IS IT RIGHT FOR YOU? PAGE 8
If St. Dolly says it’s OK to have a face-lift, then it’s OK by me BY LESA CROWE | For The Oklahoman
“If I see something sagging, bagging or dragging, I’ll get it nipped, tucked or sucked.” — St. Dolly
I
have finally started the investigative process into getting a face-lift. For you faithful readers who have followed me for years, you know I have been threatening this for some time. My departed mother even told me it was OK to spend my inheritance on fixing my face. I have had approval from everyone, including (but not limited to) my husband, my friends and Dolly Parton, the Patron Saint of Plastic Surgery. But I hadn’t given myself approval. That is, until I walked into a bar to have drinks with my husband on a busy Friday night. Walk with me, in your mind’s eye, if you would. Big outdoor bar. The place is packed. I look good. (My sister, Kelly, has moved five minutes away from me and takes me out every morning and makes me exercise. Really. Exercise. I know. Me? Imagine. I’ve already lost two inches off my waist and two on my hips, so frankly, I really do look good.) I’ve let my country club blonde hair grow out, so it’s below my shoulders. Little T-shirt, cute jeans, sunglasses, I’m ready on a hot Friday night to go romance my hub. As I walk through the crowd, some little 20-something runs up to me and says, “Hey girl, can I buy you a drink?” I lower my sunglasses, look him full in the face, and he positively cringes. “Oh, I’m sorry, ma’am,” he says and runs away as quick as his little Birkenstocks could take him. I’ve become one of those long-hair wearing, heightand weight-appropriate old women that shock people with my old face. And so, with withered face and petered-out checkbook, I have begun the process of getting this done. FUNDING THIS SUCKER “It costs a lot of money to look this cheap.” — St. Dolly Did you know they have payment plans for facelifts? I kid you not. There are handy dandy little flyers littering the medical spa/plastic surgeon’s office extolling the virtues of buying your new face on credit. Can you imagine? Knowing my luck, I’d finance my face-lift for five years and up and die three years into the loan. Can’t you just see my knuckle-dragging husband paying for the remainder of my face-lift through probate? And the comments at the funeral! “Well, she didn’t get much use out of that face-lift!” My mother would never let me hear the end of it on the Other Side. SEE ST. DOLLY, PAGE 3
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“It costs a lot of money to look this cheap.” — St. Dolly [PHOTO ILLUSTRATION BY TODD PENDLETON, THE OKLAHOMAN]
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GOING UNDER THE KNIFE … OR NOT
I’ve thought seriously about sacking the 401(k), but that would give my accountant a heart attack. So I’ve finally started squirreling away money every time I make a purchase. You know how to do that, right? Go to the grocery store. Use your debit card. When it asks if you want money back, you say, “Well, yes. Yes, I do!” And you take out an extra $40 without the spouse knowing and tuck it into the face-lift stash, otherwise known as the underwear drawer. Now, you may be asking yourself, “How does she know how to do this and hasn’t she just outted herself to her husband?” Ladies, please. HE’S the one I learned that from, Mr. Take-$200-Out-of-the-BankAnytime-I-Want-To-And-GetChewed-Out-for-It-Because-WeAre-On-A-Budget Crowe. (Yep. Busted, mister.) I’m up to a couple of thousand. At this rate, I’ll be 74 before I can get this face fixed.
“Thanks to Botox and fillers, as well as the work I’ve already had, my face pretty well maintains itself.” — St. Dolly
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I went to a recent affair and as it happens, encountered a set of tables where people were selling their wares. Of course there was a medical spa there. (Side note: You know, some part of me looks up and asks myself, “Should medical and spa be in the same title?” And I answer, “Yes, sometimes” … It is hard to live inside my head.) Lots and lots of brightly colored brochures jabbering on about the virtues of fixing everything with a needle. “Nonsurgical.” We’ll put some in — we’ll take some out sort of thing. They promise to cost less and deliver more. I probably would have considered this option, but two things stood in my way. First, the brochures were chocked full of 30-year-old women. At 59, I am most certainly NOT their
target market. And the people who were selling these nonsurgical procedures? They look like they had gotten a little carried away with their own products. I mean, lips for days. People could hardly blink, much less smile. I do not want to be one of God’s frozen few, so no. Just no. STICKING WITH TRIED AND TRUE If God didn’t want plastic surgeons, he wouldn’t have given them hands to work with.” — St. Dolly I’ve visited with two plastic surgeons. One was a positive experience. The other, frankly, was a bit iffy. Have you seen that commercial on TV with Debbie Boone talking about the “lunch” lift? They use piano strings or something to reattach your chin somewhere up round your eyebrows. It’s supposed to be “painfree” and they say you’ll experience
no downtime. What’s not pain-free? How much they cost. Eyes, throat and facial peel would run me about $12,500. And they said it with a straight face. I thought, “No way, Jose. I’m going to a real surgeon.” I’ve read the reviews, heard the pros and cons of many, but in the end, I’ve selected one that’s worked on a friend of mine. The friend’s a bit younger than I am, but she looks 40, without even trying. Thank you, St. Dolly, for the inspiration to go through with this. Now, I have to go to the grocery store for more money. Mama needs a facelift. Lesa Deason Crowe is the head honcho of atomic.marketing and the girlfriend/wife of her knuckle-dragging Neanderthal husband, Norman. She’s having a lovely spring with her grandkids, the wedding of son, Taylor, to adopted daughter, Lila, was wonderful and she is poised to stage a bloodless coup over her new homeowner’s association. Stay tuned.
