Corrective Rhinoplasty

Corrective Rhinoplasty
By Andrew Ordon, MD, FACS, ABPS, ASPS
Andrew Ordon, MD

Plastic surgery results usually come out great, but there are exceptions. Unsatisfactory results occur often enough that some surgeons, like me, develop a reputation as being the go-to man to rescue a bad result.
When a surgical nose result is bad, it’s very troubling to a person. It cannot be concealed. Make up helps a little, but not enough. Another challenge for the unhappy nasal patient is that there must be a relatively long waiting period before revision surgery can be done. I rarely break my one-year rule, because for up to a year there may still be a little swelling. The problem with going in too early is that swelling may conceal an issue. Furthermore, swelling may be the entire reason for the patients’ discontent and additional surgery ends up being unnecessary.
To understand the nature of the poor result, a little anatomy lesson is in order. The upper nose is made of two bones that arise from the cheek bone. The nasal bones are connected to the middle part of the nose, which are the upper lateral cartilages. The lower part of the nose (the tip) is made of the lower lateral cartilages which arch up from the nostrils, bend inward at the tip and continue inward together forming the bit of tissue between your nostrils, called the columella. The nasal septum begins just above the columella and continues upward to right between your eyes. The lower part is cartilage and the upper part is bone. That means that cosmetically, the nose has three thirds: the upper which is bone, and the middle and lower (tip) which are cartilaginous.
One of the hardest things to do in plastic surgery is to have smooth transitions between these three parts. Specifically, the junction of the upper nose and the middle third is the most troublesome. Dissatisfaction with the tip is the second most commonly reported complaint. Lastly, it can be a concern if the resulting nose is not straight or symmetrical.
The fix for these problems is usually surgery, but surprisingly, some of them can be substantially improved with the use of injectable fillers or injectable steroids. If surgery is required, it is imperative for the surgeon to educate the patient about this anatomy and where the problem lies. A “punch list” of problems needs to be identified for the patient to fully understand the root of the dissatisfaction. Patients who understand the nature of the defect are most likely to be happy with revision surgery, even if not every single item can be corrected. Patients who are vague and say: “I just don’t like it” are not helping their surgeon establish a pre-operative plan.
Healing from revision surgery takes longer than healing from first-time surgery and patients need to know that ahead of time. That’s the reason revising a nose by simply injecting it has become the first choice, if the defect can be managed that way.
To determine if your unsatisfactory surgical result can be remedied, contact a board certified plastic and reconstructive surgeon.
Dr. Ordon is medical director and owner of The Plastic Surgery Institute in Rancho Mirage and co-host of The Doctors television show. The Plastic Surgery Institute can be reached at (760) 568.2211.

