Tag Archives: wrinkles

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I’m not saying your trainer is a liar or a bad person. It’s just that when it comes to certain issues about how diet and exercise actually affect the human body on a cellular level, many personal trainers don’t know exactly what they’re talking about. Or they do know what they’re talking about, and they continue to talk and take your money.

So before you take everything your trainer says at face value, and feel ashamed that no matter how hard you work out, your body isn’t turning into what your trainer promised you it would, ask yourself these three questions:

1) Does your trainer happen to have a PhD, Master’s, or at least a Bachelor’s degree in Biology that includes courses in Human Physiology?

2) Can your trainer talk to you in detail about the process of aging at a cellular level, especially about what’s happening to the skin on your arms and above your knees?

3) Does your trainer know how and where in the digestive system fat/protein/carbohydrates are absorbed and what happens to them once they hit the bloodstream?

I would bet not.

As someone who was FORCED to spend SIX painful years STUDYING and RELEARNING and MEMORIZING the basic science of the human body (all of my colleagues out there who made it through a pyramidal general surgery program and had to obtain high scores on the “In-Service Exam” to keep their jobs feel my pain), I am fully prepared to go head to head with your trainer who shames you by telling you that if you just keep doing the workouts they prescribe, and eat the way you’re supposed to, they can fix those things about your body that you hate.

So below are the five most common myths that every patient of mine with a trainer has been shamed into believing. I am sick of hearing them and I am here to set the record straight:


  • “If I just keep working out, this will go away.”

If you’re generally overweight, yes. Fat will burn off in general and you will get thinner. But if you are at a reasonable weight for your height and build, and you are working out and taking care of yourself, and there is muffin top/bra fat/saddle bags/inner thighs that you’ve had your whole life or developed after pregnancy or menopause and just won’t budge, IT WILL NEVER GO AWAY. Unless you are twenty pounds underweight. And who has time for that?

Because while you can tone designated muscles, you cannot spot reduce your body with exercise. (ie) Running isn’t going to necessarily get rid of fat from your legs. Rowing is not necessarily going to get rid of fat from your arms.

Fat is simply a form of energy storage. Elements of Carbon, Oxygen and Hydrogen (yeah, remember that periodic table from eleventh grade chemistry?) are broken down from the food you eat and bonded together into lipids (the building blocks of fat.) Lipids are stored in fat cells. The thing is that you don’t get to pick which cells will be used for storage. When your body needs energy, it breaks those bonds and releases the energy (like gasoline in a car) from wherever it is programmed to do so. Not necessarily the part of the body you are exercising. If you want to target an area of fat, that’s a lipo, possibly a Coolsculpt, or at least a Vixen.

So for example, if you lose ten pounds, your body could use the stored fat in your face and breasts, and you could wind up with deflated boobs and a sunken, older-looking face and still have thick arms. In fact, if you’ve had thick arms your whole life, I can almost guarantee that they will stay thick.


  • “If I work out my legs it will tighten the skin.”

The skin is a waterproof covering of your body. It is made of collagen and elastin and other building blocks whose names are too technical to get into here.

The main thing to understand is that the skin does not participate in your exercise regimen. It can tighten as a healing response to direct injury from things like lasers and peels. It can look better after treatment with non-invasive “skin tightening” machines like Velashape and Exilis, though long term results are still questionable.

So, contrary to popular belief, the skin does not tighten with exercise.


  • “Well, then I can build up my muscle and fill out the loose skin.”

That might be true if you started taking steroids. Take a look at the skin you want to fill out and how much you have to pull it to make it look tight. Do you really want your muscles that big? And chances are, you wouldn’t be able to get them big enough without taking some questionable supplements.

In most situations where skin is really sagging, a skin excision procedure (tummy tuck, thigh lift, arm lift) is necessary to get the result you want. For the abdomen, a tummy tuck can be a good option if you are okay with the scar hidden beneath your underwear line, as the tradeoff for having tighter skin.

On an arm or leg, the scar would be hidden in most positions, but still present. So, unless you have had massive weight loss, and can’t live with the extra skin anymore, I am not recommending thigh lifts and arm lifts.

As we age, our skin just gets crappier. Childbearing also takes a toll. No matter what we do, it loses elasticity that we cannot get back.

