Platinum Follicle Award for Jerzy Kolasiński

XXVI World Congress of the International Society of Hair Restoration Surgery took place in Hollywood, LA 10 – 14 October, 2018. ISHRS is an world’s largest association on the field of reconstruction of hair in all its aspects. It has a number of international committees.

The Society’s annual, wonderful and extremely festive Red Carpet Dinner & Award Ceremony takes place at the Dolby Theater (commonly known for the Oscar awards).

The award is presented by ISHRS President, Sungjoo Hwang from South Korea.

Each year, the International Society of Hair Restoration Surgeons (ISHRS) honors the significant contribution to the Society’s development and achievement in the field of science and education. This year, we’re proud to announce that Dr Jerzy Kolasinski was presented this prestigious award. He is the first Pole who joined the worlds elite of over a dozen leaders of hair restoration surgery.

This award coped Dr Kolasiński’s 34-year work in the field of hair reconstructive surgery.

It is worth noting that during the ceremony awards were also given in the category “Most ISHRS Opertion Restore Cases Award” dedicated to surgeons who spare their time and skills for free reconstructive treatment for disadvantaged patients – OperationRestore Pro-Bono Program. In this category Dr Jerzy Kolasiński was also the winner. In this year he performed the most of Pro-Bono repair operations.

In the picture from left: Victoria Ceh (Executive Director of ISHRS), Ken Washenik (Immediate Past-President of ISHRS), Jerzy Kolasiński, Sungjoo Hwang (President of ISHRS)

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During the meeting, the regulation of the treatments in the field of hair restoration surgery in different regions of the world was discussed. ISHRS plays an important role in supporting all societies. Thanks to their activity, hair restoration surgery is developing dynamically worldwide. The main aim of the Polish Society of Hair Restoration Surgery is the education of new generations of doctors interested in hair restoration surgery, so this meeting fits perfectly in this process.

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The coverage of this and other flights at www.gliding-team.pl

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The Jury consisting of prominent personalities of the Polish medicine awarded the title of Manager of the Year in Health Protection – in the category of Non-public Health Care Center to Dr Jerzy Kolasinski in recognition for his 27-year-long work in the field of non-public health protection and creation of such an exemplary medical company as Klinika Kolasinski. The award ceremony took place on December 14, 2011 in the Museum of John Paul II Collection Porczynski Gallery in Warsaw. The meeting was dignified by the Speaker of the Sejm (the Lower House of the Polish Parliament) Ewa Kopacz and Health Minister Bartosz Arłukowicz, who personally presented this year leaders in medicine with the awards.

The Formal Gala of Health ProtectiThe Formal Gala of Health Protection Leaders of the Year 2011 in Porczynski Gallery in Warsaw (the first from the left Dr Jerzy Kolasinski, in the middle the Speaker of the Sejm Ewa Kopacz and Health Minister Bartosz Arłukowicz) on Leaders of the Year 2011 in Porczynski Gallery in Warsaw (the first from the left Dr Jerzy Kolasinski, in the middle the Speaker of the Sejm Ewa Kopacz and Health Minister Bartosz Arłukowicz)

In recognition for Dr Jerzy Kolasinski’s achievements and his assiduous effort in creating and managing his own clinic, the province governor Piotr Florek send a congratulatory letter to our laureate.

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The participants of the Global Council of Hair Restoration Surgery Societies Meeting – the first from the left, the President of ISHRS Jerry E. Cooley, in the middle Dr Małgorzata Kolenda and Dr Jerzy Kolasinski

ARTAS – a robot used for collecting hair grafts

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Dr Jerzy Kolasinski during his presentation in Istanbul

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ISHRS Board during the meeting in Miami, the fourth from the left Dr Jerzy Kolasinski

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The Master Course participants in Stockholm – in the middle Dr Per Heden, the second from the right Dr Jerzy Kolasinski

Dr Per Heden during a demonstration surgery

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3D Imaging System consists of two basic elements: a set of high-resolution cameras and an image processor. The final effect comes not only as a 3D image of the body, which may be analyzed from all perspectives, but the system also allows for size and volume analyses. It is especially important in the analysis of the human face as well as the body profile, chest and breast.

Due to highly advanced technology we can simulate and preview feasible outcomes of plastic surgery or esthetic procedures.

Additionally, whatever takes place on the computer screen is reversible and may help patients define precisely the outcomes they want to achieve.

When a proper module is set and patients wear specially designed glasses, they may see their face as well as the whole body as a 3D image. It gives them a unique opportunity to look at themselves just as other people perceive them in three dimensions every day.

The procedure starts with taking a precise picture of the patient. The six high-resolution cameras capture the image obtained from different projections, which is next processed by the imaging system.

The next step involves introducing a number of orientation points which will facilitate a more exact analysis of the patient’s appearance and calibrate the image in life-size. In other words, we will receive a linear and volumetric analysis of face and the whole body. This will be helpful in planning precisely corrective procedures.

An extremely important element necessary to plan the medical treatment is the specification of the patient’s expectations. The methods applied so far in terms of doctor-patient communication have not been accurate enough. #d imagining system allows for previewing the surgery outcomes. By the same token it provides patients with a unique opportunity to verify their own expectations and the final effects which the supposed surgery may bring. Therefore, instead of making the decision somehow blindly, they may see their own face or breast after the surgery without a scratch. In this case, however, what we mean is a totally reversible, virtual surgery.

It should be remembered that the application of computer simulation does not guarantee specific changes and is used only to demonstrate the patient feasible effects of appearance modifications the surgery may bring about.

The real-life operation may hide many surprises and its outcome may slightly differ from the computer preview.

3D imaging system plays a huge role in the selection of suitable breast implants. Due to the precise analysis of breast shape and size, the surgery may be much better planned. The vast majority of women suffer from different degrees of chest and breast asymmetry. Sometimes, it is only the 3D examination that lets them realize the existence of such defects. The size and volume analyses of such parameters improves significantly the quality of surgeon’s work, who may choose proper breast implants with precision. The data base of 3D imaging system stores a few hundred of round and anatomical breast implants manufactured by world leading producers. 3D suggests such implants which are recommended for a particular patient. At the same time the preview of expected results is played in 3D format.

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Before & after pictures
Rhinoplasty

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Nose correction – rhinoplasty

The correction of the nose, also called rhinoplasty, is a procedure which improves the appearance and proportions of the nose in relation to the remaining components of the face. Sometimes it is performed to restore a proper nasal airway and, consequently, improve breathing.

What can such a nose surgery correct?

Rhinoplasty may correct:

• Nose size in relation to other parts of the face
• Nose width at the bridge
• Nose profile with its humps and depressions on the bridge
• Nasal tip if it is bulbous, drooping or upturned too much
• Nostrils if they are too big or too wide
• Nasal asymmetry and deviation
• Nasal septum setting
• Innate and post-traumatic defects

Who can undergo nose correction surgery?

The surgical correction of the nose is an individualized procedure and should fulfill the patient’s expectations. If the patient decides to undergo the surgery, he/she must beware of other’s opinions and avoid comparing the expectations with an idealized image.

Corrective surgery of the nose may be performed:

• At people aged 16-18 when the process of facial growth has completely finished
• At people enjoying good health
• At non-smokers
• At people who have realistic expectations in mind for the final results

What to expect during the consultation preceding nose correction surgery?

The consultation preceding nose correction surgery plays an important role in the treatment process. If the patient schedules an appointment with a doctor, he/she should expect a conversation concerning the following issues:

• the reason for nose correction procedure and individual expectations
• general health condition, previous surgeries, allergies to medications and substances
• taken medications, vitamins, herbal preparations, alcohol and smoking

Moreover the surgeon during such medical consultations:

• evaluates the general health status of the patient
• evaluates the patient’s face proportions
• discusses the risk and possible complications
• discusses the type of anesthetic applied during the surgery

How to prepare for nose correction surgery?

Prior to nose correction surgery, the following steps should be taken:

• laboratory examinations
• no smoking at least 4 weeks before the surgery
• no Aspirin or any other medications which contain acetylsalicylic acid and vitamin as well as other medications diminishing blood coagulation
• arrange someone to drive you home and ensure post-operative care during the first few days after the surgery.

Risk of possible complications:

The decision to undergo nose correction surgery is very individual and the patient should allow for any associated risk. The most frequent complications include:

• infection
• poor wound healing
• bleeding and hematoma
• nose asymmetry
• changes in skin sensation
• nose breathing problems
• persistent pain of the nose
• rough surface of the nose
• enduring nose swelling and skin discoloration
• disorders of nasal skin innervations (stiffening)
• disorders of airflow through the nose
• prolonging painfulness of the nose
• unfavorable scarring

Subsequent steps in nose correction operation

Step 1 – anesthesia

Proper medication are administered to guarantee the patient the highest comfort during the surgery. Depending on the indications and previous arrangements with the doctor, the surgery is performed under so called intravenous sedation, i.e. shallow anesthesia together with local anesthesia or under general anesthesia.

Step 2 – incisions

Nose correction surgery is performed using:

• closed procedure – small incisions are hidden inside the nose
• open procedure – incisions are made inside the nose and across the columella

Through these incisions, soft nasal tissues are lifted allowing access to such structures of the nose as bones and cartilages.

Step 3 – shaping nose structures

Depending on the recommendations, nose structures (bones and cartilages) are reduced or rebuilt by means of cartilages grafted from other parts of the body such as nasal septum, ear or rib cartilages. In the case of aquiline nose correction, the hump is reduced and nasal bones are joined in this region.

Step 4 – nasal septum correction

If the nasal septum is deviated, the procedure of its straightening is performed, which later facilitates nose breathing.

Step 5 – stitching

After nose structures are reshaped, the skin and soft tissues are redraped, and surgical incision are closed. If the ala of a nose are excessively developed, they are trimmed and the scars are closed with cosmetics sutures.

Step 6 – nose stabilization

A tape dressing is applied to the nose. In the case of bone structures correction, the nose is immobilized by means of a small slab plaster or the one made of elastomer. The structure and the septum of the nose are stabilized from the inside by means of proper tampons.

Step 7 – return to daily activities

When the procedure is completed, the nose and cheeks are swollen. Also bruising in the region of lower eyelids and cheeks is reported. It sustains about 2 weeks. The swelling of the nose and the surrounding area subsides within a few weeks. The swelling is usually bigger in the morning. Within the next few months the nose shape returns to its standard shape. The final effect is achieved after one year.

The surgeon will provide the patient with full and comprehensive information concerning the recommendations and follow-up care.

The durability of nose corrective surgeries

Mostly, the effects of nose correction procedures are permanent. However, within the next few years, the skin, soft tissues and cartilages of the nose may undergo slight changes, which in future may require further correction surgeries.

Nose correction surgeries are performed by dr Andrzej Bielecki – plastic surgery specialist within his own Private Healthcare Institution.

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Soaking the operated area with right fluid significantly reduces intra-operative bleeding

In recent years an increase in the occurrence of male breast hypertrophy called gynecomastia has been observed. It may manifest itself in three forms: adipose, glandular and mixed. The most efficient method of treating adipose gynecomastia is by liposuction. If there is a glandular component present (mixed or glandular gynecomastia) it is necessary to excise glandular tissue, with the resulting scarring of the areola. The latest method of surgical treatment of glandular gynecomastia permits excision of the entire lesion through a small incision in the submammary area. The small size of the incision (approx. 3 mm) and its location make the scar undetectable.

Indications

Suction of adipose tissue with a thin cannule

The most common form of gynecomastia is its mixed form. It is not always possible to precisely diagnose what proportion of the lesion the mammary gland is. Therefore each individual case of gynecomastia is a potential indication for no-scar treatment with the shave method. Also repeat procedures following an earlier breast liposuction can be performed using this method. However, corrections of poorly performed gynecomastia excisions usually require a more individualized approach and involve surgical incision within the areola.

Procedure

Suction of adipose tissue with a thin cannule

Corrective gynecomastia is performed under general anesthesia. Typically the first step of the procedure is suction of breast adipose tissue. It is carried out using tumescence method (wet), which significantly reduces intra-operative bleeding (Photo 1). A micro cannule to remove adipose tissue is inserted through a small incision of about 3 mm in the sub-mammary area (Photo 2). Following the liposuction the surgeon decides whether it is necessary to remove glandular tissue (Photo 3). If so, then a device (shaver) is inserted through the same incision to excise glandular tissue (Photo 4). Usually a thin layer of glandular tissue is left directly under the areola to ensure a natural and esthetic cosmetic effect in the area. In some cases it is possible to examine microscopically the excised tissues. Then the small sub-mammary incision is closed with steri-strips. Occasionally a single suture may be applied. Also occasionally a thin bulb drain is left in the operated area. In some cases (e.g. with heavy bleeding)it may be necessary to expand the procedure by incising the areola. Postoperatively the patient is fitted with a compression vest on the chest.

Postoperatively

Glandular tissue is being removed with the shaver

Patients remain in the clinic one day following the procedure. Usually they are able to get up and about in the evening. If a bulb drain has been applied, it is removed within 24 hours postoperatively. Edema in the operated area and localized bruises may subsist for up to a month post-op. Also a compression vest is recommended for a month although it may be removed for baths. If the wound has been closed with steri-strips then patients do not need to come for follow-up after one week. One week is also the length of time after which sporting activities may be undertaken. The final effect is usually achieved three months after the procedure. After that period it is recommended to report to the clinic for treatment evaluation.

Advantages of the shave method

• Precise removal of male breast hypertrophy – gynecomastia
• The entire procedure is performed via a small incision in the sub-mammary area, leaving an undetectable scar
• It is possible to microscopically examine the excised glands
• Short convalescence period
• No need for follow-up visits immediately after procedure

Disadvantages of the shave method

• A small risk of bleeding in the operated area necessitating the use of bulb drains
• In some cases it may be necessary to expand the procedure with incision in the areola area.

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Indications

Typically the FUE hair transplant procedure is performed in young patients who wish to avoid scarring in donor area. Such approach allows for very short crew cut. Frequently a FUE procedure is carried out in corrections of minor hair loss (receding hairline, eyebrows or moustache) and scars – also subsequently to hair transplant procedures performed with the classic method. Also, the FUE method is of particular use in patients with inelastic scalp as well as in those with a tendency to hypertrophic massive scars. The FUE method may also be used in correcting larger areas of alopecia although it may be necessary to spread the procedure over several sessions. Patients in whom this procedure is most preferably carried out have straight dark hair, and it is preferable if the hair is quite dense. The FUE method lends itself  very well to collecting hair from other body areas such as beard, torso or pubic area. (Photo 3)

FUE graft collection from chin area

Preparation for procedure

Just as prior to a classic hair transplant procedure recommended tests should be done. Within two weeks before the procedure aspirin or drugs containing acetylsalicylic acid should not be administered. If a thickening procedure is planned it is recommended to apply 5% Loxon (Regaine 5%) at least once daily for two months prior to procedure. On the day before procedure neither strong coffee nor alcohol should be drunk. There is no need to grow longer hair before procedure. However, it is advisable to bring to the clinic a cap (best with a visor like a baseball cap, not a tight woolen hat). At consultation the surgeon may give a different set of recommendations, which  should be observed.

Procedure

FUE hair transplant procedure is carried out under local anesthesia. Its detailed plan is presented to the patient at initial consultation.  Prior to procedure the surgeon selects areas from which grafts will be collected (donor areas) and areas where grafts will be inserted (recipient areas).For the purposes of medical documentation photos are taken. The surgeon may evaluate hair density using a video microscope or Trichoscan.

Team collects grafts using FUE method

Donor area is shaved as this enhances the precision of the procedure. For graft collection the patient lies on his belly. Patience is of paramount importance as this stage of procedure lasts from 2 to 4 hours. (Photo 1). The surgeon and his assistant collect individual follicular units with a special surgical instruments (Photo 2). There is always a probability that due to specific hair growth pattern the graft collecting procedure using  FUE method may not be carried out. What then remains is to collect grafts using the classic strip method. Such a  change is possible only with the patient’s  consent.

FUE graft collection requires tremendous precision

The collected grafts are inserted in  microscopic incisions. For many years Klinika Kolasinski has been using a special technique called four hands stick and place, which allows for a rapid and precise placement of grafts in recipient area. That is possible to place maximum 3000 grafts during one session but such operation takes 10 to 12 hours. So usually this procedure is carry out two or free smaller sessions day by day.

After the procedure the head remains without any dressing. In some cases the surgeon may decide to apply a dressing on the first day postoperatively. Usually the  patient can leave the clinic immediately after procedure. In some cases, however, he may have to stay in the clinic for a day.