Face Lifts: The Real Deal

Face Lifts: The Real Deal

One of the nice things about a free market economy is competition, which creates the incentive to be better at what we do. In medicine, we strive to achieve our patients’ goals more predictably, with shorter recovery and less down time. The competition between health care providers, medical device companies and pharmaceutical companies encourages evolution and development at a rapid rate. It makes us better.
Unfortunately, competition also provides incentive to make claims that bend the truth in order to gain a financial advantage. Safe guards are in place, but I commonly see treatment that is described as non-surgical when it isn’t; or non-invasive when it actually is invasive.
So, what’s the real deal in face lifting? Is there a non-surgical lift? Is there an incision-less face lift? Let’s remove the smoke and mirrors and reveal the state of the art in facial rejuvenation.
I perform face lifts in four ways, including the traditional facelift, the O-lift, hybrid jawline contouring, and non-invasive techniques which require no incision. No beating around the bush, three of these are surgical; one is not. Procedures promising weekend recovery, and/or involve chin implants and liposuction are surgical, even if they claim to be non-surgical.
These are the four types of surgery I have offered for nearly 30 years. Let’s go from least to most as it pertains to expense, recovery and invasiveness.
An aged, droopy face is caused by an imbalance between how much face you have and how much skin you have to cover it. So the least invasive methods address that discrepancy one of two ways: shrink the covering or fill the face.
Filling the face is easy and fast with nearly no recovery. We call it the liquid facelift. We inject fillers or collagen stimulators into the hollow areas of the face, filling out the skin and improving the contours. The result is a smoother, fuller more youthful look that can be instantaneous. There are many fillers out there, but the ones we rely upon the most are Sculptra, Voluma, and Lyft.
Shrinking the facial skin can be done two ways: ablative and non-ablative. My favorite ablative technique is Total FX laser because it offers both deep skin tightening and resurfacing of the fine wrinkles in one treatment. Even though this treatment involves a week or so of down time, it is considered non-invasive because no incisions are made. Non-ablative methods use a laser or radio waves to penetrate and stimulate the deep dermis and leave no surface changes at all. Thermage (radio wave) patients are back to work the next day and the face tightens over a 6-month period.
Hybrid Jawline Contouring
One of the first things that makes a person look older is a jowl. It is the fullness along the jaw-line next to a relatively receded chin. That is where neck and jaw line contouring come in. It is surgical, but it offers a predictably fast recovery of just a few days with a result that lasts years, not months.
We now can remove small amounts of fat in the jowl and neck while using an ultrasonic probe to stimulate tightening of the skin down the line. When this is conducted with special sutures along the neckbands and sometimes a small implant to fill in the pre-jowl sulcus (the indent just inside the jowl), the jaw line can benefit from a miraculous improvement with a single 1- or 2-centimeter incision beneath the chin. The recovery is fast and the impact is vast.
The O-Lift
The O-Lift is my personal answer to the abbreviated facelift. The O-Lift is a moderate facelift through a very short incision. We lift both the muscle and skin and yes, there is an incision. It’s hard to find, but it’s there, hidden within the natural folds of the ear and the side-burn area of the temple. I have revealed my results on our show The Doctors in only three days, but healing of ten days is more typical. We do this type of surgery on many women and men in their 40s and 50s. We often combine it with other procedures like blepharoplasty (eye lids) and forehead lifting through a scope with tiny incisions.
Traditional Facelift
When I perform a traditional face-lift, I am usually doing it for someone who has earned their lines, people in their 60s and 70s who have waited until they really needed it to correct deep furrows, heavy jowls and a collapsed neck with substantial banding. This patient is looking for improvement all the way from the Adam’s apple to the hairline. Our incision is similar to the O-Lift but extends around the ear lobe in a natural crease and runs up the back of the ear to, and along, the hairline. Both the skin and muscle are lifted in a vertical vector so that the face is lifted, not pulled. The result is a dramatic transformation that sometimes makes old friends gasp. While the improvement is dramatic, I am careful to attain a natural look that does not look “done.”
So, there you have it, the real deal in face lifting. When considering a procedure, be sure to ask questions to ensure realistic expectations, and when considering a plastic surgeon, I recommend an experienced board-certified specialist. It’s better to do it once and do it right than to attempt some half measure that may result in regret.
Dr. Ordon is medical director of The Plastic Surgery Institute in Rancho Mirage and co-host of The Doctors television show. The Plastic Surgery Institute can be reached at (760) 568.2211.

Guidelines to Your “Perfect Diet”

Guidelines to Your “Perfect Diet”