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More Americans 65 and older are getting plastic surgery BY TARA BAHRAMPOUR The Washington Post
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aria Vargas was fed up with looking like an old woman. That was how the 68-yearold felt when she walked down the street. “I’d lost the looks of men,” said Vargas, who is divorced. “I’d walk by men, and men would probably go, “Yeah, there’s a cute grandma.’” So in February, after months of wrestling with the decision, she got a neck lift. “I got so excited about the difference that it made that I was like, ‘Oh my god, I want more,’” said Vargas, a Sacramento, California, resident who had never had elective plastic surgery before. Now, she said, “No 30- or 45-year-old guy is going to ask me, ‘Hey, what’s your number, honey?’ But a 60-year-old will.” According to the American Society for Aesthetic Plastic Surgery, the number of people 65 and older getting face-lifts and cosmetic eyelid surgeries has more than doubled over the last two decades, with much of that increase occurring over the last five years. In 2015, 39,772 eyelid surgeries and 37,632 face-lifts were performed on people 65 and older. Although there is no age breakdown within the category, doctors report that most of their older patients are between 65 and 75, and around three-quarters are new to plastic surgery. Part of it is demographics. People are living longer, and the baby boomer generation started turning 65 five years ago, so there are more people over 65 than in the past. But even accounting for that, the rate of eyelid surgeries in that age group has risen 62 percent and the rate of facelifts has doubled. The trend appears to reflect both cultural and economic shifts, including a growing acceptance of elective surgery helped along by popular
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Jean Stark, 83, a retiree in Lakewood, Colorado, with her surgeon, Jack Zamora. [FAMILY PHOTO]
shows like “Nip/Tuck” and a reduction in the procedures’ cost and invasiveness. Then, too, people are remaining in the workforce and dating game later in life and fear falling victim to age discrimination.
Some advocates contend that in trying to avoid the latter, older people who get plastic surgery to look younger are inadvertently perpetuating ageism. But at the same time, they concede that in a world that
fetishizes youth, the impulse may make practical sense. “People are making a calculated decision, trying to escape the stigma of aging and buy a little time, be in the world and not be sidelined because of their appearance,” said Bill Thomas, a geriatrician who is trying to push Americans toward accepting old age as a welcome stage of life. “It’s the age equivalent of ‘passing’” Thomas said. “You’re actually in this cohort but can you get everybody to believe you’re in a different cohort?” In recent years, both surgical and nonsurgical options have expanded. Many people are forgoing the far more expensive traditional face-lift in favor of in-office surgical procedures that cost $4,500 to $6,500, and also lessen the risk of medical complications more prevalent in older patients. “With technology we’re able to do a more minimally invasive procedures, without general anesthesia, without hospitalization,” said Jack Zamora, an oculofacial plastic surgeon in Denver, Colorado. The lowered cost has made plastic surgery an option beyond the ranks of the elite. A generation ago “you may have had the odd movie star having something done, but it wasn’t something for the masses,” said Colin Milner, CEO of the International Council on Active Aging, an organization that promotes healthy aging. There are different economic considerations now. More Americans 65 and older are working than at any time since the turn of the century, and many face age discrimination. If opportunities are accruing to the young “and you begin to get old, you want to fit in. ... You’re invisible. And maybe this is the way for people to be visible.” Milner said. SEE SURGERY, PAGE 5
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But the change is also reflects an evolution of how older people perceive themselves — which is to say, often not as old as they once did. “I’m 60 and I remember when my grandfather and grandmother were 60 and it was like they had a foot on a banana peel, and the other in the grave — and now (people their age) are skiing,” said Dan Mills, president of the American Society for Aesthetic Plastic Surgery. Increasingly, as Americans remain more physically fit later in life, they often see a disconnect in how they look versus how they feel. That concern is not limited to baby boomers. Mills recalled a 78-year-old woman who played tennis and yet was constantly fending off a little boy who wanted to carry her groceries. After a face-lift and a forehead lift, the offers stopped. Unsurprisingly, given the greater pressure on women to stay physically attractive, most older patients are women. But rather than the wholesale change in appearance that was more common in the past, they are more often seeking to return to work or social lives looking more refreshed than transformed. When Linda Dodson, 68, of Oroville, California, had a complete face-lift in March, “a lot of people, unless I told them, they didn’t really