If you stayed out of the sun when you were younger, you’re ahead of the game. But chances are, unless you are fortunate enough to have amazing genetics (which really plays the biggest role in having “tight skin”) after your mid-forties you are probably constantly bemoaning the skin on your body.

My personal solution: Spray tans

If you really have money to burn, you could do weekly Velashape treatments for the rest of your life.

But for most of us, (myself definitely included) when it comes to the skin on our bodies, in general, we have to GET OVER OURSELVES. And do the best we can. Look the best we can for our age.

We need to accept that our days parading around in a tiny bikini and getting checked out by every guy at the hotel pool may be over. That’s okay. Hopefully by now we have other, more important things going on.

Because really, besides feeding our egos, what did getting superficial attention from a bunch of strangers actually do for us, anyway?

Moving on.

  • “If I keep working out my core, my abdomen will be flatter, and I’ll get a six pack.”

 I’m talking about that situation that we all have after a certain age—that your abdomen is flat in the morning but as soon as you eat or drink something, it starts sticking out.

Even if you haven’t had kids, as we age, our abdominal walls become looser. It’s not the muscle, it’s the tissue around the muscles and holding everything together (the fascia) that is loosening. Again—loss of tissue elasticity. Like your skin, your fascia does not participate in pilates.

You can definitely make your abs muscles stronger, and you can learn to keep them tight and held in, but the fascia can’t tighten itself. And sit-ups do not flatten your abdomen.

So if you’re really doing everything you can to be fit and healthy, and your abs muscles won’t get flatter, and you still can’t see them, the answer is one of two things:

A tummy tuck with plication of the deep abdominal wall (permanent suturing inside like an internal corset)


Liposuction to get the fat off your abdomen so you can uncover the muscles underneath that you’ve been working so hard on. Remember, you cannot spot reduce fat (see myth #1)


  • “If I cut down on the carbs I will lose weight.”

 Weight loss is not rocket science. It’s first grade math. Although these days, kids are probably doing this kind of math before they hit kindergarten. Energy in, Energy out. All food gets broken down to simple sugars, amino acids and lipids—that’s sugar, protein, and fat. Calories are a measurement of energy in the food that you eat. Like money—it doesn’t matter how you get it, green is green. Whether it comes from sugar, fat or protein, a Calorie is a Calorie.

So don’t get caught up in the good carb/bad carb thing. All carbs get broken down to the same basic simple sugars by the time they hit your bloodstream.

If you are trying to lose weight, you need to have your energy intake be less than what you are expending.

It’s not WHAT you’re eating, it’s HOW MUCH of it.

Most of us are not completely honest with ourselves about how much we are eating. Especially if we go out to a lot of dinner meetings. Those appetizers sitting there…and it seems like you’re not eating that much because there’s still so much food left on the table.

Unfortunately, it is much easier to put energy into your body than it is to get rid of it. Running four miles barely burns off a bagel. So, unless you are a professional athlete training for the Olympics, or Natalie Portman preparing for Black Swan, most weight loss has to do with HOW MUCH YOU ARE EATING—not necessarily WHAT you are eating—and not how much you’re working out.

If you feel that you are dieting and exercising and not losing the weight that you want to, the best way to get a handle on it is to start recording into your phone notepad whatever you eat throughout the day. It sucks, but things add up quickly.


So those are the main self-deprecating quotes I hear from women who can’t seem to meet their workout goals. Whether it’s a trainer telling them, or they are telling themselves these things, they are inaccurate.

To be clear, I am not advocating body contouring or skin tightening procedures as a replacement for working out and keeping a healthy diet. Addressing resistant areas of fat is a supplement to–and should only be performed–in conjunction with a healthy lifestyle.

If you are already taking care of yourself, having a procedure that targets a certain area might even give you a kick-start if you are stuck at a plateau.

For instance, wouldn’t you be more motivated to work out and eat less if your thighs didn’t rub together while you’re on the treadmill, or you didn’t have to keep re-arranging your LuLu Lemons to keep your muffin top or post-baby sagging abdominal wall skin from getting exposed? Those are legitimate concerns.


Just saying.




Okay, you guys know I’ll somehow tie this together at the end, so just stay with me.

First of all, the question that I get before every procedure–“when will I look normal again?”—needs to be defined. Are you talking “normal” enough to drive to a Whole Foods in a different neighborhood to pick up more Arnica and a few pre-cooked meals, wearing a scarf, hat and sunglasses so that everyone  thinks you’re trying to look like an incognito movie star but the woman standing next to you on the check-out line can see the bruises under your eyes and thinks, “Oh, yeah, she had something done,” but you don’t care because you’ll never see her again?

Or are you talking about an impromptu reunion with the hottest guy from your Med School class who you haven’t seen for over a decade but just happens to be in town for a meeting and wants to catch up over drinks two weeks after you just had a brow lift and your lower lids done?

Speaking from personal experience, I can answer both questions.

Shortly after opening my practice in Beverly Hills, I had an endoscopic brow lift (with tiny incisions in the hairline ) and fat transposition of my lower eyelids (see earlier post “What can I do about the bags under my eyes?”)

To those of you who don’t live here in La La Land, I know this sounds like a lot of surgery for someone who’s still relatively “young” but really, this wasn’t me being crazy because I’d just moved to Beverly Hills. It was a procedure I’d been thinking about for years (and had been told by several colleagues–not so tactfully–that I could really use.)  Sometimes you look at your parents and the writing’s just on the wall. It’s not aging, it’s genetics and you shouldn’t have to apologize for wanting to fix it. In my case it was those fat bulges under my eyes, and the constant creases across my forehead from trying to keep my eyebrows off my upper lids. The upside was that I saved a lot of money on make-up because there was nowhere to put eyeshadow. Too much Botox in this situation–to get rid of transverse forehead creases on someone who has a short forehead and a low brow–risks making you looking like a Neanderthal:

So I had the procedure done. I had the best doctor in town—Dr. Andrew Frankel, at the Lasky Clinic in Beverly Hills—and I would recommend him to anyone in a second. And everything went swimmingly, except…I am a bruiser. I don’t know if it was the lower lids or the brow lift, but I was scary swollen and bruised for about a month. Like blue-black, can’t-cover-with-professional-makeup bruised. Even with all of the Arnica and Bromelein and Hyperbaric Oxygen Treatments in town.

I believe that for most people, it would be reasonable to expect this kind of swelling and bruising for a week. But everyone responds differently and after my experience, I have to say that if you have an event that you really care about, give yourself at least a month to six weeks after this kind of surgery.

Okay, let’s define “care about”:

I was able to drive and go back to work three days later. Swollen and bruised and looking scary, but my patients were all so intrigued, and full of questions, and I didn’t mind telling them about it because you have to practice what you preach, right?

Don’t care.

One week post-op, while picking up dry cleaning I heard some teenage girls on skateboards say (not even whisper) as I passed them, “That lady had plastic surgery.” I was more upset that they had referred to me as a “lady” than the fact that they had called me out on my surgery.

But, never going to see them again and I don’t know their mothers. So, still don’t care.

Ten days post-op a colleague takes me to a big party for a Craniofacial Surgery Society. For this one I got professional makeup done because I wasn’t really looking forward to sporting my still-very- obvious cosmetic surgery bruises in a room full of male plastic surgeons. I thought the professional makeup was doing the trick, until a couple of hours into it, I caught a glimpse of myself in a mirror and realized that the packed-on concealer under my eyes was there no longer and the bruises were as dark and obvious as ever, and I wasn’t fooling anyone.

Oh, well. They’re not my crowd anyway. Still don’t care.

But then….two and a half weeks after my surgery…pretty much back to my normal routine…My browlift is looking amazing, and the bruising and swelling under my eyes is slowly getting better but still extremely obvious but, what the hell…at this point I’ve given up trying to hide it…and anyway, we’re in Beverly Hills, I’m wearing it all like a badge of honor…and then one day my office manager rips one of those phone message things from the book and hands me my copy and says, “Oh, this Doctor C.M. is coming into town for a meeting this weekend. He said to call him, maybe you guys can get together.”

At this point I am a successful Board-Certified Plastic Surgeon in Beverly Hills. I’ve got it going on. People respect and like me. My patients love me. I’m an accomplished adult.

And yet my first thought is: OMG!!! C.M.? C.M. was by far the cutest guy in my Med school class. I had not seen or spoken to C.M. for fourteen years. I didn’t think he even knew who I was. How did he find me? And did he mean to find me? I had never had another “Suzanne” in a class with me my entire life, until Med school where there were three of us. And as luck would have it, the other two were: 1) a beauty pageant queen from Maryland and 2) a cute-as-a-button girl who went by “Suzie.” Surely C.M. was confused. Surely he thought he was calling one of them.