We would all love to find a convenient way to follow the “perfect diet,” after we figure out what that actually looks like. Many studies agreed on the same healthy diet philosophy. The most popular was published in 2014 by Yale University and identified ‘the best human diet for health’ was to simply eat whole foods.1 This traditional nutrient-dense approach to diet has proven to be effective for those who follow it. However, due to information overload in our society and lack of clear guidelines, implementing a whole food approach on a day-to-day basis can feel overwhelming and unattainable for many.
Here are some easy guidelines to simplify the process of mastering your optimal diet, despite your lifestyle:
Lower carb meals. Aside from some athletes, many health professionals suggest approximately 80% of your meals should lean towards having a lower, or ‘slower’ carbohydrate content.2,3 Slow means the carbohydrates have high fiber content which slow blood sugar spikes. A typical low carb lunch may consist of a large salad, chopped vegetables and beans or chicken. Tip: Don’t skip the healthy fats like olive oil-based dressing or added nuts and seeds.
1/2 plate full of vegetables. Your carbohydrates should come from mostly vegetables. This means replacing your bun and fries with lettuce wrap and a double side of sautéed broccoli. Easy!
Protein. The absolute best appetite suppressant known to date is protein. It also repairs tissues and sustains energy like nothing else. Prioritize and budget for high-quality of protein, especially if from an animal source. Plant-based proteins like beans, lentils, and seeds count too!
Nothing from a bag or a box. Probably not new advice to you, but track how many snacks you consume that are pre-packaged…replace those with veggies and dip, boiled eggs, homemade low-sugar trail mix…real food.
Limit alcohol to 2 days per week. Especially for fat loss; 1-2 drinks max. Nothing thwarts fat loss like alcohol. As a sugary additive to our diet at an average 7 calories per gram, it can easily put your body into fat-storing mode.
The secret behind the above guidelines is not so much that it is offering you the “perfect diet” (still worth following since perfect doesn’t exist!), but it is actually setting your body up for better digestion, increased metabolism for fat burning, and enhanced detoxification. When we provide the body with the optimal nutrition from real food, along with healthy lifestyle habits like exercise and well-managed stress, we can make it easy to manage detoxification, blood sugar and even an occasional ‘off the diet’ splurge.
Diet is at the root of health, so it must be a priority. Thankfully, unlike some life situations and environmental toxins, it is something we can control. Keep these simple guidelines in mind to easily improve and maintain your health.
Tiffany is a certified nutrition consultant and functional diagnostic nutrition practitioner and can be reached at (760) 285.1221.
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Five Ways to Wear Fall Fashion in Warm Weather

Five Ways to Wear Fall Fashion in Warm Weather
By Elizabeth Scarcella
“Tawny Port” is THE color for fall.

Although Father Time says it’s autumn, Mother Nature seems to have a different opinion. With temperatures still cresting over 85 degrees, one may find it frustrating to put together a fall outfit that doesn’t cause heat stroke, yet is a bit more substantial than strappy sandals and a billowy maxi dress.
Fellow fashion icon and fitness guru, Natalie Corona, and I have highlighted five fall fashion finds that will help you effortlessly transition into autumn attire.
Pantone announced that “Tawny Port” was THE color for fall, and since our weather, besides being very warm, is also perpetually sunny, we chose a muted burgundy that does not feel heavy amidst the palm trees and bright skies. If burgundy is not your thing, instead, reach for dove grey, peacock or navy, which are also featured colors on this fall’s color line up. Don’t be afraid to mix these fall tones with the soft colors you wore in the summer. One of our favorite combos is blush, also known as “ballet slipper” with any of the Pantone “it” colors listed above.
Nothing hollers autumn like boots. Whether your preference is ankle or knee high, boots are an easy and fun way to transition from flip flops to fall follies. There are so many color and fabric choices when it comes to boots. Keeping a bare leg allows us desert dwellers the opportunity to wear peep-toe booties and corset tie-up shoes throughout the season without worrying about frosty toes. Natalie and I both love a shorter skirt or even denim or leather shorts with suede boots. Boots of all kinds make a decided statement that the holiday season is here.
With the Valley temperatures dramatically dipping after sunset, layering is a great way to go from chilled to cozy. Natalie chose a fall-colored flannel that is casually tied around her waist to create a cinched-in waistline. A plaid shirt in flannel or cotton blend gives a cool vibe when watching weekend football games or strolling down El Paseo with family or friends. I chose a wool blend shrug left open to give the casual knit dress a sturdier and more dressed-up appearance. A textured shrug or cropped sweater is a fashion forward choice when meeting with friends or co-workers for an impromptu happy hour at one of our favorite outdoor eateries in the heart of Palm Springs.
Since we will not be routinely adding a shearling, wool or fur coat to our fall repertoire, fringe accessories are the perfect way to add substance and the swing factor to our warm weather fall outfits. In our pics, Natalie has fringe on her boots that give a playful and grounded look, while I have donned a fringed belt that gives another layer of weight and movement that we have come to love in traditional fall styling. Fringe-infused totes, clutches and satchels are all the rage this season…especially in fun fall colors, like Grenadine, a poppy red that claims to look great on everybody and yet another easy way to bring an autumn vibe to our warm fall climate.
As our days get shorter and soirees get more plentiful, this season’s fall make-up trends are a fan favorite to showcase our lean toward impending festivities, all while keeping us cool…in more ways than one. Natalie and I are wearing a warm nude lip color, which is always in style no matter the climate or time of year. However, to step up the sizzle factor, warm chestnut, silky mauve and candy apple red are so ‘right now.’ Try adding a matte finish to bring your conquer-the-world factor up a notch or two. Not into bold lips? Then experiment with a unique eye color, such as a bold chunky eyeliner in peacock or cobalt, or add mountain shadow hues, like terra-cotta and deep rich mocha onto your upper eye lids. Surprisingly, all the tips mentioned above work on a multitude of skin tones and eye colors.
When you feel a hankering to drink apple cider and hot cocoa, but need to blast your A/C to do so, remember that you can easily add a fall flair to your summer wardrobe by choosing more saturated colors like burgundy, throw on a pair of suede or leather booties, grab a fringed bag and layer your outfit with a flannel or nubby textured vest.
Regardless of what autumnal accents you apply, the most important time-tested trend is to never leave the house without an unmovable belief in yourself, loving kindness towards others, and an attitude of gratitude.
Elizabeth Scarcella, founder of Go Get Young, is a lifestyle counselor who helps her clients reclaim their best self by utilizing a variety of holistic methodologies. For more information, visit Natalie Corona, mom to 2 youngsters, is a transformation coach passionate about helping her clients to look and feel their best. For more information, visit

