What if there was a whole different level of skincare products available that could make your skin glow with good health?

Where would you find them? Would they be safe? What would they be called?

The answer is, they would be called "cosmeceuticals" and they're not a product of the future, but of the today. You can find them in your dermatologist's office, as well as on the drug store shelf.

Cosmeceutical products are interesting hybrids — not quite a pharmaceutical requiring a prescription, but definitely more potent than your average jar of cold cream.

According to Detroit-based dermatologist Steven Grekin, D.O., cosmeceuticals get their name because they are often a combination of cosmetic science and pharmaceutical research and development (R&D), and they usually offer a higher level of active ingredients.

"Cosmeceuticals often provide higher levels of antioxidant ingredients and have a greater impact on the skin," he explains. "They are usually studied longer than the average cosmetic skincare product, and this more extensive level of R&D gives the skin an increased level of active ingredients."

ANTIOXIDANT BENEFITS

Dr. Grekin cites products, such as Prevage MD, for instance, which is an anti-aging treatment that contains idebenone 1 percent and has been scientifically shown to be the most powerful antioxidant available in a skincare product, according to its manufacturer.

Prevage MD helps correct present damage and protect skin from future damage by environmental stressors known to cause skin aging, including UV radiation, ozone, air pollution, cigarette smoke and the aging process itself.

Ingredients such as Co-Q10 and vitamin C are antioxidants found in many cosmeceutical products. These are known for their ability to bind with free radicals and minimize or correct damage from stressors such as the sun and pollution.

Vitamin C, however, is a tricky ingredient, as it is often difficult to keep its potency shelf-stable. A good product to try is Cellex-C.

Other antioxidant products to consider is RevaleSkin by Stiefel with coffee berry extract and CE Ferrulic by SkinCeuticals by L'Oreal with ferrulic acid.

WHAT'S IN THAT?

The cosmeceutical arena is often the place to look for the active ingredients that one can't find in regular skincare products.

Dr. Grekin's office features a product called Natural Oxygenating Serum that contains live yeast cell derivative. This adds oxygen to the skin tissues under the eyes to improve the appearance of fine lines and wrinkles and to minimize discoloration that often leaves eyes with what are commonly known as "dark circles."

Another cosmeceutical ingredient that has been in the news is niacin, which can be found in NIA 24 Skin Strengthening Cream. While dermatologists have long recognized niacin for its anti-inflammatory properties, it took years of research to create a molecule that could actually deliver this ingredient into the skin, helping to repair sun damage and hyperpigmentation — often reversing the unsightly brown spots and lines that come from too much sun exposure.

Luzern Organic Cosmeceuticals offers a line of products for those who want the purity of organics without sacrificing luxury and results. Featured products include Force De Vie Pure Oxygen Crème; Force De Vie Eye Contour; Force De Vie Micro-Gel; System 02 Infuse; Serum Wrinkle Erase Absolut; and Serum Rosacea Care Absolut. These items are available from spas, dermatologists, plastic surgeons, medispas and other skincare professionals in the United States and worldwide.

FROM DRUGSTORES AND CATALOGS

Can you find cosmeceuticals in the drug store or in a catalog? You bet. Just look for ingredients such as hexapeptides and retinol often found in skincare products in the Oil of Olay Regenerist line.

Avon also offers a line of skincare products with ingredients to help skin positively glow with good health! Avon's Anew lifts the brow bone and under and upper eye areas. The Anew line includes Deep Crease Concentrate with BoHylurox; ThermFirm Face Lifting Cream; Plump & Smooth Lip System; Advanced Wrinkle Corrector; and Instant Face Lift.

Many years ago I conducted a study on models from the international modeling agency Ford Models. In an attempt to better understand, from a mathematical and geometric perspective, facial proportions and symmetry, I incorporated the work of Dr. Leslie Farkas, laboriously measuring minute differences in the facial alignments of these "attractive" women. But after all the spreadsheets were tabulated and the regression lines drawn, what truly constitutes facial beauty? In other cultures and times, people enhanced their physical appeal through body piercings, scarification, lip rings and earrings. In our culture today, what is the ideal of beauty? Who is our Venus de Milo? Our Mona Lisa?