Then there was the issue of my face. Even after I moved into the Hyperbaric Oxygen chamber for the next two days and tried the professional makeup again, there was no way my face was ready for a reunion with C.M.

He was staying two blocks away, at the Century Plaza Hyatt. I called him and we had a nice chat. We confirmed that he knew exactly which Suzanne he was talking to—that I was not the ex “Miss Maryland” or the darling five-foot-one girl that everyone was always giving piggy back rides to. He’d heard from a friend that I was in L.A. and he didn’t know anyone here and was hoping we could get together. During this conversation I tried to convey how improved I was since Med School. I was a Beverly Hills Plastic Surgeon. I had cool friends and I myself was incredibly cool, so much cooler and improved than when he knew me in fact, that I was not going to be able to meet him this weekend because in a few hours I was leaving to go snowboarding in Mammoth.

To have to lie like that was pure agony. But there was no way I was going to meet C.M. after fourteen years looking like Frankenstein.

My patients and I share stories like this all the time and when I tell this one–even to the women who are settled and married and out of the dating world (as am I!)—they feel my pain as if it were their own. Because no matter what we do as women professionally, when it comes to dating, for some reason the playing field is completely leveled out and when we get really excited about someone, we start acting like we’re in high school again.

On that note, as much as I generally dislike medical TV shows, I can’t help noticing that there are a couple of new ones this fall that resonate with me–“The Mindy Project” on Fox and “Emily Owens, MD” on the CW–about young Bridget-Jonesy female physicians failing miserably in their personal lives despite their successful careers. While the main character in my book, Lipo Queen isn’t bumbling around the hospital, mooning after her colleagues in between saving lives, what makes her interesting is her confidence in the workplace, and lack thereof around men. So I’m curious to tune in, particularly to “Emily Owens, MD,” which has the tag-line “High school in the hospital.” However, I don’t think doctors, with their stunted social development, are the only ones who tend to behave like high schoolers in the workplace. I’m guessing that behind closed doors, the big law firms and business offices are not very different.

If you don’t have a reason to watch it, I’ll give you one:

My husband can make fun of me all he wants, but he’s the one watching Vampire Diaries and asking, “Honey, why aren’t these girls taking their clothes off?” and I have to tell him, “They’re underage, and you’re on the wrong network.”

The show premieres October 16th on the CW, but the pilot is available online. Here’s a link to watch it: 

Check it out! It looks like fun, and a dichotomy (big word for me, I know) that most women can relate to!  But please remember, no matter what those TV doctors say—not all of us plastic surgeons are mean girls. 😉



You asked and we answered! See below:

The latest and greatest Fraxel machine is called the Fraxel Restore.  It is a fractionalized resurfacing laser that has two wavelengths (1550 nm and 1927 nm).  The 1550 penetrates deeper then the 1927, which means it is good for fine lines, wrinkles, acne and surgical scars.  The 1927 wavelength has more superficial penetration and is great for any hyperpigmentation spots (sun spots) as well as Actinic Keratoses (pre-cancerous lesions).  The laser puts microscopic pinpoint holes into the skin called microscopic treatment zones (MTZs), which in turn spares the surrounding area from injury compared to traditional CO2 laser resurfacing where the entire area is injured.  This also allows for less healing time and less risk than traditional CO2.  These small wounds trigger your body’s healing response system to produce collagen and elastin in the treated areas. There is about 5 days of redness and swelling after Fraxel before one starts to see the results. Even though results start to take effect within the first week, Read More

So Christine and her equally awesome sister Karianne–who is a nurse at Ava MD—and I had a Fraxel® party on Friday. The Fraxel® laser does skin resurfacing for wrinkles, acne scars, sun spots, and surgical scars (and it’s less harsh than the time-honored C02 laser, that works but can leave you red for weeks.) Christine was completely honest with me about how it temporarily makes you scary swollen and has about five days of downtime on the face, so I chickened out and just did my neck because I had a meeting the next day. With numbing cream on an hour before it really didn’t hurt much at all, and it got red but not outrageous. The next day it was pretty swollen but now, forty-eight hours out, it just feels a little tight (which was the point, I guess, right?) and a little rough, but not too weird. My skin definitely looks more Read More