Resolving to QUIT in 2019

Resolving to QUIT in 2019
By Jennifer Yockey

The New Year is upon us, and for many resolutions will be set and abandoned within the first 8 weeks of the year. Those resolutions were more than likely set to achieve some level of happiness – financial, physical or emotional.
THIS year, let’s quit some stuff in order to move towards happiness rather than adding, abandoning and then feeling the subsequent self-loathing for lack of achievement. Just QUIT the following:
Comparing. Comparison is the thief of joy. It truly is. And let’s be honest, we really don’t know the whole story when we are viewing snapshots of vacations or parties that we see on social media. The picture that you see may have been preceded by devastating news or an argument. Stay in your own lane. Get clear on what you really want and chase that.
Expectations of Others. “Expectations are a down payment on future resentments.” The bar you set for yourself is for YOU. Placing that same bar for others is a really quick way to get frustrated and disappointed. People have different values and place importance on different virtues. Being on time, for instance, is NOT important to some people. If it is to you, be on time. If your BFF is chronically late, tell her to meet you 15 minutes early. Problem solved.
Controlling Behavior. Listen, you only have control over you and your behavior, reactions and responses. You have control over the process but not the outcome. And here’s the truth…sometimes, you miss the TRUE outcome, the BETTER outcome because you were too busy trying to manipulate the outcome you THOUGHT you wanted. Let it go. Do your best. Put one foot in front of the other, do the next right thing… the outcome will sort itself out.
Approval of Others. You don’t need it. You are an adult and are capable of writing your own permission slips. Life is short and you are allowed to do, think and feel what is best for YOUR Soul. This doesn’t mean you are selfish and don’t think of others, it means YOU COUNT. Remember, you are not responsible for other people’s reactions to your decisions. You are only responsible for how you impart and implement your own desires.
Your Limiting Beliefs. You are amazing! Take a moment to write down all that you have achieved. Really. Do it. If you are more than 2 years old, you have achieved a LOT. Write down the things that you think you should just “blow off”; learning to walk, read, write. It’s a big deal. Continue to be a student. When you think that you can’t do something, add the word “yet.” It changes everything.
It’s 2019 and it is going to be an amazing year. You will be challenged, there will be change, there will be joy, love, loss, excitement and fear. It’s all happening. Some of it you will like and some of it you won’t. How you navigate and respond to it all will shape your year. So, CHEERS to YOU, the New Year and QUITTING!
Jen Yockey is the owner of Gather, a movement and wellness studio, and founder of the Recover You™ Program. She is a certified yoga instructor and master life coach and can be reached at (760) 219.7953, [email protected] or

What is Medical Micro-Needling?