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notice. They all just said I look great.” She made the decision after receiving treatment for breast cancer, including a mastectomy. “Things had been taken away from me personally, because of the cancer, and this was something I wanted to do for me,” she said. Not everyone was convinced. “My husband was totally against it. He’d say, ‘I don’t want you to change, I love you the way you are. It made me feel good, because that’s how a husband should feel about you, but ... I wanted to wake up in the morning and feel better about myself.” Her husband ended up liking it — and it had other effects. “As I became older, I had noticed that the general public isn’t as interested in what you have to say,” she said, “but afterward I noticed a big change in how people react to me.” That reality is discouraging for Ashton Applewhite, an anti-ageism activist who equates plastic surgery with “a prejudice against your own future self.” “I really, really get the reasons why people dye their gray hair, lie about their age, and have cosmetic surgery,” she said. “But it’s not good for us, because it’s not authentic and it gives a pass to the underlying discrimination that makes those things necessary.” However, Jean Stark, 83, a retiree in Lake-
“
With technology we’re able to do more minimally invasive procedures, without general anesthesia, without hospitalization.” — Jack Zamora, an oculofacial plastic surgeon in Denver, Colorado
wood, Colorado, sees no need to hold off as a political statement. She had work done on her eyelids a decade ago and is planning further procedures, including to her neck and jaw. It’s not such a big deal, she says. “If you look in the mirror and you don’t like the way you look, if you can improve yourself, why not?” Stark said. “I would have done this years and years ago, but then a lot of this wasn’t available years and years ago. ... What in the world have I got to lose? If I drop dead the next day, at least the undertaker will have a good face to look at.” The Washington Post’s Ted Mellnik contributed to this story.
WEDNESDAY, JUNE 21, 2017
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‘Second skin’
could treat eczema and hide wrinkles By Rachel Feltman | The Washington Post
E
ven if you try to love the skin you’re in, chances are that you’d make a few tweaks if you could. But what if instead of plastic surgery or questionable cosmetic potions, you could slather on a second skin that eliminated some of those imperfections? Scientists from the Massachusetts Institute of Technology and Harvard say that the material they’ve developed can seamlessly smooth the appearance of wrinkles and sagging under the eye. And the same “second skin” could have a wide range of medical applications. The material might sound familiar: Initially developed by skin and haircare company Living Proof, the so-called Strateris platform (now under development with a spinoff company called Olivo Labs) was briefly introduced to a small number of dermatology practices in 2014. At the time, it was marketed solely as a undereye solution — and it’s no longer available for sale. But a paper published Monday in Nature Materials tests the limits of the unique skin coating, and the researchers involved say it could actually find its best use in patients with severe skin problems such as eczema or psoriasis, which can both cause extremely dry and itchy skin. That’s because the system — which goes on the skin in two steps, each a simple application of a gel or cream — locks in moisture, as well as the thickest, stickiest ointments can. And instead of washing off or becoming less effective as it smears away onto clothing and other surfaces, the second skin can stay on for at least 24 hours, or until users deliberately rub and peel it off. In tests of 25 users, just two had visible “edges” after 16 hours of wear. Study co-author Barbara A. Gilchrest, acting president of the American Skin Association, said that she hopes to see the material used to treat eczema and psoriasis, which can be debilitatingly uncomfortable in the elderly. These conditions largely come down to the skin’s failure as a barrier between the body and the outside world, she explained, and artificially supporting that barrier with a new layer of “skin” could keep patients more comfortable. “The only thing we have to offer people at present is a heavy moisturizer, which does work temporarily ... but it’s not at all ideal,” Gilchrest told The Post. “This heavy layer of moisturizer looks and feels greasy. It gets all over your clothes and bedclothes. It’s just really not very good.” SEE SKIN, PAGE 7
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The new material acts more like skin than like a layer of ointment. It contains a chemical structure known as siloxane (a chain of alternating atoms of silicon and oxygen) that assembles itself into an interlocked network when exposed to another chemical compound. The siloxane slides on smooth, then hardens when the second layer is added. Still, it retains impressive elasticity: It can return to its original state after being stretched more than 250 percent, while natural skin can only be elongated about 180 percent. And the second skin returned to its smooth state much faster than saggy under-eye skin or “invisible” wound coverings currently available on the market. The researchers involved cycled through 100 siloxane-based polymers to find one with such desirable properties. The study reports no negative effects in the test subjects, and Gilchrest claims that the subjects used to test the wrinkle-fighting powers of the polymer absolutely loved it. In the future, the polymer could even contain medications that otherwise might not properly penetrate the skin. “Ointments have the same