Friday, February 9, 2018

She's Got Legs

by Delia von Neuschatz

“Thank you BeyoncĂ© and everybody for making it OK to have shapely buttocks and legs,” says leading dermatologist, Ellen Marmur, MD. “In the past, it was all about getting rid of the fat and getting our legs to be made smaller and smaller. Now it’s really about keeping shapely.” In fact, legs seem to have kicked arms and abs aside, coming into focus as the feature chosen to telegraph health, strength and sex appeal. Consider country music star Faith Hill. Or rather, consider her gams. At last year’s Country Music Association Awards, her mile-long, bronzed and toned pins stole the show, sparking a social media frenzy, soon trending with their own hashtag and inspiring a Twitter account (@FaithHillsLeg).

The singer is 50 years old, so it’s important to note that sexy legs are not the sole province of the young. Indeed, a quick internet search for “celebrities with shapely legs” will more often than not reward the viewer with photographs of the more mature sirens.
Christie Brinkley, Nicole Kidman, Gwyneth Paltrow, Jennifer Aniston, Cameron Diaz, Naomi Campbell, Jennifer Lopez, Kate Beckinsale, Heidi Klum, Julia Roberts, Liz Hurley and Sandra Bullock among many others can strut right past younger beauties like Carrie Underwood, Rihanna and Taylor Swift with sure-footed confidence.

If you are justifiably proud of your legs, flaunt them by all means. But, if gravity, age and sun damage have taken their toll, don’t despair for there are many ways to successfully address a litany of leg issues — just in time for summer too. Below, several dermatologist discuss treatment options.
It must be noted that the grande dame of gams, of course, is Tina Turner, 78, who reportedly insured her trademark legs for $3 million.
“The leg really starts at the hip, not at the thigh and so we start from the hips down and talk to people about what their goals are,” explains Dr. Marmur whose Total Leg Anti-Aging Makeover program was inspired by her patients’ interest in bodysculpting and by an increasing number of complaints about crinkly knees. The makeover takes a multi-faceted approach, tackling concerns about shape, color and veins.
According to Dr. Ellen Marmur: “Leg sculpting is a very big part of our practice. People come in and they say ‘My legs bother me.’ They’re not so specific. They’re more general. So, when I make a master plan for people to improve the appearance of their legs, it ends up being a multi-faceted approach. It’s a good of way of grasping that when we’re working on your knee, it may not be just one magic thing that works. It might have to be a combination approach.”
SCULPTING THE LEG

Starting at the top, a flattening backside can morph into a perkier tush with the addition of filler in the upper butt area to achieve a pleasingly round shape. Hyaluronic acid fillers like Restylane, Juvederm and Sculptra are best says Dr. Marmur who favors Sculptra because “each vial goes a long way so you could put one vial in each tush and get a nice lift.” Results from a series of three treatments spread over three months typically last one to two years. Longer lasting, but more invasive butt lifting procedures include a thread lift (called Instalift) and fat transfer (aka a Brazilian butt lift).

Moving down, just below the tush is the junction of the buttocks and the back of the thighs, an area where it is not uncommon for an extra layer of fat — a “banana roll” — to form. Nicknamed the “b’thigh” by Dr. Marmur, it usually appears with age, dissolving the youthful distinction between the back of the upper thigh and the butt.

The best treatment for this pesky condition, which can be irritatingly impervious to diet and exercise, is CoolScultping, according to Dr. Marmur. CoolSculpting is an FDA-cleared, non-surgical fat-reduction treatment that uses a handheld device to freeze and destroy fat below the skin. It is ideal for stubborn “pinchable” areas of fat. “Patients typically see a 20% - 25% reduction of fat cells in the treated area,” said Dr. Marmur, with optimal results occurring one to three months after treatment.” Award-winning actress, Debra Messing, is a fan.
Dr. Ellen Marmur and Debra Messing. The Global Brand Ambassador for CoolSculpting, Debra Messing says: “I am proud of my body and I work hard to maintain a healthy diet and an active lifestyle, but let’s face it — everyone has those stubborn areas that resist all of your hard work. For me, CoolSculpting has worked extremely well. I tell people it’s my best discovery of the year. The treatment is non-surgical and has little to no downtime, which works for my busy lifestyle.”
Liposuction is the more invasive option for the banana roll. Although effective in creating definition between the top of the thighs and the derriere, care must be taken not too remove too much fat as this can actually cause buttocks to droop.