What is Medical Micro-Needling?
By Deidre Braun, MS, LAc

Micro-needling stimulates the body’s own collagen and elastin production
Medical micro-needling, also referred to as collagen induction therapy (CIT), is a relatively new concept aimed at stimulating the body’s own collagen and elastin production to tighten, lift and rejuvenate the skin. The benefits of this treatment include the reduction of fine lines and wrinkles, minimized pores, and the disappearance of stretch marks, crepey skin, and scarring such as surgical and acne scars.
Micro-needling devices are a vibrating stamp-like motion of a disposable needle tip. Modern techniques control the levels of dermal penetrations through precise depth adjustments set on the application hand piece. Each of the thousands of micro-passages within the dermis activates and stimulates the cascade of normal positive wound healing by releasing growth factors for eventual collagen and elastin production and maturation. These growth factors have deteriorated with age and by asking the skin to heal, they are called into action.
Another advantage of micro-needling is the creation of thousands of micro-channels for the delivery of beneficial bioactive peptides and cosmeceuticals (cosmetic products with biologically active ingredients), as well as active growth factors and anti-acne agents for advanced skin care and acne scar treatment.
Researchers are also investigating the potential benefits of combining your own platelet-rich plasma (PRP) with micro-needling to further rejuvenate your skin, stimulate hair growth, and improve scars, stretch marks, and crepey skin in the face, décolletage, abdomen, and inner arms.
Micro-needling treatments take 30-45 minutes and are virtually painless because of the action of a topical anesthetic gel. Following the treatment, your face feels like a moderate to severe sunburn, which subsides after 1-2 hours. You may see slight redness after 24 hours, and it is important not to be in direct sunlight for 24-48 hours.
The procedure, which can be used for almost all skin types, is repeated every 4-6 weeks with 3-6 treatments for maximum benefit. Results are standardly visible in six weeks’ time with maximum collagen induction for skin tightening and rejuvenation usually observed in three to six months.
Medical micro-needling has a high safety record and is performed by medical skin care specialists.
Deidre Braun is a licensed acupuncturist and founder of Revive the Skin in Rancho Mirage. She can be reached at (760) 485.2870.

Ladies, Why Go Red?

Ladies, Why Go Red?
To know your risk for cardiovascular disease

Every minute in America, a woman dies of a heart attack, stroke or another form of cardiovascular disease (CVD) — and one out of every three women experiences some form of CVD in her lifetime. And yet, most of those cases are preventable if you lead a heart-healthy lifestyle.
“We are all at risk for developing cardiovascular disease; it is the number one killer of women – and men. The key to reducing cardiovascular disease is through risk factor modification, early screening and community awareness of early warning signs,” says nurse practitioner at Eisenhower Medical Center and American Heart Association volunteer Cari Sudmeier, RN, MSN, FNP-C.
Key health indicators. Some risk factors for cardiovascular disease include high blood pressure, high cholesterol, body weight/body mass index and high blood glucose. Testing should occur as follows:

Blood pressure – every regular health care visit starting at age 20
Cholesterol – every five years starting at age 20. More often if: total cholesterol is above 200; if you are older than 50; if your HDL is less than 50; or, if you have other cardiovascular risk factors
Weight/body mass index – every health care visit starting at age 20
Waist circumference – as needed starting at age 20
Blood glucose – every three years starting at age 45

Family history. If you know you have a family history of heart disease, it’s important to share that information with your doctor. This will help cue your physician into your genetics, making him or her more aware of additional risk factors.
Health habits. Do you smoke? Are you physically inactive? Do you eat a diet high in fat? The answers could also impact your risk. Talk to your doctor so he or she has a better idea of your lifestyle, how to improve your health and to determine whether or not you need to be screened.
Join the movement and Go Red, Coachella Valley!