problem that greasy moisturizers have,” Gilchrest explained. Patients often opt to get their topical medications in cream form — ones that slide on and absorb quickly like lotions — to avoid having sticky ointments on their skin. But these don’t usually work as well. “Having something that would be practical and stay on and be acceptable to patients as a way of delivering more medication where it’s needed could open up a whole area in which we could provide more effective, more practical, more pleasant treatments,” she said. The researchers wouldn’t comment on projected costs, and when it was offered in limited quantities in 2014 the second skin cost a hefty $500 per month for a supply intended to hide under-eye wrinkles. One shudders to think at what it would cost to slather the stuff all over an itchy body, but a scale-up in production could presumably THE OKLAHOMAN | NEWSOK.COM
cut the cost. And if the technology makes its way into prescription pharmaceutical products, insurance companies may foot part of the bill for patients in need. Study author Amir Nashat, who received his Ph.D. in chemical engineering under fellow study author Robert Langer, of MIT, and who has been involved with Living Proof since its early days, confirmed that Olivo will be focused on medical applications — and primarily skin conditions like eczema — for the time being. The lab expects to have clinical data within the next year. “We do know that there are beauty and cosmetic and wellness applications, and over time we’ll explore and commercialize those as well,” Nashat told The Post. Gilchrest doesn’t think the cosmetic applications are anything to wrinkle your nose at: The undereye area produces some of the most visibly prominent signs of aging, and large bags make you seem tired and disinterested. Humans are superficial beasts. “The truth is that appearance matters to people, especially in this country,” Gilchrest said, explaining that there isn’t a particularly effective alternative to surgical intervention on the market. “There are a number of things on the market that work by hydrating the skin, but they have a largely transitive effect,” she said. “People use these things religiously.” Indeed, one recent survey projected that the global anti-aging market would be worth $191.7 billion by 2019. But studies have found many of the lotions and potions to be woefully ineffective. The new second skin seems to provide a more notable, immediate effect — but whether it will ever be an affordable beauty aide is another matter entirely. For now it can’t be layered on or under makeup, which would likely turn off a large portion of its cosmetic customer base. If Olivo Labs moves the product back into the beauty world, material scientists may have to tweak the formula to make it suitable for use with makeup — or just create entirely new makeup products to go with it. WEDNESDAY, JUNE 21, 2017
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Boomers increasingly seek nips, tucks to ‘stay relevant’ With the advent of an array of minimally invasive procedures that complement surgery, boomers are getting better results that are increasingly more affordable. [PHOTO PROVIDED]
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BY MELISSA HOWELL | mhowell@oklahoman.com
hat does it mean to “be younger?” To look younger? To feel more vital? Maybe it’s just a youthful state of mind. Most over the age of 55 would say all of the above. According to a Pew Research survey, the typical boomer feels nine years younger than his or her chronological age and believes that old age doesn’t begin until age 72 — a far cry from the previous
generation when old age generally was considered to start at 65. Ah, but there are those pesky aches and pains, the occasional health scare, and yeah, sags and wrinkles that remind boomers they aren’t getting any younger — despite their “forever young” anthem. It’s a dilemma that has led boomers in record numbers to med spas and surgical suites to remedy the insult of physical aging. SEE RELEVANT, PAGE 9
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BOOMING BUSINESS FOR BOOMERS
Dr. Tim Love [PHOTO PROVIDED]
“
Aging results from a number of different factors including genetics, habits and environment. We can’t stop aging, but we can modify or slow it.” — Dr. Tim Love
Dr. Tim Love, an Oklahoma City-based plastic surgeon, says he has seen a continual rise in his boomer patients. “People start visible signs of aging in their early 20s,” he said. “Aging results from a number of different factors including genetics, habits and environment. We can’t stop aging, but we can modify or slow it. When I talk to a patient, I try to focus on either correcting the ageing feature or slowing the aging process. People want to look as good as they can for as long as they can.” The good news is, with the advent of an array of minimally invasive procedures that complement surgery, boomers are getting better results that are increasingly more affordable. “Traditional cosmetic surgical procedures and nonsurgical rejuvenation technologies area complementary to one another. What surgery can accomplish oftentimes nonsurgical procedures cannot,” he said. “Various nonsurgical technologies can very much enhance a surgical outcome. Clearly the lines between ‘surgical’ and ‘nonsurgical’ can be confusing to the public.”
to and accepting of the time and commitment required to achieve an optimal surgical outcome. Post-pregnancy, breast and body changes can be priorities to our patients wanting to regain their pre-pregnancy bodies.”
“Cosmetic surgery can be either a motivator or a hard-earned reward for a lifestyle change. Regardless of the timing of the surgery, this is an investment in personal wellness. It’s not an egotistical thing. Everyone needs to feel like they are improving.”
GREAT EXPECTATIONS MEN ARE KEEPING UP APPEARANCES, TOO An interesting statistic coming out of the most recent survey by the American Society of Plastic Surgeons, is that more men are seeking nips and tucks, but they’re not the same as procedures as what women request. “In my practice, men are receptive to hair transplants, gynecomastia surgery and liposuction in larger numbers. Male faces come with their own set of issues because they have facial hair, side burns, short haircuts and don’t wear makeup that limits their ability to conceal facial procedures. Women, in general, are more receptive
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With the advent of an array of minimally invasive procedures that complement surgery, boomers are getting better results that are increasingly more affordable. [THINKSTOCK]
BE A DOC FIRST Before undergoing a cosmetic surgical procedure, experts say it is imperative to be realistic about the outcome. “It is important that patients need to be educated regarding realistic expectations,” he said. Patients often ask ‘what can you do for me?’ and I respond by informing them of available options. Through that education process, we formulate a surgery plan specific to each person’s needs.” But Love adds, unrealistic expectations are not often something he sees. “A sense of wellness goes hand and hand with being pleased with one’s appearance,” he said.
In the end, Love says he and his fellow plastic surgeons look to be doctors first, making the health of their patients the foremost concern. “First and foremost, patient safety is paramount,” he said. “Cosmetic surgery, even though being done for appearance issues, is still surgery and has to be taken seriously. I am very thorough in first doing no harm. Complete medical evaluation is a fundamental part of the surgical experience. I spend a lot of time preparing my patients for surgery. The best way to do surgery is to do it right the first time.”
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Millions of Americans are undergoing cosmetic and surgical procedures A new report from the American Society of Plastic Surgeons reveals that Americans who are 55 and older underwent 3.9 million cosmetic and surgical procedures in 2015. Among the more popular cosmetic surgical procedures among older patients and their related costs were:
SURGICAL COSMETIC PROCEDURES Dermabrasion
National average cost: $1,162 Eyelid surgery
National average cost: $3,022 Face-lift
National average cost: (Full face-lift) $7,122 (Mini face-lift) $5,029
MINIMALLY INVASIVE COSMETIC PROCEDURES Among the more popular minimally-invasive cosmetic procedures and their related costs were: Wrinkle treatment injections (botulinum toxin type-A, such as Botox, Dysport) National average cost: $385 Soft tissue fillers
•Calcium hydroxylapatite (e.g. Radiesse) National average cost: $687 •Fat National average cost: $1,930 •Hyaluronic acid (e.g. Juvederm, Perlane, Restylane) National average cost: $644 •Polylactic acid (e.g. Sculptra) National average cost: $773 •Polymethyl-methacrylate microspheres (e.g. Artefill) National average cost: $859 Chemical peel
National average cost: $673
Trends: It’s all about the flab From body fat reduction to harvesting fat to enhance other parts of the body, the data shows new cosmetic procedural trends related to the role of fat in body shaping. “One trend we are seeing with fat involves an increase in fat grafting procedures. Plastic surgeons harvest a patient’s unwanted fat from their abdomen using liposuction and then inject it to lift and rejuvenate other areas such as the face, buttock and even the breast,” said ASPS President Dr. Debra Johnson. “Because the material injected is the patient’s own fat the results typically last longer than fillers.” •Minimally invasive cosmetic fat injections increased 13 percent. •Buttock augmentation using fat grafting increased 26 percent. •Breast augmentation using fat grafting increased 72 percent. Newer, noninvasive fat reduction and skin tightening procedures are gaining popularity among patients:
•Injection-based procedures that target fat pockets in specific areas such as under the chin, increased 18 percent. •Noninvasive fat reduction procedures that use special technology to “freeze” fat without surgery increased 5 percent. •Noninvasive skin tightening procedures that target fat and tighten sagging areas increased 5 percent. “These newer, noninvasive procedures appeal to a broad range of patients,” Johnson said. “Even though they aren’t surgeries, patients still need to take these procedures seriously. Before undergoing any procedure, consult with a board-certified, ASPS-member surgeon who will ensure that it’s performed to the highest medical standards.” — American Society of Plastic Surgeons
Microdermabrasion Liposuction
National average cost: $3,200
National average cost: $138 Laser treatments (intense pulsed light)
National average cost: $433
At a glance: Cosmetic procedures SURGICAL Arm Lift Buttock Augmentation Body Lift Thigh Lift Tummy Tuck Body Contouring Breast Augmentation Breast Lift Fat Transfer Breast Augmentation Breast Reduction Liposuction Liposuction — Laser Ultrasound Assisted Nonsurgical Fat Reduction Chin Surgery Ear Surgery Facial Implants Rhinoplasty