Post-operative

The period of recovery is very short. Donor area usually takes 1-2 weeks to heal. During that period collection sites heal and become invisible. Regrowing hair in that area helps camouflage small scars. The FUE method makes it possible to have short hair without a worry about traces of surgical intervention.

Donor area heals just as quickly. For the first couple of days postoperatively precaution must be taken so as not to damage the grafts. Hair is washed three days postoperatively. As an appropriate anesthesia is applied, usually there is no swelling of the forehead. Little scabs covering  grafts disappear within a week, and the transplanted hair goes through telogen phase, falling out within two weeks. New hair grows back after three months. Patients usually make a full recovery within one to two weeks and therefore can normally work. Also sporting activities can be undertaken one week postoperatively. The FUE hair transplant method does not necessitate any follow-up visits or suture removal.

Advantages of fue method

• Scars invisible at donor sites
• Possibility of wearing close cropped hair
• Method can be used in patients with a tendency to massive hypertrophic scars
• Possibility of correcting scars in the scalp
• Full quick recovery
• No need of follow-up visits

Disadvantages of fue method

• Considerably longer duration of procedure
• Higher cost
• Not possible in patients with very curly hair

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Since the very young age, a lot of my female friends wanted to change some elements of their physical appearance. Many of them would lose a few or even a dozen or so kilos, whereas, I dreamt of my small breast being a little larger. During adolescence, after my sport classes or basketball trainings, I used to glanced furtively at my friends beautiful and firm breast while taking a shower. I tried to comfort myself thinking that I was still young and, finally, my breast would be as beautiful as theirs. But, it did not happen. I was a tall, slim and sportish girl with long legs. I treated lack of breast as physical immaturity and a kind of handicap. When I was a teenager boys used to laugh at me and call me flat-chested. When I looked very critically into the mirror, it was not so bad. I could notice some slight glands with areolas and mammillas. However, I felt ashamed while walking down the streets holding my head up high, and it seemed to me that if I was hunched, no one would notice my defect. I looked horrible. An image of a tall, slim and hunched girl with prominent shoulder blades, who looked down at the sidewalk made of tarmac, was disastrous. I have lots of bad memories from this period of my life. I often used to buy bras of a larger size of cups, and then I filled them with cotton wool or pieces of sponge. The effect, however, was rather miserable. Cotton wool usually changed into hard balls, and the sponge moved with every movement of my shoulders.

At the age of 18, my mother and I went together to the endocrinologist’s. The doctor calmed me down and did not detect any hormonal disorders. He advised me to put on some weight, as the BMI results reached the lower limit, and wait patiently. I followed every single instruction he gave me. I put on a few kilos and, consequently, my breast enlarged a little. At that time I also attended the gym regularly believing that well built chest muscles would replace lack of breast as such.

Finally, it was not until my studies that I changed my view on the problem. First of all, I had too little time to think about it and, secondly, there were a few young gentlemen who did not bother about my problem and dated me. After some time I had my beloved boyfriend and the jokes about my little ping-pong balls did not bother me any more. After the fourth year of my studies I got married and a few months later I got pregnant. Then, in the third trimester, my breast were just beautiful, the ones I had always dreamt about. They were not too big but plump, firm, smooth and sensitive. I give birth to a baby girl and as a typical mother I breastfed my daughter.

After my maternity leave, I came back to finish my studies. Then, I took up a job, although my husband earned well, and again my problem came back. Looking into the mirror I was scared seeing the breast of a mature and after delivery woman. Although I was in my twenties, my breast looked as if they belonged to a woman at the age of 40. It was a real tragedy.

I started seeking for help. I found in many magazines some articles on plastic surgery aimed at improving the look and shape of the breast. There were some articles on types of prostheses as well as pros and cons of such surgeries. After several weeks and hours spent on talking with my husband I, finally, decided to visit a doctor specializing at plastic surgery. My husband and I went together to the doctor’s and while paying such a visit I learnt the details of the surgery itself as well as the treatment afterwards. I did not know anything about possible complications before. One our visit was a real food for thought. My husband’s support was most important for me, however, the decision I needed to take on my own. Although I had dreamt for many years about beautiful breast, I took up my mind after a few weeks of sleepless nights.

The day of the surgery itself was, on the one hand, extremely stressful for me, but, on the other hand, it belonged to one of the happiest days in my entire life. The results were visible right after the surgery. I came back home 24 hours after the surgery. I could feel the pain in my breast, back and arms few days after. The pain, however, was bearable especially while looking into the mirror when I could see beautiful new shapes of my body. One week later I had to pay another visit to my surgeon for some control examination and removal of the stitches. My breast, then, was very tumid, tender and extremely sensitive. Such symptoms were felt for the following days, however, after the period of four weeks all of them went away and I felt wonderfully. It has been two years since the surgery took place. Its traces are slightly visible. Delicate three-centimeter-long scars in the subpectoral fold are invisible even if I sunbathe topless. I do not regret having undergone the surgery. I am a tall woman with beautiful, plump breast. Now, I can walk with my head up and throw out the chest. Moreover, right now I know it from my experience that small breast are very often not a small problem.

Marta

My second natural breast

At the end of November last year, being at the age of 44, I underwent another mammography control examination. It mapped out some changes in my left breast. Oncologists decided to remove the tumor. Histopathological examination revealed the presence of cancer cells, so further treatment required the amputation of the whole breast as well as the removal of the first part of the lymph glands.

I was surprised as never in my entire life had I expected suffering from cancer. During my stay in hospital, in the oncology unit, I came across many women after breast amputation. I even met a woman for whom the fact of having breast amputated was so embarrassing that she preferred to remain anonymous. However, she was not the only one. Many of them felt depressed, but still the majority tried to face such a difficult situation. After all, it was life that counted most. I was also paralyzed bearing in my mind the vision of living without my breast. Nevertheless, I assumed I would defeat the disease, and my body as well as my psyche would also defy it no matter how far the disease developed. There was, however, an aesthetic problem left.

I came across the issue of plastic surgery earlier. Many years before I had my child treated in the hospital of Polanica Zdrój. “There is still Polanica”, I tried to comfort myself. The oncologists helped me. It turned out that it would not be necessary to go to Polanica because there was one plastic surgery specialist in my hometown.

Two weeks after the first surgery, I was operated on once again. Apart from the oncologists who performed my operation, there was also a plastic surgeon whom I told what my problem was. He even imported from the Netherlands the best breast prosthesis available on the market. But honestly speaking, he offers only the best prostheses. So, after the surgery I woke up with a new breast. At first, it was quite flat, but I knew that it would be gradually filled in with a special liquid until it had a proper size. So did it happen. After several months I underwent another surgery in the clinic where my plastic surgeon worked, but this time the surgery was performed due to aesthetic factors. I had my nipple reconstructed on the artificial breast and my fine breast was raised and adjusted to the measures of the new one. My physical appearance changed definitely. Well, I gave birth to three children and breastfed them afterwards, but still my neckline and the whole figure, in comparison to the ones before the operation, both looked even better.

It could be said that the overall balance of my experience is positive. It is the very truth, however, not due to my appearance. The lesson of humility I had allows me to learn my own strong points and just think over those values that really count in life. Taking advantage of the possibilities offered by plastic surgery never made me feel like an Amazon. I treated my disease, cancer at least, as a transitional period, as pneumonia which dangerous as it is it is still curable. Five weeks after the amputation I got back to work. I even worked harder than before. I simply needed to catch up on my neglected duties. I got used to my prosthesis. Right now, it is just a part of me, my second natural breast.

Anna

Breast prostheses – a responsible decision

Breast augmentation and reconstruction is most often performed by means of prostheses, and these are the prostheses that evoke most controversies among people. The views on them are usually shaped by media which concentrates mainly on some breaking news. However, this type of news is not the one a woman needs to take a decision whether to undergo the surgery of breast augmentation or not. If she asks for help a specialist on plastic surgery, she may also expect detailed information on the topic. It is advisable, however, to have some views on breast prostheses earlier because, then, the consultation is of greater value and allows to make a good choice.

What types of prostheses are currently used worldwide and in Poland? Silicon prostheses are the ones used for the longest period of time, i.e. since 1962 (by Cronin and Gerow), next sodium chloride prostheses were introduced and became popular after the year 1992, especially in the United States. A few years ago, in search of something more perfect, the British invented the prostheses filled with soy oil. Afterwards, the German introduced hydrogel prostheses. At the very beginning, all of them had a smooth surface, however, for the last ten years textured prostheses have been used.

So, can we finally enjoy the possibility of having one ideal type of prostheses after 40 years of using them?

Unfortunately, we cannot. Let us take a brief look on types of prostheses as well as their advantages and disadvantages.

It should be emphasized at the very beginning that the covering of breast prostheses is usually made up of constant silicon, so the difference between prostheses lays in the filling. This is why, they are commonly known as silicon, saline or soy ones.

Silicon prostheses have been used for 40 years. At the very beginning they were the prostheses of first generation (1962-1970). They were characterized by a thick covering and dense consistency of silicon gel, so they were sufficiently airtight, however, they were much harder than natural breast. Within the years 1970-1980, the prostheses of the second generation were used having a thin covering. Consequently, they had better consistency, however, their tightness was not of the best quality. This was the type of prostheses that met such a frenzy of publicity due to numerous problems which, finally, led to their prohibition in the United States in 1992. Since 1980 the prostheses of the third generation have been used. They have multi-layer covering thanks to which their tightness is extremely huge and, at the same time, they are thin enough to have natural consistency. These are the prostheses that are widely used nowadays. Their only disadvantage, however, is lack of transparency for X-rays that makes mammography difficult to perform. Moreover, silicon is a nonabsorbable substance in the human body. So, if there is any leak from the prosthesis, then, silicon gathers in the breast which requires its operational removal. Nonetheless, it should be remembered that silicon is a neutral substance for the human organism. It is not a toxin poisoning our body. Besides, even if any prosthesis breaks, then it should be changed no matter what the filling is.

Sodium chloride prostheses are transparent for X-rays. Physiological solution that fills the prostheses is a neutral solution for the organism and totally absorbable in case of any leaking. They can be transplanted by means of little incision as well as by means of endoscope method. Their main disadvantage, however, is less natural consistency felt especially in the case of small breast which have insufficient amount of gland components. Also the tightness of these prostheses is much worse than in the former ones.

Much was expected as far as soy oil filling is concerned. The consistency of such prostheses resembled the consistency of natural breast very much. Moreover, they were transparent for X-rays. Unfortunately, after a few years, it turned out that soy oil resolves into free fatty acids which create an extremely unpleasant smell around a patient. For that reason doctors stopped using them.

So, what are women, who decide nowadays to undergo the surgery of breast augmentation, left with? Can they expect anything that would be safe and 100% reliable? Unfortunately, not. After 40 years we have not worked out absolutely safe prostheses. However, those 40 years resulted in reducing the risk connected with implanting breast prostheses to the minimum.

There is still the danger of developing connective tissue capsule around the prostheses. However, thanks to the producers efforts and advanced surgery techniques, the danger amounts today only to 2-4%. Also according to the research carried out all over the world, breast prostheses do not increase the development of breast tumor, but may even reduce the risk of cancer many times.

There is no ideal prosthesis nowadays, the one that could be suitable for every woman at every age.

Young women with small breast can be recommended silicon prostheses, whereas, women after 40 are advised to implant sodium chloride prostheses. If we correct dropping breast and implant the prostheses under the gland, then it is better to use the ones with silicon filling. In the case of women with a higher risk of cancer, it is more reasonable to use sodium chloride prostheses, which do not obstruct mammography examination in the future.

While deciding on the type of prostheses, such factors as health as well as aesthetics should be taken into consideration. It is extremely important to have the prostheses brought from a well-known source so that they have Polish certificates. It is strongly recommended to choose only those manufactured by well-known companies that give a guarantee of the highest quality products. Buying cheap and occasional prostheses is highly irresponsible. Unfortunately, quality is expensive. However, in the case of such a risky surgery as breast augmentation, there is no room left for risky cost cuts.

A proper decision allows to achieve the results that will become the source of happiness and satisfaction for many years.

It is worth remembering, especially when one considers seriously breast augmentation by means of prostheses.

Jerzy Kolasiński, M.D. Ph.D.

Gynaecomastia

A properly-developed breast of an adult man contains scant amount of adipose and gland tissue, whereas chest muscle, which is grown so much due to intensive physical exercises, is its basic ingredient.

Gynaecomastia is a pathological uni- or bilateral growth of breast glands in the case of men. The name itself derives from Greek gyne meaning a woman, and mastos, i.e. breast. 32-36% of adult men suffer from gynaecomastia to various extent. It is most often caused by hormones disorders in adolescence. It is one of the symptoms of the Klinefelter’s syndrome as well as other diseases related to gender hypoplasia (hypogonadism). It usually occurs between the age of 13 and 17. Moreover, it may be accompanied by an excessive production of adipose tissue in the region of the chest. Gynaecomastia can also occur while persistent taking of steroids which is extremely popular in the case of sportsmen and bodybuilders. At the adult age the development of breast is the consequence of reduced production of testosterone, and by the same token, the dominance of female hormones. Gynaecomastia can also occur while various liver diseases. One should always undergo detailed hormonal examinations before taking up surgical treatment and look for other possible causes of the illness. In the microscope study of the overgrown breast gland, the growth of leading out lymph duck as well as fibrin fibers predominate. However, if gynaecomastia is accompanied by obesity, in the histological study, adipose tissue constitutes the majority. It is the proportion of breast tissue to adipose tissue that is the basis of classification for such cases as hyperplasia. However, histological study is possible only after the surgery.

The cases of treating gynaecomastia were first mentioned in 17th century. In the first half of 20th century, all surgical methods of its treatment left unaesthetic scars around the areola and skin irregularities. In the year 1928 Dufourmentel proposed the cut on the border of the areola and the surrounding skin which resulted in a better aesthetic effect. A few years later, Webster promoted the technique of a half-round cut inside the areola leaving quite a thick layer of the tissues under the areola and the mammilla, preventing from hollows and irregularities, whereas, Balch, in order to avoid any scars in the region of the chest, proposed surgical approach from under the armpit. Taking into consideration the fact that adipose tissue constitutes a part of the breast, for the last few years, liposuction is also used in the case of surgical treatment of gynaecomastia. If gynaecomastia is complex, then the method of simultaneous suction of adipose tissue is supported, by removal of gland tissue from a slight cut in the subpectoral fold (Cohen, Pozez and Mckeown) or the areola (Pitmann). This surgical technique prevents from creating a hollow of the areola and breast dropping, and at the same time, allows to remove the excessive amount of skin when the changes are huge.

The surgery is usually performed under a general anesthetic. It is also recommended to wear a special pressure suit for 4 or 5 weeks after the surgery. The final results are often very good.

Małgorzata Kolenda, M.D. Ph.D.

The post Mammaplasty – Woman’s attribute first appeared on Kolasiński Clinic.

These are just several questions I asked myself during my whole childhood. As long as I remember, I have always had long hair. My mum used to tie it up in a ponytail hanging loose on my back and decorated it with a huge ribbon. In this way, she tried to hide my protruding auricles. And after school, as soon as I could, I had my hair loose. When I was a kid, I loved swimming. I started learning it when I was 4. My classes in the swimming pool took place several times a week. Soon, at the age of 6 I started swimming professionally in a sport club. It gave me a great pleasure. Besides, no one could see my outstanding ears, then, because they were covered by the swimming cap. However, the most unpleasant moment for me was drying my hair. I was afraid that one of my friends could see them and simply start laughing at me that would, of course, make me feel sad and probably could make me give up swimming. But my mum tried to prevent it. As soon as my swimming classes finished, she ran to the changing room to dry my hair quickly, whereas at school I used to wear colorful terry cloth headbands during my sport classes. It was extremely difficult to buy them in Poland at that time, and I remember I got them from my cousin from Australia.

Modeling, tying and brushing hair were all a nightmare for me, especially after my swimming classes. I always dreamt of short cut hair. Less hair means less work with it. I dreamt of getting rid of all my hair kits such as hair pins and buckles as well as headbands. Although my hair was long dark and curly, I didn’t like it.

That’s the way I survived up to the eighth grade. During the last year at my primary school a lot of duties I had helped me to forget about my problem for a while. I got used to the way my face looked like to a certain degree, of course. I thought that the nature bestowed on me this type of beauty and I simply had to accept it whether I liked it or not. Some people are thick, some are thin, some have red hair and face full of freckles and other need to wear glasses. All of these become usually the reason to be made fun of by other children. “Well, tough luck” I thought then. “I will have protruding ears” and I even got used to them.

