This is the second of two articles looking into the difference between “modern” medicine and “wellness” medicine. This article will delve deeper into wellness medicine as well as address change that you the consumer can effect.

I wrote the last article while I was in Houston supporting our Air Force flying mission. Over the weekend I saw quite a few patients that were physically fit and only needed a quick physical and a signature releasing them for continued duty. I also saw a few that required more face to face time counseling them about areas where improvement was needed.

Military medicine, occupational medicine, and flight medicine differ from the core of “modern” medicine. While “modern” medicine focuses on treating illnesses, “wellness” medicine focuses on ensuring that patients are initially healthy and continue to stay healthy in order to perform often-hazardous tasks.

When I see patients who are overweight, I counsel them about weight loss. When I see a patient suffering from inadequate sleep, I counsel him on sleep hygiene long before I prescribe medication to help facilitate sleep. When I see a patient who smokes, I counsel her regarding smoking cessation. Both the military medicine and occupational medicine communities insist on counseling patients about careless habits and poor lifestyle decisions that put them at higher risk for heart attacks, strokes, and diabetes.

“Modern” medicine, instead, is concerned about patient-satisfaction scores and physician production goals. Physician visits are often concluded by office staff telling the patient that they will receive a survey regarding the care provided by the physician and office staff. Many large group and corporate medicine physicians are partially compensated according to their patient satisfaction scores.

The Archives of Internal Medicine posted the results of a survey of more than 50,000 patients in March of 2012. Interestingly, higher patient satisfaction scores were associated with greater inpatient hospitalization, greater total expenditures, greater drug-related expenditures, and higher mortality. Higher mortality? Doesn’t that mean death? Yes! Patients that were the “most satisfied” with their medical care DIED sooner after spending more on their healthcare.

WOW! Maybe those hard truths that no one wants to hear are actually not only “good medicine” but can be lifesaving. Doctors shouldn’t get paid to tell patients what they want to hear. They should get paid to reduce disease risk, help you get well, and keep you that way.

What to do with the surveys? Don’t throw them away! Put the blank survey in the envelope and mail it back to the survey company. It’s a lose/lose situation for the company contracted to do the survey. Either they report to the hospital organization that their survey was ineffective or they swallow the cost of processing the blank surveys. It’s a win for the patient and their doctor and cuts one of the many middlemen out of your healthcare. In a system whose only hope for financial solvency is increased efficiency, this would be a good start.

When you do see a doctor that counsels you appropriately about risk reduction, tells you that you don’t need the medication you are asking for, or doesn’t order the unnecessary test you requested, realize that they aren’t judging you or doing it to be mean, they are working to save your life.

Final note… Need a doc who has made (ahem) some of those same poor decisions and lived to tell about it? Stop by and see me. None of my soapboxes are too high, I’ve been there.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. As before, the opinions given above are not necessarily endorsed by the U.S. Air Force, Lincoln County Medical Center, or even his wife. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

This past weekend was an Air Force weekend for me. I typically fly to Houston on Thursday, see patients Friday, Saturday, and Sunday morning, and return Sunday afternoon. It is usually only a few days away from home at a time and I enjoy being able to help those serving our country.

Military aviation medicine is quite a bit different from other medical practices in that it is mainly an occupational medicine specialty. We focus on keeping our pilots and support staff healthy so they can perform the mission. I get to talk to patients after they add a few pounds over the holidays but before they are 30 to 50 pounds overweight. I can discuss lifestyle modification strategies to help lose the weight and hopefully prevent future additions. I can emphasize that continued carelessness will not only put them at higher risk for heart attacks, strokes, and diabetes, but may terminate their military careers.

“Modern” civilian medicine? Not so! The main focus in modern medicine seems to revolve around adding medicines to help palliate health problems. Does your cholesterol medicine give you muscle aches? Here’s another pill to help control the side effects! While lifestyle changes may not be the perfect solution to all medical problems (Vytorin’s commercial illustrating contributions from both food and family/genes) they certainly go a long way.

Why do we focus so much on treating diseases caused by poor patient education? I see overweight or obese patients that are taking two medications for blood pressure control and one medication for cholesterol that haven’t tried anything to drop the weight that caused the high blood pressure and cholesterol in the first place. Why aren’t we doing a better job on educating patients about portion control and calorie counting? Some would say it’s a conspiracy!