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Neck Lift Brow Lift Eyelid Surgery Facelift Gynecomastia Surgery Hair Transplant Men
NONSURGICAL Botulinum Toxin Chemical Peel Dermal Fillers Laser Hair Removal Laser Skin Resurfacing Microdermabrasion Permanent Makeup Skin Rejuvenation and Resurfacing Spider Vein Treatment SOURCE: American Society
of Plastic Surgeons THE OKLAHOMAN | NEWSOK.COM
There’s a reason some people don’t look as old as they actually are
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BY DAVID BROWN | Special To The Washington Post
ook at Alexander Gardner’s last photographic portrait of the 55-year-old Abraham Lincoln. Or Dorothea Lange’s photograph of the “Migrant Mother,” age 32, taken in the depths of the Great Depression. Or pretty much any picture of Keith Richards from the past 25 years. It’s hard not to think, “Wow, they really look old for their age.” The idea that time wears on the body in a predictable way — and that for some people the process is accelerated or slowed — seems obvious. But is it true? Do we have a bodily timekeeper? Where might it reside? Can we tell whether it’s in sync with the calendar? These questions are central to the mystery of aging, our one-way ride on the arrow of time. They’re also important to understanding chronic diseases — the heart attack, stroke, cancer and dementia that grow more likely the older we get. The newest strategy to prevent disease, in fact, is to find ways to slow aging. “There is such a thing as ‘biological age,’ and it is distinct from chronological age,” said Steve Horvath, a professor of human genetics at UCLA. “There is a huge debate about how to measure it. But everybody would agree ‘biological age’ should be a better predictor of how long you Steve Horvath live than chronological age.” Brian K. Kennedy, who heads the Buck Institute for Research on Aging, in Marin County, California, goes a step further. “I’m a firm believer that there is a ‘biological age,’ that it is different for different people, and that it can be manipulated,” he said. “At least it can be manipulated in animals, and I think we will be able to manipulate it in humans, too.” SEE AGE, PAGE 12
Biological age is a better measurement of vitality than chronological age. [PHOTO PROVIDED]
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AGE, CONTINUED FROM PAGE 11
The idea that biological age is measurable and predictive only recently moved out of the mouse lab into human epidemiology. A study published last year looked at roughly 1,000 New Zealanders who have been followed by researchers since their birth in the city of Dunedin in 1972 and 1973. The group is periodically given tests of organs (heart, lungs, liver, kidneys, immune system, etc.) whose function slowly begins to decline starting about age 30. The results are used to calculate “biological age.” (The researchers employed a formula developed from a sample of 9,400 Americans aged 30 to 75. Biological age describes how a person’s measured physiological profile compares to that of the average person of the same age in the population.) In the Dunedin study, biological age was calculated for each person when the group was 26, 32 and 38 years old. Because the calculation was done repeatedly over a dozen years, the researchers were also able to estimate a “pace of aging” for each person. The results were startling. Even though all subjects had a chronological age of 38, their biological ages ranged from 28 to 61. There was a similarly wide range in the pace of aging. A few people showed virtually no aging over 12 years, a few showed three years of biological aging per year lived, and the rest fell in between. ‘A SYSTEMIC PROCESS’ People with higher biological age did less well on tests of balance, fine motor skill, grip strength and abstract reasoning. The blood vessels in their retinas — a view 12
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Telomere extension at the ends of chromosomes, shown here in green, was linked in a 2015 study to anti-aging in cultured human cells. [PHOTO PROVIDED BY STANFORD MEDICINE, STANFORD UNIVERSITY]
into the blood vessels in the brain — looked older. When a panel of college students estimated the age of these Dunedin individuals based on a photograph, those with advanced biological age were judged older. The conclusion was that people who were “biologically old” for their age showed it in many ways — with weaker muscles, slower thinking, narrower arteries and a careworn appearance. “Our data suggest that aging is a systemic process — that you see an accumu-
lating loss of integrity across many systems of human physiology,” said Daniel W. Belsky, an epidemiologist at Duke University who was lead author of the study in the Proceedings of the National Academy of Sciences. Although few people in the Dunedin group had an age-related chronic disease, research suggests that the biologically old among them will soon start getting sick. A study last year found that people in their 70s whose biological age is five
years greater than their chronological age have a 20 percent higher risk of dying over six years than people whose biological and chronological ages are the same. A study of Danish twins in their 80s found that when a pair has different biological ages, the “older” one was twice as likely to die over the ensuing eight years as the “younger” one. Biological age appears to be real and able to predict the future, at least to some extent. But what is driving it?