Progressing to the thighs, we are confronted with the age-old issue of cellulite, a condition that afflicts nearly 90% of adult women. No one, not even very thin women, is immune from the irksome dimpling which occurs when enlarged packets of body fat deposited deep under the skin balloon to the surface, pushing through the fibrous tissue that connects the skin to muscle wall. Nor is cellulite limited to the buttocks and back of the thighs. The resulting orange peel skin forms on the front of the thighs too. While it’s not possible to eliminate cellulite completely, there are ways to reduce its appearance.
Before CoolSculpting.
After CoolSculpting. Photos: Eric Bachelor, MD, FAC
To that end, Dr. Marmur deploys a one-two punch: Vanquish Flex for slimming and BTL Cellutone to combat cellulite. Vanquish Flex uses radio frequency to heat up and destroy fat cells. The system hovers over the thighs, never coming into direct contact with the patient, so it does not harm the skin. It does require a time commitment, however: four to six half-hour sessions spaced a week or ten days apart.

Cellutone uses ultrasound to create mechanical vibrations which enhance circulation and oxygen supply in the affected area resulting in increased blood supply and removal of excess fluid. “I call it an ultrasound jackhammer,” says Dr. Marmur. “It breaks up the cellulite by blowing up the fat cells which have been heated to the point where they’ve been liquefied.”
Before & After of Vanquish and Cellutone treatments. Photos: Dr. Ellen Marmur
There are numerous cellulite treatments available today and many don’t deliver on their promises, so just how effective is Cellutone? It’s pretty good, according to Dr. Marmur. “Cellulite is the holy grail so, I never promise that you’re going to have 100% reduction in your cellulite. But it’s an improvement by breaking up the fat and breaking up the anchors. The skin is anchored into the fat. That’s why you get the dimpling. Cellutone helps destroy those two factors which helps improve the look of the cellulite.” More invasive options to combat dimpled derrieres include liposuction and subcision. “But if you’d prefer a non-invasive regimen, “the three that I’m mentioning — CoolSculpting, Vanquish and Cellutone, are very helpful,” maintains Dr. Marmur.

The knee area is another part of the leg which people are fixated on discloses Dr. Marmur. The top of the knee where the muscle attachment occurs, begins to sag. For this, the dermatologist likes to use Sculptra. “Just like we inject Sculptra in the top of the butt, we can put it above the knee to help smooth out the area.”
Before & After Sculptra injections. Photos: Dr. Ellen Marmur
Dermatologist Paul Jarrod Frank, MD agrees. He also uses biostimulating fillers like Radiesse and Sculptra in the knee area. They last a few years he says, and they stimulate tissue to grow collagen, thickening the skin. But what about liposution? When it comes to knees, Dr. Frank explains, it’s about volume and elasticity. “The knee is an area where there’s a lot of motion and torque, so if you remove the volume, it makes the skin worse,” he cautions. It may be advisable to remove fat that’s on the side of the knee — in the inner knee — but if the fat is positioned above the joint, the area does not respond well to fat removal.
Dr. Paul Jarrod Frank: “I do as much body work as I do facial work. We’re now looking at the aging process for the whole body. People want to look good everywhere.”
To tighten the skin on the thighs, Dr. Frank prefers Exilis Ultra, a technology that combines powerful radiofrequency with high frequency ultrasound. The device heats up the skin's layers underneath the surface, triggering collagen synthesis. This causes the skin to contract and imparts a more youthful texture and appearance. Four treatments — which feel like an intense hot stone massage — spaced one to three weeks apart are required to achieve optimal results, which will last about two years.
Exilis Ultra Before & After. Photo: Paul Jarrod Frank, MD
A new and minimally invasive option is the thread lift. In this procedure, long barbed threads are inserted into the upper thighs. They are absorbable and the effects last 12-18 months. But, candidates have to be picked carefully cautions Dr. Frank.

COLOR

So you’ve diminished the dimpling and tightened the thighs on your legs. What about skin tone? “Brown spots drive people mad!” exclaims Dr. Marmur who is excited about a new laser called PiQo4. In addition to effectively removing tattoos, its powerful range of energy works on moles, freckles and sun damage.