But one evening when we all set around the table to have dinner, my parents brought up the problem of my ears. They asked me whether I would do something with my ears if had a chance to change them. I must admit that I was surprised then and scared at the same time. Of course earlier I asked my parents many times about the correction of my ears, but their answer was always negative. On hearing such news I just started thinking of the cost of a possible surgery. I asked my parents whether they meant Polanica Zdrój. But they denied. They found out that there was a possibility to carry out such a surgery also in our town. Earlier they got all the necessary information concerning the surgery as well as the cost. They suggested that we should go together to consult it with a surgeon. Without any hesitation I agreed. After a few days since the conversation took place, we were all sitting in the waiting room in front of the doctor’s office. He asked us to come in and took a look at my “tragic” auricles and told me every detail about the procedure as well as what I needed to be ready for after all. On being asked whether I was ready to undergo the surgery, I immediately answered YES and if that was possible I would stay in the clinic at once. The doctor, however, suggested my holidays as a perfect time to do it. Holidays were more favorable mainly due to two reasons. First, none of my friends would see me having head wrapped up in a dressing, and secondly, my new friends at my new school that I was to start from September would know me with beautiful ears. “This is a perfect idea” I thought. The time I spent waiting for my vacation was the longest one in my whole life. I looked through a dozen or so catalogues with haircuts. They all were wonderful, but I was interested only in those with short hair. Finally, the longed for end of the school year came. On this day my mother and I went straight ahead to the clinic. In the waiting room I was welcomed by a nurse that gave me a pair of pyjamas to put on and a capsule of antibiotics to swallow. About 10 minutes later I was taken to an operating room. The moment I entered it, my knees started shaking and I felt fear. However, the will to correct my ears was stronger than my fears connected with the surgery I was to undergo. The surgery itself was performed under local anesthesia. The doctor explained to me the details and asked me often whether I was ok. “Everything is ok” I always answered. I felt a few injections and after a while my ear was numb. Since that moment I could feel nothing. I just could hear some nice talks, music pleasant to the ear and soft clinking of the medical tools. After 45 minutes my right ear was ready. My head was turned on to the other side and the surgery continued. Again I felt a few unpleasant pricks of a needle. After all I was put a dressing around my head and an elastic bandage. It was already the end. I regretted then that I hadn’t undergone this surgery earlier. I went to get dressed and everyone could see a smile on my face. I got also some water to drink and two pills of a painkiller.

Equipped with all the things I needed I returned home. Luckily, my mother called a taxi. It was already dark outside. I didn’t meet any neighbors of mine as well as any friends. I didn’t want anyone to see me. Earlier I told everyone that I was going to visit my relatives for holidays. I had to wear a dressing all week long. I had to sleep having it on my head and I couldn’t wash my hair. On the first day nothing hurt me, however, on the second and third day my ears hurt me a little bit. The doctor warned me that I could suffer a little. Well, I could do it. The vision of having a nice haircut buoyed me up. So the week passed. Finally, I could see the result of the surgery and wash my hair. The dressing was taken off in the clinic and I was given a mirror. I took a look and …”wow they are beautiful” I exclaimed and gave a big hug to the doctor. Never had I been so happy before. I even gave a kiss the doctor and ran to my mother. Indeed the result was very nice. At the very end I found out that I needed to sleep with a headband, the same I wore during my sport classes, one month more. After a week or so I went to the hairdresser. I cut my hair and did a nice short haircut. I was happy. My friends I was seeing within the next few days didn’t recognize me at first. In September I went to a new school. There, no one laughed at me because of my protruding ears as they were not protruding any more. My dreams finally came true. Indeed, the dreams can really come true…

Angelika

The correction of protruding auricles

Although protruding ears are a congenital defect occurring most often in the region of head and neck, there were only 8 % of the operated patients whose defect could be observed in their families. The protruding auricles are the concern of about 5 % of the population. They are purely an aesthetic problem and usually other defects accompany it very rarely. At about 61% of children, the defect is visible just after the birth irrespectively of sex. Usually the defect is bilateral rarely unilateral, and it occurs most often at the female sex. The defect of protruding auricles described by Luckett results from the failure of antihelical fold to develop, the occurance of a large and deep concha as well as the abnormal ending of the edge of the helix. Very often the incorrect structure of the ear lobule also occurs. The technique of correcting auricles, i.e. otoplasty, was first described by Sushrut and Tagliacozzi. The modified era of otoplasty, however, dates back to the year 1848 when Dieffenbach described the correction technique of microtia. In 1881 Ely, in order to correct protruding auricles from the region of behind the ears, removed a strip of skin from the conchonavicular angle from the posterior surface of the ear, and it was Keen who modified the technique so that a scar remaining after the surgery could be as minute as possible. The next century brought about various further technical solutions. Since 1940 the corrective surgery of protruding auricles consisted in removing a fragment of the cartilage from behind the ears approach. Also instead of removing the cartilage, it is possible to incise its posterior surface. In 1960 Mustarde used non-absorbable stitches to create an antihelical fold from the posterior approach by ellipsical excision of the skin. Three years later Stenstrom and Chongchet made a posterior excision of a fragment of the cartilage to make the fold elastic. In 1968 Furnas described the procedure based on the Miller’s technique that consisted in attaching the concha up to the periosteum of the scull mastoid process in order to diminish the conchonavicular angle. Currently, there are about 200 surgical techniques described that correct the defect of protruding auricles including endoscope method, too. However, what is most important for the patient and the surgeon is obtaining the best cosmetic effect leaving the smallest scar on the posterior surface of the ear. Each of the above described surgery techniques consists in breaking subcutaneously the anterior surface of the antihelix (according to Stenstrom), putting on non-absorbable stitches that break the antihelix (according to Mustarde) and additional stitches between the concha and the periosteum of the scull mastoid process to diminish the conchonavicular angle (Furnas’ maneuver).

The ear corrective surgery is most often performed after the age of seven. Then, a child’s ear is fully developed and stops growing. In the case of small children the surgery is performed under general anesthetic, whereas, in the case of adults under local anesthetic using 1% lidokaine with adrenaline. On the posterior surface of the ear concha a little elliptical excision of the skin is made. Next, the skin is pulled off from the surface of the cartilage on the posterior wall of the ear, and by means of needles, the region of break of the future antihelical fold is marked. The posterior surface of the cartilage is incised and from the back approach non-absorbable stitches are put on in order to form a fold. Additional stitches are put on to diminish the conchonavicular angle between the ear concha and the periosteum of the scull mastoid process. An absorbable stitch is usually put on the skin in a continuous way.

A dressing with antibiotics ointment is put directly after the surgery. Prophylactically, just before and three days after the surgery, antibiotics are taken orally. The dressing should be worn for a week. One cannot wash his/her hair and it is recommended to refrain from school, professional and social life. Winter or summer vacations are the best moment to undergo the corrective surgery in the case of children. After a week, the dressing is taken off in the clinic, and the ears are a little swollen and red. However these symptoms disappear after two or three days. For the period of two months after the surgery, sleeping in a special elastic headband made of terry cloth is recommended. This kind of protection is also recommended during sport classes and practicing sport, generally. It is necessary due to the danger of “dodging” the auricle during an injury. The cartilage rebuilds itself within the period of two months. After such a period of time it becomes hard, elastic and resistant to damages.

Possible complications:

1. Infections. In order to prevent them, antibiotics are administered prophylactically as well as caution and full aseptic are kept during the surgery and one-week-long convalescence after the surgery
2. Coming out of the non-absorbable stitches through or under the skin on the posterior surface of the auricle. It is the most common and the slightest complication. It refers to about 10% of the operated cases. After the period of two months since the surgery was performed, the outstanding stitches should be taken out under local anesthetic
3. Ear “dodging”, i.e. the return to the initial state. It happens extremely rarely and only in the case when stitches are taken out too early. In such cases another surgery is needed.
4. Bleedings and haematomata. They occur very rarely and refer to about 2% of the operated. Not big haematomata, bruises and oedema in the region under the ear appearing on the second and third day after the surgery are something normal.

The corrective surgery of protruding auricles allows not only for the radical change of the appearance, but it is also very beneficial to the psyche of a little patent.

Małgorzata Kolenda, M.D. Ph.D.

The post Ear correction – a dream to come true first appeared on Kolasiński Clinic.

As far as I remember, all women in my family have always had thin hair. When I was a little girl, everybody paid attention to my grandma’s poor hair. As a young girl, she used to wear her hair in a bun. I saw her pictures when she was a young and beautiful woman with a beautiful bun. I thought that she had wonderful long hair. However, once I had a chance to see her in wet hair just after she washed it. Unfortunately, she didn’t manage to hide her thin hair form me. She always wrapped hair around her head that gave the impression of thick hair and wavy curly hair covered tightly the bald places. That time, however, I found out the truth.

My parents told me that when I was born, namely 32 years ago, I didn’t have thick hair. They were afraid a little as I was bald for a longer time. Not surprisingly, everybody, i.e. my mum’s friends and curious neighbors confused me with a boy. It was a real problem for my parents. They were afraid that I would not have any hair or that it would be as poor and thin as my grandma’s. However, after one year my hair started growing. They were becoming longer and thicker. When I was in the kindergarten, I was even taken a picture (a black and white picture) with my dark, long hair which I used to have loose or my mother pinned it up in two ponytails decorated with huge ribbons covering my ears. In elementary school and high schools I also didn’t have any problems with hair such as its excessive falling out. I had long up to my waist curly hair which soon became the object of admiration and jealousy. My friends used to call me a witch, and my teachers forced me to pinned my hair in a ponytail. Then, the problem of balding didn’t exist. I even didn’t suspect that it might concern me in the future. My wonderful hair was my pride. I did take care of them using best available shampoos and conditioners. I also didn’t dry my hair with a hairdryer because dry and hot air could dry my hair too much and destroy hair stems. I even tried not to pinned it up not to destroy it mechanically.

The problem appeared during my studies due to irregular lifestyle I led and unreasonable diet I followed. My diet consisted mainly of carbohydrates, fast-food and coca cola. Anything that was fast and cheap to eat in the city center became a part and parcel of my every day menu. I ate it during the breaks between my classes. Moreover, huge number of classes and studying at night, not enough sleep, stress caused by difficult exams, all that resulted in my hair falling out. At the very beginning, it was my mum who noticed it while sweeping my room. Then, I didn’t bother about it. I comforted her and myself that my long hair actually equaled 4-5 short hair, hence, it seemed that my hair was more than my father’s or brother’s. Besides, everybody had always short hair. Unconsciously, however, I became sensitive to the issue of my hair. I washed it once a week, but still I was scared looking into the bath and at my comb to check whether it didn’t fall out too much. Since then, I didn’t allow anyone to touch it. I didn’t like when my mother or my boyfriend stroke me on my hair or put their fingers in it. I also stopped going to the hairdresser. I did everything on my own including cutting. During the last year of my studies, I lost a few kilos due to huge stress I was under every day. First, I was happy as I wasn’t a thin person, however, my happiness did not last long. The loss of weight resulted after several months in loss of hair. I was scared seeing the condition of my hair. After having estimated it carefully I noticed that my hair got thinner on the temples and the forehead up to the head vertex. I was worried a lot. I thought, then, that my lifestyle led for the last years contributed to it. At that time I finished studies and started working professionally. I changed my diet. I ate huge amounts of fruits and vegetables. I spent my free time sleeping and relaxing. However, the change of my lifestyle did not improve the condition of my hair. I decided to cut my hair short however, it also did not bring any improvement. Then, I reminded myself my grandma and her problem. I broke down in tears. I asked my dear friend, who was a dermatologist, for advice. She advised me to go to a specialist dealing with hair transplantation. She knew like me that all conditioners, ointments or liquids were of no use, then. Before I decided to follow my friend’s advice, I search for some information in the Internet. I found out there were two ways of treating falling out hair, surgical one and non-surgical. Non-surgical methods consisted in suiting a wig. However, I crossed it out of my list at the very beginning. I was interested in the surgical method. I found a few addresses of the clinics where the surgeries of hair transplant from the anterior region of the head and back area, were performed. Driven by my curiosity and slightly being under my friends’ influence, I scheduled for the first visit with a surgeon who dealt with hair transplants. During the visit I explained the reasons of my coming and I suggested the possibility of female balding in my family. The doctor after having examined my hair carefully, could evaluate its density and the number of bald places as well as how a possible surgery could be performed. The consultation lasted almost hour. It was then when, I also found out what the most common reasons of balding were and what the possibilities of surgical treatment I could undergo. First, I needed to know whether my baldness was not due to some endocrynological disorders or even the tumor of the pituitatry gland or the adrenal glands. I was directed to the endocrynologist’s. The surgeon assured me that if he excluded the diseases of the hormonal system, I could count on the help of the surgeon. Eagerly or not, I went to the endocrynologist’s. I had my blood tested in various periods of the cycle. Eventually, it turned out that my hormonal system functioned properly, and the reason should have been searched for in some other areas. Having such a diagnosis I came back to the clinic. There I found out that it was necessary to have 1500 hair transplanted during the first surgery. After six months when my hair would start growing another surgery might have been taken into consideration to obtain a maximal density of hair. I left the clinic very happy. There was a ray of hope that my problem would disappear. If I underwent such a surgery, I would enjoy again beautiful hair. Maybe not as thick as before but at least not as thin as now. Hmmmmm. I needed to think it over. However, the vision of my hair, few and far between, in the mirror helped me to make up my mind.

I called the clinic next morning and I scheduled the appointment. Before the deadline, I had to have my blood tested and vaccinate against hepatitis and follow every instruction the doctor gave me. One week before the surgery I could not take aspirin and two days before I could not drink any coffee and smoke. All night before the surgery I could not sleep. I was so excited. In the morning I went by car to the clinic’s gate. I was accommodated in a 2-bed room with a bathroom. I was the only woman operated on that day. One hour later I was in the operating room. The surgery was performed by the surgeon known by me earlier. He was accompanied by two nurses, namely theater nurses. The only thing I remember was a nice music, atmosphere and a few tender tappings in the head skin in order to have anesthetic injected. Afterwards I had an evening off. ‘Fear has big eyes’, it is very much so. Before I entered the operating room I was really scared. First of all, I was afraid of the pain and unpleasant experience, but, on the other hand, I was not 100% sure of the results.

Next day the dressing was taken off. The sight was not nice. Among my hair I noticed numerous little red eschars. In the anterior part of my head I could feel slight pain and tension. So, I comb my hair so that no signs of the operation were visible. I even wrapped a scarf around my head and I went home.

The next few days were horrible. Not because of the pain but the swelling on my forehead and eyelids. I looked as if I got several punches from my husband. Fortunately, I could afford not going out for a week. One week passed and the swelling disappeared. After seven days I went again to the clinic for a visit control and to have the stitches taken off from the back region of my head. The eschars were slightly visible, but few days later there were less and less of them. After several days all the eschars fell out and I looked as before the surgery. I started even bothering that the transplants would not be tolerated and the surgery would not succeed. According to the doctor’s instructions, I tried to be patient. And it paid off. After three months the skin of my head was not so much visible. Of course, I needed to wait longer until my hair grew but still the results were already visible. I was extremely happy like a little kid. So, to celebrate my success, my husband and I drank the whole bottle of champagne.

Six months passed. My new hair grew as fast as the rest. I even went to the hairdresser to have it cut. I wondered whether my hairdresser would realize that I was after hair transplantation. But he didn’t notice anything. I felt wonderful. So, once again I went to the clinic. After having examined my hair, the doctor suggested one more surgery with 1500 hair transplants. Thanks to it, I would have more hair on my head. This time I agreed without any hesitation. The second surgery was similar to the first one. It was only me who was calmer and more confident as far as the method was concerned.

Two years have passed since that Saturday sunny morning when after the second surgery I left the clinic. Maybe I don’t have as dense hair as before but my hair grow very nice. I even change the haircut in the meantime. I have slightly longer hair up to my shoulders, and my hair is not a problem for me anymore. I am even not afraid of some curious glances and a despaired look of my hairdresser asking me what he should do with so little hair on my head. Now, I don’t hide my head under a scarf or cap. The most important for me is my good mood and my mental state which improved significantly. Who would think that balding is just a men’s problem?

Natalii

The treatment of alopecia in the case of women – a different matter

The person who thinks that baldness is a typically male problem can never be more wrong. Indeed, baldness refers to males to a large extend. However, a balding man is commonly accepted by a society. The situation of women is much worse. Women, if they do not have hair, are not accepted by their surrounding environment, and consequently, those who are suffering from it are forced to hide the defect. Many times the only solution left is wearing a wig. However, it usually happens that baldness is not total and it is usually limited to some loss of hair in the region of the head vertex, with hair remaining in the forehead line. A well trained hairdresser may be of good help. However, more often balding women look for surgical help.

Surgical treatment of baldness in the case of women should be treated differently. Although balding can be one of the symptoms of a very serious diseases, most often it is connected with the hormonal system. For this reason, while qualifying a patient to a particular treatment such factors are taken into consideration as the symptoms which suggest some disorders in the system. The following data are extremely important:

• First period
• Regularity of menstruation
• Undergone deliveries and miscarriages
• Taking contraceptives and other hormonal medications
• Family history in terms of balding (especially in a woman’s line)
• The dependence of intensive balding on undergone deliveries

While the patient is examined, such issues as abnormal hair in the region of the face, chest and hypogastrium are taken into account. Also the condition of the thyroid gland is tested. In some justified cases endocrynological examination is recommended which estimates the level and proportions of sex hormones (oestrogen and androgen) especially when balding occurs for just a few years, i.e. it started clearly in a certain period of time and was connected with menstruation disorders. The confirmation of disorders in the hormonal system obligates the patient to its treatment first, and afterwards the treatment of balding should be applied. However, most often the treatment of the hormonal system diseases improves the condition of hair on the head.

The exclusion of hormonal disorders allows to prescribe some surgical treatment. It is performed similarly to the one in the case of men, however, also here there are some differences.

A female hair line differs a lot from the male one. In the case of women hair cover not only the majority of the forehead region but also a greater part of the temples. While covering those regions with transplants, such factors as the direction and angle of growing hair are taken into account. So, only transplants which contain single hair are used here. It requires using a special microsurgical technique by means of needles.

The treatment repeated many times comes down to make the thinner region of the peak of the head more dense. Also here a precision in making cuts plays an important role. It is important not to damage hair growing nearby. Usually before the surgery and just afterwards 2% of solution of Minoxidil is administered to prevent balding after the surgery (telogen efluvium).

In the case of operating scars (postrinjuries and postburn) the procedure is similar to the one in the case of children. Expanders, skin lobes and hair transplants are used here.

After hair transplantation surgery, the swelling of the forehead usually takes place. It remains usually from the second up to the fifth day after the surgery. However, using cold compresses may be a great relief. In order to improve the cosmetic effect, it is advisable to have a haircut done by a specialist and dying hair light colors.

A full understanding of women’s nature dissimilarity and taking into consideration the differences in the surgery and postoperational treatment allows to avoid operating those women at whom balding is just a symptom of another serious disease of the hormonal system.

Obtained good cosmetic effects of the treatment satisfy not only a doctor but also a patient.

Jerzy Kolasiński, M.D. Ph.D.

Hair reconstruction surgeries in the case of children

Loss of hair on the head is a horrible experience for children. It is the result of children’s personality as well as the environment around them which shows less tolerance in comparison to the adults environment. The case of a kid without hair in some parts of his/her head happens irrespectively of sex. It also differentiates this group of patients from the adult one as adult men with no hair are commonly accepted.

The main causes of hair loss in the case children are as follows; birth defects, perinatal injuries such as perinatal haematoma, mechanical injuries, termal and chemical burns, postoperative scars and radiation caused by roentgen rays during treatment therapy of the central nervous system cancer and leukaemia.

While correcting the loss of hair on a kid’s head, there are some operational techniques used most often such as straight excision, the excision together with the covering of the bald region by means of skin lobes, stretching hairy skin by means of expanders and forming the lobes by means of the stretched hairy skin as well as autogenic transplant of hair follicles.

While taking into consideration the application of proper techniques in the corrective treatment, a lot of factors are considered. One of the most important ones is the size and the character of the loss. Also dissimilarity of a child’s skin is taken into account. It is thinner, more flexible and susceptible to stretching. It facilitates, on the one hand, the use of expanders, but, on the other hand, it makes the postoperative scars wider due to stretching in the period of reconstruction. Moreover, children’s hair is thinner, and adipose tissue in the region of a kid’s head is poorer. The kid’s skin is well blooded which facilitates the performance of various surgeries in this region.

A little patient’s personality is also different. Children are usually more sensitive to pain. Hence, there is the necessity to use a general anesthetic during the surgery. Moreover, a kid is a more demanding patient, so gaining its trust requires more efforts on the part of the doctor.

In the case of multifocal loss of hair or considerable thin hair, the autogenic implant of hair follicles is applied. In order to get the transplant, a strip of skin of the width of 1 cm and the length depending on the presumed number of grafts (7-12cm) is taken from the back region of the head. Then, by means of triple enlargement, the transplants containing 1-2 pieces of hair (micrografts) or 3-4 (minigrafts) pieces of hair are prepared. The grafts are inserted into microexcisons made in the recipient region. The most precise and, at the same time, the fastest technique of transplant performance is the method called „four hands stick and place” worked by Hair Clinic Poznań.

In the case of massive regions deprived of hair, the treatment with the use of expanders is administered supported in some cases by autogenic transplant of hair follicles. During the first surgery, an expander is inserted under the hairy skin in the region of a scar. It is an implant in the form of an empty ‘bag’ connected with a valve which enables tapping many times. Two weeks after the first surgery, physiological solution is injected by the tap of the valve. The stretch of the expander to the required volume makes the hairy skin stretch over the implant. The second surgery consists in excision of the loss (scar or baldness) and covering it with the lobes of the stretched hairy skin.

The loss of hair in the case of children is most often caused by external factors such as injury, burn or radiation. The loss of hair is the cause of not only cosmetic defect, but also contributes to a deep psychological trauma.

The corrective treatment should be performed in such cases as early as possible before some permanent changes in a kid’s psyche happen.

Jerzy Kolasiński, M.D. Ph.D.

Hair transplantation in the treatment of baldness after radiation

Tumors in the case of children are most often the second (after accidents and injuries) cause of death from the age of 1-14. Leukeamia and tumors of the central nerve system constitute about 50% of all the tumor cases at children.

Associated treatment consists in surgical treatment, radiotherapy and chemotherapy. In many cases this type of treatment is effective and allows to obtain a high rate of survival in the case of little patients.

However, lasting baldness of the hairy region of the head is very often a result of radiation.

At the beginning of radiotherapy, balding encompasses the majority of the head. After the end of the treatment hair grows partially. However, there are still some regions of the head which are deprived of hair for ever. It constitutes a serious cosmetic defect, which many times, influences negatively the psyche of a little child.

One of the most effective ways to treat postradiation baldness is autogenic transplant of hair follicles.

It was Norman Orentreich, an American dermatologist, who as the first in the world suggested the treatment of baldness by means of autogenic transplant of hair follicles in the year 1959. The main assumption of the method was the conviction that hairy skin of the head from the regions of the back does not undergo balding and, moved into the regions of the skin that are bald, maintains its original features resulting in hair growth. Many clinical experiments confirmed the validity of the thesis. In the very first stage of using this method, the grafts had the diameter of 4-5 mm. Even though the obtained effect of hair growth was good, there was much left as far as cosmetic effect was concerned. Hair grew in convergence bringing about unnatural look. In order to improve the cosmetic effect, Rolf Nordstrőm from Finland as the first suggested in the year 1981 the use of micrografts containing 1-3 pieces of hair. Thanks to such little transplants, the cosmetic effect improved significantly, especially, in the region of forehead line. In 1986 Carlos Uebel from Brazil started performing massive operations using 1000 micrografts. The technique gained its popularity in the second half of the 90s. Right now, the standard is to use 1500-3000 micro- and minigrafts. Most often the treatment is applied in the case of androgenic balding of women and men. A well learnt technique allowed to administer the autogenic transplant of hair follicles in the treatment of postinjuries and postradiation balding. It is usually performed in advanced stages of baldness.

Due to the postradiation changes in the region of head skin in the form of endogenous growth of collagen and damage of bloodness it is recommended to use some modifications of the transplant hair surgery. The number of performed grafts should be lowered during one surgery and larger distance should be kept between the grafts, i.e. 1-1,5 mm. It allows to have 30-40 grafts per square cm.

In the case of baldness after radiotherapy, the density does not exceed 15-20 grafts per square cm. When there is a necessity to cover with the grafts huge areas of the head, then it is performed in stages, placing the grafts concentrationally from the perimeter to the central part of the baldness. A few months long breaks should be kept between the surgeries.

The care of having special asepsis during the performance of the hair transplant surgery is extremely important especially in the case of patients after radiotherapy. Worse bloodness of the hairy regions of the head results in their greater susceptibility to various infections. Antibiotics prophylactic is also important.

The time of performing hair transplantation operation is also crucial. It is commonly known that the viability of the grafts lowers 4 hours from the moment of their taking. The four hands stick and place technique worked out in Hair Clinic Poznań allows to shorten maximally the most time consuming stage of the operation, namely insertion of the grafts into the regions of baldness.

It consists in the immediate insertion of the grafts in the incised places. It allows to make the size of incision more precise and prevents from inserting two grafts into one cut.

The growth of hair in the case of patients after radiotherapy occurs later than in the case of patients who suffer from androgenous baldness, respectively 4-5 months and 3 months. It is probably due to worse bloodness of the recipient region. So, it requires greater patience on the part of a doctor and patient.

A properly performed surgery of hair transplant in the case of patients suffering from postradiation baldness allows to obtain good results and sometimes even very good cosmetic effects. Not only does a patient’s appearance improves, but also his/her psychological state. It is of great influence on the comfort of their lives.

Jerzy Kolasiński, M.D. Ph.D.

Reconstruction surgery of eyebrows and lower lip hair

Autogenic transplant of hair follicles is mostly used in the reconstruction of hair loss on the head skin. Baldness is most often caused by the so called autogenic typical of male balding that occurs both in the case of men and women. The loss of eyebrow and upper lip hair takes place very rarely. The most often reason of the lack of hair in those regions is an injury, for example a chemical one, like burning or mechanical one, for instance, accident with numerous face scars, too often extraction of eyebrow hair by women or remaining scars after cleft palate or harelip surgeries.

A skin scar does not contain in its structure the elements characteristic of healthy skin, namely, does not contain hair follicles.

In order to reconstruct hair in the region of eyebrows or moustache, a surgery, similar to the transplant of hair in the region of the hairy head, is performed. The technique of the surgery performed under a local anesthetic consists in extraction of a hairy skin strip from the back region. The strip is next cut into smaller pieces which contain single hair follicles (called micrografts). Then, in the regions into which we want to insert the graft, slight incisions are made, modeling at the same time a proper angle and the direction of new hair growth. Next, the obtained micrografts are inserted by means of very little tools. Usually, the scar skin itself is very hard and every tap is connected with pushing out the grafts which have already been inserted. So, delicacy is really important is such surgeries as well as precision and huge patience of the operator. Many surgeons may ask whether a transplanted skin in scar tissue is tolerated. Certainly, it is. The main condition, however, is inserting the grafts in proper distance. Thus, the necessity arrives to perform several surgeries in the same region. Every surgery finishes with a dressing on the donor and recipient areas. The patients usually stay in clinic for 24 hours. Next day morning, the dressing is taken off, and the patient may come back home without the dressing. For the following few days, the aftercare of the two regions, donor and recipient ones consists in bathing the places with spirit and spraying them with an antibiotics according to the doctor’s prescriptions. In the place of transplanted hair follicles little eschares are visible. After one week it is required to pay a control visit in the clinic. The stitches need to be taken out from the back region of the head and the evaluation of the operated places should be made. The eschares peel off after 10-12 days and from now on, one should wait patiently for hair to grow. It will appear on the skin surface three months later. In the case of injury scars or postoperational ones, the period of waiting for hair growth is sometimes slightly longer.

Małgorzata Kolenda, M.D. Ph.D.

The post Hair transplantation – It is not only men′s problem first appeared on Kolasiński Clinic.

After my final exams in high school, I started studies at the Technical University in Poznań in the Department of Computer Science as computers have always been my passion. During the studies I experienced a lot of stressful situations connected with the exams and hard studying. I eat irregularly and suffered from insufficient amount of sleep. It was not until the third year that I had a little more free time. I met then a wonderful girl and I wanted her to like me. I started going regularly to the hairdresser to have my hair always cut shortly Afterwards I could model it with a small amount of gel so it didn,t give the impression of a chaos. I also used very good perfumes. I could afford them as I gave private classes on mathematics and computer science. A part time job I took up in my father,s company helped me to save some pocket money for a cinema or coffee with my beloved. So, the months passed happily. Unfortunately, once I noticed that my hair was thinning in the region of the hairlines and the forehead. I was then 23 years old and I did get worried. I asked my father about the history of balding in his case and what our grandparents, who I didn,t have a chance to meet, looked like. I heard then that the problem of balding concerned every male in my family. All of them went bald similarly. First, it was only in the region of the hairlines and then in the region of the forehead and the top of the head. The good thing was that none of them was as bald as a coot, which comforted me somehow.

Since then I started taking care of my haircut. I bought a set of shampoos against balding, conditioners and special ampoules with Minoxidil to be rubbed in the skin of my head for the following 40 days. Was it enough? I didn,t know. I just had the feeling that I did my utmost to prevent balding.

A few years more passed. I graduated from my school, got married. My two wonderful daughters were born. I also had a good, responsible and quite a well-paid job. I did not complain about the lack of things to do, contrarily, my family more often accused me of having no time for them. I decided to slow down a little and take care more of my daughters. I also found some free time for myself. One day after having washed my hair I noticed with a worry that a lot of my hair left in the bath. It must be spring, I thought. My hair was always slightly weak at the beginning of spring so it simply fell out more than usually. The following warm months, proper diet enriched with huge amount of fresh vegetables and fruits slowed down this process and resulted in strengthening of the skin. This time, however, I decided not to wait and buy a set of vitamins. Our market is abundant in such medications. I comforted myself that as soon as I balanced the level of vitamins everything would come back to the original state. Soon, summer came. We spent summer vacation at the seaside and in the mountains. My girls also went to summer sports camps with their friends as both swam pretty good. We spent a few days at my parent’s-in-law forester,s lodge at the end of summer. Forest, fresh air, contact with nature resulted in forgetting about all my problems either professional or health ones. I even forgot about the problem of my hair.
When I came back to work, the amount of responsibilities and matters to deal with resulted in a huge level of stress I was exposed to and consequently the problem of balding came back. Unfortunately I had an impression that I had much less hair on my head than before the vacations. The hairline enlarged significantly as well as the skin started to show through in the region of the forehead and the top of my head. The only unchanged passages were the regions of the temple and occipital. What should I do?, I thought. I was then 35 years old. I felt young and I wanted to look young. One autumn evening I sat down at my computer and started browsing the websites in search of some information on balding and the ways of its treatment. I thought about new shampoos and conditioners as those that I used for many years seemed not to work any more. The vitamins also did not appear to be effective. I visited many websites and found some information on surgical treatment of baldness consisting in moving the hair from the occipital region so where the hair does not fall out in the bald regions of thin ones. I decided to read more about this problem. On the website of one of the clinics that dealt with such surgeries I had the opportunity to ask questions anonymously on line. I did it. Without giving my name I ask a few embarrassing questions. Next day I received the answer. I was informed that it was difficult to estimate whether I was right person to undergo the surgery and how many hair drafts I needed and what the price of the surgery would be. I was invited for a consultations with a surgeon. I decided to go there. Earlier I discussed everything with my wife who fully supported my idea. One afternoon I arrived at the clinic. Some people were already waiting in the waiting room. The lady at the reception desk gave me a leaflet and a brochure and she told me I was the third in the line. I waited patiently and 30 minutes later I was in the doctor,s office. The room did not resemble a traditional doctor,s office at all. It helped me to relax. The doctor examined my hair, ask my age and about the process of balding as well as similar cases in my family. The premises pointed genetic background of my balding. He also told me about the surgery, the number of grafts I needed to cover the whole thinning surface to obtain thick hair and how to schedule the appointments. He also prescribed me some medications that prevent hair follicles to fall out. They were some hormonal tablets which influenced male hormone metabolism and by the same token blocked hair receptors and prevented their falling out. He claimed that I was still a young man and the medications would not imbalance the level of hormones or change anything in my libido. Certainly, they would slow down the process of hair falling out especially in the central and top region. As I was going for the consultations with the intension of undergoing the surgery I decided on it at once.

After several weeks the deadline came and on the appointed day I arrived at the clinic in the morning. The service was extremely friendly so I did not feel as in an hospital. The surgery was to take place in the afternoon so I had some time to catch on reading papers. In the theater room my blood pressure was measured. It turned out to be slightly higher because of my excitement. In the first stage of the surgery I was lying on my stomach, then in some more comfortable reclining position. The injections were the worst part of the surgery but still I think that I was brave enough. To be honest I thought they would be more painful. The surgery was performed under a local anesthetic so I could listen to music and chat a little with the doctor during the surgery. I also had the feeling that I napped a while. After three hours I came back to my room. I ate dinner and I had the time only for relaxing. I had a dressing on my head that was taken off next day. After my breakfast during another meeting with the doctor, he explained me what I should do for the following days. I knew I could look horrible because of the swelling of the forehead and numerous scabs so I took two weeks off in advance. I came back home and all three girls looked interestingly at my cut skin head. Next day my forehead was swollen very much. I started using the cold compresses recommended by the doctor. Unfortunately, they did not help much. The swelling went lower to my eyes and I could hardly open my eyes. After three days everything was like before. Then I could wash my hair for the first time. It was the greatest relief for me. After one week I came back to the clinic for a control visit. The itches put in the taking place were taken off. After several days later all the scabs and little hair fell out. At that moment I looked exactly like before the surgery, quite normal. I needed to wait patiently until hair follicles appear on the surface of the skin.

These were the hardest three month in my life ever. How shall I wait patiently?, I thought. However my family and professional duties made the time pass quickly. One evening when I took a look into the mirror I noticed that something started to germinate, and I was not wrong. My hair started growing. After three more months they were 3 cm long and I could go to the hairdresser to have my luxuriant hair cut.

Adam

A non-balding person has about 100 up to 140 thousands growing hairs in the region of the hairy skin of the head. Their number depends on the thickness and color of the hair. Every hair usually grows about 1 cm a month and every day we lose about 50-100 hairs. Every hair undergoes three stages of its life: anagen, namely the period of growth, catagen, the transitional period and telogen, the time of rest. Properly when one hair falls out another one grows in its place and the whole cycle repeats. However, when more than 100 hairs fall out a day and, additionally, no new hair appears it is an alert state. The most frequent cause of balding is androgenic balding that concerns about 80% of men. It is genetically conditioned and passed down from one male generation to another. The beginning phase of balding consists in drawing back the forehead and temple line as well as gradual enlarging of hairlines. Next, the so called central balding appears on the top of the head. Usually these are male hormones, namely androgens whose main representative of is testosterone, which are responsible for this process. The hormone undergoes a transformation in blood under the influence of 5-alfa-reductase enzyme, and it changes into dihydrotestosterone (DHT), which consequently results in the disappearance of hair follicles with falling out of hair. Fortunately, not every hair follicle is susceptible to this substance, especially those situated around the head, namely in the occipital and temple region. In the population of white people balding concerns about 30% of men at the age of 30 and 50% of men at the age of 50. It is a long-lasting process and lasts from 15-25 years, in some extreme cases just 5 years. Within one year a balding man usually loses about 5% of his hair. The loss of hair is very often considered something negative by the man himself as well as other people. It results in deterioration of psychological condition, the feeling of low self-attractiveness, lowered self-esteem and sometimes even depression. It is commonly believed that balding man succeeds less in professional and private life.

There are many liquids and shampoos available on the market preventing hair falling out and influencing hair growth. Let us remember, however, that hair is a dead product of hair follicle and no substance applied externally is able to block the process of its falling out. Hence, all those medications are ineffective in baldness treatment.

Hair loss are most often corrected by means of various hairpieces and wigs. In numerous hair salons there is a tendency to promote the fashion of hair thickening and prolonging by adding artificial hair. Unfortunately, not only does it not give a positive result but also destroys, weakens and mechanically damages still growing hair. If one wants to take advantage of wigs or hairpieces, it is recommended to shave head to glue and adjust properly the wig to the head. Certainly, it is a solution but only in extreme cases when surgical treatment is impossible. Thanks to modern techniques, artificial hair can be adjusted to the rest of the hair very well by choosing proper color and thickness.

The only permanent and natural way of baldness correction is surgical treatment consisting in filling in non-hairy head regions by means of hair grafts.

The technique of moving some fragments of skin head containing hair follicles has been known for over 100 years. It was first mentioned in 1822 when Dieffenbach published experimental transplantation of animal fur and goose leathers. Te first surgery of hair graft was performed by a Japanese doctor Okuda in the year 1939. The inventor of today practised method was an American dermatologist Norman Orentreich whose papers were published in the 50s of 20thc. At the beginning the method called punch-technique was used, however, it left some skin irregularities and hair tufts that resulted in a very unnatural esthetic look. It was then replaced by micro and macro grafts proposed in the year 1981 by Rolf Nordtröm. In the year 1984 Headington as the first defined the technique and since 1990 many others (Limmer, Rassman, Shapiro, Bernstein) made the technique and the notion of follicular units popular.

The surgical treatment of balding consists in taking a sample of a hairy skin from the occiput region, proper preparation of micro and macro grafts containing single follicular units and next inserting those skin fragments into the regions where there is no hair or where hair is thin. All the operational stages are performed under a local anesthetic and only in exceptional cases especially in the case of children under a general unaesthetic. The skin fragment taken from the posterior part of the head can be a single strip 1-1,5cm long or consist of a few thin strips or little rollers obtained by means of punch-technique. During the recent years the FUE method (follicular unit extraction) has been gaining popularity. The technique consists in taking little fragments of hairy skin which contains single follicular units. The popularizers of this method are delighted with this technique, however, it has many limitations. It is usually applied in the case of young people at whom only the hairlines are thinning since the maximal number of grafts amounts to 500-600 during one surgery. The advantage is that instead of one horizontal few centimeters long scar in the posterior part of the head, there are several little scars. The method allows to have hair cut very shortly in the posterior region of the head which is quite popular among young men those days. The surgery based on this technique usually lasts 2-3 times longer than the traditional method and it is connected with higher costs.

Hair Clinic Poznań, which exists over 20 years has developed new technique of inserting grafts. It is widely recommended technique by Kolasiński M.D. called Four Hands Stick and Place. The method consists in inserting grafts in tiny skin cuts directly after they were created. Thanks to this technique it is possible to adjust more precisely the size of the cut to the diameter of the graft. Two surgeons work simultaneously using their two hands, which certainly shortens the time of surgery and a patient does not need a long-lasting unaesthetic. This perfect technique saves many hours spent on the operational table and is the fastest way of performing hair transplantation in the world.

In such a surgical treatment, it is extremely important that the patient,s expectations are adjusted to the technical possibilities and esthetic taste of the surgeon performing the surgery. During preliminary consultations the number of grafts should be estimated, their placement as well as plan carefully the front line of hair. While drawing up this line, individual features of face should be taken into consideration such as the height and width of the forehead, eyes distance, color and thickness of hair and the difference between the color of hair and skin. The grafts in the recipient region are inserted with a 1-1,5 mm space between them. It assures a proper healing but not always the needed thickness. So, usually the second surgery is needed in the same region so that the final thickness was satisfying. In the case of huge non-hairy areas, it is possible to perform several surgeries usually connected with scalp reduction. Nowadays the patients are offered to undergo huge sessions during which even 3000 grafts are taken. Such a surgery requires a huge ability on the part of the surgeons and right now not many clinics in the world are able to perform it. Hair Clinic Poznań is among those few and far between that perform the surgery.

For some time many surgeons dealing with hair surgeries recommend supplementing the therapy with some medications taken orally. In 1998 in the United States an oral medication called Propecia, i.e. Finasteride was introduced. Right now it is registered in 53 countries and the recommended dose is 1 mg daily. It is a hormonal medicine applied prescribed only men in the cases of treating androgenic balding. The aim of the medication is to block testosterone transformation to its metabolite, dihydrotestosterone (DHT). DHT prolongs the telogene phase and shortens anagenic one, i.e. the growth phase resulting in disappearance of hair follicle. The MSD Company producing Propecia recommends application of the pills in a constant way and the effect is visible after three months.

The future can belong to mother cells. During the recent years they have been mentioned more and more often in plastic and reconstructive surgery. If they are present in the skin, they stimulate the development of epidermis cells, sebaceous and sweat glands as well as hair follicles. Numerous growth factors present in the skin facilitate their growth and stimulate all elements of human hair to grow as well as its cyclic transformations. There seems to be a ray of hope in genetic and tissue engineering. It will allow in the future to find a suitable key to mother cells and stimulate them in such a way so that it would result not only in their unlimited development but also control of their growth in the regions with no hair.

In Poland the first hair transplantation surgery was performed by Jerzy Kolasiński in the year 1984. His first experiment was described during a symposium in Wroclaw in 1988. Dr Kolasiński belongs to the best surgeons in the world who deal with the problem of balding and its surgical treatment. He is invited to many countries to lecture, guide courses and train many doctors during workshops in various parts of the world. In the clinic he works in a team consisting of people together with Małgorzata Kolenda and Wojciech Zieliński.

Małgorzata Kolenda M.D., Ph.D.

The post Hair transplantation – Luxuriant hair again first appeared on Kolasiński Clinic.

When I was a young and beautiful girl, I used to wear mini skirts. They were fashionable, at that time, and I was not ashamed to show my beautiful, shapely and smooth legs. Even during winter I was not scared of the temperatures below zero or not to mention snow, and I simply wore my beloved mini skirts. My teachers used to nag all the time about the length of my and my friends’ skirts, or rather their shortness. However, we knew how to deal with it. The skirt was usually longer, up to the knees, but after having left home or school, we pulled it up so that it would scarcely cover the buttocks. Unfortunately, with age my legs were not as beautiful as they used to be and, consequently, I did not show them so eagerly. There started to appear gradually little widened blood vessels on the skin in the region of thighs and calves that resembled little webs. Little venules, almost invisible at the beginning, were becoming wider and wider and did not look nice. I gave up wearing short skirts, and started wearing long ones and trousers. I was a little worried about the condition of my legs.

I remembered very well that my grandmother suffered from varices of the lower legs. She did not undergo any operation as she was scared of having any very much. Even though she was not very old, she used to sit on the coach very often with swollen and painful legs, especially in the region of ankles, and she asked me to massage them a little. While massaging them, I could feel under thick tights widened and large varicose veins.

My professional job requires sitting long hours in front of a computer screen. So, many times I could feel a kind of heaviness in my legs, and in the evening I noticed slightly swollen ankles. I read a little about varices in the books available. I knew it was a hereditary disease and I could expect it somewhere in the future. I even tried to change my lifestyle a bit. At work I got up and do some physical exercises from time to time. I did some climbing up on my heels and toes, short walks in the office and, during the breaks, I put my legs higher. I tried not to wear socks up to my knees or socks, generally, that would squeeze my calves. I simply wore tights or naked legs. In summer on hot days, I did not wear high-heeled shoes or shoes that would constrain or squeeze my feet, but rather flip-flops and loose comfortable shoes. I did not go to solarium, sauna or take hot baths.

My tragedy, however, started when I got pregnant. At the very beginning everything was as it used to be. Nevertheless, when my belly grew bigger and bigger, so were the changes in my legs. Little varicose veins changed into big ones. Moreover, new ones also appeared, earlier not present at all, which with elapse of time changed into bigger widened blood veins. I even scheduled an appointment at the doctor’s. First, my gynaecologist examined me and recommended a surgical consultation. The surgeon told me that in such cases, with some genetic endowment, sitting or standing character of my job, during pregnancy, varices either exacerbated or started to appear. Unfortunately, he could not help me due to the state I was in. He recommended me a few additional exercises, comfortable shoes and patience, and another visit, this time after the delivery. I gave birth and raised my daughter. Unfortunately, the problem of my legs came back. Still, I was not an old woman, and I would eagerly uncover my legs during summer, on the beach or at the swimming pool.

So, again I visited the surgeon. He prescribed me having ultrasonography examination, the so called Doppler’s test to measure the capability of the venous system of the lower legs. It was the examination from which he conditioned the size of the surgery because, as he warned me, the operation was unavoidable. My varices were not any longer a cosmetic problem, but after all a healthy one as varices might result in very serious complications such as for instance, pulmonary embolism which, finally, could end up with death in the future. Scary, isn’t it? I did not have any choice. I underwent the prescribed medical examination and having all the results in my hand I arrived in the right place and in the right time. The surgery was performed under a general anesthetic. The surgeon informed me that the surgery consisted in removing incompetent superficial veins, one main saphenous vein and other smaller lateral veins changed due to varices. When I woke up the next day, my both legs were covered with elastic bandages. In the region of the groin, there were little dressings covering slight cuts each being 3cm long. After the morning doctor’s visit and change of the dressing, I went back home. During the following two weeks, my legs changed colors into violet, navy blue, green and yellow. In the places where I could see bruises, the body was hard and painful. However, after two weeks everything came back to the norm. There were just few places where I could feel the pain while pressing the place harder. There were, however, no visible and protruding “grape bunches” as before. Few more weeks later I totally forgot about my varices. Then, beautiful and warm spring came, and I started showing my legs and, again, I convinced myself to wear mini skirts.

Judyta

Surgical treatment of varices – radicalism and cosmetics

There are 1,8% of women and 1,1% of men aged between 30-39 who suffer from varices. The frequency of the disease increases with age and refers to 20,7% of women and 24,2% of men over the age of 70. In Poland, it usually attacks women, namely 69% of their population suffer from varices.

Varices cause either objective problems like swelling, discolorations, echemas and ulceration or is connected with more serious complications like inflammation of superficial veins, deep vein thrombosis or pulmonary embolism.

It also causes serious cosmetic defects.

The treatment of veins changes can be either preventive or surgical ones. However, in the case of fully developed disease, only surgical treatment allows to obtain the desired therapeutic and cosmetic effects.
The venous system of the lower legs consists of superficial veins and deep ones connected with each other by means of perforating veins and the outlet of saphenous and small saphenous vein. Deep veins of the lower legs run under the fascia, and in doubled number accompany the arteries. Superficial veins run under hypodermis tissue. They are accompanied by sensory nerves fibers and lymph vessels. In the case of a healthy man, 90% of blood flows from the lower limbs to the heart by means of deep veins, and only 10% through the superficial system.

The moment muscles contract during any movement of the leg, blood pressure increases inside the fascial sheaths up to 200 mm Hg. Then, it squeezes blood out of the little veins in the region of the muscle, and also from bigger veins which run through fasciae. Blood goes through venous valves that give it a proper direction. During muscle diastole, blood pressure decreases in the veins, however, properly working valves unable blood regurgitation. This way deep veins have temporarily low blood pressure that makes them be able to suck blood from little muscular and superficial veins. A normal flow of blood from superficial veins to the deep ones is assured by perforating veins and the outlets of saphenous and small saphenous veins together with their valves.

Varices of the lower limbs.

Varices are morbidly changed veins with their permanent baggy and fusiform widening and prolonging with a fixed incompetence of the valves of the superficial and perforating veins. These are women who suffer most often. In 85% of the cases they refer to the system of small saphenous vein. The factors responsible for varices most often are as follows:

• heredity
• race (most often occur in the case of white race)
• overweight
• undergone pregnancies
• hormonal treatment
• type of activity (sitting or standing job)

Currently, there are two theories presented most often concerning the reasons of varices, namely hemodynamic and the theory of incompetence of a vein wall.

• Hemodynamic theory; the main factor contributing to creating varices is hydrostatic blood pressure in veins. The pressure is to result in valves damage and the following widening of veins. By the same token, blood regurgitation takes place.
• The theory of incompetence of a vein wall is based on some genetic premises.

The creation of varices is explained in terms of degeneration of collagenous fibers and the atrophy of muscular cells of the internal and external membrane. Varices widening result in valves damage which, consequently, results in reverse of blood.

In physiological conditions, blood always flows from superficial saphenous veins to the deep ones in two ways. One, through the outlet of the saphenous or small saphenous or perforating veins. This blood flow is supported by a muscular pump (the moment a muscle diastoles, blood is sucked in from the superficial veins to the deep ones).
In the case of damaged valves, blood is squeezed under a huge blood pressure from deep veins into the superficial ones. The created reflux causes high blood pressure in the superficial veins which may increase even to 200 cm H2O. It results in the development of widened superficial veins, i.e. varices.
Depending on the degree of venous system incompetence, one may differentiate the following stages of the disease.

