Frequently Asked Questions

ANTI-AGING QUESTIONS

AESTHETIC MEDICINE QUESTIONS


ANTI-AGING QUESTIONS & ANSWERS

  • What is anti-aging medicine?

    • Anti-aging is about healthy aging-living long while remaining well. It has also been called age-management or longevity medicine. Anti-aging medicine is a new field of medical expertise which aims to prevent or reverse the symptoms and signs of aging. I think of it as turbo charged preventative medicine.

      With anti-aging medicine there is paradigm shift in the underlying premise of the aging process. Often, conventional medicine views aging and age-related disease as inevitable; the loss of function and dependence unavoidable. Anti-aging views aging as a disease which can be treated and aims to prevent or slow the aging process by treating the underlying causes. This new paradigm influences both the evaluation you will have and the program developed for you.

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  • How is an anti-aging medicine assessment different from a regular check up?

    • There are numerous differences between the assessment and treatment plan you receive at Live Young and the routine check up you may have within conventional medicine. We take more time, the visits are typically 1- 1.5 hrs long. We do a comprehensive review of your medical history, current health status, risks and exposures, family history and lab and other tests in order to assess not only how you are currently feeling and functioning but to also determine the diseases and disability you may be at risk for. Our model is based on the assumption that optimal health is achieved by using youthful bench marks and ranges for function as well as for lab and other test results.

      After the evaluation we build a program specifically for you that addresses your physical, mental and sexual health for the short and long term. My goal is to help you live out your life expectancy while maintaining youthful, resilient and optimally functioning organ systems.

      We do this by modulating or balancing hormones and council you regarding effective lifestyle changes. The 7 pillars of an anti-aging program are: diet and nutrition, exercise for body and mind, nutritional supplementation, stress and sleep management, risk factor reduction, elimination of toxic exposures and hormone balancing. The goal with our treatment plans is to address the root cause for diseases not just the diseases themselves.

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  • What will anti-aging medicine do for me?

    • A customized AA program will give you:

    • Better energy
    • Improved memory and concentration
    • Greater sense of wellbeing
    • Decreased body fat and increased muscle and bone mass
    • Improved physical performance and reaction time
    • Improved immune function
    • Improved sexual function
    • Skin rejuvenation
    • Less stress
    • Better mood

    • It will show you what diseases you are at risk for and the path for prevention. Not only will you feel better, you will have an accurate idea of what you need to do to maintain your health and vigor over a long life time.

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  • How can I tell if I have a hormonal deficiency?

    • When the levels of hormone decline our physical and mental function is impaired. Hormones decline due to age, menopause/andropause, disease or trauma. When our hormone levels fall the aging process begins to accelerate. This is because hormones are essential for normal cellular function for all organ systems. This influences not only our energy and vigor but the body's ability to repair and regulate itself.

      As we age we often develop hormone insufficiencies- levels lower than youthful, physiological levels. ( with the hormones cortisol and insulin levels go up). The symptoms can include: weight gain, loss of muscle mass, degenerative diseases (such as diabetes, heart disease and osteoporosis), compromised immune system, memory and cognitive decline, depression and stress, insulin resistance, loss of sex drive and poor sexual function, fatigue, sleep disorders, and wrinkled and thinning skin. This influences not only our energy and vigor but the body's ability to repair and regulate itself.

      The good news is that replenishing these hormones to optimal physiological levels can address these age-related changes. Hormone modulation is beneficial to men and women at any age but the best long term protective benefits are achieved if they are rebalanced sooner rather than later.

      At Live Young, we do assessments and lab tests to assess all the hormones - thyroid, DHEA, estrogen, progesterone, testosterone, insulin, cortisol, growth hormone and melatonin. When there are insufficiencies or excesses we restore levels to youthful normal ranges.

      We also provide ongoing evaluation following the initiation of hormone replacement or modulation to ensure the blood hormone levels remain in the optimal youthful ranges but never exceed what the body was accustomed to in its' younger years.

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  • What are natural or bio-identical hormones?

    • The terms natural and bio-identical hormone replacement are often used interchangeably. Natural hormones are those chemical messengers which have existed in our bodies since conception. Bio-identical hormones are structurally identical to the hormones our bodies naturally create but are made in a lab and are ingested to replace falling natural hormone levels. The hormone receptors cannot tell the difference, the body accepts and metabolizes these bio-identical hormones as if it made them. They are not drugs but are produced by pharmaceutical manufacturers or compounding pharmacies so potency and purity are assured. This is quite different from the creams sold at health food stores.

      In contrast, synthetic hormones are created by pharmaceutical companies by altering the natural hormone's structure so that their product can be patented. Synthetic hormones can produce many desirable effects but may also have negative side effects or dangerous metabolites (see below).

      I use bio-identical hormone replacement wherever possible.

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  • Do we really need to take supplements?

    • Yes we do for many reasons:

    • It is not possible to obtain all the micronutrients we need in sufficient quantities from diet alone for example the Vit. C content in 5 serving of fruits and vegetables is about 200mg we need 500mg/day. This is especially important as crops are often grown in depleted soil.
    • The traditional recommendations were based on prevention of deficiency states not on optimal levels.
    • Now even the most conservative organizations are recommending people take a multivitamin/mineral.
      • Canada food guide
      • Harvard revised guidelines for vitamins, Lancet 2002

    • As we age our needs change because there is:

    • Less efficient absorption or production of many micronutrients: calcium. Vit B12, Vit D and Vit K to name a few examples.
    • Higher demand for anti-oxidants as wear and tear accumulates
    • Higher demand for natural anti-inflammatory as chronic inflammation takes hold ( this is where Omega 3 fatty acids play an important role)
    • Higher demand for detoxification i.e. Homocysteine metabolism and B12/ B6 and folic acid
    • Increased need for the compounds needed for cellular energy production especially for optimal function of:
      • Cardiac cells
      • Brain cells
      • Immune cells

    • Live Young has its own line of nutritional supplements that have been developed for 2 primary reasons:

    • Compliance- they are put together so that they are easy, convenient to take and Provide, not only the baseline essentials but also additional supplements for optimized cardiac, brain, immune and bone health.
    • Safety- they are made from pharmaceutical grade ingredients in sufficiently high doses to be effective but won't cause toxicity through inadvertent multi-dosing. For example, I have seen several cases where patients were getting far too much selenium as it was in several of the supplements they were taking.
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  • I am active in my job do I really need to exercise?

    • It is a bonus if you have an active job or lifestyle but everyone needs to exercise in ways that specifically target the declining cardiovascular function and lean body mass that we experience as we age. Exercise truly is the fountain of youth and reduces our risk for all known diseases of aging. Not only that, it makes us feel and sleep better and improves our appearance as it raises metabolism, builds muscle and burns fat.

      At Live Young we advocate interval training for 2 essential components of fitness: cardiovascular and strengthening training.

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  • Why is stress management such an important part of the anti-aging program?

    • A little bit of stress is motivating but the problem with our lifestyles is that we often experience excessive and prolonged stress and do not know or have the time to implement stress management. A strategy to counter stress is essential because we now know that stress not only affects our sleep and makes us feel lousy but it is also a major risk factor for cardiovascular disease which is the leading cause of death for men and women in North America. Not only that it raises obesity rates, causes memory problems, impairs immune function, raises the risk for osteoporosis and mood disorders and interferes with the secretion of repair and regeneration hormones such as growth hormone and melatonin. Stress causes so many ill effects primarily through the secretion of excess cortisol and adrenalin-the stress hormones.

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  • I have a family history where every one seems to develop diabetes and heart disease. Is there something you can do about my risks?

    • Yes, my goal is early detection or prevention of disease. Every program is developed by putting together each patients individual risk profile and this incorporates the risks due to family history. The wonderful thing about prevention is that we can change the course of history by intervening before disease set in. This is true for a number of illnesses including diabetes, heart disease, strokes, Alzheimer's, osteoporosis and some cancers. Your assessment will involve screening for these and other common illnesses and if you are at risk for less common medical problems we will explore that too. Once we have assessed your current health status I develop a program to address the risk factors. For example, we will treat and closely monitor your weight, insulin, cholesterol, homocysteine, blood pressure and refer you for advanced diagnostic tests as needed. I use the 7 pillars framework for your treatment plan. (See question 2 above.)

      If you already have diabetes or other established disease I will develop a program to control or reverse that as well.

      Excerpts from Dr Rozier's writings on hormone replacement.

      What are the problems with synthetic hormones?

      When first developed, synthetic hormones were well received because they provided some of the benefits of hormone replacement: controlling the symptoms of menopause and fighting osteoporosis and heart disease. However, the long-term results have shown that synthetic hormones sometimes elicit a negative metabolic response. Some women can't tolerate synthetic hormones - often suffering with side effects such as bloating, bleeding or mood swings. In some patients, synthetic estrogens and progestins contributed to the development of breast and uterine cancer.

      Synthetic hormones are not a perfect match in the body. Synthetic hormones produce abnormal metabolites that can cause side effects and increase the risk of cancer. A natural hormone is a perfect fit in the body - it is a biologically identical hormone replacement.

      What is the truth about the recent publicity about the risks of taking hormones?

      The Women's Health Initiative (WHI) is a study that focused on synthetic estrogen (Premarin) and progestin (Provera). NOTE: Progestin is not progesterone. There were different "arms" of the study using different drug combinations. The arm of the study using Premarin and Provera (PremPro) was discontinued before completion because an increased risk of breast cancer was detected in the early stages of the study. This risk is attributed to the Provera portion of the regimen. This is not the first time progestins have been implicated in increasing risks for women. The arm of the study using Premarin did not show an increased risk of breast cancer, but was discontinued because of an increased incidence of strokes in older women. A recent study showed that natural estrogen did not have the same effects.

      Unfortunately, the media has misrepresented the facts of this study by targeting all hormone therapy. THIS IS WRONG! Again, the culprits are synthetic progestin, Provera and horse estrogen (equilinin) not natural estrogen or natural progesterone. There are numerous studies showing the long term benefits of hormone therapy. You just need to make sure you are receiving the right hormones (bio-identical) in the right balance. It is also important to begin hormone replacement as soon as you begin to lose the hormones to avoid any length of time without their protective benefits.

      What if I have been taking synthetic hormones?

      You need hormones, but you need the right kind, the natural bio-identical hormones, in the right balance. Don't tolerate the risks of the synthetic hormones when a safe alternative is available. Find a physician who will prescribe the natural hormones and then make the switch.

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AESTHETIC MEDICINE QUESTIONS & ANSWERS

  • What is aesthetic medicine?

    • Aesthetic medicine is a new area of medical expertise which uses minimally invasive procedures to enhance physical appearance. It employs non-surgical treatments to prevent or reverse changes in appearance caused by age, the sun and other environmental factors. Typically, the procedures are more affordable than surgery and do not carry the same risks or recovery time. They are also used for many age related changes that surgery does not address and in cases where surgery is not yet appropriate. For example, when there is sagging or loss of fullness in the cheeks a facelift may be too radical. When aging changes are early dermal fillers rather than surgery may be a better choice and can reverse up to a decade of lost volume and restore a more youthful look to the cheek, under-eye and the smile lines in the cheeks. In some cases patients are choosing to use our treatments as a means to prevent the changes that aging brings.

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  • How expensive are the cosmetic treatments?

    • Cosmetic medical treatments are a luxury treatment but are often much less expensive than people think, especially if you consider their effectiveness. I can't give an accurate assessment of price for most treatments without a consultation because most treatments are individualized but to give you an idea, a typical Botox treatment for the glabellar frown lines (those ones between the eyebrows) costs about $400-$450. It lasts 3-6 months. The lasers and dermal fillers are in the same ballpark. When I calculate how much it costs to get my hair cut and colored every month, the cosmetic treatments and hair care are in the same price range. The difference is that we are used to paying for great hair and pay for it monthly rather than every 3-4 months in a larger payment. The great news about Botox and other treatments is that they last longer the more you do them. Many of my patients who have been using Botox for over a year now only need to be treated twice a year.

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  • There is so much promised with skin care, what can I really expect from creams?

    • No cream can reverse significant wrinkles or even deeper lines but they can help with skin texture and tone and minimize fine lines and pores. I see them as a support for the treatments we provide at the clinic. Some can help stimulate collagen and others are exfoliators. Vitamin A remains the gold standard for wrinkle treatment but we also carry the peptides (argeriline and others) and other active ingredients for those who can't tolerate Vit A or who want an added boost.

      The key is getting the right ingredients, in sufficient quantities, in a delivery system that will deliver the active ingredients into the skins deeper layers. Our clinic sells skincare that does all 3 as well as a selection of sunscreens for protection. Our prices are very reasonable as I believe that you do not need to spend a fortune to get what you need in skin care.

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  • I have read that microdermabrasion will treat skin discoloration such as brown spots; I have also heard you need a laser to do this. Which treatment is best?

    • Laser or IPL is the best way to treat color discoloration in the skin that is caused by pigment deposits or dilated blood vessels. Microdermabrasion is a superficial treatment that polishes the skin and improves the sheen but does not go deep enough to lift the brown pigment deposits that cause sun or age spots. Both can be used together to get great looking, healthy skin because they treat all the skin layers.

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  • What is photorejuvenation and why shouldn't I be tanned before or become tanned after a treatment?

    • Photorejuvenation is a series of laser or IPL treatments that gradually improve skin texture, decrease redness and broken capillaries and lighten dark spots on the skin. It is most often used for treating the face, chest, arms and hands but can treat any skin area. The treatments should not be done if you have a tan because the light will be attracted to the melanin in the skin causing the tan and away from the problems we want to target. Following the treatment you need to avoid tanning because your body may get irregular pigment if you tan in the 4 weeks after. I encourage you to give up tanning all together as ultraviolet light is the most important accelerator of skin aging and promotes skin cancer.

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  • What is the best way to treat wrinkles?

    • That depends on where the wrinkles are and how deep they are. Fine lines are treated with collagen boosting procedures such as a course of microdermabrasion and peels. Better yet we can boost collagen production with 3-5 laser or IPL treatments (this is called photorejuvenation) or with 1-3 photodynamic treatments where we combine Levulan with the IPL.

      Deeper lines and wrinkles are better treated with either Botox especially in the upper face and the dermal fillers which are best in the lower face.

      These treatments address the wrinkles or folds at a deeper level and have the added advantage of rebalancing the facial expressions so you do not look so tired, sad or stressed.

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  • Botox seems so popular but is it really as safe as they say?

    • Botox is often confused with botulism poisoning. The two are very different just like penicillin is very different from the mold it comes from. With botulism poisoning large quantities of toxin are ingested usually from a contaminated food source. When Botox is used for cosmetic and medical treatments the protein is purified from its natural source. This purification is carried out under strict quality control by the pharmaceutical company Allergan. During the treatment tiny amounts are delivered by injection into targeted muscle groups to relax them. There are no systemic effects.

      Botox has been used in medicine for over 20 years and has been extensively studied for its safety. It has a better safety and tolerability profile than many drugs we do not think twice about taking such as the use of tetracyclines when treating acne or rosacea. It is so safe that it is approved for use in children as young as 2 years old. I use it myself and would never do anything that I thought would jeopardize my health in the short or long term.

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  • What are the different fillers and why would I try them instead of Botox or photorejuvenation?

    • There are a lot of dermal or soft tissue fillers available today. Dermal fillers are categorized as temporary, semi-permanent or permanent. I use either temporary or semi-permanent fillers for several reasons but most importantly because as our face ages and descends due to volume loss and gravity the appearance of a permanent filler in the face may become less desirable. In addition, fashion changes as well as our face structure and what looks great at one time may not be the look you want at another. I see this sometimes with permanent makeup.

      At present, I am using dermal fillers which come from hyaluronic acid or collagen but am constantly reviewing and evaluating what is new. These 2 products have a track record for safety and give natural looking results.

      Typically, the dermal fillers work best in the lower face for lines and folds and are used in the cheeks, lips, jaw line and under the eyes to restore the volume that is lost with time. They can be used alone on in combination with Botox and photorejuvenation for a real impact. At all times, my focus is to deliver great results which appear natural.

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  • I see that a lot of spas are now performing laser treatments. What is different about coming to a medical facility?

    • There is a big difference. You will be seen by me for your initial assessment and I also perform most procedures or directly over see them. Being assessed and treated by a medical doctor ensures you will be given advice with scientific backing and be recommended treatments which are not only effective but safe. The treatments will be different as the actual laser treatments are given at higher settings with a more powerful system. Not only will your treatment have the benefit of medical expertise but you can be assured of the appropriate follow up and post treatment care and will be in the hands of a professional who can manage complications should they occur. This holds true for all the treatments I perform such as microdermabrasion, chemical peels, Botox, lipodissolve and the dermal fillers.

      Be careful of facilities claiming to be medispas. To be called a medical spa they must have a medical director who is a licensed MD.

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  • I have a friend who had a series of laser hair removal treatments at a spa; they were less expensive but didn't last. Do you guarantee your results?

    • The term laser is used for all light based systems. However, not all light based systems are created equally and, I am afraid, your friend was probably treated with a system that did not deliver enough energy to do the job. This is both a good thing and a bad thing. On the positive side, from a safety standpoint, the higher powered medical lasers should only be used by a well trained medical professional. In the wrong hands even the weaker lasers sold to spas have caused unsightly pigment changes in darker skinned individuals. The bad news for your friend is that she had a disappointing result for which she invested both time and money.

      Our results are what we predict, for the most part, but as with all things dealing with the human body results vary from person to person so we cannot guarantee results. However, I can assure you that you will get scientifically based advice and professional treatment.

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