Get Your Numbers: Ask your doctor to check your blood pressure and cholesterol.
Own Your Lifestyle: Stop smoking, lose weight, exercise and eat healthy.
Realize Your Risk: We think it won’t happen to us, but heart disease kills 1 in 3 women.
Educate Your Family: Make healthy food choices for you and your family.
Don’t be silent: Tell every woman you know that heart disease is our #1 killer.

Learn more about your numbers and key health indicators by visiting and join the Go Red Luncheon Friday, Feb. 13 at Renaissance Indian Wells for physician and survivor lectures, educational session, health expo and heart healthy lunch. (760) 346.8109.

Turn Up the Volume

Turn Up the Volume

Results achieved using non-invasive Radiesse volumizing filler with little to no downtime
Plastic surgeons used to focus on “removing the problem.” Eyelid bagginess? Remove the fat. Jowls on the jaw line? Suck it out and cut away some skin. Droopy brow? Take away a strip of the scalp.
But times change and new philosophies have emerged regarding facial rejuvenation. Retaining the fullness of youth is a new concept that has taken the plastic surgery field by storm. We now recognize that aging carries with it a thinning out of the soft tissues of the face. There is also a “remodeling” of some of the facial bones as we age, a re-absorption that collapses the mid face and flattens the cheeks. This happens to everyone, no matter what your diet, health habits or genetics.
The results can be a hollow, sallow, gaunt look that becomes more and more skeletal over time. This loss of facial volume represents at least half of the problem of aging. Gravity is the other half. So lifting (as in face lift surgery) alone is not the answer. In fact, we have found that restoring facial volume alone adequately treats the changes of facial aging in most patients with a minimum of risk, downtime and expense. This advance is a real advantage for patients today, as the procedures tend to be less expensive and lower risk with a faster recovery.
There are three ways to retain or add facial volume for a youthful look. Let’s take a look at the methods from most to least involved:
Tissue Transfer
With this technique, we surgically move tissue from one area of the face or eyes to another without detaching it from its point of origin. One example: When the soft tissues (fat pads) of the eyes herniated out from the deep layers, a “bag” of fat beneath the eye is formed. Below this bag is a circular indentation we call the Tear Trough. This circle can be dark, deep and very aging. Worse, it makes a youthful, energetic person look tired, as if they missed a night’s sleep. But no one has to live that way.
I perform “septal reset surgery” on this problem. From inside the eye lid (with no external incisions), I relocate the hammock of tissue (the orbital septum) that holds the fat there, transferring some of the fat into the trough and eliminating the dark, indented circle. In this way I transfer some of the fat and septum to fill a defect that made my patient look tired and old and restore a smooth youthful look.
In a similar manner, the soft tissue of a jowl can be relocated to fill in hollow cheeks. And bagginess of the neck can be replaced to the shrinking jaw line and make my patients proud of their neck once again. These procedures require some recovery (one to two weeks) but is well worth it to turn the clock back ten years or more.
Free Fat Transfer
Free grafting is a medical term that refers to the technique of separating tissue from one’s body and relocating it. It differs from tissue transfer, where we leave the tissue attached. Most people have heard of fat transfer by now. We take fat from where it isn’t needed, such as the tummy, the knees or thighs, and purify and condense that fat into a thick paste so that we have as many survivable fat cells per millimeter as possible. Then we insert the fat gently wherever that patient needs it. We can use it to fill the tear troughs and cheek hollows, as described above, but we can do even more! This fat/graft/paste is a wonderful sculpting medium. We sometimes build cheekbones, fill lips and correct the hollow in the temporal area that gets deeper as we age, especially in women. This typically requires about a week of recovery but some people need even less time. The quality of this result depends on how much of the fat “takes.” By that I mean what percentage of fat cells survive the transfer process. In recent years, improvements such as adding PRP (platelet rich plasma) which contains growth factors make this procedure better than ever.
Injectable Fillers
These fillers come in a syringe or a vial from a pharmaceutical company. They can do much of what fat injection can do but in a different way. In some ways they are more versatile and allow more options. You see, fat can only be injected beneath the skin, not within the fiber of the skin itself. That is great for filling in contours and larger volume defects, but it doesn’t do much to help fine lines, wrinkles and crinkles. For those smaller problems, I must inject the material directly into the dermis (layer of skin) itself to plump it up. These fillers can also be used beneath the skin, but I reserve their use for smaller volume defects because they are like a painter’s fine-tipped brush. Fillers like Voluma, Restylane and Juvederm are for minor problems or putting the finishing touches on big problems. These improvements can be made with what I call “same day recovery.” With some of them, my patients go right back to work. If we get a little more involved, returning to normal activity the next day is wise.
Restoration of facial volume is the wave of the future. These three modes of treatment provide all patients with the type of improvement they need at a cost they can afford with a recovery they can manage. And like most surgeons, I enjoy bringing you to the “cutting edge”!
Dr. Chopra is medical director of The Plastic Surgery Institute in Rancho Mirage and can be reached at (760) 568.2211. Please send your ideas and recommended topics for his new column via email to [email protected]

