpable ripples. Now, the downside to going below the muscle is that sometimes they ride a little bit high, and people don't like that high appearance, where you look like you can obviously tell that you've had a breast augmentation. So what I do is I release a significant portion of the muscle so that two-thirds of the implant is below the muscle and the bottom third peaks out below the muscle, giving you kind of the best of both worlds. You have the below the muscle implant that feels natural, gives you better mammogram, and you have an above the muscle look below so that the implant doesn't ride too high.

Teri Struck: Ok, let's move on to tummy tucks. How's the scar, I mean where's the scar? I hear that all the time, and actually, I don't know. I mean, I have a C-section scar, but can you use a C-section scar for a tummy tuck?

Dr. Steven Struck: A C-section scar is part of a tummy tuck incision, it's larger than a C-section scar, it's probably half again as long of an incision. I think the main thing with tummy tucks is, when a patient needs a tummy tuck, they don't care about the scar, because they need a tummy tuck. Where you get in trouble is with someone who's borderline or not even borderline who tries to convince you that they need a tummy tuck, and if someone doesn't need one and they get that scar, they're going to be very unhappy. The scar extends essentially from the hip bone to the pubic hair line, across the pubic hair line and across to the other side. But with that I can remove a piece of skin that is about 7 inches by 12 inches in width, and it makes a significant difference in someone who has hanging skin or stretch marks below the bellybutton.

Teri Struck: So, in that sense you're trading a scar for the hanging skin?

Dr. Steven Struck: Right. You need to have something to trade. If you don't have anything to trade for it, you shouldn't have the scar, but if your trading stretch marks or excess skin it's probably one of the highest patient satisfaction procedures.

Teri Struck: Let's talk about the laser lipo, Smart Lipo, I read it in People, everybody's asking me about it, I don't know.

Dr. Steven Struck: Being a smart consumer, I'm not surprised you've heard of Smart Liposuction. But I do think, it did come out in the last month, and I think that it does have some good benefits to it. The concept is that you place a laser in to the subcutaneous tissues where the fat are and that the laser makes in the fat into a liquid. The liquid is then much easier to remove, much less traumatic to remove, resulting in less bruising and pain, and should result in a smoother result as well, because you've liquefied the fat as opposed to just sucking it out with a large canula. I do think that that isn't a completely new idea, and that ultrasonic liposuction that was prior to this by a few years also liquefies fat and also gives a smoother result. But I am excited to see what the Smart Lipo can do with skin tightening, as that laser bounces underneath the skin, it will also tighten the skin, which I think would be a significant improvement if that's shown to be true.

Teri Struck: So, now let's talk about endoscopic versus full-frontal forehead lifts. I know that a lot of my friends are interested in getting their brows raised, but they don't want that huge scar.

Dr. Steven Struck: Well, the huge scar that you refer to is a scar that goes from ear to ear, and what we do is we remove a large strip of the scalp about 2 inches in width, and we use that strip of scalp that we remove to elevate your brows. So, we're removing a strip of the scalp, elevating your brows, and that results in the brow lift. The upside to that is that it's pretty effective, because you're removing a strip of scalp and that's raising the eyebrows. The downside is that you're having a scar which goes from ear to ear, not only the scar, you can lose hair in the scar, and the nerves to the back part of your scalp can all be cut, so you can have pretty large areas of numbness in the back of your scalp as well. So, those are the downsides: numbness, hair-loss and scaring. The upside is, it's effective. But when you look at an endoscopic browlift, it's equally effective, and the scars are literally 1/20th the size of a full browlift. They're very small, we don't cut those nerves, you don't have the numbness, you don't have the hair loss situation and you can still elevate the brow, without all the downsides.

Teri Struck: So, when you do the endoscopic, you use little screws, and tell us what's in those screws? [laughs]

Dr. Steven Struck: Well, that's true, and most patients laugh, like you are, when we discuss it. What we have to do, since we're not taking out all the skin to anchor the skin, we have to have some mechanism of anchoring the skin, and we use a screw, which we place in the outer layer of the skull - it doesn't go through the skull, your skull is actually very thick, and we can place the screw there, and we use that to suspend everything, as opposed to the other way. Those screws do dissolve, once everything's in place, the screw dissolves and it goes away, and now the brow's in it's new location, with elevated brows, and arched brows.

Teri Struck: I know a lot, but you're telling me that screws going through the skull, and the skulls thick - are you actually drilling into the skull to do that?

Dr. Steven Struck: Yea, we have a small hand drill that we use during the surgery, and it doesn't go in very far. The screws are quite small as well. It's actually a very controlled process, I do them under IV sedation, the patient is still awake and talking to me while I do it,

Teri Struck: I've seen beautiful results. I have seen beautiful results. It just seems kind of scary to think about, and the thought of minimal scars is great. The last thing I think I really want to talk about is your face lifts. Neck lift. You know, define face lift, neck lift, all that kind of stuff.

Dr. Steven Struck: I think the best way to think about that is to divide the face essentially into thirds. One third we already talked about is the brow region. I think the best way to address that is the endoscopic brow lift, less incisions, you can achieve brow elevation without all the hair issues we already mentioned.

Then, you move to the middle third of the face, from the eyes to the mouth, in this region mostly what you hear about are cheeklifts, where we're trying to suspend cheek fat that's fallen from up on your cheekbones down to by your mouth, and it gives you that heaviness down low, and a square face. It gives you a squareness to your face and we try to triangulate your face again, create a youthful face, by lifting that cheek fat back up. And finally, we can address the neck, which is usually the most problematic area, by tightening the neck and giving you a more refined neckline. Teri Struck: I want to talk more about the neck. It's what all my friends talk about. So, let's just take a break, for our sponsors, and we'll get right back to you.

Teri Stuck: Hi, I'm Teri Struck, host of Beauty Now, and I'm so lucky to have my husband, Dr. Steven Struck. Let's talk more about face lifts.

Dr. Steven Struck: Well, I think we left off with the three thirds of the face. The upper third, middle third, and lower third. And the upper third we've already talked about with the brow lifts, endoscopic brow lifts and other ways of elevating the brows. When we addressed the brows, the main thing we want to achieve is an arch to the brow, and you want the arch to be centered over the lateral part of the colored part of your eye. So that's where I shoot for arching the brow - right above the lateral part of your colored eye brow. I think that's a good thing you can achieve with a brow lift, you can also weaken some of the frown muscles that give you the frown lines.

Then, as we move down the face, the fat of your cheek tends to fall with time, and it falls forward, forward, forward and it eventually hits some ligaments down by your mouth and creates the jowl or the squareness of the face. And the squarer face tends to be more of a sign of being older of aged, whereas a triangulated face is more of a youthful appearance. With the facelift, we recreate that in the middle third of the face by getting a hold of that fat, elevating it, and resuspending it back up on the cheek where it originally was. You can do that with the Smas facelift - a lot of people have heard of that - S-M-A-S, the Smas, that's something you're going to want to know about as a consumer because if you're going to visit a surgeon, you're going to want to know are you doing a skin lift, a Smas lift, or whatever kind of lift, because if it's a skin-only facelift the recovery time will be quick but your results wont really last that long. A Smas lift is where we go a little bit deeper, we get a hold of the deeper tissues, and we create a smooth, underlying foundation by lifting that fat up, and putting it back where it belongs. After we recreate that foundation, we redrape the skin over the top of it, and you have a nice natural youthful looking cheek. So, think of the Smas when you're asking questions about facelifts.

And then, as we move down into the neck, most people are looking at what you could describe as the turkey-gobbler neck, those two bands that extend out from your neck that most patients I have say that their grandma or their grandpa had and they don't want to look like their grandma or their grandpa, so... how do we deal with that? The main way we deal with that is we make one incision under the chin, I go down under your chin, I find those two muscles that are giving that turkey banding, and I sew those two together, and then I cut them to weaken them so you don't have that band under there. Then weave some stitches from ear to ear to further suspend the neck and get rid of that banding. Again, we create your foundation, a youthful foundation with a lifted neck, and then we redrape your skin over the top of it. Most of the work is done from below and then the skin is just redraped to create a natural, youthful appearance.

Teri Struck: How long does that take to heal?

Dr. Steven Struck: With facelifts, a lot of people ask about healing time, the surgical time on that is about three hours - I'd say that you're in surgery, then you go home, within two weeks you look pretty good, after most facelifts, unless we're being pretty aggressive with the Smas - the average patient for the average facelift, within a couple weeks looks pretty good. Within a month they look really good. If you're doing family photos or some big important event, you may want to give it a little longer than a month. But in my patient base, I usually tell people two weeks off work.

Teri Struck: So, you look bruised or swollen or what do you look like?

Dr. Steven Struck: There usually isn't a whole lot of bruising, with the faces - it's more that they swell. And gravity pulls that swelling, so let's say that we've addressed all three thirds of the neck - of the face - all that swelling is going to be pulled down by gravity into the neck and you're going to get a full looking neck afterwards. So, it's mainly swelling that we're dealing with. For that reason, we put a strap around your neck for about five days to hold that up, to prevent that swelling from forming or getting set there. So, if we keep the swelling down, that's the main thing, the bruising is always pretty minimal.

Teri Struck: So, not to get off subject, but I know we talked about Smart Lipo, but now that you're talking about all these stripes and straps, I just want to know more about lipo. Because I just know that a lot of my friends have had to have garments and things like that for four weeks - is that still true?