Zero degree Lack of clinical ailments. The sick wear the burden of genetic premises passed down by their family. The stem of saphenous vein is slightly visible through the skin.

First degree Light symptoms. The sick declare the feeling of legs heaviness, temporal swelling in the region of the ankles, growing in the afternoon. The stem of saphenous vein can be widened.

Second degree Medium serious stage. Past history as in the first degree. Widening of the saphenous vein on a longer distance. Massive hypodermic varices, discoloration in the region of the ankles. The symptoms of reverse leak in the outlet of saphenous and small saphenous veins confirmed by Doppler’s examination.

Third degree Serious stage. Skin complications connected with the damage of valves, massive varices and swellings.

The doctor deciding on the surgery should know since when the symptoms have been occurring, whether their occurrence was connected with undergone pregnancy, whether the patient suffers from swellings and crural cramps, whether suffered in the past from the symptoms typical of inflammation of veins. It is also important whether the patient takes hormonal medications (contraceptives).
While examining a patient, the doctor examines carefully the way varices run, estimates whether there are any swellings, skin discoloration or ulceration, and makes many trial activities.
The performance of duplex Doppler’s test with colorful marking of the flow is extremely important. It helps to estimate the condition of the deep veins as well as it shows the places where the reverse of blood takes place. Thanks to this examination the surgical treatment is more precise and effective.

The treatment of varices

The aim of the treatment is to eliminate all the places of the leak of blood from the deep system to the superficial one as well as the removal of the veins changed by the disease. The treatment can be either preventive or surgical one. In the case of developed varices, only the surgical treatment allows to obtain proper therapeutic and cosmetic effects.

One of the stages of the operation is the removal of incompetent and widened saphenous vein. Consequently, a slight cut is made in the groin and in the region of medial ankle. The application of a proper technique results in almost invisible scars.

The further stage of the operation consists in the removal of varices and their branches. One of the most attractive ways to do so is the Müler’s method which consists in making 2-3 mm long incisions and removal of a single varix by means of a special hook. Such incisions can be done in a number of places along a particular varix removing it on the whole length. If the cuts are made in accordance with skin lines and closed with Steri-Strip plaster, the scars after 6 months are almost invisible. An improved method of this operation is the operation with a cryosurgical probe.

At the very end of the probe, a very low temperature is sustained up to ’80C degrees. The area of freezing around the probe equals 3-6 mm. The moment the probe freezes of, it sticks to the varix enabling its removal. This way, from one slight incision, a large number of varices can be removed in all directions on the length of 20 cm. The cut is usually ended with a Steri-Strip plaster. It allows to obtain a very good cosmetic effect.

The cryosurgical probe allows not only to remove varices (cryostripping). Thanks to it, the closure of vein vessels is possible to make, the so called cryobliteration. This method is usually used in the case of people with high operational risk, at whom the removal of varices could be dangerous to their health or lives.

Cryosurgical operations of varices have the following advantages:

• The possibility of a more precise removal of varices without the surrounding tissues.
• The possibility of operation after having undergone sclerotherapy
• The possibility of removal an incompetent saphenous and small saphenous veins without any additional skin cuts.
• The possibility of operation with the presence of little trophic changes
• Beneficial aesthetic effects
• Smaller number of the required skin cuts
• Shorter time of operation

The appliance of the operational technique is connected with the necessity of having very specialized equipment as well as the surgeon is required to have proper job experience at operations with the use of cryosurgical probes.
However, the advantages of this method, especially very good cosmetic effects together with its radicalism make that it is a strongly recommended method of the treatment of varices.

Jerzy Kolasiński, M.D. Ph.D.

The method of cryosurgical operation of varices has been used in Hair Clinic Poznań for many years. The work devoted to its use written by the group of surgeons from Hair Clinic Poznań and was published in THE AMERICAN JOURNAL OF COSMETIC SURGERY.

The author of the article led a course devoted to this method during 16th Meeting of the American Academy of Cosmetic Surgery w Orlando, USA in January 2000.

Sclerosis application in the case of incompetence of the lower legs veins

Sclerotherapy is one of the therapeutic methods used in the treatment of veins chronic incompetence. This well known, for many years, method in Western Europe supports the treatment of the lower limbs varices.
Sclerotherapy consists in purposefully induced inflammatory reaction of a blood vein wall changed due to varices which, finally, results in. What is obtained is the closure of the vessel lumen. The injected medication irritates the inner membrane bringing about vasoconstriction. An additional mechanism, which closes the vessel of 2/3 of its transection, works on a nervous way. Thanks to such an irritated and narrowed vessel, a thrombus is created, which next undergoes fibrosis and scaring. The vessel closes and stops being patent.

Varices of the lower legs, ulceration over incompetent vessel plexuses as well as incompetence of the perforating veins in embolism syndrome. The postphlebitis syndrome is a indicator to perform sclerosis.

The most popular medications used to close vein vessels are as follows: Scleremo, Variglobin, Varicocid, Aethoksysclerol. Unfortunately, not each of those medications is available in Poland.

The technique of medical treatment in the case of varices obliteration and venulactasies of the lower legs consist in injecting obliteration medication directly to the visible just under the skin changed vessel.

Recently, however, preparations in the form of foam instead of water solution have been used more eagerly. The main advantage of a foam is a slower inactivation of the obliteration medication before it reaches the aim as well as the transport of the active substance in the direction of vessel wall is more effective. The application of foam allows to apply a lower level and smaller amount of the medication, which, consequently, increases the safety of its use. Its efficacy is much longer as longer is the time of its working in a particular region.

In order to perform sclerosis, it should be remembered about numerous anatomical types of the venous system. Before performing sclerosis of a greater vein axes, ultrasonography examination should be performed as well as Doppler’s test of the lower legs or, even better, the examination with a colorful picturing flow, the so called color Doppler’s test.

The aim of the treatment is the closure of varices, lowering vein pressure after a physical effort and prolonging the time of blood inflow to the veins after muscular effort was made.

The sclerosis of incompetent superficial veins is least efficient in the case of coexisting reflux, i.e. blood flowing backwards into the deep system as most often it may result in redrainage of the vessels. The conclusion is as follows. In the case of patients suffering from blood reflux to the deep veins, more effective forms of treatment, namely surgical one, should be applied, not sclerosis. Additionally, such patients should wear tights or up to the knees socks of gradual compression during the convalescence after the surgery.

In the case of obliteration of huge vein axes, specially adjusted pressure sponges are used as well as compressive tights are recommended, and in the case of obliteration of small vessels, an elastic bandage squeezing the places of medicine administration place is enough. Such a dressing is worn from 24 up to 72 hours. In this period of time the creation of thrombus takes place that usually lasts till 18th day after the surgery. Only then, the final result of the obliteration therapy is visible. After the surgery, the sick should avoid having hot baths as well taking medications that lower blood coagulation.

The most often and difficult treated cases are slight and little widened skin vessels, the so called vessel webs; blue ones contain venous blood (venulactasies) and the red ones contain arterial blood (teleangiectasies). Blue vessels are easier to close, but they also may be the problem, especially, when they have a number of vertical and horizontal connections with deep vessel plexus or even huge deep veins or muscular ones.

The surgery of sclerosis should be performed several times, with two days breaks, especially, at more expanded changes. At 30% of the cases very good results are obtained (the disappearance of widened vessels) and good results at 40% (almost total disappearance of the widened vessels). Complications occur extremely rarely (generally about 0.5%), and most often are skin necrosis and trophic discolorations.

Małgorzata Kolenda, M.D. Ph.D.

The post Varices of lower legs – New legs first appeared on Kolasiński Clinic.

While analyzing my past years, family life and professional career, as a forty-year-old man, I must admit I am a lucky guy. Thanks to my wonderful parents I graduated from a prominent university. I am an engineer employed in an ambitious international company. My job is dynamic since I travel abroad on many business trips abroad. Moreover, knowledge of foreign languages broadens my horizons. Additionally, I have a wonderful wife, a warm and understanding woman and two lovely kids. All things considered, one may think that I should be full of energy and joy of life. However, I have started doubting in my lucky star recently. After having crossed the threshold of the age of 40, I noticed that I gradually was losing my vigor, I was getting tired much faster and I had difficulties getting up in the morning, whereas in the evening, I helped myself with a glass of whiskey to fasten falling asleep. In the afternoons I was too lazy to force myself to do at least 30-minute-long physical exercises. I must confess that I also put on some kilos. Although I knew the reason of it, i.e. irregular and too abundant eating, I didn’t have enough strength to change it. Moreover, I noticed that I had problems with concentration more often and I started forgetting some details. I couldn’t stand the moments of depression that came just from nowhere, I also didn’t like meeting my friends not to mention some night attacks of fear. My skin became dry and peeling, and in the evenings my ankles were swollen. Unfortunately, sex issues were also a matter of discussion. I started thinking how I could treat it. I was wondering what I was to do to get back my energy and good physical and psychological condition. I realized that I had a lot of years to live on and I wanted to live them the best I could. I asked my friend, who was a doctor, about my problems but, unfortunately, he could not recommend me any specialist who would deal with such problems. I started browsing some web sites. I thought that in the US such problems had to be solved somehow. Having keyed in other terms in English concerning my condition, I found very quickly many sites dealing with such problems. Their common ‘password’ was the word anti-aging. I read a lot and found out many pieces of useful information on what was wrong with me and how I could improve that. I also learnt that it had been many years since a separate field of medicine existed. To my great surprise, among numerous foreign web sites, I found a Polish medical center which specializing at applying anti-aging therapy I called the doctor, who suggested preliminary consultation, very quickly. The doctor devoted a lot of her time to me and suggested detailed medical examinations on another day. This time the visit lasted much longer and it resembled a very serious test of my body and mind capacities. At the very end, my blood was taken to be tested. After one week I met the doctor again. This time I got a detailed report on the condition of my health, the dangers resulting from genetic premises and led lifestyle. Moreover, not being enough, I found some colorful diagrams and charts providing me with the information on what was functioning well in my organism and what was deviating from the norm. On the basis of these examinations I got lots of diet guidelines, physical exercises instructions to follow and a long list of medications. Right now, I have been working on my health for three months already and I must say I am proud of myself as I have already noticed some positive results of the therapy. I lost three kilos, I get up easily in the morning with a greater enthusiasm, whereas at work, I can concentrate on many things and I feel I am happy and enjoy doing it. For two weeks I have been falling asleep without any problems and, moreover, I do not need any aid, and I am able to sleep all night long without any breaks between 3 and 4 a.m. Also my wife does not have now any reasons to complain about her man. I realize that this is just the beginning, but the initial effects of the treatment encourage me to continue the therapy since I would like to be ranked better during the control test six months after the first test. Spring felt in the air is another incentive to work on myself.

Jack

Theories aimed at explaining the reasons for aging

For many years, scientists have been wondering about the mechanisms of, what we call, aging and they have been looking for some elements which are responsible for this process. They also want to create some measures that would help slow down the mechanisms.
There are numerous theories explaining the reasons for aging. Many of them overlap just like the biological processes in our organisms and the factors, which influence them, do.

Genetic theory

The source of coded information passed down from our parents is located in DNA, nucleic acids, which is present in every single cell of our body. This is also the place where genes, responsible for the speed and the character of our aging, are found. This genetic clock does not function peacefully. It is under influence of many factors which often effect it destructively. They can be substances contained in the food we eat, toxins, pollution and radiation.
The most recent theory concerning the damage of genes is the theory of telomerase. Telomeres are just the sequences of nucleic acids coming out from the distal ends of chromosome arms. They shorten during every cell division. It is claimed that this telomere shortening leads to cell damage and, by the same token, makes a normal division difficult. The enzyme called telomerase (so far found only in cancer cells) has the capacity to rebuild dying telomeres and sustain the normal process of cell division.

Neuroendocrine theory

The theory is based on knowledge concerning hormones and their mutual relations. The main center of hormonal command is located in the brain. It is the hypothalamus that by discharging some substances controls other endocrine glands by means of the pituitary gland. With elapsed time when we are becoming older the hypothalamus gradually loses its precision and receptors located on its cells, which catch certain hormones, are becoming less sensitive. At the same time, the discharge of hormones diminishes with age as well as their efficacy is becoming weaker.

The theory of free radicals

A free radical is a term used to describe a cell containing one free electron. Although it facilitates the reaction with normal cells, it also damages them and, at the same time, destroys their balance and, finally, reshapes them into other free radicals. Free radicals are produced as a result of natural processes taking place in our organism, but there are many other factors that may contribute to their faster creation. These are as follows, inappropriate diets, cigarettes or alcohol. Free radicals influence destructively many cell structures leading to cell dysfunction. The ‘sweeper’ of free radicals, more often called antioxidant, makes radicals restructure into normal cells. Antioxidants are commonly known vitamins such as B, E and beta-carotene as well as melantonin.

Membrane theory

All cell membranes in our organism contain less and less fat and water with age, and are becoming more compact. It influences their functioning, worsening their work, especially those connected with the transportation of numerous substances. It results in toxin accumulations in a cell. One of such toxins is lipofuscin, the deposits of which are more and more abundant in the brain, heart and skin. It has been proved that the patients suffering from Alzheimer’s disease have higher levels of lipofuscin in comparison to healthy people.

The theory of limited number of cell division

It turns out that a human cell may divide itself about 50 times and, then, it dies. It has been also proved that nutrition influences such a condition of a cell. ‘Overfed’ cells divide faster than undernourished ones. It has been well-proved on the basis of experiments carried out on animals. It turned out that calories reduction diet prolonged animal lives.

Mitochondrial theory

Mitochondria are intracellular structures (organelle) that produce energy for the whole organism. Their most substantial energy product is a cell called adenosine triphosphata (ATP). ATP allows us to live as every second of our activity requires supplying the energy from that cell. With age, mitochondria are becoming less effective, their number diminishes and, what follows, the decrease in ATP production takes place.

Glycosion theory.

The theory is based on the process of joining glucose to proteins in the organism. After the process took place, the white cell is no longer normal and cannot function fully the way it should. The process of glycosion occurs three times faster in the case of people suffering from diabetes and at whom the process of aging is speeded up.

The briefly discussed theories of aging present the variety of processes influencing the changes which take place in our organism. Their understanding helps to draw up certain guidelines and directions of interference allowing to slow down the processes of aging by properly adjusted diet, healthy lifestyle, avoidance of destructive factors, using vitamines, antioxidants and, in some cases, even hormones. It provides us with the opportunity to enjoy young condition for many years.
Developing, in recent years, anti-aging programs take advantage of medicine and computer science to set up the rules which the doctors try to follow while dealing with this new branch of medicine.

Anna Modelska-Ziółkiewicz, M.D. Ph.D.

Introduction to Anti–Aging medicine

‘Aging’, i.e. the process of getting older, is a term which widely describes processes taking place in a human body. These processes are natural, concern every human being and, finally, happen with age. Nowadays, there is a tendency to treat such changes in terms of pathology that requires a proper diagnostic, prevention and treatment. The most basic difference between aging disease and other diseases is that the former one concerns every human irrespectively of race and place of living.

Aging is a long and complicated process that concerns many aspects of our lives, namely connected with our physical, mental and social activities. At that point, a wide range of hormonal changes can be mentioned. The production of some hormones decreases with age as, for instance, growth hormone, dehydroepiandrosterone, melatonin or thyroid hormone. Others, however, tend to increase changing sometimes significantly the proportions of the hormones existing at young age. Cortisol and insulin are good examples of such. Also the functioning of immune system changes with age. The system is weaker, so it usually results in a greater susceptibility to infections and other diseases at old people. As one may assume, the changes occurring in our body with age can be presented over and over again, showing how complicated individuals we are and from how many factors, internal and external, ones we depend.

Analyzing particular components, scientists wanted to picture the way optimal health looks like, presenting it in the form of a pyramid. The basis of the pyramid is occupied by genetic premises we are bestowed by our parents, encoded information passed down from our parents. Going upwards, lifestyle is located and such issues as nutrition and physical activity. Next, we have the influence of vitamins, minerals and antioxidants. Hormones occupy the very top. Looking at this structure, we may see the huge influence the man himself has on optimal health, his strong will and activities as well as professional medical knowledge which directs him at the most rational use of scientific achievements.
Scientists and doctors defined this branch of medicine as prophylactic measurements which slow down aging processes of a human being. It is made by, according to the most recent contemporary knowledge, creating optimal health conditions for the body and soul of the patient. In practice, it means adopting a proper lifestyle as well as supplementing the organism’s activities with many beneficial substances.

The main trend of “anti-aging” medicine was created in the United States. Then, there was a group of prominent scientists and doctors interested in this field of medicine who founded The American Academy of ‘Anti Aging’ Medicine (A4M). A lot of theories were made up in the world of medicine as well as new discoveries concerning the processes of aging. The research has become the basis of promotion of many products aimed at slowing down the processes which lead to dysfunction of our organism with age. A good example is the use of substances protecting normal functioning of mitochondria or nucleic acid in cells, applying medications that refresh brain tissue, slowing down not beneficial changes in our brain and age dementia. Further preventive measures may concern the use of antioxidants, ‘the supporters’ of the immune system, wide ranged substitution of hormones (completion to the normal level) as well as enzyme preparations. It turns out that the earlier prophylactic measures are applied the better final results in older age. A good example is Parkinson’s disease which is the result of decreasing level of neurotransmitter, i.e. dopamine. It turns out that the diagnosis of the disease is made when a patient has already lost 80% of this substance. Many years must elapse when the level of dopamine reaches such a low limit. ‘Anti Aging’ medicine suggests using pharmacological substances which prevent the decrease of the neurotransmitter much earlier, when the level of dopamine is not so low and does not give the symptoms of the disease.

Apart from the processes occurring in our organism, which influence aging, the attention should be also paid to the role of external factors. Stress, environment in which we live, and connected with it pollution, toxic metals, chemicals in food industry, unhealthy water and not properly processed food, fast food, these are just some of the examples of factors which make it difficult to shape the pyramid of optimal health.

The main sources of achieving optimal health and, by the same token, prolonging our lives may be summed up as follows:

• Genetics (mostly dependent on our parents).
• Life style: stress reduction, no smoking, moderate use of alcohol, eating natural and fresh food, drinking still mineral water, avoiding radiation, heavy metals and pollution.
• Toxins: avoiding them as much as it is possible.
• Physical and mental exercises: they do not have to be intensive, more important is to do them regularly, also the ability to use relaxation techniques.
• Nutrition: implementing fresh and natural diet enriched in vitamines and minerals.
• Antioxidants: using them to eliminate free radicals (the main reason of premature aging).
• Immune system: the main aim is to strengthen the immune system as a way to prevent infections and other diseases.
• Nootropical substances that refresh brain tissue; the aim is to shape brain functions on an optimal level.
• Hormonal substitutions: hormones substitution and their precursors to obtain their optimal levels compared to the levels at the age of 25 and 30.
• Energy: using preparations which on the cellular level protect mainly motochondria from their pollution.
• Specifics: dietary and medical help in particular problems of an individual patient like for example, impotence treatment, figure correction, physical appearance improvement, by means of a surgery.

Anna Modelska-Ziółkiewicz, M.D. Ph.D.

Enzymes – the genesis of good health

Enzymes and their supplement.

Enzymes are protein substances essential to perform all life functions. They are present in all plant and animal cells, and their basic role is to control biochemical reactions taking place in our organisms.

Digestive enzymes, which are produced in numerous regions of the digestive system starting from the salivary glands and finishing with the small intestine, are the most known ones. These enzymes decompose food gradually to the easiest molecules such as glucose, amino acids and fatty acid which, then, may be used by the organism as a building block and the source of energy.

The enzymes contained in food are destroyed in food processing industry or during cooking. Fresh food contains natural enzymes which, however, can be inactive after eating them due to gastric acid reaction or the presence of other inhibitors. Then, we need to use our internal enzymes potential to a large extend.

For those reasons, ready enzymes are added to food very often or we can buy them in the form of capsules or powder. They are produced, in such a condensed form, by pharmaceutical centers and are characterized by higher cleanness, stability and efficacy than those used in food industry.

More often people are encouraged to use enzymes to improve general condition of health and prevent various diseases.

The main reasons of losing enzymes in our organisms.

With the exception of some genetic enzyme insufficiencies, the majority of organisms has the capacity to synthesize and secretion of enzymes which are necessary in their metabolism. However, in certain cases, synthesis or enzyme activation may be incorrect. They are usually the result of poor diet, unhealthy lifestyle (alcohol, cigarettes etc.), the contact with toxins and environmental pollution as well as the process of aging. Unfortunately, these disorders are becoming rather a norm than an exception together with the developing civilization.

Anna Modelska-Ziółkiewicz, M.D. Ph.D.

Bio-Aging system

BIO-AGING system was created by a German doctor, professor Alfred Wolf, who is a prominent expert in ‘anti-aging’ medicine, together with other specialists in computer science and experts on other sciences. The main goal of the program is a very detailed and reliable evaluation of a biological age of an examined person. This type of age should be differentiated from the chronological one known by everyone of us. It turns out that our biological age, the real reflection of our general condition, can differ from the age marked in our ID. There are many factors that may influence the former one such as genetics, our lifestyle as well as the effects the surrounding world has on us. However, if we know our biological age and the amount of particular elements influencing it, we may change it rationally into a more beneficial one. The case when the biological age is almost the same as the chronological one or slightly smaller is an optimal situation.
BIO-AGING system is a program specially created for the purpose of individual analysis of a patient, and it consists of four elements strictly connected with each other.

The first part consists of a questionnaire containing series of questions aimed at detailed analysis of one’s lifestyle and health. The data need to be keyed in into a computer which usually takes about 30-55 minutes. All the questions are easily formulated and can be understood by every patient. They may concern, for example, the history of the patient’s undergone diseases as well as his or her family, information concerning lifestyle, applied diets and physical activities.

The second part of BIO-AGING system is used to collect all necessary parameters to define the biological age as well as to evaluate vitality of a patient. The time devoted to this part equals about 30-55 minutes. This part consists mainly in collecting data concerning the actual condition of a patient, calculating body components, i.e. muscle and fat weight, evaluating muscle strength and functioning of the cardiovascular and respiratory system (including lung volume and other important parameters like FEV or FEV1). Moreover, the functioning of cerebral tissue is analyzed (hearing, sight, memory and concentration span).

The third part of the discussed system is to group and interpret all essential results of the laboratory examinations needed for further evaluation of vitality and the biological age of the patient. The results of such examinations as the density of bones, the level of various substances in blood, for instance, lipids, homocysteine, lipoprotein A, fibrinogen, CRP (proteins of sharp phase) or PSA (antygene typical of the perineal glan) can be analyzed. Hormones typing is an extremely important factor influencing the overall evaluation of the patient, for example, the level of estradiol, testosterone, cortisol, IGF-1, insulin, TSH, FSH, LH and DHEA-S. Typing a total oxidation capacity (TOC) and antioxidation one (TAC) is another interesting idea.

The very last part of the proposed BIO-AGING system contains a detailed interpretation of all the analyses obtained earlier. The report, which is also available in a printed version, enriched with some graphics, presents graphically the obtained results with a full medical comment.

The system is based on the most recent research in the field of anti-aging medicine and the prevention of diseases typical of particular age. It has become a new link between the patient, doctor and modern medicine.

Hair Clinic Poznan as the first clinic in Poland uses BIO-AGING system in the prevention and treatment of premature aging processes.

Anna Modelska-Ziółkiewicz, M.D. Ph.D.

The post Anti – aging system first appeared on Kolasiński Clinic.

Our face is the best reflection of inevitably elapsing time as well as it shows up our real biological age. Studies and career, on the one hand, and good genes, proper lifestyle and rational nourishment, on the other hand, all made that up till now I haven’t had time or even a need to take a look into the mirror to check the way time marked significant changes in my face and body. Right now, I am already 33. I have a loving husband and two wonderful children, a good profession as well as quite a well-paid and attractive job. So, summing up, I have everything a woman can have at my age to feel fulfilled and valued. However, expectations are growing at work, and employers, taking care of the image of their companies, employ younger and younger women. Also my husband seemed to have lost his interest in me as a woman. It seemed to me that my attractiveness went pale. Consequently, I started looking into the mirror more often. Unfortunately, it was not a magic mirror that would correct all my shortcomings. On a still young face there appeared forehead frown lines as well as the vertical ones, and not big the so called crow’s feet, especially visible when I laugh genuinely and, finally, considerable furrows leading from my nose down to the corners of my mouth. Additionally, some little discoloration and remnants of acne I suffered from long time ago, all seemed to be more visible at that time than they used to be. On seeing my reflection I got scared. Moreover, giving birth to my wonderful boys, now 6 and 3 years old, and afterwards breastfeeding them, influenced destructively on the condition of my breast. Actually, I could not wear a cotton t-shirt without a bra underneath any more. My dropping breast and sadly hanging nipples, unfortunately, were not as alluring as they were a few years ago. I didn’t blame my husband that he was hankering after the beautiful shape of my body.

Thinking and looking into the mirror, I was wondering whether I could change anything. I must admit that my husband strongly encouraged me to change. Did that mean that it was much worse than that? Having a wide access to the Internet, I decided to browse a little and read something on plastic surgery. One day I came across some websites of several surgery clinics. I also broadened my knowledge on the topic by reading some foreign articles concerning face wrinkles and the corrective surgery of dropping breast. I had thought so far that the problem was not so common. For a few days I read with a great interest the comments of women, who had already corrected this and that, on a chat-line. It convinced me that I was not the only one in the word and there were lots of women in their 30s who were dealing with similar problems. Thanks to their opinions I found out how and where such surgeries could be performed. I felt a great relief. It was a chance for me.

Having collected new pieces of information, I searched for the Internet address of a famous plastic surgery clinic that had wide experience in terms of the surgeries I was interested in. On the websites, the clinic had an on-line section devoted to giving advice. I wrote an anonymous letter with some questions that bothered me. I got the answer the following day. I also interviewed my friends and relatives whether they knew a surgeon they would recommend me. I was afraid a little bit of their reaction, but it turned out quickly that lots of my friends and colleagues had been using this type of help for several years. I was recommended exactly the same clinic I had written to earlier. I phoned the clinic and found out there were some consultations available. On the appointed day I arrived there. In the waiting room there were a lot of people awaiting. I was abashed and embarrassed. While I was waiting for my turn, fear and anxiety accompanied me all the time. I was wondering what I was going to say and how the doctor was going to treat me and whether he would laugh at me or not. Being busy with the preparation of a speech in my mind, there came finally the time to take my turn to consult with the doctor. I entered the doctor’s surgery where I met a very nice surgeon. An extremely pleasant talk made my fear and uncertainty soon go away. The doctor put my mind at rest saying that all the shortcomings of my face could be improved by means of some preparations filling wrinkles and paralyzing mimic muscles. My discoloration and post-acne irregularities of the skin were easy to be removed by means of mechanical peeling, namely dermabrasion. My breast was a bigger problem. The surgeon, however, comforted me saying that it was quite common among young women who breastfed two or more kids. He offered me undergoing a surgery that would lift and, at the same time, fill the breast by means of silicon prostheses. After one-hour-long chat I left the office filled with optimism and new faith. I decided to think it over and discuss it with my husband. Full acceptance on my husband’s part and his support made me schedule an appointment to have my first surgery one week later. We started the correction program from injections aimed directly at face wrinkles. I showed up at the surgery on early Thursday afternoon. The doctor injected with gentle stabs a toxin of clostridium botulinum (dysport) in the skin of the forehead region as well as between the eyebrows and lateral regions of the eyes, whereas, in the naso-labial furrows, which are responsible for a sad look on the face, he injected hydrogel’ Aquamid. And at my insistence, he agreed to inject it also, in a small amount, into the lips in order to enlarge them slightly. The surgery was almost painless. Directly after it, I had to lie with cold compresses on my face for 45 minutes. Afterwards, I returned home relaxed and happy. On that day and two days later the places of injection were slightly swollen and exquisitely tender. However, on Monday the result of the surgery was astonishing. A smooth face with no wrinkles on it and a little prominent lips were noticed by all my colleagues at work. Oh, I wanted to live so much. I felt wonderful. And it was just the beginning of my surgical adventure.

Two weeks later I underwent a simultaneous surgery of dermabrasion of the face skin and the correction of my breast. They all were performed under a general anesthetic. I preferred to undergo both surgeries at the same time while being under one anesthetic. The doctor agreed to such a solution. Besides after the doctor had gained my absolute trust, I simply wanted the surgery to be over as quickly as possible. I woke directly after the surgery in the operating room. I had a soft dressing with a brown ointment on my face, whereas my breast were covered with plasters and white cotton bra. I was tired and felt pain. I slept a lot that day. The day after the surgery, after having had the dressing changed in the region of the breast I could return home. My husband greeted my tenderly but I guess he didn’t expect to see a mummy wrapped up in plasters. ‘Whatever’, I thought to myself. The most important for me was that everything was over and I just had to just wait for the results. I looked sometimes into the mirror impatiently and with uncertainty. My breast made an impression. I was warned that for a few days they may be painful, sensitive to any touch and quite swollen. I dared to think that something could go wrong. I had to wait patiently until one week passed because only then I could visit the doctor.

One week seemed eternity to me. During my control visit, the doctor took the dressing off from the face as well as the stitches from the grooves under the breast. My face was pink a little, but I could already use some make-up. The breast, however, looked amazing. I guess even better than before the delivery. They were big, firm and outstanding. Happily I thanked the doctor and I ran as quickly as I could to show up at home and share my happiness with my loving husband.

I had to wait a little for the final result of dermabrasion. The pink places disappeared all after six weeks. Summer was coming and I was happy mainly due to two reasons. First of all, I love this season and, secondly, that summer was supposed to be extremely wonderful. Being young and beautiful again, I could wear my light dress and show my tempting body as it was a few years ago. Here, I could just write the way men looked at me on the beach, how many intoxicating nights I spent with my husband, however, the best compliment I heard was the one said by my older son who, before going to bed, said ‘you are beautiful mummy’.

Viktoria

Human face is the reflection of our feelings and emotions. It helps us to express happiness and sadness. And it is also the face where the first signs of elapsing time start to appear. In the case of a 30-year-old woman those changes are slight, however, much depends on some genetic prerequisites as well as the lifestyle. The former ones can be easily predicted by a woman while observing her mother. They both usually have similar gestures, similar ways of expressing emotions and consequently similar wrinkles. Huge volumes can be written about the influence women’s lifestyle has on them. However, it is beyond the shadow of doubt that it is the woman who influences her face, which is a kind of her own ‘business card’. It is worth thinking in advance about those two basic factors influencing our beauty because their skillful prevention helps a lot in maintaining a young and attractive face. We cannot influence everything that is genetically acquired, but if there appear some wrinkles on the face of our 30-year-old woman’s mother, then the woman herself should think of avoiding sun in advance. Too intensive sunbathing results in faster aging of collagen and, consequently, excessive building of slight wrinkles. It is also extremely important to use prophylacticly brand creams of high quality. If a mother has a very expressive face with visible crow’s feet in the corners of her eyes as well as on the forehead, a daughter may also expect to have the same. So, if she notices the beginning of this type of wrinkles, then it is not worth waiting passively until their full development, but it is better to start using some preparations containing a toxin of Clostridium Botulinum of A type (Botox or Dysport). Their earlier systematic using will allow to prevent the development of wrinkles in the region of the eyes and the forehead.

The last years in plastic surgery can be called the era of Clostridium Botulinum. It has been known since 1930 when it was used as a serious poison in the production of biological weapon in army forces of a few world empires. It was not until 1980 when people noticed the possibility of its use in medicine. First, the toxin of Clostridium Botulinum was used in the case of children suffering from squint, next, in the treatment of various types of muscle spasms, disorders in face symmetry after nerve paralysis as well as the alleviation of the nerve tricks symptoms. Then, at the end of the 90s, the toxin of Clostridium Botulinum of A type was used in the treatment of face wrinkles. Poland was one of the first countries in the world to certify the use of the medication in plastic surgery*. In this case we exceeded even the USA that decided upon this issue in the year 2002. The most reliable evidence of the toxin’s of A type popularity is its leading role in non-surgical methods of face corrections. According to the American Society of Plastic Surgeons in the year 2002 as many as 1 123 510 people underwent such surgeries. There are no such statistics in Poland, however, a constant increase of the number of patients taking advantage of Clostridium Botulinum injections can be noticed. Its main advantage is a huge even spectacular efficacy with minimal pain. What is also important is that no side effects of such a therapy have been registered so far.