FACE OF THE FUTURE One weekend I took a break from the office and took a walk to a nearby magazine store. I picked up as many international fashion magazines as I could carry. Flipping through the glossy pages of editorials, advertisements and layouts, there was a universality to these images. Whether from Asia, Europe, Eastern Europe or South America, the women featured in these pages had similar looks. Was this evidence of a multicultural melding? As our world grows smaller and our disparate cultures continue to mix, are our standards of beauty cross-fertilizing beyond geographic boundaries? Will the beautiful face of the future be a true combination of vast cultures and varied peoples? Or perhaps an amalgamation is not what we are witnessing. Maybe the homogeneity of beauty is a westernization of beauty that colonizes and replaces other long-standing traditions and values. Maybe the beautiful face of the future will be a white woman with decidedly western features.

INDUSTRY INFLUENCE It is a contested cultural debate. And what is the plastic surgeon's involvement in the evolution of facial beauty? It is not enough for an ethically minded, socially responsible plastic surgeon to absolve himself in this discourse by saying, "I am simply providing a service that people demand in an open marketplace." As an industry, I feel it is important for us to engage in this social dialogue. Some have argued that plastic surgery is a modern democratic solution to the fickle way in which Mother Nature dispenses beauty. In this light, cosmetic surgery endorses free market, personal fulfillment, self-actualization and free choice. It is liberating that we can take our physical appearance into our own hands and transform ourselves in an act of reinvention. It is a very American notion! Others have criticized the industry, claiming that plastic surgery has added to the image-driven culture we find ourselves in. Some have said that as cosmetic procedures become more and more commonplace, a standardization of beauty, particularly female beauty, has developed. Globally, this homogenization of beauty, they contend, is strikingly Western and white.

ENGAGE AND EXCHANGE Plastic and reconstructive surgery first made its mark in the medical field during the first World War. When malicious trench warfare injured and damaged countless young men and women, our field found ways of surgically healing the wounds. We devised techniques to restore their physical appearance, to mask the disfigurement. Now the field of plastic and reconstructive surgery encompasses the medical response of everything from the emergencies of warfare to the pursuit of beauty and physical perfection. This scope is incredible and singular in medicine.

The motivations for seeking plastic surgery are as varied as the procedures themselves. With all the possibilities, our profession must be vigilant in the practice of ethical, moral medicine. We must celebrate the good and positive things, but we must not shy away from asking the difficult questions. There are no simple answers as we explore the social and cultural significance of cosmetic surgery and the beauty industry. I encourage all of us to engage in the exchange of ideas: Can we personally define for ourselves our moral and ethical viewpoints in this debate? And how do we, as a profession, navigate the many fault lines of this extremely important discussion?

Darrick E. Antell, M.D., F.A.C.S. , received his general surgery training at Stanford University Medical Center and went on to specialize in plastic/reconstructive surgery at the New York Hospital/Cornell Medical Center and the Memorial Sloan-Kettering Cancer Center. He has been in practice for over 20 years at his Park Avenue office in New York City.

Dr. Shestak

"The 'marriage' abdominoplasty approach is still applicable in patients with good skin tone, who can benefit from a combination of general muscle placation in the lower abdomen and whose deformity can be treated by suction of the abdomen, including a fairly aggressive suction of the upper abdomen," Kenneth C. Shestak, M.D., tells Cosmetic Surgery Times .

A 48-year-old female who underwent marriage abdominoplasty had 2100 cc of adipose tissue aspirated from the abdomen and posterior hips. The approach was a vertically oriented musculo-fascial plication of the infra-umbilical rectus muscles of 5 cm in width, and a 7-cm skin excision above the pubic area. (left) Shown pre-operative and (right) two years post-operative.

Same 48-year-old female marriage abdominoplasty patient. (left) Pre-operative lateral view and (right) two years post-operative lateral view.

'MARRIAGE' RATIONALE When first developed, marriage abdominoplasty reigned in an endoscopic-heavy environment; the entire direction of cosmetic surgery from the mid-1990s to the beginning of the new millennium was toward smaller operations with shorter incisions and less down time — a time when the majority of patients opted for the marriage approach, according to dr. shestak.

Same 48-year-old female marriage abdominoplasty patient. (left) Pre-operative anterolateral view and (right) two years post-operative anterolateral view.

Q: I've had brown splotches on my face since the summer. What are they, and what can I do?

Joel Schlessinger, M.D., F.A.A.D., F.A.A.C.S.

Products such as TriLuma can also improve the condition, and regimens such as those offered by Obagi and Vivier can help. All these products contain hydroquinone, which helps lighten the areas. Laser has been used as well.