CELL DIVISION For a while it looked like the answer was: “Telomeres.” Telomeres are tails of extra DNA on the end of our chromosomes. The end of the tail gets docked each time a cell divides because the duplicating machinery can’t copy the last few DNA “letters” at a chromosome’s ends. Some cells have an enzyme that restores telomeres, but in many cells the SEE AGE, PAGE 13
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AGE, CONTINUED FROM PAGE 12
telomeres shorten over time until the cell loses the ability to divide. It then becomes senescent. Not only may it function poorly, it may also secrete substances that pollute the neighborhood, causing inflammation that leads to disease. The notion that telomere wear was the engine of aging had many adherents — until research revealed the story was much more complicated. It is true that short telomeres are associated with a higher risk for heart disease, diabetes, some cancers and poor immune function. Life stress also appears to shorten telomeres, which may partly explain high disease prevalence in the poor. However, people with a rare mutation that keeps telomeres long are more, not less, susceptible to some cancers, such as melanoma. The reason may be that their cells divide more times, increasing the chance of malignant mutation in ones that are especially vulnerable, such as cells in the skin. Furthermore, many mammals (including mice and rats) have short lives and die with long telomeres; the latter don’t assure longevity. “There’s been 20 years of research, and the field has learned that telomere shortening plays a role in aging. But it is not the fundamental cause of aging,” Horvath, the genetics professor, said. “We can debate how important it is.” EPIGENETIC CLOCK A newer and more informative measure is known as the epigenetic clock. It keeps track of age-related changes in molecules, called methyl groups, that attach to the outside of our strands of DNA, like barnacles on a rope dangling off a dock. “DNA methylation” plays a part in regulating genes; its exact role is still being worked out. A person’s methylation pattern is partly inherited and can be altered by lifestyle and environmental exposures. DNA damage, telomere shortening and cell senescence also change methylation patterns. But the biggest driver is the passage of time. THE OKLAHOMAN | NEWSOK.COM
The most accurate epigenetic clock looks at 353 methylation sites out of millions on our chromosomes. Of those, 193 gain methylation with age and 160 lose it. The clock considers both gains and losses. People with HIV infection or Down syndrome — conditions that put them at risk for early heart disease and dementia — have older-than-expected epigenetic ages. On the other hand, people who live to be 100 have epigenetic ages that are nine years younger, on average, than their actual age. Interestingly, their children also have younger-than-expected epigenetic ages, which suggests they’re aging more slowly, too. (Research suggests that about 25 percent of longevity is determined by genes.) DNA methylation appears to be a true biological clock, turned on at birth and not stopping until death. Whether it’s the engine of aging is another question. “In my opinion, there is a fundamental aging process — the true root cause of aging,” Horvath said. Whatever the answer, it’s clear that aging slowly, avoiding disease and living a long time are intertwined phenomena. For example, centenarians not only have retarded biological ages, they’re also more likely to carry specific gene variations (called single nucleotide polymorphisms, or SNPs) that protect against disease. A study published last year found five regions in the human genome where such SNPs reside. In one region, certain SNPs lowered the risk for Alzheimer’s disease, high cholesterol and pancreatic cancer. In a second, the SNPs protected against heart disease and diabetes. In a third, they made lung cancer, pancreatic cancer, heart disease and rheumatoid arthritis less likely. In the end, a person who avoids fatal diseases is likely to grow old and have a body that seems younger than it is, even at age 100. It’s hard to know what causes what. REPAIRING DNA DAMAGE The fact that we don’t yet know the fundamental drivers of aging may be irrelevant. That’s because we already know enough about how
aging happens in organs, cells and molecules to tinker with it. For a cell to remain youthful, it has to maintain the ability to detect and repair DNA damage, keep up its energy production, dispose of its garbage, send out the right chemical messages, stay attached to other cells and do lots of other things. In recent decades, scientists have identified genes, enzymes, metabolic pathways and signaling molecules that control those activities. Stimulating or blocking them, with the goal of lengthening life, especially healthy life, can now begin. Nearly all the experiments so far have been in laboratory organisms ranging from yeast to monkeys. The experiments often require drastic steps (such as knocking out genes, killing cells with antibodies, sewing animals together) that are impossible in humans. The hope is to find behaviors or drugs that accomplish the same thing as those experiments have. The easiest way to extend life in many organisms couldn’t be more low-tech. It’s controlled starvation: limiting the intake of food, but not to the point of malnutrition. Caloric restriction invokes myriad physiological responses. It makes organisms more resistant to stress and toxins, more sensitive to glucose and insulin, and in mice it helps prevent heart attack, diabetes, stroke, dementia and Parkinson’s disease. Simply limiting components of the diet (such as protein), or even specific amino acids, lengthens life in some organisms. Many interventions now or soon to be in human trials seek to mimic those effects. And caloric restriction itself is being tried. Researchers last year reported on a two-year study in which 218 non-obese people ages 21 to 51 were randomly assigned either to eat as they wanted or to reduce their caloric intake by 25 percent. People in the caloric-restriction group cut their calories by 12 percent over the two years (more the first year than the second), and lost 10 percent of their weight. Metabolic rate, blood pressure, cholesterol, insulin resistance and a marker of inflammation all moved in healthful directions. But the study was too small and short