That Sneaky Desert Sun

That Sneaky Desert Sun

We love the sun, but the sun doesn’t always love us.
Okay, I will admit it; I am trying to scare you. The big, bad summer is here and with it comes the threat of too much heat, too much sun, and the danger and risk that accompanies both. You might say, “I know, I know. I wear sun block” or “I’ll become prematurely aged and get skin cancer someday.”
If aging and cancer were the only things showing up in my office as the downside of having fun in the sun, it wouldn’t be so bad. But it doesn’t end there, unfortunately.
Overheating can result in prickly heat which usually appears on the clothed regions of the body.
Remember your mother’s warning, “You’ll go blind!” if you did certain things? Well, long-term sun exposure can cause exactly that, with corneal opacities. The cornea of the eye thickens and whitens, creating a cataract. Even though cataract surgery is routine and predictably successful, it’s best to avoid if you can. That means wearing polarized lens sunglasses at all times when the sun is out. I recommend wearing them especially when driving or doing outdoor sports. (A side benefit is less crow’s feet from squinting in the bright sunlight).
One of the acute, sudden effects of summer in the desert is prickly heat, or miliaria. It is caused by overheating of the skin and overexposure to the sun. It usually surfaces on the clothed regions of the body like armpits, back, upper chest, groin or abdomen, which can throw you off, since those are not the primary areas of sun exposure. It can present as tiny blisters spread over the top of the arms, neck and back. Anyone can get it at any age, from infants in incubators to elderly, bedridden patients with high fever and inadequate temperature control. It begins with excessive perspiration, which tends to damage the cells on the surface of the skin. This forms a barrier and traps the sweat beneath the skin, resulting in characteristic bumps. When these bumps burst, sweat is released causing a prickly, stinging, or burning feeling.
Polarized sun glasses are an essential desert accessory.
For desert dwellers, the way to avoid prickly heat is to use sunscreen with a minimum SPF15 (30 is even better) applied at least 20 minutes prior to going out in the sun, and reapplied hourly. Be especially careful in humid environments and avoid strenuous physical activity. Wear loose fitting, breathable cotton or natural fiber clothing and a wide-brimmed hat to protect your skin against the sun. Drink a lot of water. If you aren’t going to the bathroom every hour or so, you are not drinking enough. And as always, don’t let things go too far before seeking medical help if the symptoms arise.
Another consequence of too much sun and heat is sun allergy. It affects sun sensitive people, and you probably already know who you are if you are one of those at risk. I often see a bright red V-shape or redness on the neck and outer part of the legs in people with sun allergy. I usually see it in visitors to the desert who aren’t used to our intense June, July and August sun. The sun causes changes in the skin to which the body reacts, as if it is foreign material. Then the allergic response begins. Steroids are the usual remedy.
Many foods contain vitamin D, however, supplementation is recommended.
I am not saying all sun is bad. The sun helps your skin form essential vitamin D. But there are other ways to get this important vitamin such as in food rich in vitamin D like salmon and fortified milk. The recommendation for supplemental vitamin D is 600 International Units (IU) daily for all age groups between 1 and 70 years old.
So play outside. I am a big fan of regular exercise, both indoors and out. But definitely watch out for these lesser known dangers of sun and heat.
Dr. Chopra is medical director of The Plastic Surgery Institute in Rancho Mirage and can be reached at (760) 568.2211. Please send your ideas and recommended topics for his column via email to [email protected]