Dr. Steven Struck: Yea, with the liposuction, again, we deal with a period of swelling, the maximal period of swelling with any procedure is probably 48 hours afterwards. If you're dealing with neck liposuction or liposuction associated with the facelift, usually five days of compression is adequate. That's fine, at that point. I do have some lymphatic drainage techniques and other things we can use to keep the swelling down after that five days. With body work, you're looking at more like 3 weeks of wearing a garment. The garments are custom-fitted and custom-designed so they don't really interfere, if people go back to work usually a week after liposuction, they just wear those garments to work and no one can tell they're there.

Teri Struck: But if you have aggressive lipo, you have to wear one of those garments and it's, about four weeks, right? Of healing? It's not like Smart Lipo, or one of these gimmicks?

Dr. Steven Struck: Well, I think it's more a matter of how much fat you need to remove. The technology, it's really interesting and people love to talk about it, and you can create a lot of great names like Smart Lipo and LipoSelection or all these names that really catch the consumers eye, I think it's mostly about, if you're a big person and we're doing a big lipo on you, you're going to be swollen whatever liposuction technique we use on you. And if you're a smaller person, the swelling is probably going to be less, and you're not going to be as aggressive with that patient no matter what technique you use and they're not going to have as much swelling.

Teri Struck: For how many months?

Dr. Steven Struck: Well, in general, I think it's realistic - when patients come in and follow up, I've done their surgery and they're seeing me on their follow up visits, you usually see 80% of the results within 2-3 weeks. So, you're going to look a lot better 2-3 weeks. But, the final results, and we're all striving for perfection, to get to that final result it is 6 months, and I usually tell people to wait the whole six months for the results to get finalized, it can even be a little longer than that. But, 80% of the results are there within a couple months.

Teri Struck: Alright, let's talk about the Restylan face lift, which you know how I feel about that. I believe in Radiance, Botox, all the other fillers. So let's talk about that. People are talking about Radiance and Restylan.

Dr. Steven Struck: Well, I think with facial aging the main thing is were looking at two things: we're looking at skin access, wrinkles, and problems of the skin, which are fairly easy to address - you just redrape the skin. But in a lot of those trim patients, who have lost a lot of facial volume, as you age you lose facial fat, some people are extremely trim, they get a thin face, which actually though they are very trim, they look older, because their face is too trim. And the best way to correct that is to add some volume to the face. If you look at the progression of face lifts, nowadays we're actually using a lot of fillers to keep people looking more youthful. We inject the fat either into the lips, into the nasal-labial folds, into the cheekbones, and all of these areas that will give you more volume and make you actually look more youthful. The Restylan facelift - mainly, we're injecting the Restylan into the eyelid area, the nasal-labial folds and the cheekbones in order to plump up the face, make them look more youthful, without having had surgery.

Teri Struck: And I know that you are trained in the threadlift, and then you decided not to do them. I've seen so much things like on the View and all my friends talking about them, and actually the things that they showed on the View were pretty horrifying - they make a break in your face - do you still believe that? Tell us about the threadlift.

Dr. Steven Struck: I think that as a surgeon, we expect to get A) results for what we do, when people come to see a plastic surgeon, they want to see a result, they may not want to see an overdone result, but they want to see some improvement. And, as a surgeon I have a hard time trying to convince people that something has happened when it hasn't really happened. And I think that is the main downside to a threadlift is that the results are pretty minimal, often you're trying to convince the patient that they look a lot better, and I'm just not really comfortable in that environment. So, I stay away from it because I don't want to spend one-third of my day convincing people that they look better.

Teri Struck: But is it really true that if the threadlift breaks in your face that you can't get it out of your cheek? Because I did see one horrifying picture, and it's not that it's true, but...

Dr. Steven Struck: Well, it kinda is true, the stitches are barb seutchars, that was the whole premise of how it was designed is that they have little hooks coming out of them and the hooks are all the way along the stitch and the hools grab the skin and hold it where you want it to be. So if the stitch breaks, most seutchars that we use are smooth, so it slides right out just like a piece of thread, there's no barbs or anything, once you cut the knot the stitch comes out. These are barbed and they are hard to remove - I've never had to remove one, but removing one would not be easy because you've got these barbs throughout, and people who do a lot of them say they're very difficult to remove. They're also hard to reposition, if you want to change where they are, if something is a little bit asymmetric, you have to reposition this thread that's got barbs all over it. Whereas with the Restylan face lift, if someone has something that's a little bit asymmetric, you just inject a little more Restylan and it evens it out.

Teri Struck: But be honest, I mean, you can't really inject Restylan to lift your face?

Dr. Steven Struck: You can inject Restylan to give yourself more facial fullness, so in a way it does lift your face, I think that though, the main thing is that in most patients a facelift is a better procedure. I think very few people have the time to come in every three months and spend $2,500 having their face plumped up and then come back in three months later and do the same... If you look at it from a cost analysis, you're going to spend $5,000 at least every year doing that, so most of your facelift would have been paid for very shortly, and I do think that a facelift delivers much more. If you're a very young, early facelift patient, you may not even need a facelift, when you're 35 and 33 and you think you need a facelift, Restylan's probably the way to go, because it will rejuvenate you without the surgery. But, once someone really needs a facelift, I think the facelift is the way to go.

Teri Struck: See, that's so confusing, because I'm thinking that Restylan just fills in lines, but you're talking about a facelift.

Dr. Steven Struck: It does fill in lines, but it's also a filler. So, if someone has deficient cheeks, you could put a cheek implant in that would fill them in, and you understand that, the implant fills the cheek in. The Restylan's the same thing - instead of putting an implant in you're just injecting a bunch of Restylan in there. So it is a different product, and it's a different concept because you're using much more of the product, but you're still doing the same thing. You're not lifting the skin, you're lifting the underlying tissue which then makes the skin look more full and tighter.

Teri Struck: Well, I just want to ask you, if somebody came in and they didn't have much money, and they're really wrinkled, feeling bad about themselves, feeling down, what would you suggest?

Dr. Steven Struck: Well, I think that's an interesting question because I think that I would probably suggest something that's probably more expensive but in the end would deliver much more for them. I think the facelift is going to be a more definitive procedure, they're going to come in, they're going to have one thing done, and it's going to work for them and they'll be able to stick with it. I think that people who are really making a huge financial sacrifice - if they do something that's kind of a moderate solution to the problem - they're not happy, because they feel like �Wow, I spent all this, it's a lot to me, and I didn't get what I want', whereas for a few thousand dollars more they could do something that they're going to be completely satisfied with.

Teri Struck: Let's take a break and we'll be back with Dr. Steven Struck.

Teri Struck: Hi, I'm Teri Struck, we're back and we're going to talk about fillers with my husband, Dr. Steven Struck. I just want to know honey, what about Juvederm, Botox, Radiance, clarify everything for us.

Dr. Steven Struck: I think you mentioned most of the big names in fillers. Botox has obviously been around for quite some time, it is the number one performed filler for any procedure in plastic surgery. Juvederm is a new filler; Restylan and Radiance - those are the main ones that I use. There are a number of other fillers out there but I think those are the main four - so if you're thinking about fillers, I would think about one of those four: Botox, Juvederm, Radiance and Restylan. When you look at fillers you need to think about what you're trying to achieve - it's funny, patients will come into me and say "I want Botox" and then they'll show me something that you would clearly use something else on. So, I think that in order to learn what is the best indication, you need to think about what kind of wrinkle you're dealing with. Most these fillers are all for wrinkles.

A static wrinkle is a wrinkle that's always there. When you're looking at someone, they see it. Those can be normally wrinkles around your mouth, a standing wrinkle that's always there around your mouth and bugs you when you're looking at it.

Dynamic wrinkles are caused by muscle action or animation of your face. Those are your crows feet lines, frown lines in your face, those are caused by an underlying muscle, so if you think about the cause, then you can think about what the treatment is.

If you're dealing with a dynamic wrinkle, the crows feat, the frown line, that's Botox. And the reason for that is that Botox paralyses, or partially paralyses the muscle that causes that wrinkle. If you weaken that muscle, the dynamic action of that muscle is gone, and the wrinkle disappears. We usually use Botox for that reason in the area of the eyes and above. Smile lines or crows feat, frown lines in the forehead, and those are the main areas for Botox.

If you have a static wrinkle, those we have to fill it, it's not a muscle that's causing them, it's a deficiency in soft tissue underneath the wrinkle that causes the wrinkle so you need to fill it. When you get into fillers it's mostly about how big the particle is. So, if you put a big particle in a big wrinkle, it's going to last a lot longer. If you put a small particle in, your body, the little Pac-Man guys in your body, that digest the product that we put in, are going to gobble it up faster and the smaller lighter products are going to disappear faster. That's why some injectibles last longer than other ones. It's mostly about their particle size. So, if you look at the nasal-labial folds, which are the lines that extend from your nose down to your mouth, those are normally deep in almost everyone. So you want to use a heavy filler in that area, and I use Radiance in that area - it's probably the heaviest filler, the upside to it is that it last a year and a half. So, you can inject the nasal-labial folds and the patient doesn't need to come back for a year to a year and a half.

Teri Struck: Right, but you can't you that in other areas, right? Radiance is very heavy, you shouldn't use it in your lips, right?

Dr. Steven Struck: That's true. So if you have a fine line, around the lips, it's the same thing. If you think about particle size, you put a big particle in a fine line, it's going to over correct it, and it can give you a lump there that you're not going to like. So, then you move down the ladder to something like Restylan or Juvederm, which is a thinner product, you can put it directly in a very fine wrinkle, and eliminate that. Now, since it's a smaller product, it goes away a little bit quicker. If you're dealing with lines around your mouth, with Restylan or Juvederm, you looking at 6 months at the longest of recovery time... of lasting time of the product. And what you said about lumpiness is especially true in the lip. In the beginning when Radiance first came out, we injected in the lips, but a good 30% of people were getting significant lumps in the lips, not just little lumps that go away, and we say "just rub that and it will go away", they were big lumps that didn't go away right away. So in the lips right away you usually want to use either Restylan or Juvederm.

Teri Struck: Ok, I understand all that. And last want to ask you about Botox in the sense that how come sometimes it goes away in four weeks and sometimes it goes away in 6 months? What I understand - and as a disclaimer my family founded Allergan, but it has nothing to do with it anymore, I wish it did! - but I understand that you can get three people to a bottle and then you see all these disclaimers, Oh, my God, you can get Botox for a hundred bucks, but isn't it true that physicians can water it down and that's what it's all about?

Dr. Steven Struck: Well it's true that it's all about the concentration of the Botox that you're using. And, all physicians water down Botox, because essentially it comes to us dry. I remember one of my friends called me for the first time and he was going to use Botox and he said "Hey, they sent me my vial from Allergan and it's empty" and it comes to us dry and you look on the bottom of that bottle and there's a thing of powder in there and that's the Botox, so we have to dilute it. So, the problem with that is you can dilute it as much as you want to, and the more you dilute it the more patients you can treat, but the less Botox you're giving each patient. So, if you give someone diluted Botox, then it isn't going to last that long. That's just the way it is.

Teri Struck: Right, cause I have a lot of friends that said "Oh, I got it for $199" and I'm like "Yea, you and 12 other people". So, if you get it, you get it from a qualified physician who is Allergan approved, so you get two to three people per bottle.

Dr. Steven Struck: That's in general true. I think that at $199, it's hard to imagine that you could treat someone without losing money.

Teri Struck: Right, so again. Actually, one of the questions I forgot to ask you is, let's just talk about that. You want to go to a board-certified physician. And I know that a lot of people just go to these cosmetic physicians, and they get a better deal. And that's what I'm talking about with Botox and everything else. So, why would you want to go to a board-certified physician as opposed to somebody whose just a cosmetic person?

Dr. Steven Struck: Well, I think with board-certification theres a certain amount of ego, that I'm a board certified surgeon and blah blah blah. But I think there is some importance to having a board-certified person and I think the main thing is a lot of these procedures that we do aren't extremely complicated. Injecting Restylan or Botox really isn't that hard to do. But if you're a board certified plastic surgeon doing it you're being regulated by a higher governing body that tells you this is right, this is wrong, you can do this, you can't do that, and they're in general looking out for the patients best interest. And people who have no governing body above them are not board certified by any board, they do whatever they want to do and there's really no consequence to that. So I think as a consumer going to a doctor who you don't really know, at least you can feel comfortable that this person is going to do what's ethically right in a safe way for me that's going to deliver a result and isn't really going to jeopardize my health. When you're dealing with surgery I think it's even more important to have the proper certification cause there you're dealing with an operation that you're going ot have and if someone has no governing body above them, they just can do whatever anyone - it's amazing that in the state of California where I practice - anyone can do surgery in their office that has an MD. They don't have to have any particular training to do it - if they have the guts to set up a practice to do it, and can convince someone to let them do it on them, they're really not regulated, is to that fact. I think the main thing about when you're questioning a surgeon is can you do this procedure at the hospital? If a doctor can do it at the hospital, they have to go through all the hoops that you have to go through to get permission at the hospital to do it, they've checked him out, they've had a residency, they've been trained, and they've done X number of procedures and the hospital is willing to sign off on them. So even though you don't need to have your surgery done at the hospital, it can sometimes be a helpful question to say "If I wanted to, could you do my tummy tuck at the hospital?"

Teri Struck: What do you think of all those shows? Extreme Makeover, Dr. 90210, and damn, those girls butt lifts look good, those Brazilian butt lifts?

Dr. Steven Struck: I think in general those shows have been good for our field and good for the consumers. I think that if you probably tracked the statistics of plastic surgery procedures, they've gone up quite a bit, since the, mainly Extreme Makeover and Swan show in the beginning, because those were shows that exposed a whole �nother subset of the population who thought plastic surgery is only for rich people or plastic surgery is only for people not like me. And then they saw these shows and they thought, Wow, this person is just like me, and so the frequency went way up, I think the frequency went up in men too - men saw men doing these procedures and men started doing it. So those shows were pretty educational, the dramas are what they are, they're a drama, they're entertaining...

Teri Struck: But still, those butt lifts?

Dr. Steven Struck: The Brazilian butt lift - I just had a patient ask me about this today, so obviously it's sticking with a lot of people, and it's pretty catchy and that was on Extreme Makeover as I remember, and it is a good procedure and there are no real incisions with it because you're injecting fat into the butt to lift it, that's what a Brazilian butt lift is mainly designed for, is to fill the butt back in so it doesn't droop, by injecting fat back in it. You liposuction an area of the body, you inject the fat in there, that lifts the butt and makes it more full, and that's how it works.

Teri Struck: What about the lift part - I want to know about the lift. I want the lift part.

Dr. Steven Struck: Well, it's just like the Restylan facelift - where were adding fat to lift the butt, if you really need a butt lift, you have to make a fairly large incision, so for you it wouldn't be a good idea. For someone who needs there butt lifted, they have to be willing, just like with the tummy tuck like we talked about earlier, to accept the consequences of that which is a fairly large incision, and when it's worth it, it's worth it.

Teri Struck: Thank you so much for being our guest today.

Dr. Steven Struck: Alright, thanks for having me.

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Episode 21: How Celebrities Stay Young and Wrinkle Free with the Fraxel Laser with Dr. Steven Struck

Teri interviews Dr. Steven Struck about how anyone, not just celebrities,like Jillian Barbie keep their skin looking so young at all ages. Celebrities, such as Jillian of the Fox Good Morning LA show, use Fraxel, a non invasive laser that reverses sun damage.Dr. Struck goes through all the treatments including but not limited to sun damage, melasma, pore size, wrinkles, skin tightening, brown spots and much more of those lovely maladies. There is no excuse to suffer anymore. Listen and learn about Fraxel and what it can do for you. Would you like to have the skin you had before all that damage was done! We all do and Fraxel is an amazing treatment with even more new lasers coming out. Beauty now uncovers how you can have beautiful skin with just a few treatments of Fraxel. Go to Personallifemedia.com to find out more and be sure to download this episode.

How Celebrities Stay Young and Wrinkle Free with the Fraxel Laser

Teri Hausman: I'm Teri Struck, host of Beauty Now, a weekly pod cast that brings you the latest in the three L's: laser, lypo, and lifts, plus much more.

Dr. Steven Struck: Fraxel works on both men and women. It's a laser that burns little micro thermal zones that are called into the skin, which are pinpoint microscopic burns that you can't see with the naked eye. Actually, those burns are what enable it to rejuvenate the skin, but, interestingly, I've seen men sometimes respond even better than women. Fraxel treats pore size, fine lines, photo damage; it's very effective with photo damage, which is kind of the dullness of your skin and how the skin doesn't glow anymore and doesn't look as healthy. It treats brown spots, fine lines, but mainly pore size issues.

Hausman: Today we're getting latest on the Fraxel laser, a laser with very little down-time and very big results. They have a new, even more-improved Fraxel, and we have an expert today, Dr. Steven Struck. Welcome, Dr. Struck.

Dr. Struck: Thank you.

Hausman: Dr. Struck is a leading plastic and reconstructive surgeon. So, can you tell us, for our listeners who have never even heard about Fraxel, tell us about Fraxel.

Dr. Struck: Fraxel is a laser that falls in the "no down-time" group of lasers, which a lot of people have heard of, and what that really means is that these are lasers that are designed to rejuvenate your skin in a number of ways without requiring much down time at all. I think the problem that you can get into, sometimes, is that some of them have no down time whatsoever; however, often, those don't really deliver. As a consumer, you have to do a little research on these things, so hopefully today we'll be able to do that. The Fraxel laser has about overnight healing time with some redness and swelling, perhaps the next day, so that's why we describe it as a no down time laser, because many of the lasers have a 10-day healing period. I think the way to look at it is: Fraxel is a laser that will rejuvenate your skin, make your skin look younger, with an overnight-type healing period.

Hausman: This Fraxel works on both men and women.

Dr. Struck: Fraxel works on both men and women. It's a laser that burns little micro thermal zones that are called into the skin, which are pinpoint microscopic burns that you can't see with the naked eye. Actually, those burns are what enable it to rejuvenate the skin, but, interestingly, I've seen men sometimes respond even better than women, and I've never really figured out why that is. It's either because they don't do much to their skin, so that when they do do something, they really respond, or they have a thicker type of skin, so that the skin has more target for the laser to treat.