Pharmaceutical companies profit from the pills they sell. Insurance companies rely on health risks like heart attack and stroke to ensure patients are willing to pay the premiums. If patients take better care of their bodies, the pharmaceutical and insurance companies stand to lose in a big way. Physicians are only now starting to get organized with PACs and lobbyists. Big pharma and medical insurers have successfully lobbied for years.

Is this a true conspiracy with cloaks, daggers, and blacked-out boardrooms? The likelihood is that these companies are only working to protect their investments. The burden is placed on us as American citizens to take care of ourselves. The only problem is that we haven’t been appropriately educated on our care and feeding.

The advances in modern medicine have extended the average American lifespan. Unfortunately, the obesity epidemic is threatening to take back the advantage. Most physicians are under such pressure from diminishing returns that the easy fix is to rely on pills instead of patient counseling. We have allowed the pharmaceutical and insurance companies to dictate how we practice medicine long enough. We need to move beyond “modern” medicine.

P.S. If you don’t see my column next week, please ask for an investigation as to my disappearance. Maybe it is a real conspiracy…

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. The opinions given above are not necessarily endorsed by the U.S. Air Force, Lincoln County Medical Center, or even his wife. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Thanksgiving has come and gone and Christmas will be here soon. Everyone is aware that the holiday season provides extra opportunities not only to be with loved ones but also to experience extra stress. Stress is good- in moderation. Our bodies require good stress (the medical term is eustress) to stay alive.

Experimental data has proven this; stress is essential for continued existence. Unfortunately, there is a small margin of error between good stress that keeps us alive and bad stress (distress) that will age the body faster. So, the critical question is “How can we prevent distress from overcoming eustress?” Mental and physical exercise both play a key role…

My family’s plan was to fly to New Braunfels the weekend before Thanksgiving for an early celebration due to schedule conflicts. As it was cheaper to fly private and we had access to a small plane, we would drop a friend off in Midland on the way. (This allowed us to avoid the invasive TSA screeners. Ask me to tell you about our honeymoon sometime…) We had an uneventful flight to Midland Airpark, dropped our friend off, and taxied to the runway. We stopped to wait for another plane to land, received our clearance, and I advanced the throttle.

Most people have experienced a flat tire. In a car you hear a distinctive sound and the car tends to pull hard to the side of the flat. In a plane the engine noise drowns out the sound but the pull is even greater as there are only three wheels. We were fortunate that the mesquite thorn on the taxiway caused a fast leak prior to takeoff. A slow leak could have been catastrophic as it wouldn’t have been evident until landing. A flat tire will act like a locked brake, bringing one side of the plane to a quick stop while the other side is still going 90 mph- typically not a good outcome and one of the reasons larger planes have two wheels per axle.

My wife and kids did wind sprints in the maintenance hanger while a wonderful mechanic from Basin Aviation replaced the flat tire. (We learned that it doesn’t help the stress factor when a 5 year old is looking over your shoulder and asking questions.) We loaded back up in the plane only to discover that the alternator belt had also decided to take a holiday. Overnight stay in Midland, the plane was fixed around noon and we arrived in time for family photos.

Everyone experiences holiday stress. It may be due to a family member that knows the right buttons to push, it may be due to travel-related malfunctions, or it just may be the crowded environment. How you respond to the stress determines the effect on your body. Say the Serenity Prayer, meditate, or exercise. Accept what you can’t change (others and environment), change what you can (self), and keep the stress from changing you. Go outside, walk, and look at nature. Exercise helps your mind and body respond better in stressful situations.

Final centrifuge recovery update- I think I’m back to 99% of normal (my normal- don’t laugh). I don’t have medical data to support it but I would venture to say that centrifuge training is NOT good stress.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not a family psychotherapist but he has dealt with many family members needing psychotherapy. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

It seems I have started a running commentary on my physical recovery from multiple rides in the Air Force centrifuge, so here’s the latest… Nope, still not back to baseline. The aches and pains now are mostly felt in the sneezes and posterior bony prominences. Things continue to improve on a daily basis and I’m hoping Thanksgiving will bring an end to my post-centrifuge woes. (This little bit of commentary won’t make much sense if you haven’t read the previous two articles. You can find them on the Fusion Medical Spa Facebook page or on the Ruidoso Free Press site by typing Dr Rath into the search box.)

Winter is upon us. The nights bring temperatures in the teens and the days are getting shorter. Old Man Winter has returned. I think he has a few health issues. Let’s examine his symptoms. 1) He falls asleep while the rest of us have at least a few extra hours of energy left. 2) He doesn’t seem to sleep well- many winter nights we can hear him moaning. 3) He likely suffers from depression (think about the descriptive words- bitter, gloomy, harsh, dreary, long).

Do the symptoms sound familiar? They did to me! I think Old Man Winter, like the majority of most men and women age 50 and older, suffers from low testosterone (low T). He has three of the hallmark complaints exhibited by patients suffering from low T. Don’t ask me about his sex drive- I’m not sure how that symptom fits in to my metaphor. Although snow could be indicative of a weak stream when voiding…

So, Dr. Rath, your patient is a season. How are you going to treat him? Bio-identical hormone replacement! He needs testosterone supplementation, and soon. I’m still working on the delivery method; it should be ready towards the end of March. You’ll know I achieved success if spring comes…

Seriously- some people don’t do well with the onset of winter. When the days get shorter we lose visual cues that our body uses to maintain our sense of well-being. Seasonal Affective Disorder (SAD) is a diagnosis afflicting many patients in winter climates. The symptoms: increased appetite, increased need for sleep, hopelessness, increased irritability, decreased energy, and difficulty concentrating are a few.

Sounds a bit like someone suffering from low T. Just had your annual checkup and don’t want to have another doctor’s visit so soon? Treatment for SAD (I can’t take credit for the clever abbreviation) involves exercise, a healthy diet, and outside activities in the daytime to maximize the visual cues and light exposure. Bundle up and take a walk! Ruidoso is beautiful in the winter- you just need to take a few minutes each day to mentally relax and get outside. You’ll discover why they call it a “brisk” walk.

If a week of healthy diet, exercise, and exposure to the great outdoors doesn’t help ameliorate your symptoms, see your doctor or come talk to me about screening tests for hormone replacement therapy. Firsthand experience- it can make a big difference.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not a meteorologist but he can talk to you about restoring your “Spring”. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Now that the elections are behind us, I thought it would be good to dedicate a column to answering some of the recent questions. As usual, feel free to either email or stop by Fusion Medical Spa with questions.

Q: How will the results of the 2012 election affect aesthetic medicine?

A: The short answer is there won’t be any major changes. Aesthetic medicine isn’t affected by changes in the insurance industry or the political arena. Caveat- Some patients may require a few more units of Botox over the next four years. Need a little extra help dealing with the smile or frown lines resulting from the election? Stop by Fusion Medical Spa and talk to me. We can help make anyone look and feel like their candidate won! (Yes, I posted this on Facebook last week. If you don’t follow us already, look us up! Everything that follows is new material).

Q: For the follow up… Does Botox really help depression?

A: Yes! This September’s Scientific American reported the results of a small study that showed a 47% decrease in depressive symptoms in the Botox group compared with a 9% reduction in the control group. So, Botox works on migraine headache symptoms, frown lines, and helps fight depression that doesn’t respond to typical treatment. The study author’s theory was Botox interrupted “feedback from the facial musculature to the brain”. I’m of the opinion that the visual feedback was more beneficial. When I look in the mirror and can’t make an angry face at myself it actually makes me feel better! Think about it. With one less person frowning at you life has to appear a little better.

Q: How long does it take the human body to recover from three rides in the Air Force Centrifuge?

A: I don’t know. Ask me in a few weeks. As some areas get better I’m discovering new parts that are exquisitely tender. Fortunately, as long as no more than three years elapse between high G jet rides (F-16, T-38), a single qualifying ride is good for life. Parents and family already wonder what possessed me when they view the videos; I probably won’t be allowed to do it again if I expire. (Yes, the irony is intentional. I probably won’t be allowed to do it again even if I don’t expire due to the risk of expiring.)

Q: Do you really believe that time will end on December 21^st?

A: I was pretty sure that time was ending when I was strapped in the centrifuge. I don’t think the Mayan technology was well advanced when they built their calendar, but it is possibly the reason why their calendar was shaped like a wheel. I am not planning any major events on December 22^nd just in case. I would hate to have to cancel an appointment.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on time or time-management (ask the other Dr. Rath) but he looks forward to seeing the end of time on December 21^st. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

I just returned from visiting the U.S. Air Force’s only operational centrifuge located at Brooks City-Base (San Antonio), Texas. During my visit and my subsequent centrifuge ride a few facts were further reinforced and I made a few new observations.

• Gravity isn’t kind. Gravity is measured in G’s, and since the earth exerts the constant force we use to define a “G”, we are all constantly under a one G load while on the earth. Not happy with the relaxation (sagging isn’t considered politically correct) you see in the mirror? Leave the earth and visit space (0 G environment) or the moon (less than 1 G). Gravity actually makes us look older due to the downward pull on the skin when the collagen and elastin fibers start to break down. Sadly, the breakdown starts soon after birth and is usually clinically apparent when one reaches the 20 to 30 year age range.
• If you think 1 G makes you look bad, try 9! The Air Force protocol to clear pilots, flight surgeons like myself, or engineers to fly in an F-16 requires that the prospective service-member undergo several profiles in the “fuge” to include 3 experiences with 9 G’s. While 1 G will age your face, 9 G’s gives the youngest face jowls, droopy eyelids, and floppy lips. Not a pretty sight!
• The human body isn’t made to experience a high-G load. Maintaining consciousness during a 9G spin is difficult and requires the use of lower body muscle groups as well as a specialized breathing technique. The blood doesn’t want to stay in the brain due to the high gravity environment and tends to pool away from the G force. For the wordsmiths: the red skin lesions resembling a childhood disease that appear on the posterior portions of the body after a high-G spin are called “G”easels.
• Failure to perform a proper AGSM (anti-G straining maneuver) results in loss of consciousness due to a blood starved brain. When this occurs, one relaxes the grips on the control, the centrifuge slows, and the body is given time to play “catch-up”. Many that experience G-LOC (G-induced loss of consciousness) will also have out of body experiences or “dreamlets” along with the usual limb jerking and eye rolling while the brain fills back up. (Don’t ask me how I know.)

So, a little gravity is good and helps keep our feet firmly planted on the ground. A lot of gravity (9 G’s) is painful and makes your body feel like a truck has hit it when the ride ends. Is there any hope for the faces that are beginning to look like they are always under a 3+ G load due to the normal collage fiber relaxation and loss of facial fat? Radiesse, a type of dermal filler, has been used for years to not only replace volume but to stimulate new collagen production.

Final conclusion- Radiesse has been tested in a 9 G environment with no ill effects. You won’t find this information in any study or scientific journal as I’m pretty sure it’s never been tested before. Official Air Force policy dictates that I deny having any knowledge of this knowledge.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an aerospace physiologist but he is willing to withstand powerful forces to prove the effectiveness of Fusion Medical Spa’s products. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

As we approach December 21^st, 2012, the end of civilization according to the Mayan calendar, I think it is worth reflecting on the Mayan style of medicine and comparing it with current practice.

While I prefer to use peer -reviewed journals as a primary source, Wikipedia appears to rival other resources for Mayan medicine and was consulted for this article. For those who have been pushed into the digital age against their will (my nurse Janet comes to mind) Wikipedia is an online open-source encyclopedia reviewed by many subject matter experts before an article is deemed to meet acceptable standards. Arguably, the original texts are better resources, but my education didn’t include the Mayan language.

We practice one of the first types of medicine in our home. The origin in our household was probably the same as in prehistoric times. Dad’s back isn’t the same as it used to be- mine is largely due to years of jumping out of airplanes. After dinner, while the kids are getting ready for bed, dad lies down on the floor. The kids finish getting ready for bed and are ready to perform one of the earliest pain control rituals known to man- my kids call it “Walk on Back”. After a short therapy session, the kids are ready to go to sleep and dad feels a bit better. Perhaps the earliest subspecialty: family medicine?

Many of us are aware that the Mayan culture occasionally used live sacrifice in purification rituals in an effort to cure disease. In the event the person sacrificed was also one of the afflicted, they achieved a 100% cure rate; something modern medicine has yet to achieve. Modern patients seem to be okay with this, as open-heart surgery without anesthesia also carries an extremely high death rate. (“Doc, we can only assume he was cured, he stopped complaining shortly after the surgery began.”)

So, excepting live sacrifice, are there any areas we have in common? Sure! Ancient healers would often formulate a healing plan after obtaining a detailed history of the patient’s life and past experiences. While many of our current medical specialties seem to fast-forward through the subjective (patient reported) in favor of the objective (measured and tested), some practices, including my own aesthetic practice, rely heavily on where the patient has been in order to formulate a plan to help them get to their desired destination.

Call me old fashioned; I actually enjoy taking a history of a patient’s life and experiences. I find that in doing so, I am able to establish a connection with more than 99% of the patients I see. What about the less than 1%? Are they just difficult patients? Call me an optimist, but I think that sort of connection can be established with anyone given enough time.

Given enough time… Nobody knows how much time we have left on this planet. According to the ancient Mayans, not much. I subscribe to the theory that they ran out of space on the rock calendar. I guess time will tell!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on ancient medicine but he believes he can make a difference in modern medicine. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

If you haven’t figured it out by now, this article series is designed to be interactive. If you have a question don’t be afraid to ask. I’ll start this article by answering a question recently posed.

The question: “Dr Rath, you probably examine more skin and skin lesions than any other physician in town. Why do you insist that I have a dermatologist look at a suspect lesion before you are willing to remove the lesion or perform a “Bladeless Facelift?” Answer: I’m not a dermatologist and I don’t play one on TV. Even if I slept in a Holiday Inn Express last night I would still not have the 4 years of skin cancer education that dermatologists receive. Dermatologists are the only specialists that have the appropriate education to evaluate suspect skin lesions in vivo, or while still live on the body. Unfortunately, Ruidoso doesn’t have a dermatologist and it requires a drive to Roswell or further to get an appointment. Need a derm? Dr Henry in Roswell accepts new patients and is my personal dermatologist.

The title of this article, My Face Is Smoking (Hot) alludes to smoking. What does smoking have to do with ageless or anti-aging medicine? Dr Rath, why are you attacking my (one) vice?

First of all, let me clarify that this soapbox can’t be too high. I am a reformed smoker. When I was a helicopter mechanic in the Army, the smokers received smoke breaks while the non-smokers worked without any breaks. As you might imagine, the choice of staying out on the hot flightline or walking over to a shady spot and smoking with a group of friends was a no-brainer. It wasn’t the best policy for troop health, and has since changed; but I was a smoker. When I left the active duty Army at the end of a six-year enlistment and went to college I used the opportunity to quit.

Every smoker can look on the side of a pack and see that smoking will increase the risk of lung cancer. What isn’t listed is the microvascular disease that smoking causes. Microvascular disease? Smoking causes the smallest blood vessels to constrict, decreasing blood flow to end organs such as skin and sex organs. What does that mean to me? Smoking makes you look older. Combine smoking with no sunscreen and you’re on the fast track to older skin.

According to Wikipedia, in January 2012 the excise tax per pack in New Mexico was $1.66. This cost is tacked on to the manufacturer’s price. Using the average price I paid years ago on base, $2.50 + $1.66. About $4. One pack a day? $120. Over four months? $480. We have patients who pay for their Botox or laser procedures with the money they saved when they quit.

Want to stop but don’t know how? Stop by and ask me how I quit. (My method requires a cannuter valve).

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on the cigarette industry but he can help reverse the aesthetic affects of smoking.

My Dermatologist is Better than Yours. You can insert whatever medical specialty you like into the sentence. Mine is better! Sound like something you’d hear on the playground? Sure. My five-year-old daughter started kindergarten in August and we are already starting to hear similar phrases. But, unlike most things you hear on the playground, my doctor really is better. How do I know? I checked!

Medicine has evolved considerably since you visited your barber to remove a skin lesion. My grandfather, Albert Rath Sr, graduated from medical school in 1939, did a one-year internship, and opened his medical practice as a General Practitioner (GP). By the time my father, Albert Rath Jr, graduated from medical school in 1970, the majority of physicians were entering residency training after internship and “specializing”. At the time of my graduation, the U.S. military was the only route to take if one wanted to enter practice without residency specialization. To the best of my knowledge, all services now require specialty training within a few years of completion of internship.

Sound involved? It is. Most physicians have a minimum of 24 years of education prior to entering unsupervised practice. Twelve years of primary education (thirteen if you count kindergarten), four years of undergraduate studies, four years of medical school, and three to seven years of residency. Sub-specialties require additional years of fellowship training. The end result: a physician that is board-eligible, or has permission to sit for specialty boards to verify that enough information stuck during the years of education. After you pass your written, and for some specialties, oral boards you can legally advertise that you are board certified. The extra initials after MD or DO are usually shorthand for the board specialty. Board certified anesthesiologist? D.A.B.A. Board certified family practitioner? F.A.A.F.P. Board certified dermatologist? F.A.A.D.

How did I check to see if my dermatologist was board certified? www.docboard.org/nm/ is the website for the organization many state medical boards have contracted for credentials verification. Substitute /tx instead of /nm if your doc practices in Texas. Enter the physician’s name and discover where they trained as well as their specialty. Most state medical boards don’t verify board certification, so that requires a trip to www.abms.org, the American Board of Medical Specialties site and a short login (anyone can create an account in about a minute). Osteopathic physicians have their own boards and are the easiest to find at www.osteopathic.org/osteopathic-health/find-a-do.

Still have questions? Find out if your doc has hospital privileges. State medical boards only act when they receive a complaint while the local medical community does a good job of policing their own if the physician has hospital privileges. Joan Pelkey, Medical Staff Affairs Manager at Lincoln County Medical Center does an excellent job of keeping the physicians straight and is a good resource in Lincoln County.

More questions? Ask around. This town is called Rumor-doso for a reason. Our community is small enough and you can always find someone willing to talk.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on medical education, but he will be happy to recount the trials and tribulations he has encountered during his 24 years of education.

This is the second article in a series about combating the aging process and turning back the hands of time. This article will delve deeper into the structural changes that occur in the aging face.

Again, aging isn’t graceful! When you look in the mirror and experience the harsh realization that time hasn’t been kind; don’t fret. You are not alone. We all have the same basic genetic material and experience the same gravitational forces. So, while you may not be the happiest with your own transformation, people the same age around you are either experiencing the same emotions or have resigned to accept what they cannot change. (You CAN change- more on that in a subsequent article.)

There are three changes that occur in the face as we age; two that are important for this discussion. The third change involves the demineralization and remineralization that occurs in the bony structure of the face. While the bony structure does experience minor remodeling throughout one’s lifespan, the changes are minor. For example, your high school chemistry teacher will still recognize you as the person responsible for the minor explosion that involved evacuating one wing of the school. He will recognize however, that while you are the same person with essentially the same underlying bony structure, your face has aged.

Most people will lose the “apples” in their cheeks somewhere in the transition from 20 to 35 years of age. The fat pads that help hold the cheeks up against gravity are either resorbed or begin the “Great Downward Migration”. This is coupled with a breakdown of the collagen and elastin fibers that help the unlucky infants cheeks to spring back into position after an assault from the over-zealous aunt. The breakdown of collagen fibers is accelerated by unprotected sun exposure and first or second hand smoke exposure, but will inevitably occur as part of the aging process.

When you combine the collagen fiber breakdown with the loss of volume in the cheeks you have the recipe for an aesthetic disaster (not the chemistry lab type). Aesthetic disasters are subtler, take place over a much longer period of time, and fortunately do not involve large amounts of smoke.

The face is anchored around the bony openings; the eyes, nose and mouth, all in the midline. As the skin of the face starts to relax and succumb to gravity because of collagen fiber breakdown and loss of volume in the cheeks, the lines around the eyes, nose, and mouth are pulled down. Crow’s feet lines around the eyes, nasolabial folds on either side of the nose, and marionette lines at the corners of the mouth as well as pre-jowls or jowls accentuate the aging appearance.

So, when you look in the mirror and aren’t happy with what you see, remember you are not alone. See the next article for more information on combating the aging process and turning back the hands of time!

Disclaimer: Dr Stephen Rath is the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. Under advisement from his lawyer, he no longer offers advice on chemistry experiments, but he will be happy to help you with your “aesthetic emergencies”!