Dr. Borud

Unlike most other arenas of aesthetic surgery, post-bariatric body contouring can be a truly life-changing event for the patient, with major physical, social and psychological impact. Most overweight patients have struggled much of their lives with physical issues, medical comorbidities, self-esteem and body image problems and social discrimination. After the weight loss has been achieved, despite major improvements in health, patients are disappointed to see a substantial disconnect between their new healthy lifestyle and their sagging physical appearance. They are unable to fit into proper-sized clothing or look as good as they feel. Old body image concerns resurface worse than ever. In short, many patients find they are not enjoying life the way they should be because of all of the excess skin and other deformities present after MWL.

CONTOURING 'COSTS' Surveys have shown that nearly all MWL patients would like to have some form of body contouring surgery. The major roadblock, of course, is cost. With some exceptions, these procedures are aesthetic in nature. Except for the panniculectomy, third-party payors rarely "cover" body contouring procedures after MWL in the United States at this time. Optimally, patients would be educated much earlier in the weight loss process about what to expect financially as well as physically and emotionally after the weight loss process is complete and the patients are considering plastic surgery.

Plastic surgeons who treat MWL patients are faced with a whole host of new challenges. The "old-fashioned" tried-and-true body contouring procedures yield sub-par results when directly applied to the MWL patient. Surgical innovators have had to adapt and update procedures and, in some cases, devise completely new procedures for dealing with these challenges. Although many plastic surgeons are interested in learning and developing experience in post-bariatric body contouring surgery, others — understandably — do not feel equipped in their practice setting to perform such large, labor-intensive operations with complication rates exceeding those of other aesthetic procedures. The interested plastic surgeons need to be committed to learning these new techniques by visiting other surgeons, attending conferences and reading the literature.

CHALLENGES & CAVEATS For plastic surgeons learning post-bariatric body contouring surgery, the technical aspect of the procedures is the tip of the iceberg — patient management and judgment issues abound. Surgery should not occur before the patient has achieved a new and stable weight for some months. In addition to the usual pre-operative evaluation for major surgery, the surgeon must focus on identifying and correcting malnutrition, which can be epidemic in these patients, yet unrecognized. Protein-malnourished patients will suffer massive wound-healing problems. Psychosocial issues are prevalent in this patient population, including depression, other mood disorders, personality disorders and substance abuse. Frequently, there is marital or relationship strife or an unstable family environment. Although most patients find some support among their friends, spouses or family for undergoing bariatric surgery, the same support is often lacking once the weight is lost and the patient is seeking plastic surgery.

Informed consent takes on a new and more complex dimension in these patients as well. In many cases, even the most skilled surgeons cannot produce aesthetic results analogous to aesthetic procedures in the non-MWL patient. BMI at the time of body contouring is, in our experience, the prime indicator of what results can be achieved. This is paramount in helping the patient formulate realistic expectations of outcome. The patient must also be advised about the physiological magnitude of these procedures including real possibilities of blood transfusion, DVT, pulmonary embolism, major fluid shifts, wound dehiscence, damage to lymphatics, unfavorable or asymmetric scarring, seromas and a high "revision" or "touch-up" rate from post-operative loosening of the skin or other causes. Patient safety is also more complicated in the MWL patient. Special attention must be devoted to issues such as obstructive sleep apnea, autologous blood donation and DVT prophylaxis.

Dr. Kluska

(Left) 28-year-old female 36A cup pre-op and (right) 36 full-D cup 11 months post-op. Submuscular implants are moderate-profile 500 cc smooth round saline filled to 550 cc. (Photo credit: Michael S. Kluska, D.O.)

(Left) 34-year-old female 34A cup pre-op and (right) 34D cup six months post-op. Submuscular implants are high-profile 400 cc smooth round saline filled to 420 cc. (Photo credit: Michael S. Kluska, D.O.)

"The balloon-assisted technique enables adequate pocket dissection with minimal risk of trauma in an efficient and timely manner. In my experience with the balloon, total operative time from skin opening to closure is now under 30 minutes. There have been no added safety concerns associated with its use, and results have been excellent regarding implant position and longevity of the outcomes."

Dr. Kluska notes that the longest duration of patient follow-up to date extends to seven years, but he expects the favorable cosmetic results should be maintained for much longer.

"This technique allows implant placement in a complete submuscular or subfascial plane and overcomes the challenge of sagging and malpositioning due to partial submuscular placement found many times in the transaxillary approach."

BAAM BY THE NUMBERS The BAAM technique is performed in two primary and a third optional step.