Hausman: If a man or woman were looking in the mirror, and they were saying, "My skin doesn't actually look very good," they'd call into you for consultation. Walk us through a consultation for Fraxel.

Dr. Struck: I usually, what I do is I have the patient, the first thing I ask them is what they mainly want to work on. Sometimes people will come in and say, "I want to do 'X'." I think it's better to determine what they want to work on, because with ads in the media and Allure magazines and all these things that the laser companies have paid for, sometimes people don't know exactly what they do need but they know what they want. Usually, they'll describe some areas of photo damage, brown spots, fine lines, or some pigmentary issues with Melasma; they'll usually point those things out to me. I describe to them how this laser will work on that treatment, or if a different laser will work for them, or if a surgical procedure would perhaps be better. I let them guide me to where they want to go, and I try to pick a plan that will work best for them with their lifestyle and what they want to achieve.

Hausman: For our listeners who don't understand what Melasma is, could you explain melasma?

Dr. Struck: Melasma is one of the harder problems that we see. Most people know it as the mask of pregnancy. It's hyper-pigmentation or darkness around the jaw line that almost looks like a mask. It's pretty hard to treat, and Fraxel is effective at treating that to some extent, which most machines aren't. Melasma is known mainly as the mask of pregnancy, often after pregnancy, or when people are taking hormones or birth-control pills.

Hausman: When you say "treat", what exactly does Fraxel treat?

Dr. Struck: Fraxel treats pore size, fine lines, photo damage; it's very effective with photo damage, which is kind of the dullness of your skin and how the skin doesn't glow anymore and doesn't look as healthy. It treats brown spots, fine lines, but mainly pore size issues.

Hausman: How many treatments does the average patient need?

Dr. Struck: That depends on the patient; if you get into someone who is over 45 with some significant photo damage, I recommend around four treatments. Some of the younger patients who have skin that is in pretty good shape, sometimes I'll tell them just one or two treatments. I think that's what's nice about Fraxel; some of the original no down-time lasers, it took a good four or five treatments before the patients even saw anything, and it was kind of hard to get the patients to follow through on the procedure. When we'd go to the scientific meetings, a lot of doctors would question whether or not the devices were working, and that was probably as recent as two or three years ago. With Fraxel, on the other hand, there are many patients who will come in, and within two treatments, will say that they are satisfied with their results. I think that's one of the nicer points of Fraxel; you can count on a consistent result within two treatments. If you need a little more work, you'll get up to three or four treatments.

Hausman: Our listeners often hear the words "ablative, non-ablative, fractional"; can you explain all those terms for us?

Dr. Struck: The main terms are probably "ablative" and "non-ablative". A non-ablative treatment is something that doesn't destroy anything. Ablation means to destroy or vaporize the skin. A non-ablative treatment is a treatment that mainly heats the skin. The upside to a non-ablative treatment is since you're only heating the skin, you're really going to have zero down time. That was where the early machines, about eight years ago, started out. They were mainly heating the skin, hoping to stimulate collagen growth. As I said, the problem with those was they frequently didn't deliver; as high as 50% of the patients would really see nothing.

A non-ablative process is one that doesn't burn the skin at all, it only heats it, which is a little bit inconsistent. An ablative process is one that vaporizes the skin or burns the skin. The classic for that is the CO2 laser, which was the original laser. That's the one that most people are scared of; it's the one that completely burns your skin. You have the raw skin and the redness and the scariness, and usually, when someone has a friend who's done that, they'll say, "I don't ever want to do that". That is the gold standard of laser resurfacing because it does tighten the skin the most, but since it's completely ablating or destroying the skin, it has a ten-day healing period. You're comparing a zero-day healing period to a 10-day healing period; obviously the 10-day healing period isn't very attractive, but it does deliver in every patient.

When you get into fractional resurfacing, which is Fraxel's main area, what they decided to do was, instead of going non-ablative, they did minimally-ablative. They only burn 20% of your skin's surface with the little microscopic burns that you can't even see. The upside to fractional resurfacing is: you're going to deliver, you're going to see something, because your skin is being ablated and it is going to tighten. The other upside to it is we're leaving 80% of your skin completely alone so that your skin will look normal and you'll be able to go out and do things while it is healing. Also, if you do three or four treatments, then you get up to 80% of your skin being treatments. You've minimized healing time, you've minimized risk, and you've maximized results.

Hausman: So, when you say "no down time", you actually can go to work the next day; it's just that you might be swollen or...

Dr. Struck: Yeah, I tell patients that it depends on them and how willing they are to go out, because you clearly look sun-tanned or red or puffy. People who want no one to know about it probably shouldn't go to work the next day because they're going to be puffy and red. Most people aren't really bothered by that amount of redness and puffiness and they do go. I would say that if you're not puffy and red the next day, you probably didn't have a strong-enough treatment.

Hausman: What type of skin problems are treated by Fraxel other than Melasma?

Dr. Struck: I think the main thing that people like is the photo damage treatment because it really works for that. Most people have some photo damage on their skin; they have brown spots, they have dullness of the skin, they have some fine lines. Fraxel will consistently treat that. I think the number point is what people will see after one treatment. I have treated probably 1000 or 2000 people. I can only think of one or two where someone didn't comment on their skin looking better, so I think that's the main thing. They're going to go out- they're going to come in with dull, sun-damaged skin, and within a week, someone's going to comment, "Gee, your skin looks better; what are you doing?" That's the photo damage treatment. When you get into the fine lines, it's tougher, but it does also treat fine lines and pore size.

Hausman: I'm sorry, what about wrinkles?

Dr. Struck: That's where your fine lines are. I think, with wrinkles, as long as you're dealing with fine lines around the eyes, forehead, cheeks, you're going to see improvement in that. It's not going to eliminate wrinkles, but it's definitely going to improve upon them. The lines around the mouth are even a little bit tougher, but you can turn the energy up high and get those. Or, the future machine, which will come out probably next year, will be a little better at treating actual wrinkles.

Hausman: I have a lot of women ask me about the lines around their mouth, so let's talk about that right now. That's actually a good topic to touch on.

Dr. Struck: Lines around the mouth are probably the hardest lines in plastic surgery because Botox around the mouth is very difficult to do; I'll do a limited amount of Botox around the mouth just to kind of blunt those lines. Fillers are probably the mainstay of treatment of lines around the mouth because they are effective and they do work. A laser, any laser, when you compare CO2 or Fraxel, which are the two strongest lasers out there, they'll reduce those wrinkles by 50%. What I recommend to people is, if you want a permanent reduction or at least a five-year reduction, do a laser, and expect 50% reduction in those lines. If you want 100% reduction, then you should add some fillers to your treatment.

Hausman: So, you're talking about doing, can women do the Fraxel laser three or four times and fillers, or are you talking that they need to go in for the CO2?

Dr. Struck: I think that the best treatment is to do four Fraxels, and then with the fourth Fraxel I like to do the filler, because then we've seen what the Fraxel's going to do. The patients are also numb from the Fraxel treatment, so the fillers around the mouth don't hurt as much because they've had numbing medicine on for an hour or so. I think the best treatment is Fraxel resurfacing four times around the mouth and then follow that with the filler.

Hausman: What type of filler do you prefer around the mouth?

Dr. Struck: I think Restylane is the best filler, usually, around the mouth, unless the wrinkles are very superficial. If they're very superficial, the Fraxel will probably treat them itself.

Hausman: And Restylane is? Tell us about Restylane really quick.

Dr. Struck: Restylane is a hyaluronic acid product. Hyaluronic acid is very prevalent in your skin and your body. It's a human product created in a lab, which is a natural filler, which people like; they don't have to be skin tested for it. It's very good at filling lines around the mouth, cheeks, even around the eyes we'll use it to fill in some spots around the eyes.

Hausman: Hyaluronic acid- that's another show we need to do. We need to do fillers, too, because when you do the Fraxel and your lifts and lasers and everything, the fillers really add everything, fill in your lines.

Dr. Struck: Yeah, I think a nice treatment for your average 30- to 40- year old patient with moderate skin damage is to do a Fraxel series followed by fillers. I think that will dramatically change their appearance and rejuvenate them without having any surgical down time or anything that will affect their lifestyle.

Hausman: Well, thank you for talking with us. We're going to need to take a quick break to thank our sponsors. We're going to be right back with Dr. Struck and the Fraxel laser.

Hausman: I'm Teri Struck, host of Beauty Now. So, we've been talking about the Fraxel laser, what it can and can't do. Tell us more about the down time and about coming in and treating your skin. What other problems might a stronger laser be better at treating?

Dr. Struck: I think, when you're looking at the down time part of the question, there's the immediate down time, which is the time right after the procedure. The upside to that is, once we're done with the treatment, there really isn't any residual pain. A lot of people ask about pain. You're skin's just going to feel warm. When we get done with the treatment, you'll numb for an hour, we'll do the treatment which will take about 10 minutes, so you're an hour and 10 minutes in, and your skin will feel warm.

You won't have any bleeding or oozing; those are all things that people worry about that they've seen pictures of. So you'll just look sunburned right afterwards and feel warm; a lot of people use a fan that night or take a shower that night. You can wear makeup that night, you can do all your normal things that night- you're just going to feel a bit warm. The next morning, you should feel a little bit puffy and swollen, but not too bad. You should be able to do most things that you do during the day, except maybe a major social event: you might want to lay low as far as that goes.

Then, you look at the long-term things. I have all these people that are worried about big hats and how much sunscreen they need to wear and activities, and with the Fractional CO2, we're treating such a minimal part of your skin that as long as you're not actively sun tanning, I think you're fine. So basically, a normal sunscreen would be fine. Here in California, that's nice, because a lot of people are very active. They spend a lot of time outside, either running or exercising, and they can continue to do all those things almost immediately after the treatment.

Hausman: So, you brought up a couple of good things. You were just talking about the pain. Let's just break this down, because I hate pain, and I know a lot of women do. What can we do to minimize the pain of the laser?

Dr. Struck: There are a few ways to minimize it. As far as how do you look at the pain level of the treatment, I would say that one to two patients out of 10 will think it hurts. I would say that eight patients think it's just annoying, and two patients won't feel anything. Usually, that gives the patient a barometer, because they usually know whether they're going to be one of the ones who think it hurts, doesn't hurt, or are in the middle.

How do we minimize that pain for every patient? We use a numbing cream. There are no shots; a lot of people are afraid we're going to numb them with injections. We don't give any injections. We put some numbing cream on the skin- the entire face if we're treating the face; we can treat other areas of the body as well. We numb that area with a numbing cream that's about five times as strong as the normal numbing cream. We let that work for an hour. We then begin the treatment. We also can use a Zimmer, it's called, which is like an air conditioner unit that blows spray directly on your skin. I don't think every patient needs that, but in some patients, I use that as well, to minimize the pain. So, those are the two ways: numbing cream and cooling spray.

Hausman: So the cooling spray blows directly on your skin?

Dr. Struck: Yeah.

Hausman: To minimize the pain. And you do that as you're doing the treatment or after?

Dr. Struck: You do it as you are doing it. You can do it after as well, but mainly you do it during the treatment. Because afterwards, it really doesn't, hardly anyone thinks it hurts afterwards.

Hausman: How do you feel afterwards? Pretty hot?

Dr. Struck: Yeah. You just feel sunburned and a little bit red.

Hausman: Then you were talking about going in the sun after that. You're saying people need to use sunscreen? What do they need to do?

Dr. Struck: People definitely need to use sunscreen if they're going to be outside to minimize any pigmentary issues. The main reasons we want you to use sunscreen is to stop the laser to stop pigmenting afterwards. Since we're fractionally resurfacing, you usually don't see those same pigmentary issues which are normally associated with CO2 laser or the stronger lasers. A little normal sunscreen should be adequate.

Hausman: What's the negative about the Fraxel?

Dr. Struck: Well, I think what we're always striving for with all these lasers is to get the most maximal results, and I think the move from the first-generation Fraxels to the upcoming second-generation Fraxel is more designed for wrinkles. The average patient who isn't completely satisfied with the laser treatment is because it doesn't treat wrinkles aggressively enough. The second-generation machine will, I think, be more effective with that. Other than that, there really aren't any significant downsides that I've seen with the Fraxel machines.

Hausman: Do you think that's because the average patient is not realistic about what lasers can actually do for you and they don't understand that they might have to do a filler as well?

Dr. Struck: I think that's definitely true. I think that you see that a lot also with patients who probably need a surgical procedure and either opt for a non-surgical procedure or maybe the physician doing the treatment doesn't do any surgical procedures, so they'll oversell a laser treatment in hopes of retaining the patient. I think that if the patients are properly educated on what to expect, they should be happy.

That's why I say, "Your wrinkle's going to be reduced 30%. If you look in the mirror, you're going to see the same wrinkle, but if it's a significant wrinkle, it's just going to be blunted by 30%." If they will be happy with the fact that someone's going to notice that their skin looks better so clearly; their skin does look better. Their lines will be reduced by 30% and their brown spots will be reduced by 80%, those people should be happy.

Hausman: Which, most people would be happy if they were reduced 30%, don't you think?

Dr. Struck: I think so, but I think, what I see the most of, is I see people who want their neck tighter, and they'll say, "Can you tighten my neck up with this?". Since I do face lifts and the whole gamut of treatments, I tell them, "no" and I say, "You should do a face lift or neck lift if that's really what you want to treat. The odds are, if you go through a Fraxel series to tighten your neck up, you're going to spend a fair amount of money and time and really not be completely happy."

Hausman: Usually, by the time somebody's neck is sagging, they just need to have skin removed, right? And then you could tighten it up later with Fraxel?

Dr. Struck: What I like, about eight years ago, I bought my first laser and back then there weren't as many plastic surgeons doing lasers; it was more of a derm phenomenon. The reason I bought it was exactly that reason: I bought it as something to make my surgical results better, because some people clearly need a facelift or a neck lift to tighten their structural features, to tighten their skin, remove their jowls, do all that; however, surgery, or deep procedures is what I tell the patients, they deal with deep issues. Surgical procedure does nothing for your skin quality, really, so if you combine a surgical procedure with a laser procedure, you're then treating the deep stuff to get the foundation set right, and you're creating nice, healthy-looking skin over the top.

Hausman: What's the oldest patient you've had?

Dr. Struck: For a Fraxel?

Hausman: For a Fraxel.

Dr. Struck: Oh, I've had people in their 70s and 80s.

Hausman: And they've had good results?

Dr. Struck: They have had good results. I mean, you have to, first of all, you get a whole variety of skin damage at that age. As long as you know what to expect, I think they're happy. A lot of those patients are people who know they're never going to do a surgical procedure, and they're happy with an injection and a laser treatment. You can achieve quite a bit, even in a 70-year-old, if you do injections along with Fraxel or another laser.

Hausman: I also read that Fraxel treats acne scars. How effective is it with the acne?

Dr. Struck: I think that Fraxel's pretty effective with acne. I think the percentage on that would be more like a 20% reduction. Some of the pictures we have are pretty impressive. There are those outlier patients who respond extremely well, but I think the acne patients are happy. The main reason is, even with CO2, even with going through that 10-day healing period and the mask, and ten days off work, and four weeks of pigmentary issues, I think, when you compare Fraxel with that treatment three months later or six months later, I don't think you can tell a definitive difference of which one the person did. I think as long as they know they're going to see a 20-30% improvement and no down time, as opposed to a lot of down time, they're happy. I also think you can really improve your results, in this case, with filler in the deeper acne scars. So that's what I like to do: combine Fraxel with fillers for acne scars.

Hausman: I also want to say that you can treat hands and chest. So many women hate their chest skin from years of sun damage. Tell us about how you could treat the chest.

Dr. Struck: Well, that's another nice thing about this technology, is that you can use it, essentially, anywhere on the body that the patient wants to treat. The good thing is that there really aren't any good options as far as chest skin, neck skin, and arm and hand skin. The CO2 laser's too strong; none of the ablative procedures can be used on the neck, chest, or body, because there's too much risk of scar formation and complication. As you look at the whole gamut of treatments, comparing microdermabrasion to Fraxel to CO2, Fraxel is the strongest technology that works on the body that will actually deliver, so that's why I like using it on the neck, chest, and arms.

Hausman: So you think Fraxel is the best treatment for reducing sun damage on your chest?

Dr. Struck: Yep

Hausman: And what about hands?

Dr. Struck: I think it does a very good job on hands, too.

Hausman: And do you use it on any other parts of the body?

Dr. Struck: Yep. People like their knees treated, elbows, all kinds of various...

Hausman: So you can treat all those different parts. That's great.

Dr. Struck: You can. You can't do them all at once, because the local's too strong, and if you put that much local on someone's body you could have a complication.

Hausman: Is there anyone who's been allergic to the local?

Dr. Struck: I haven't seen that, but the local's definitely strong enough that if you weren't in the proper setting and you weren't being watched by someone who had a lot of experience with the local, you could have some complications.

Hausman: Because I've read in Florida and other places that people get into trouble if they do too much of this numbing cream. Is this the same type of numbing cream that they're talking about?

Dr. Struck: It is similar. Those patients, I read about those, and my understanding is that they were sent home with numbing cream. When you send someone home with something that strong, they're going to think, usually, people think more is better, so they keep putting more on, and some people do a lot of Internet research, and they find out that if you put Saran Wrap or some kind of cover over it, it will even be more effective, so they put more on, they leave it on for longer than an hour, and then they put Saran Wrap over the top. There have actually been a couple patients who had seizures and even died from that. You need to do it in the office. If you treat a face, neck, and chest with a thin layer of topical, and leave it on for one hour, you're not going to have any problems.

Hausman: Well, I also, on every show, with every expert that I have, I like to stress that you do want to go to somebody qualified. How can someone find a qualified technician for Fraxel?

Dr. Struck: Well, the Fraxel website has a physician finder that will tell you everyone that has a machine. Those people are usually tracked and trained by Fraxel. The good thing about a heavier machine like this is it's pretty expensive. It's probably three to four times, for the physician, the cost of less-expensive machines. I think that often weeds out people who are just trying to dabble in lasers, because if they're trying to create a little shop and make a little extra money, they're going to go with a cheaper laser.

Hausman: How can people be sure that they have the actual Fraxel laser? I've also heard of physicians claiming that it's a Fraxel and it's actually a Photofacial or something else.

Dr. Struck: I think that that, again, you could probably do with their website, because they do list their physicians. That's the main way. It's hard to tell that, that's a good question, but normally, Photofacial, which is a different machine, it's just a flash of bright light. A light-based treatment you'd be able to tell because it's just a flash of light.

Hausman: And what does Photofacial treat? That's also a very good product, but I wanted to know what the difference is.

Dr. Struck: I have both Photofacial and Fraxel because I think they do different things. I think Photofacial is very good at redness and rosacea. The people who have a lot of redness in their skin, I will often direct them towards Photofacial as opposed to Fraxel. I think people who have very youthful skin and really don't need the aggressiveness of a Fraxel treatment, I will also push them towards the Photofacial machine. Those are my main groups: redness, rosacea, and minimal sun damage.

Hausman: So younger patients actually could do the Photofacial as opposed to the Fraxel if they have really good skin.

Dr. Struck: Yeah, I think they can, and still get very good results with a little less expense. It's probably half as expensive, definitely a little less down time. Right when they walk out of the office, they normally look fine.

Hausman: And that's the last thing we have to talk about. How much does this cost? How much do lasers cost? Break that all down for us.

Dr. Struck: Some of it depends on your geographic location. Where I am, in California, the average Fraxel patient, for a face, it's $1000, and that's per treatment. If you're going to do, the younger patients do two, so they're looking at $2000. They usually do their treatments about two weeks apart. If you're doing four, you're obviously at $4000. When you get into face, neck, and chest, which is very common, it gets up to about $1400. Usually, you get a little break for the extra procedures. So anywhere from $1000- $1400 for Fraxel. Photofacial, originally, was fairly expensive, back seven years ago. At this time, I'd say Photofacials run about $400 per treatment. Usually, you have to do four or five of those, though, so you're looking at about $2000 for a whole series of a Photofacial.

Hausman: And most physicians will try to offer you a package, if you buy four treatments together. Is that correct?

Dr. Struck: Yeah. That's correct. I think you saw that more with the Photofacials because we wanted to make sure that people completed the series because they usually didn't see a lot with their first or second. We wanted to get people to pay up front so they would complete the series and actually see the full benefit. Usually, with Fraxels, I just let people pay per treatment because some people will want to do four and some people will want to do one.

Hausman: And what about follow-up? If you've done your four treatments and you think your skin looks great, but it's been six months and you start to look a little dull. Would you get a touch-up?

Dr. Struck: I have people that do it once every six months; I have people that do it once a year. Just one treatment, though, on the follow-ups.

Hausman: Just to renew your skin and feel good?

Dr. Struck: Right.

Hausman: Well, we're running out of time, so I wanted to know if there's anything you wanted to add about Fraxel?

Dr. Struck: I think, with Fraxel, one interesting thing is the new machine that's going to come out. The new machine is more of an ablative process. As we talked about, it completely vaporizes the areas that are treated. It still treats only 20% of the skin, but since you're actually removing the skin, it will allow the skin to shrink. You can almost visualize that if you just envision removing small points of skin, the skin is then going to actively shrink to fill those holes, and that's why it's going to be much better at shrinking skin. One treatment will actually remove about 7cc's of skin, which is about seven blueberries. A lot of patients think in terms of blueberries. If you remove seven blueberries' worth of skin from your facial skin, it's going to shrink and tighten.

Hausman: So, is that going to have way more down-time?

Dr. Struck: It will have in-between the level of the present Fraxel and the CO2. The present Fraxel is one day; this will be about four days, and the CO2 is ten days.

Hausman: Will your skin scab up?

Dr. Struck: There will be little pinpoint bleeding but not the true, big scabs. There'll just be little, pinpoint bleeding sites with this process. The other upside to it as opposed to, this is definitely getting up to the level of CO2, which is the strongest machine. The other upside is, in addition to being half the healing time, it has way less complications. You're not going to see the pigmentary issues that you see with the full CO2, so it's a little bit safer and a little bit faster.

Hausman: For our patients and listeners that would like to have a Fraxel treatment, they can go to the Fraxel website and find a physician near them.

Dr. Struck: Yeah, that's through Reliant Technologies.

Hausman: Reliant Technologies or Fraxel.com?

Dr. Struck: Right.

Hausman: Well, thank you for joining us today, and we're out of time, so we'll have to have you back to have a follow-up on the new Fraxel laser as well. If anyone would like to submit ideas for our show or other lasers, please email me at: teri@personallifemedia.com. If you would like transcripts for today's show or any of our past shows, on hormones, lypo, Dr. Perricone, and many more, go to: personallifemedia.com. Thanks again for being our guest, Dr. Struck.

Dr. Struck: Thank you.

Episode 55: The 20/20 Facelift: Dr Steven Struck Shares With Beauty Now This Revolutionary Lift.

What is a 20/20 facelift? It is the latest technology brought to you by Repair laser and an amazing procedure that literally restores your skin to its once youthful appearance. . Listen to how Dr. Steven Struck, a pioneer of this procedure, tells you how combining a lift with this Restore reverses the ravages of time and sun. Why just do a lift when you can do both procedures at the same time? Be prepared to look years younger. Lift and restore makes sure that your lift lasts. Don't be fooled by gimmicks. Be informed by a leading plastic and reconstructive surgeon who is Stanford trained and board certified. Dr. Steven Struck informs our listeners how they can maximize their downtime and attain a lift that lasts.

Teri Hausman: I'm Teri Stuck, host of Beauty Now, a weekly podcast that brings you the latest in all things beauty. We've had shows on lifts, lasers, lipo, breast augs, tummy tucks, keeping your skin young, weight loss, rash and hair extensions, with many, many famous experts. Today we have Dr. Steven Struck, a Stamford trained, board certified plastic and reconstructive surgeon. Welcome Dr. Struck.

Teri Hausman: Thank you.

Teri Hausman: Today you're going to tell us about the 20/20 facelift, and that's actually a facelift that's combined with, is it called the repair laser?

Dr. Steven Struck: Yeah, it is. It's a full facelift, and I combine that with the Fractal Repair Laser, which is a fractional Co2 laser.

Teri Hausman: What are the benefits of doing the laser with the facelift?

Dr. Steven Struck: Well I think the benefit is, is that the two procedure, fractal laser resurfacing and facelifts are really completely different procedures and they treat different things. The facelift treats the jaw line, creates youthful structures to the face, gets rid of the bands of the neck and hanging skin. However, it doesn't really do anything for the actual skin quality. Whereas a laser makes the skin look more youthful, it gets rid of photo damage, and most people who need a facelift also need to have their facial skin rejuvenated, so if you can do them both at the same time you're going to get a youthful face with youthful structures and youthful skin.

Teri Hausman: I don't know why people haven't thought of this before. I mean, going in just for the laser procedure is pretty, you know, time consuming.

Dr. Steven Struck: Well we have, people have, we have thought of it before. The difficulty is that when you do, historically speaking, when you do a whole facelift we have limited the laser to only the mouth area and only the forehead and nose area. And the reason for that is that the lasers that we used before surgically have been too harsh to treat the face that you've actually lifted during a facelift, which is the neck and cheek skin. So with the advent of fractional lasers, like the CO2 laser, we've been able to treat that skin less harshly and now we can treat the entirety of the face as opposed to only isolated areas.

Teri Hausman: So you're saying that this laser is completely different than the old lasers that they were using.

Dr. Steven Struck: It's similar but different. It's the same technology and that it's a CO2 laser, and what's nice about that is CO2 lasers are kind of the gold standard because they do deliver. A CO2 laser's not a no downtime laser, it's a laser that actually does treat the skin so that you get predictable results. The difference is that the laser energy is provided fractionally, and to make that, just a kind of a short explanation of that is we treat twenty percent of the skin surface as opposed to a hundred percent of the skin surface with this laser.

Teri Hausman: Well lets start actually asking about the facelift. Do you do the facelift first and the laser second or vice versa?

Dr. Steven Struck: In surgery I do the facelift first. I like to do that because when we've treated the laser, when we use laser to treat the skin, the skin has been burnt, it's swollen, it's a little bit traumatized, so I like to set the foundation first by doing the facelift so that I have the neck line how I want it, the jaw line is created the way that we want it, all the deep structures are dealt with first, and then we can come in secondarily and go over the skin with the laser once we've set our foundation.

Teri Hausman: So basically you're saying a woman's going to come in to you and she'll be having saggy skin, but also sun damaged skin.

Dr. Steven Struck: That's correct.

Teri Hausman: And she can correct both of those by doing the 20/20 Facelift.

Dr. Steven Struck: That's right.

Teri Hausman: So tell our listeners for the ones who haven't listened to the facelift show, there is another show on facelifts, but lets talk about that really quick... What is, how is a facelift done? A woman comes in to you for a consultation, how do you proceed?

Dr. Steven Struck: Well I think that, well when I see the patient what I like to do is determine what they actually want to achieve. It's funny, with everyone having so much information available to them I would say 25 percent of patients who come in come in with an idea of what treatment they want, as opposed to what they actually want to correct, and sometimes people will have, you know, a lot of spat of their neck and hanging neck skin and will say they want a laser when a facelift is actually what treats that. So first thing I like to do is determine what they want to achieve. And if a patient wants to get rid of, say, the turkey bands of the neck, which a lot of people describe them, the two lines that go down the middle of the neck, if people point at their jowl and say, "I really want to lift this jowl", or say they want to make their cheeks more full, those three things are deep issues and those are only going to be treated by a facelift. There are not lasers that are aggressive enough to elevate someone's jowl or make their neck more youthful looking. So if that's their complaint, then I think the facelift is the way to go.

Teri Hausman: So basically though you're saying... is this different procedures though? The lady comes in and wants just her neck to be corrected, then you do the neck. Where are the scars for the neck left?

Dr. Steven Struck: Well if you're doing an isolated neck lift, the scars are mainly hidden behind the ear. You don't really need to go in front of the ear to do an isolated neck lift, and patients like that idea �cause they don't want to have the incision up front. You do all the work behind the neck and a small incision under the chin, and through those two incisions you're able to create a neck, a youthful foundation with retightening the muscles of the neck and then remove some skin of the neck area to tighten some skin over the top of that.

Teri Hausman: But that doesn't correct the cheeks, does that?

Dr. Steven Struck: No, to get to the cheeks you always need to have some skin removal over the area that you want to treat, and you need to get underneath the area that you want to treat to elevate the chin, the jowl. So if it's the jowl, you need to make an incision in front of the ear, go under the skin to find the smaz, which is the deep muscular structure that contains the jowl, and then you elevate the smaz, which elevates the jowl, and then you redrape the skin over that.

Teri Hausman: Then the eyes, the saggy eyes.

Dr. Steven Stuck: And then when you get to the eyes there are really two decisions to make. One decision is the area of need only the eyes or do the brows kind of add to the problem. If the brows are below the orbital bone, which most people can just feel their eyebrow and the bone and if their eyebrows lay on or below the bone then they should probably have some type of brow elevation to get a better result, and then we just remove some skin of the eyelids to rejuvenate the eyelids.

Teri Hausman: And when you say some type of brow rejuvenation, do you mean the endoscopic procedure, which, could you explain that for our listeners?

Dr. Steven Struck: Well there're, again there're a variety of treatments there also. I think you need to look at each patient. That's the beauty of plastic surgery, every patient's different. You don't do the same procedure to every patient for sure. So what I look for in the brows is I look at the height of the hairline, I look at the level of brow droopage and I look at the number of lines in the brow. If the patient has a high hairline, an endoscopic brow lift may not be the best choice, �cause it can aggravate that by further elevating the brow, and a hairline type procedure might be a good idea, where we make the incision right at the hairline. The benefit of that is actually we can remove some of the forehead skin so that their hairline is lowered, and we've treated two things; we've raised their eyebrows, we've lowered their hairline, and we've rejuvenated their brows. If the hairline's normal and they just have some early brow droopage, I'd just do a standard endoscopic brow lift and make a few small incisions and elevate the brow that way.

Teri Hausman: And that is, for our listeners, that's with the camera, right? You go in with the little camera, and then your scars aren't so big, like the way that they used to do it?

Dr. Steven Struck: Yeah, that's with the camera and usually three small incisions. I think the benefits of that are that, A, there isn't the big incision, which means less areas of hair loss, less areas of scalp numbness. I think those are the two main advantages. Well when you make that big incision, you cut some of the nerves of the forehead region, there's no way to avoid that, and after you do that there's some pretty significant areas of scalp numbness, and there can be some areas of hair loss as well. So I like to do the endoscopic brow lift when I can.

Teri Hausman: So then you do, after all this is done, you've done all this work, then you're going to go on with the laser. Can you do the laser on the neck?

Dr. Steven Struck: With the Fractional CO2 laser you can. That machine, earlier I said we do 20 percent coverage, that's not completely what we do. In the areas where the skin needs more treatment and is more hardy like around the mouth, we will treat at about 40 percent coverage and a higher energy. When we go down to the neck and the cheek we do move it down to about a 20 percent coverage, so that that more delicate skin can go through the process, heal well and be rejuvenated without concerns for healing problems.

Teri Hausman: A lot of women complain about those lines around their lips. So you're saying this laser can really help that.

Dr. Steven Struck: Yeah, lip lines are probably one of the more difficult areas in plastic surgery, and that's another example of why you'd want to combine the two procedure. A facelift isn't going to change lines around your mouth. If we pull tight enough on a facelift to tighten the skin around your mouth, you'd have a pretty strange looking outcome. So we can't achieve mouth rejuvenation by facelift, so we can with lasers and that's what I like to do there.

Teri Hausman: So if a woman came in and she just only wanted the lasers, she didn't have any sagging, what would she ask for?

Dr. Steven Struck: Well usually then they're pointing at some fine lines. Their chief complaint, I always look for what their chief complaint is, their chief complaint is fine lines. They're not usually pointing at their neck saying, "I want this hanging skin", or their jowl, "I want this lifted", they're just saying, "I want my skin to glow more. I want to get rid of these lines. I feel like my skin's dull." Those patients I would definitely choose a laser technology alone, and do probably a pretty significant fractal resurfacing of their face.

Teri Hausman: And when you say the fractal resurfacing, there's two different types. Can you explain the two different types real quick?

Dr. Steven Struck: Yeah. The original fractal machine is now called the restore fractal. It's a little bit lighter. It's not as strong as the CO2 laser, so what it does is it still treats about 20 to 40 percent of the skin surface, but it kind of injures that skin and burns it, it doesn't vaporize it. So it's good for photo damage, it's good for fine lines. From the patient's perspective, the main benefit is the downtime is less. They come into the office, they're numbed topically with some creams for one hour, and then we treat them, they go home, they're certainly a little bit puffy and red, but they can do a lot of things if they want to. The repair laser, the stronger laser is the CO2 laser, so it's actually burning that skin and vaporizing it. The advantage of that is it really does shrink the skin, probably a little better at treating lines than the repair, I mean restore. Restores probably better at photo damage shining your skin, treating really fine lines. If the patient really wants to shrink the skin, they're probably better off going with the repair, which does have about a five day healing period associated with it that is better at treating your lines.

Teri Hausman: So repair is more downtime. We're going to need to take a commercial break, thank our sponsors. We're going to be right back with Dr. Steven Struck. Thank you Dr. Struck. We'll be right back.

Teri Hausman: I'm Teri Struck. We're talking with Dr. Steven Struck today. He's talking about the 20/20 Facelift, a facelift combined with a laser. Welcome back Dr. Struck.

Dr. Steven Struck: Thank you.

Teri Hausman: So today, I almost hear every single day from women calling me up, in fact, just yesterday, "What's this Lifestyle Lift?", "What's this other lift", "What is...", you know, you see so many different, lets just call them gimmicks or facelifts with no downtime. Tell us about that.

Dr. Steven Struck: Well I think you're right. Myself, I've had, I usually have at least a couple patients a day ask me about something like that that they've seen in the media and are interested in. I think it's easy to get people interested in something that has no incisions, no scarring, no healing time, no burning. And it's like everything, you can't truly get something for nothing. They think those procedures are probably designed for people who really don't need much of anything anyway. You need to have, to lift skin you need to have an incision, you need to have some work on underlying structures and you need to remove some skin. The funny thing is, is really when you compare the downtime of a definitive procedure to that of kind of a half measure, the healing time really isn't that much longer, so I think it's more of just attracting patients with this idea of "I can do a facelift without an incision." "I can do a facelift without the healing time", when really if they did a definitive procedure they gets something that lasts on the line of eight to ten years and truly rejuvenated them, still leaving them looking natural, as opposed to something that would last about a year and not be very definitive.

Teri Hausman: Well that's actually what I've heard too from other doctors is that it just doesn't last. So you're spending, you're spending just about almost about half of a facelift, or do you know the costs of that?

Dr. Steven Struck: You know, I don't know the costs exactly, but I think that it probably is half, sometimes it might even be more than that. Because we have, as plastic surgeons we have a variety of things that we can offer that can actually be competitive to that. If someone truly wants and needs a mini facelift, we can do a mini facelift on them. We don't, not every patient needs a definitive CO2 laser, laser facelift, you know, two weeks of healing time. Some people do need a mini facelift and a board certified trained plastic surgeon can do a mini facelift, which is probably closer in cost and still a definitive procedure without going to those types of procedures.

Teri Hausman: And I have to say, I've seen results on some of the patients that it's amazing to see the laser combined with the facelift because of your skin texture, and would you say a lot of patients come in and they just have their face done but they don't do any injections and lasers, and then their skin quality still needs to be fixed?

Dr. Steven Struck: Yeah. So I think that's the benefit. We have a lot of things to offer, and I think that's a nice thing about going to a doctor who is trained in all things is that they can offer you one of those things, they're not trying to put, you know, the square peg into the round hole. If the patient needs a laser, they're going to do a laser for you. If the patient needs a facelift, they're going to do a facelift for you. Someone who can offer all the different technologies I think is most motivated to help the patient choose the right treatment for them.

Teri Hausman: So when they do the laser with the facelift, what is the recovery time?

Dr. Steven Struck: The recover time actually is probably that of a standard facelift, I think that's a fair statement. A facelift usually has a two week healing period. The laser actually heals much faster than that, so that I think is kind of the beauty of the procedure is, is we're doing a procedure that has a two week downtime, the downtime is really not changed by adding the laser to it because it's still a two week healing process. No doubt for the first four or five days of the facelift they certainly look a little more swollen and puffy and, you know, treated. However, by the end of the two week time period when they're ready to go back to work and ready to do their thing, the 20/20 Facelift, laser facelift patients actually look the same as the standard facelift patients.