Dermatologist Julie Karen, MD is equally excited about CryoCorrect Precision, a new cryosurgery device used to remove skin tags, sun spots, liver spots and flat seborrheic keratoses. Affecting some 83 million Americans, seborrheic keratoses, aka age spots, commonly appear on arms and legs. But unlike sun spots, “they don’t just comprise an increase in pigment and therefore are not amenable to permanent treatment with a pigment specific laser,” explains Dr. Karen.
Dr. Julie Karen: “In my practice, CryoCorrect has been a game changer as I finally have a method to treat a very common lesion, flat seborrheic keratosis [aka age spots].”
For many decades, cryosurgery — the use of extreme cold to destroy abnormal tissue like warts and precancerous lesions was performed with liquid nitrogen. And while highly effective, liquid nitrogen carries the risk of permanent discoloration or hypo pigmentation. CryoCorrect, on the other hand, utilizes compressed carbon dioxide which has a much gentler boiling point so it carries a far lesser risk of permanent discoloration or scarring, reveals Dr. Karen. Most lesions require only a single treatment which entails two gentle freeze cycles taking four to ten seconds. The process is painless and heals following a superficial scab in a few weeks.
Flat seborrheic keratosis before CryoCorrect treatment ...
... after 1 week: a superficial scab crust forms which makes lesions appear much darker for one to two weeks before they start to fade ...
... after 4 weeks. Photos: Julie Karen, MD
The CryoCorrect Precision device.
Complexion-improving devices also include Fraxel and IPL (intense pulsed light). Fraxel Restore, a laser with two wavelengths, is “fantastic for large areas of skin that have sun damage. It will evenly fade a lot of the brown spots and it also give you some skin tightening,” enthuses Dr. Marmur. IPL is also good for brown spots and for redness caused by broken blood vessels — those that are too small to treat with sclerotherapy. But, it is important to note that with IPL, one has to commit to completing three sessions. One session won’t deliver a perfectly even skin tone. “I’d rather my patients not have any IPL until they are ready to complete three sessions,” says Dr. Marmur.

VEINS AND LEG HEALTH
Dr. Roy Geronemus: “Non-invasive laser treatments for post inflammatory hyperpigmentation or hemosiderin staining are typically quite effective and require several treatments which are usually well tolerated.”
Spider veins, blue veins and varicose veins are generally the products of genetics or pregnancy. The most common treatment is sclerotherapy. Vein treatment, however, can cause discoloration to the skin. Post inflammatory hyperpigmentation or hemosiderin staining can occur on the legs following sclerotherapy, surgery, trauma or from venous insufficiency. Fortunately, there are several non-invasive lasers which can effectively treat these conditions including the q-switched ruby laser, q-switched Nd:Yag laser, Picosure laser, the Clear & Brilliant laser and the LaseMD laser informs dermatologist and laser expert, Roy Geronemus, MD.
Treatment of a hemosiderin stain with the Clear & Brilliant laser. Hemosiderin staining is a permanent or semi-permanent bruise-like mark on the lower legs caused by chronic venous disease.
But, treatment for vein conditions should not be the starting point, cautions Dr. Marmur who recommends that the examination begin with an ultrasound of the leg to determine if there is venous reflux. Signs for cancer too are carefully screened. So it’s not just about aesthetics. The leg makeover also includes a more medical evaluation involving collaboration with other specialties because, as Dr. Marmur clarifies, “what you’re seeing on the outside reflects what’s going on the inside and sometimes cosmetic things on the outside point to a medical condition.” After you’ve eliminated any health concerns, rest assured that whether you are bothered about cellulite, loose skin, slack knees, droopy buttocks, unsightly veins or brown spots, there are multiple effective treatment options that will help you stride with pride.
Expert tip: Exercise is key! “A large factor in determining how your legs look has to do with muscle tone and volume. Just staying really fit and exercising really does help!” says Dr. Frank.

Dr. Marmur agrees, adding: “I think choice of exercise matters a lot for legs. If you’re just doing spin classes, you’re going to get bulkier legs so you should vary your exercises. You don’t want to forget about hip strength either. So, doing lunges and dead lifts with some weights is actually really helpful for keeping the shape of the buttock area. In addition, stretching and a ballet barre type of workout is very helpful for the whole entire leg tone. Running, on the other hand, will build muscle, but will take its toll on your ankles and feet. Something else to keep in mind is that runners tend to get a lot of sun damage. So do tennis players and golfers. We call it ‘tennis-lady legs’ and ‘golfer-lady legs’ because if you’re out playing those sports in the sun for many hours, you’re accumulating so many spots. Changing your workout leg fashion, then, is also really helpful.”
For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn