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By Judith Gurley, MD

Soft tissue fillers are growing in popularity as the demand for non-surgical facial rejuvenation surges. The advantages are immediate results, simple office-based application, and a beautiful natural enhancement without scars.

Fillers can be used by themselves, or in combination with Botox™, laser resurfacing, chemical peels, or surgical treatments.

The most common and best-performing fillers available today include:

1. Fat
   • Use your own tissue
   • No allergy testing necessary
   • Long-lasting and perhaps permanent
   • Resorption may be unpredictable
   • Requires liposuction for harvesting the fat
2. Collagen
   • Animal or human derived
   • Requires allergy testing (animal only)
   • Lasts less than 6 months
   • Expect inflammation
3. Restylane™/ Perlane™
   • Non-animal derived hyaluronic acid
   • No allergy testing necessary
   • Lasts 6-12 months
   • Easy application
   • Very natural results
4. Radiance™
   • Calcium hydroxylapatite combined with aqueous gel
   • No allergy testing necessary
   • Thicker than Restylane
   • Lasts 3 or more years
   • White substance with fewer indications than Restylane
5. Sculptra™
   • Poly-L-Lactic acid
   • No allergy testing necessary
   • Lasts 2 years in some patients; further studies needed
   • Multiple treatments may be necessary
6. Artecoll
   • Polymethylmethacrylate (PMMA) microspheres suspended in a solution of collagen
   • No allergy testing necessary
   • Permanent but uneven absorption of collagen

Instant enhancement of lips or improvement of wrinkles can be seen after one application. Different fillers are recommended for certain areas. For instance, Restylane is ideal for lip enhancement and filling the naso-labial folds. Fat injections are ideal for more extensive augmentations throughout the face.

Before and 6 months After Photos: Lip Augmentation with Restylane.

• Glabellar frowns (between the eyebrows)
• Nasolabial folds (along the sides of the nose)
• Vertical wrinkles on the upper lip
• Lines around the mouth
• Depressed corners of the mouth
• Chin crease
• Horizontal forehead furrows
• Acne scars
• Dark shadowed eyelids
• Crows feet
• Lip augmentation

We highly recommend a physician experienced in fillers perform the procedure. Each patient determines how numb the skin needs to be. You can even watch the procedure using a mirror. This is especially advantageous during lip augmentation, where the patient can provide feedback on the extent of augmentation.

Afterwards, ice is applied to minimize swelling. That evening, any discomfort is easily treated with acetaminophen (Tylenol™), and is negligible by the next day. For the lips, 2-3 days of swelling can be expected. The swelling gradually decreases over a week. For facial folds and wrinkles, mild bruising may occur for a few days.

If you have questions about anything you read here or a specific treatment, please feel free to call Suzie Massaro, R.N., at 314-432-1772 or e-mail info@genesiscosmeticsurgery.net.

By Cynthia A. Berner, M.S., R.D., L.D.

Carbohydrates are a misunderstood and maligned group. As America has alarmingly plumped up, carbohydrates as a whole have caught the brunt of negative attention. In an effort to cleanse ourselves of this supposed evil, we have eliminated an entire food group.

Ultimately weight control comes down to this: if you take in more calories than you expend, over time you will gain weight - and it doesn't matter whether those calories come from carbohydrates, protein or fat.

So, while the source of the calories doesn't matter in weight control, the nutritional quality of the foods we choose does matter to our overall health.

Common Ground
White bread, baked goods and highly processed snack chips are made of refined grains that enter our bloodstreams rapidly and are quickly processed by our bodies, providing ample calories but little to no nutritive value. A common message found in the current diet plans such as Dr. Atkins New Diet Revolution, The South Beach Diet and Dr. Dean Ornish's Eat More Weigh Less is: eat fewer refined grains and more whole grains. There is too much evidence to suggest that eliminating an entire food group makes sense.

Personalizing general nutrition recommendations are the first step in achieving a healthy diet. In this first of six articles on core dietary components, we will look at how "rough" things should be in your daily intake - beginning to build a solid foundation on whole grain breads, cereals, rice and pastas or technically known as complex carbohydrates.

The Whole Story
Research has demonstrated that a high fiber diet is beneficial in preventing diseases and improving how our bodies function. Current recommendations suggest including 20-35 grams of dietary fiber on a daily basis. The typical American diet falls significantly short of this mark. In addition, chewing is a good thing when it comes to weight control. The more hearty and fiber-rich a food, the longer it takes to chew which ultimately slows down our eating pace and rate at which our body metabolizes the carbohydrate. This in turn helps increase our sense of satiety and feeling of fullness.

Read food labels carefully to make sure you are getting a whole grain - don't rely on color or the look of product. The first ingredient on the label should say 100 percent whole grain, whole wheat or grain. A good fiber source has at least 2.5 grams of dietary fiber per serving.

Making the Change
Breakfast is one of the easiest meals to incorporate whole grains. A recent look at breakfast eaters found they consume fewer calories overall than non breakfast eaters . Combine a whole grain cereal or bread with a glass of low fat milk (1 percent milk fat or less) and a sliced banana or fresh berries and you are on your way to wholesome whole grain intake.

Homemade pizza dough, bread and muffins are easy to modify with a little bump from whole wheat flour. Try replacing half of the white flour called for in a recipe with whole wheat flour. Whole wheat tortillas, pastas, barley and oatmeal and brown rice are great examples of available foods that have the whole grain left intake.

By taking a step back from the low-carb frenzy, we can appreciate the common health message that underlies these eating plans and understand the importance of including and enjoying whole grains on a daily basis. Whole grain cereals, breads and rice serve as a key foundational point in building a healthy eating plan.

Cindy Berner is one of the founders of Simply Cooking Solutions (www.simplycooking.net), a small private company dedicated to helping people meal plan, grocery shop, and prepare recipes for healthful home cooking. She also heads the Genesis Nutritional Counseling Program.

By Stevyn Guinnip, MSEd, ACSM Health/Fitness Instructor

Ski season is here, giving you a new opportunity to improve your balance and strength in the cold months ahead. There are many things you can do before you head outside to make your experience more fun. Whether you cross country or downhill ski, you need to assess your equipment and fitness level.

Equipment is made differently for men and women because of our distinct bodies. Women typically have a center of gravity that is 1 inch lower and 1 inch farther back than men. Also, women have a greater Q angle (the angle from the hip to the knee) than men. Because of these differences, women may need heel lifts, bindings closer to the tips of the skis, or other adjustments to put them in the right position on their skis to create more control and less fatigue.

With your equipment in order, take a look at your fitness level. Are your ankles flexible? Are your legs strong enough to carry you down the mountain turn after turn? Here are a few exercises to prepare your body for the slopes.

1. To improve your ankle flexibility to allow you to "get forward" on your skis, try stretching your calves with your toes on a wall and your heel on the floor. Press your hips toward the wall while keeping your knee straight. Hold for 10 seconds and repeat by bending the knee into the wall for a lower stretch.
   
   
2. Improve your muscle endurance by doing "wall squats." Lean your back against a wall, walk your feet 1-2 feet away and slide your back down the wall until you are in a semi-sitting position. Hold until your legs begin to fatigue. Repeat three times.

You will be amazed at how a little work now can improve your skill and fun on the mountain. Visit a local outdoor store to get the proper fit for your boots. Then start your ski-specific exercise program so that you don't find yourself tumbling head over heels down the slippery slope of fatigue and sore feet.

Stevyn Guinnip, MSEd, ACSM, is founder of Healthy Image Strategies, a fitness and nutrition consulting firm. You can reach her at 314-749-9579 or stevyn@healthyimagestrategies.com, or visit www.healthyimagestrategies.com.