Teri Hausman: A lot of women also ask me about laser in the sense that if they have darker skin or if they have skin that they're afraid that it would leave little white spots or dark spots or burns, what's your answer for that?

Dr. Steven Struck: I think there, that's another advantage of the factional treatments like the repair laser. If you have, the rule of lasers is the lighter the skin, the lighter the eye color, the more aggressive you can be with the laser and the less likely your are to have pigmentary problems. As you move into darker skin, darker eye color, you definitely run more risks of either post reactive hyper pigmentation where they get darker, which usually does resolve, or whiter areas of the skin, which are lighter than the surrounding areas. The fractional nature of this allows us to say, "Okay, we have a fair skin patient here, lets keep the energy up high, lets treat them aggressively, they don't have those risks", whereas if someone has darker skin you can turn both the power down and the fraction of the skin that you're treating down so that you decrease your risk of complications.

Teri Hausman: What can African American women do for their skin?

Dr. Steven Struck: I think that's a tougher area. I think you could do, I would say in that group, I would probably stay more towards a restore type laser. I think that, which is the non burning type of fractal laser. It still delivers, it delivers consistently and usually can meet the needs of those types of patients. I think even with a light repair or a light fractional CO2 type laser, you would run some risks there that you may not want to take on.

Teri Hausman: And then in that case if the patient really, really wanted it, would you do a test patch, or...?

Dr. Steven Struck: You can definitely do that. You can test areas behind the ear, you can test different areas to see. But with that type of laser I wouldn't be too worried with the restore type laser, I think they would be fine.

Teri Hausman: So the repair is the one that you can do, kind of like the lunch time. And the restore is the more heavy duty one, about five to seven days downtime?

Dr. Steven Struck: Yeah, they're reversed to that, so it's the restore...

Teri Hausman: Okay.

Dr. Steven Struck: Restore is lighter, I think of it that restore, you're just trying to restore something, you're trying to make it a little better, whereas that with the repair you're getting in there and you're really trying to fix something, so I always get those two confused too, that's how I...

Teri Hausman: Okay, so the restore is the one, the lunch time, and the repair is the more heavy duty one.

Dr. Steven Struck: Right.

Teri Hausman: And the repair you can actually have even if you're not having any surgery. You can do that in the office as well, right?

Dr. Steven Struck: That's right.

Teri Hausman: So what are the costs of the repair and the restore?

Dr. Steven Struck: Usually...

Teri Hausman: Ballpark...

Dr. Steven Struck: with the restore I would say you're usually looking at about a thousand dollars per treatment, it usually takes a series of three to four. Those can be done about two weeks apart. So benefit, no downtime can, you really don't need to miss work. You have a day of puffiness and swelling, but most of that can be covered. With the repair, you're usually looking at four to five thousand dollars, you're usually looking at about five days off work. So if you really analyze the costs, the repairs only maybe fifteen hundred dollars more, because with the other one you need to do a series of four treatments with the restore. However, a lot of restore patients are kind of younger, really don't have that much photo damage. Many patients can get a lot of benefit from a restored one or two treatments, which is only a couple thousand dollars, and a lot of them will maybe then want to maintain that with one treatment once every year or two. So I have a lot of patients who really don't have much going on with their skin, just want to keep it looking useful, and there'll be one or two repairs in office, and then they'll continue to follow that up once every year or two.

Teri Hausman: Well we just have a couple more minutes. Lets just go back to 20/20 Facelifts, so that, is there anything that you can tell us about it?

Dr. Steven Struck: I think that we kind of went over the main things we're dealing with; healthy skin over the top of the healthy foundation. We're doing them at the same time. It's pretty hard to get someone to go through a two week healing period for a facelift, and then a month later say, "Okay, come back in and now we're going to laser your face and you're going to have another ten day healing period." I also...

Teri Hausman: That's a good point. I mean, �cause you do see women like that, that need the injections and all that kind of stuff, and you might as well do it at the same time.

Dr. Steven Struck: Yeah, and it can be done. We've documented that it's safely performed. We've got the energy set so that we can safely laser the skin without having healing problems. I think another thing that patients think about a lot is, I think the trend is more towards people wanting to look natural. People come in, they say, "I don't want to look funny. I don't want to look like so and so in the tabloids", and actually sometimes the more different treatments that you do, if you add laser to the procedure then you don't need to pull as tight on the skin �cause you're rejuvenating the skin with the laser, so your hand isn't forced to being as aggressive with the skin tightening because, you know, the lasers going to do it. So in some ways it's kind of funny that what seems like a more aggressive procedure can actually yield a more natural result because you're using the technology to kind of add to each other, as opposed to forcing one of them to work harder than it should.

Teri Hausman: Oh, and I love that because I quoted you on many shows that, you know, you say, "You can always go in back and take out more skin, but you can't, you know, you can't do it, you can't put it back in."

Dr. Steven Struck: That's correct.

Teri Hausman: Because that is kind of the fear of most people, that they don't want to look freaky or look, like they've had surgery, they want to look rested.

Dr. Steven Struck: Yeah, that's right, and patients, the patients see it and they're very happy with it.

Teri Hausman: Well I've seen the results and it's pretty amazing, so it's called the 20/20 Facelift, pretty much a laser combined with the facelift. And a lot of doctors are not doing this yet?

Dr. Steven Struck: Oh, I think that there are a lot of doctors who are doing it. I think that they're, we're going to have more information in the scientific literature about it that will even add to it, but I think it's something that, the fractional CO2 lasers have only been out for about two years now, so this is an area that's kind of a new area, but I think there's significant data now to support its use.

Teri Hausman: And what about, can you use it on the chest skin?

Dr. Steven Struck: I use it on the chest skin, yeah. There's a different mode that you can change to that's even lighter, and that's an area where obviously we don't do surgical procedures really to rejuvenate the skin. So you can continue to change your density, which is the number of impulses, and your power to treat the chest skin. Chest skin often has more photo damage than actually lines, so, you know, you can set the settings so you're treating more photo damage, you know, or if they do have lines you can change the settings and treat the lines.

Teri Hausman: And do you use the restore for that or the repair?

Dr. Steven Struck: It depends. If I'm doing a facelift procedure with the 20/20 Facelift, I'll treat the chest at the same time because we're already there and we're already going to have the healing time. If I'm looking at it as an office based procedure, often I'll use the restore there, �cause that's usually, like I said, a photo damage area. When you're thinking restore, you're usually thinking photo damage and fine lines.

Teri Hausman: What about hands real quick? We only have a couple more minutes left.

Dr. Steven Struck: Hands I think you go with the restore for sure. The, I'd, the CO2 nature machines are a little bit strong for the hands. You could do it, but you'd have to turn the energy down so far that you would actually be doing the same thing as you would be doing with the repair anyway, with the restore anyway.

Teri Hausman: And a lot of women complain about their arm skin, what can they do for that?

Dr. Steven Struck: Arm skin, you can probably go with a more of a restore type technology or a Thermage type technology, something to kind of tone the skin that you can treat large areas of the surface. There are some new things that they're working on at Thermage to try and tone the skin up in that area also.

Teri Hausman: And there's the new fat laser for Thermage, is that out yet, is that coming out?

Dr. Steven Struck: Well that's, those are, you know, I think you're going to see some new growth in those areas. You're going to see some growth in all kinds of lasers that treat fat, to tone skin over the top of skin that's had its fat treated, and that'll probably be the next area, the no downtime lasers have kind of dominated our field for the last four or five years I'd say as far as new interest, and I have a feeling in the next four or five years we'll see a lot of stuff with treatment of fat using lasers.

Teri Hausman: But you're not talking like the suction, you're talking about the, they're actually saying that they could melt fat with laser, without...

Dr. Steven Struck: There is data to show that and that's what they're working on. Some of that stuff is in the very early phases...

Teri Hausman: We'll be looking forward to that...

Dr. Steven Struck: But it'll happen soon...

Teri Hausman: We'll be looking forward to that and we'll do another show on that.

Dr. Steven Struck: Okay.

Teri Hausman: So in closing, what's your last advice for anybody looking for this type of procedure?

Dr. Steven Struck: Well I think, I would say in closing the main thing to think about as a patient what you want to treat first, and then meet with the physician to determine what type of treatment would best meet your needs, and it may be a laser, it may be just simple office injections, it may be a lighter laser or the 20/20 Facelift, but I think if you know what you want to work on and have formalized a plan, a good well trained surgeon can help you achieve that.

Teri Hausman: And again, I always recommend going to a board certified plastic surgeon for facelifts and body work and all that kind of stuff, but there's great Derm's out there that do great laser work, and just make sure you do your research on your doctors.

Dr. Steven Struck: I agree with that.

Teri Hausman: Thank you so much for being with us today Dr. Struck. We'll have you back to talk about all the other great new exciting lasers that are out there. And if anybody would like a transcript of today's show, just go to personallifemedia.com, and we're going to link you up to Dr. Struck's website from our website so you can get a hold of them if you want to go in there and get a consultation or if you have any other questions. If you'd like a transcript go to personallifemedia.com. And if you have any questions, email me at t-e-r-i, @personallifemedia.com (teri@personallifemedia.com). Thanks again for being with us today, and we'll look forward to having you back. Dr. Steven Struck: Alright, thanks for having me.

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