Succeeding at Weight Loss

Succeeding at Weight Loss
Lauren Del Sarto

Bohdan T. Olesnicky, MD
With the New Year upon us, many have started their weight loss program with enthusiasm and full intention.  Psychology Today reports that studies show while the first two weeks are usually encouraging, by February people start sliding back in to sedentary habits… and by the following December, most of us are back to where we started.
So what are the secrets to a successful weight loss plan? To answer that question, I sat down with Dr. Dan Olesnicky of Executive Wellness in Indian Wells. He recommends creating an educated game plan, selecting a diet that works for your body and lifestyle, and having an ongoing weight maintenance plan to follow.
The first step is to make sure you are ready to commit. “We won’t start anyone on a program who isn’t ready. There is no quick fix and you must be willing to make serious lifestyle adjustments.”
The next step is to establish an educated game plan that includes knowing where your body is metabolically. He adds that many people will feel ready to start a diet and will faithfully stick to it, but just can’t seem to lose the weight. “If this is the case, chances are that something is out of whack hormonally. By correcting the hormonal imbalance, you can shed the weight by adhering to the diet.”
Olesnicky recommends running blood, hormone and genetic testing to help establish a baseline and determine what is happening with your body metabolically. Are you possibly insulin resistant? Is it hormone growth failure? Are you a man in andropause or a woman in perimenopause? Starting with accurate data will increase your success rate and help you to make choices more wisely. “It’s nice to be able to tell patients who have failed at dieting that it’s not their fault.”
Next, determine the plan that will work for your body and lifestyle. I asked Olesnicky his thoughts on all the new weight loss technology on the market.  “There is no quick fix. The oldest technology – and still the best – is diet and exercise.”
Selecting a diet that fits your lifestyle is the most important element. “We have a dozen different types of diets based on lifestyle and goals. If someone is a meat eater, we may recommend Atkins or Paleo. For fast food junkies, we encourage skipping the bun and french fries and opting for one of the healthier sides now offered.”  Your diet needs to be realistic for you.  A simple first step is moving away from carbs and refined sugar, and towards proteins and low glycemic index foods such as berries.
With exercise, Olesnicky says, don’t forget the ‘thermal advantage.’ One of the best exercises for weight loss is swimming. In addition to the calories burned through exercise, your body is burning calories to maintain your body temperature. He notes that Michael Phelps consumes an average of 12,000 calories a day. And while he may expend 3,000 calories with the act of swimming, the large majority of those calories are expended maintaining his body temp in an 82 degree pool.  “If you swim, reduce the temp of your pool slightly, and you may see weight loss more quickly.”
Olesnicky adds that the best use of the new technology on the market is to further sculpt the body once you get close to a desired weight. “We may use the Zerona (cold laser) or Exilis (radiofrequency heat) to assist in reshaping trouble spots on patients who are close to their desired weight as we find these technologies very effective for such use.”
He recommends that while on a weight loss program, you check in with your doctor or health care practitioner at least once a week, preferably three, as motivation is very important.
Once you have achieved your desired weight (after a minimum of 12 weeks), maintenance is key. If you have chosen a diet that meets your lifestyle, hopefully that way of eating can become your new lifestyle. High quality foods and high quality supplements, even if it’s only a daily multivitamin, will better meet your body’s needs. “Processed foods are so nutritionally void of the nutrients your body is craving, it forces us to overeat. Spending the time and money to cook your own high quality food will save you from weight gain in the long run.”
“Make sure you have a support group or system in place to help keep the ‘new you’ on track.” A well thought out maintenance plan will ensure success tomorrow and in the many healthy years to follow.
Dr. Olesnicky can be reached at Executive Wellness (760) 346-9354.