to measure longevity or incidence of disease. Its purpose was mostly to show that such experiments are feasible and safe. The list of anti-aging compounds — verified in yeast, nematodes, flies, fish and mammals — now IS moving into human trials is growing. An immunosuppressive drug called rapamycin down regulates an enzyme called mTOR; the drug extends the life of rats by 30 percent. A widely used diabetes drug, metformin, which extends life in mice, will soon be tested in non-diabetic elderly people. Researchers want to learn whether it prevents or delays ailments such as cancer, stroke and dementia. Resveratrol, a compound in grapes and blueberries, and some other natural substances are being studied for their epigenetic effects on chromosomes. YOUR BIOLOGICAL AGE So when might any of this be coming to your doctor’s office? “We try not to share information with patients that is not of use to them,” said Belsky, the lead author of the New Zealand study. Measurements of biological age aren’t valid enough “for them to be clinically useful.” Will there be a time when they’re part of the medical exam? “Absolutely.” Kennedy, of the Buck Institute, feels similarly about drugs to slow aging. He foresees a time when patients meet with a physician at age 50 for an assessment that includes blood and gene tests, personal and family history, and talk about diet, habits and behavior. It may result in a prescription. “Some drugs will work in some people,” he said. “They will certainly work better if people are choosing healthy lifestyles.” One pill won’t do it all, and there is no Fountain of Youth. But there may be a Leaky Faucet of Youth, and ways to keep it dripping. Brown is a physician and a longtime writer on medical and health issues for The Washington Post. WEDNESDAY, JUNE 21, 2017
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Too old for braces? BY MELISSA HOWELL
C
mhowell@oklahoman.com
hildhood is the optimum time to make changes to teeth, but more and more, older adults are opting for orthodontic work to correct crooked teeth and poorly aligned bites. In fact, the American Association of Orthodontists notes that one in five orthodontic patients now is over age 18. “It’s become more acceptable now. With better dentistry and better education, we’re keeping teeth longer and people what them to look nice,” said Dr. Priscilla Pickens-Larson, who has orthodontic practices in Moore and Shawnee. “In the past, when I got my braces 20 years ago, I don’t remember seeing anyone over the age of 18 in the waiting room. Now it’s just totally a mix. I have adult patients, some in their 60s and 70s. Typically, Pickens-Larsen says older patients come to her in one of two ways. “First is the self-refer. Someone who says, ‘I had braces and didn’t wear my retainers. I want to get my teeth back so they look nice,’ “ she said. “The other group is referred from a dentist. Maybe a tooth has drifted in the way and I have to do some restorative work.” ‘DISCREET’ BRACES To keep up with the demands associated with older patients, orthodontists are offering appliances that are more discreet, including clear aligners, porcelain braces and back-of-the-teeth lingual orthodontics. Of course these products have their pros and cons. While tooth-colored ceramic or clear plastic brackets and lingual devices are less noticeable, they
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WEDNESDAY, JUNE 21, 2017
More adults are seeking orthodontic work later in life
tend to cost more and can require longer treatment than their metal counterparts, according to Harvard University publication, Healthbeat. There also is some concern about ceramic brackets wearing away tooth enamel. ISSUES TO CONSIDER That’s why Pickens-Larsen advises having a strong treatment plan that will work with the specific needs of older patients which are different from younger patients. One issue is that the bones of adults have stopped growing, so some structural changes cannot be accomplished, she said. Another consideration is gum disease. An orthodontist may have to work with a periodontist to ensure that bone loss from gum disease will not complicate the treatment. “If an older patient has had gum disease, we have to plan for that. Adjust for that. Also with older patients I don’t have growth to work with, so I have to adjust expectations. If they have a bite that needs to be fixed, there are limitations,” Pickens-Larsen said. “But often times adult treatment is easier. Adult patients are much more likely to follow instructions.” Orthodontic work can cost from $1,000 to $2,000 for minor straightening to $5,000 to $7,000 for full comprehensive treatment, Pickens-Larsen said. But dental insurance making it an option. “For some people it makes more of a difference than a face-lift,” she said. “The confidence they have from having their own great teeth almost gives them a face-lift. They smile with their whole mouth. “I encourage older adults to not let hesitation hold them back,” she said. “If you have been told in the past that you’re not a good candidate, the technology has advanced. Go for it!”
More and more, older adults are opting for orthodontic work to correct crooked teeth and poorly aligned bites. [PHOTO PROVIDED]
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