Forehead frown lines, glabellar rhytids and crow’s feet belong to the most often cured regions by means of the toxin Currently, the toxin’s injections are also used in the treatment of face antisymmetry, especially the position of the eyebrows, in the correction of wrinkles at the bottom of the nose, vertical frown lines around the mouth, the so called ape’s mouth, uprising the corners of the mouth and vertical neck bands. The efficacy of this slightly invasive therapy resulted in a considerable decrease of the number of performed forehead lifts, even those most modern performed by endoscope method. Skillfully performed toxin’s injections allow to change the position of the eyebrows according to the patient’s expectations and considerably improve the framework of the eyes that results in a younger look.

The only disadvantage of the therapy is its limited period of duration. Most often after six months the medicine stops working bringing back the initial mimics. However, the attractiveness of the obtained results encourages the patients to repeat injections every six months. Worth mentioning is the fact that many doctors and patients notice that after a few injections facial mimic habits do change, and consequently, make wrinkles smoother.

Not only does the toxin of Clostridium Botulinum paralyze the nerve endings in the region of facial mimic muscles, but it also reduces the production of sweat if injected in the region of armpits or palms. It is the only possible medication available for many people who suffer from excessive sweating of their armpits and hands. It makes them free from unpleasant consequences of the disease and improves their psychological condition.

Tissue fillers have been used in plastic surgery for many years. A preparation of an animal origin such as collagen was used for a long time. However, in spite of its unquestionable advantages it, unfortunately, also had its disadvantages of which the most important was the possibility of serious allergies (even though allergic tests were performed before) and transmitting animal diseases to the patient. For those reasons, it was replaced with the solution of hyaluronic acid within the last few years. In the case of this patent medication, no allergic reactions have been recorded so far. There is also no danger as far as any disease transmission is concerned because the drug is obtained in laboratories by means of bacteria engaged to work for the man (similarly in the case of insulin production). Hyaluronic acid is injected in deeper layers of the skin and is aimed at filling in little superficial wrinkles. Its main disadvantage is, however, the time it needs to undergo resorption. Most often six months after the surgery, the results of wrinkles filling disappear and the surgery must be repeated. For those reasons the search for durable and safe medicine, by means of which wrinkles could be filled, continues. In many cases one’s own adipose tissue transplant seems to be a good solution. Skillfully performed surgery allows to fill the losses on the face, correct naso-labial folds or enlarge the lips.

One’s own adipose tissue is also used in the breast augmentation surgeries (special cases) as well as in labia majora or minora plasty and in penis thickening surgeries. Apart from its unquestionable advantages, the transplant of adipose tissue is a larger surgery not always accepted by the patients.

A patent medication that allows to obtain quick and long-lasting results is AQUAMID (Contura Ltd. Switzerland). It has been used recently in various branches of medicine as well as in food industry and is considered to be extremely useful in the correction of deep face wrinkles (naso-labial folds, wrinkles of the mouth corners) and in enlargement and modeling surgeries of the mouth. The medication is 2,5% solution of polyacrylamide in water. Its high compatibility with a human tissue allows to use it in ophthalmology (contact lenses) and in plastic surgery. No harmful side effects concerning the influence on human organism have been detected so far**. In the case of Aquamid administration, the most common strategy applied is obtaining the final results gradually. It happens that the patient is satisfied with when only one ampule was administered. However, if after two or three weeks the patient claims that she expected a larger effect, then the filled region is supplemented with another injection.

The surgery is performed under a tubular anesthetic or EMLA ointment. It may result in some slight pains. Few days after the surgery a slight swelling of the operated regions is visible. However, it is not so huge to interrupt daily professional or social life.

30-year-old women are in the majority of those who undergo the surgery of breast augmentation. Terminated pregnancies, breast-feeding all influence destructively the shape and size of the breast. Meanwhile, the memory of women usually dates back to the times when two or three years before their breast was beautiful, firm and constitute the attribute of their attractiveness. Another significant factor worth mentioning here is as follows. After a few years of marriage, there comes the time of first trial of the relationship as a consequence of the change of marriage character, from a youthful carefree adventure to a mature responsible common life. The statistics are inevitable at that point providing an increased percentage of divorces in this period. A woman who usually notices a reasonable decrease in her husband’s interest in her, as a woman, she starts looking for some ways to prevent it. Then, she begins to look into the mirror more often. If she notices sunken breast, then she looks for some ways to improve it hoping that it will turn back the hands of time. The patients’ breast at the age of 30 is most often slightly dropped, and its upper part is sunken. Transplanting breast prostheses allows most often to regain a very attractive shape of the breast. It also happens that they are much more alluring than before getting pregnant. Sometimes even the sensitiveness of the nipples increases, which positively influences sexual life. The surgery of breast augmentation is always preceded by an exhaustive consultation with the doctor. The patient needs to be fully aware of all the dangers connected with the surgery. The thing that should be most frightened is infection and the development of a haematoma in the region of the prosthesis. A few days after the surgery there usually occur pains of breast. It is also extremely important to understand that a breast prosthesis is a foreign body and may bring about the development of connective tissue bag around its surface. Even though a wide spectrum of precautions are taken such as textured prostheses, suitable surgeon technique or breast massage, the risk is not totally eliminated. It is advisable that a woman should discuss with her husband the decision of taking up a surgery. His approval or its lack cannot be diminished. An extremely important issue helping to make up one’s mind is the recent scientific research that eliminates any relation between breast cancer and the surgery of transplanting breast prostheses***.

A well-motivated patent, understanding the point of the surgery and accepting the possibility of complication is the best candidate to undergo breast enlargement. The obtained results not only improve her physical appearance, but definitely improve her mental state and life comfort. They also influence beneficially the relationship with her husband many times and make the relationship enter second youth.

Jerzy Kolasiński, M.D. Ph.D.

*The doctors of Hair Clinic Poznan as one of the first in Poland started using Clostridium Botulinum in the treatment of face wrinkle. It was possible due to the participation in specialized courses organized for the first time in the world by the European Academy of Cosmetic Surgery (Dusseldorf ‘1999) and the American Academy of Cosmetic Surgery (New Orleans – 2000).

**Lise H.Christensen and all:’Long-Term Effects of Polyacrylamide Hydrogel on Human Breast Tissue’. Plastic and Reconstructive Surgery, May 2003.

***Susan J. Hoshaw and all: ‘Causation, Delayed Detection, and Survival’. Plastic and Reconstructive Surgery, May 2001.

Life begins after forty

I used to hear many times from my parents and friends that ‘life begins after 40’. I was always thinking about the meaning of this sentence. I was a teenager then, and people older than 40 seemed to be very old to me. ‘How come?’, I thought. ‘What are they talking about?’ ‘They have already experienced everything that is beautiful and young’. I could never be so wrong. Now, I am 42 and my life has just started.

So far I haven’t paid much attention to my physical appearance or the state of my complexion. I have always had a contact with cigarettes since I was very little. My parents were heavy smokers and often invited their friends and relatives for home parties. When, as a teenager, I started smoking at home, no one was surprised.

My mum never paid any attention to using good quality cosmetics or living a healthy lifestyle. So, I didn’t have any patterns to follow. I never used any diets either balanced or detoxicating. At the age of 30 I gave birth to a daughter. During my pregnancy I gained a lot of spare kilograms. I didn’t care about my appearance and I even wasn’t interested in losing some weight, although I was left with 15 kilos more after pregnancy. My husband wasn’t also the slimmest one since at home no one used any diets. Besides, we enjoyed high living standards.

My life, however, has changed a lot since then. My family situation changed dramatically, too. I lost my job two years ago. I am a pedagogist and, to be honest, who needs a pedagogist these days. I was looking for a new job for a long time but without any results. Even though I was 40 with good physical appearance, excellent qualifications and the knowledge of two foreign languages, I didn’t have any chances. During one of my job interviews, my potential employer suggested me a slight change of my image. I must admit I was surprised a bit. I didn’t exactly know what I should have thought about it. ‘Do I look old?’ ‘Or maybe am I too fat?’ That evening I came back home very nervous. I poured a glass of whisky and light up one cigarette. After a while my anger went away and I started thinking what I could really change about my appearance. I looked into the mirror very critically and I made a list of my new resolutions. First of all, I was to quit smoking and change my diet. It was very easy because my husband hasn’t been smoking for several years now, practices intensively jogging and goes to the gym. Secondly, I thought it was high time to visit a good cosmetician. I implemented my resolutions the same day. The changes started with an honest talk with my husband. He understood me and promised to support me in every activity I was to take up. That unfortunate evening cigarette was the last one in my life. In the evening I also went with my husband to the gym.

After six months of hard work and sacrifice I looked definitely better. My body had different shape and my physical condition improved significantly. Unfortunately, my happiness was not full. Some scant remnants of fatty tissue were quite visible in the region of my hips, thighs and knees. None of the exercises I did could help me to reduce adipose tissue in those regions. The results of smoking and other bad habits became also visible on my face. Grey complexion, horny skin, discolorations and considerable sacs under my eyes as well as dropping upper eyelids that were slightly visible, all bothered me much. I decided to go to the beautician. I had some face masks and massages done. After a few appointments, which did not bring any visible results, my beautician advised me to go to a surgeon who specialized at plastic surgery. A ray of hope for a better look came back immediately.

I went to a known and recommended surgeon. During my first visit I asked many questions since I wanted to know everything at once. I learnt that all my body shortcomings and slight irregularities could be easily removed by means of liposuction. As far as my face was concerned, the doctor suggested me to undergo the corrective surgery of the upper and lower eyelids as well as chemical peeling. As I knew that my husband fully supported me in my crazy ideas, I scheduled an appointment to have the first surgery without any hesitation. My correction program started from the changes in slight shortcomings of my body. With a file of laboratory examinations in my hands I came out on the exact day of the surgery. It consisted in removing an excessive amount of fatty tissue from the regions of my hips, thighs and knees. Just after the surgery I was dressed in a special pressure suit the aim of which was to adjust my skin to a new shape of my body. The results were immediate. However, few days later my measurements were exactly the same as at the beginning due to the swelling in the operated regions. I was also told that the final result would be visible after 6 or 8 weeks. So, I needed to wait impatiently. Some bruises and pains maintained for 2 weeks after the surgery. I must admit that I was worried a little, but I knew I was operated on by a specialist, so I had to put up with all the inconveniences. After two weeks time I went for a control visit. I decided to take advantage of the visit and undergo another surgery from the previously established program, i.e. the correction of the upper and lower eyelids. The surgery was performed under a local anesthetic. By means of a slight cuts in the eyelids breakings, the surgeon excised an excessive amount of droopy skin. Only very thin stitches were left which, later, were covered by little pieces of plaster. After I went out from the clinic I wore my sunglasses so that no one could notice the marks left after the surgery. Five days later I went for a control check-up to the clinic during which the surgeon removed plaster and stitches. Unfortunately, the bruises were still visible in the region of the eyes few more days. However, I was extremely happy with the results and nothing bothered me. Several weeks later I underwent, additionally, the so called mechanic peeling. The peeling of this kind is much deeper in comparison to the one made by beauticians. The surgery was performed under a short general anesthetic, and consequently, I had to stay one day in the clinic. The following day when I took a look into the mirror I laughed at myself a lot. I looked like a ‘smurf’, a character form kid’s stories, with a blue glow on my face. For the next few days, the skin on my face peeled off a lot. However, I didn’t have to wait long for the final results. A new me, with new shapes of my body and at least fifteen-year-younger face, I set off to conquer the world. I found a few job advertisements in a paper. So, I decided to try out my new power. It was not long until my first job interview with the owner of a company that I was offered a very interesting post on the position of public relations agent. Moreover, I could take up this job at once. Not only do the skills, qualification and experience count at work nowadays, but also an employee’s appearance that somehow is a business card of the company. I am very happy that I have changed so much in my life itself and my appearance. Now, I know why life begins after 40.

Grace

The turning point of the 4th and 5th decade of life may be for a woman a difficult period or, on the contrary, one of the best periods in her life. A 40-year-old woman has already survived many uneasy moments. Most often the kids are brought up, the financial situation already established and stable, personal life after first stormy moments, still full of energy and her physical appearance…… Here comes the problem. Does the appearance comes up to the expectations set by the spirit? A lot depends on a woman herself. For sure, unhealthy lifestyle will show up its first signs right at that moment. Nicotine is a toxin not only for health, but also for the beauty of a woman. Even though we are flooded with more and more special types of cigarettes, they are still one of the most disastrous addictions for the appearance of a woman. Not only will breath and teeth remind us about the disastrous effects of this addiction, but mostly skin face and hands will do. If a woman started smoking at the age of 20, then at the age of 40 some worsening in her skin will be still visible as well as additional wrinkles on the face and her tiring look. The best creams and face masks will be simply useless. The only way to protect the face and bring back its fresh look is to give up smoking. However, it happens that tiring sacs under the eyes never disappear, and often at the moments of tiredness they are becoming bigger.

Then, a surgery is extremely helpful. The correction of the lower eyelids does not consist in cutting out the excessive skin. The amount of the skin removed comparatively small in the correction surgery of eyelids. What is performed is the plasty of fatty tissue responsible for creating the sacs under the eyes. According to the prescriptions, they are either removed totally or just removed below to fill the frowns in the region of the lower orbits. The correction of the lower eyelids in performed under a local anesthetic. The cuts are located under the eyelashes and the scars remaining after the surgery are invisible. During the first few days after the surgery, the eyelids are swollen and some bruises may appear. It is strongly recommended to wear sunglasses even on cloudy days. However, one week later, make up can be put on and one may return to work. The eyelids may be swollen slightly for several weeks. Still, it is not visible, but the patients themselves may feel discomfort. The correction of the lower and upper eyelids allows for the improvement in the framework of the eyes. It helps to bring back young and attractive look. The surgery is also supplemented with the injections of a Clostridium Botulinum toxin thanks to which the eyebrows are raised and crow’s feet are eliminated. In the same way the asymmetry of the eyebrows may be improved.

The excessive amount of adipose tissue is the problem of many people. At the end of the fourth decade of women’s life, fatty tissue starts accumulating in the region of thighs, hips and knees. It appeares rarely in the region of the abdominal, although the waist may also enlarge a little. Unfortunately, repeated draconian diets do not bring any results in losing the tissue in those regions. Probably, face features will be more visible, the breast will get thinner and fall down and irresistible hips and thighs will remain well-built. A solution used in such cases is the surgery of modeling the figure by means of appropriately constructed probes, the so called cannulas connected with an aspirator. The surgery is called liposuction and it is actually the technique of sculpting human body. It was first introduced by Giorgio Fischer in the year 1986 and, soon, it became one of the most popular procedure used in plastic surgery. In most parts of the body, adipose tissue appears in two layers, namely superficial and deep one.

If one wants to reduce the size of a particular region, the doctor sucks fatty tissue from the two layers. When we want to obtain a smoother surface and, at the same time, make the skin contract, then we perform the surgery in the superficial layer. The suction of the deep layer only in some regions may result in skin dropping and its folding (for example in the region of the thighs and hips). The surgeon performing the surgery should have a wide knowledge in the field of operational techniques. It is extremely important to insert the probe into appropriate layers and know the limits as far as the amount of removed adipose tissue is concerned. The doctor should not be influenced by the patients’ suggestions the aim of which is to encourage the doctor to remove more of the hated fatty tissue. Lack of reasoning in such cases may result in deformation of skin surface, the appearance of frowns and irregularities. Their corrections bring about lots of problems in the future. Another issue to concern is the safety of such surgeries. There were some cases reported that concerned very serious complications or even death afterwards. The most often causes of death were embolism syndromes of blood type rarely fatty. The recent years brought about revolutionary changes improving the safety of performing liposuction. Right now, adipose tissue is impregnated by means of a proper liquid, namely Klein’s liquid, just before the surgery, which reduces considerably the injury of blood vessels as well as bleeding during the surgery. At the same time the patient receives, before the operation, micromolecule heparin, the medication that lowers blood coagulation. The surgery is performed by means of thin probes called microcannulas. However, the most important condition is to suck not too huge amount of adipose tissue during one operation, up to 3 liters, and to qualify only healthy people to the surgeries not those who suffer from varicocele of the lower limbs, heart defects, overcollaguation of blood or diabetes. The surgery is performed under a local anesthetic (not a huge region) or general anesthetic (greater regions). Directly after the surgery the patient is dressed up with a special pressure dressing that, on the one hand, reduces the swelling, and, on the other hand, allows to model the skin to a new shape. The dressing is usually worn 2 up to 4 weeks taking it off only during washing. After the surgery some bruises may appear and pains in the operated regions. The troubles, however, are not big enough and do not limit daily activities. The results can be evaluated after a month, however, the final effect is visible after 3 months. It is measured in centimeters and the changes of the figure not by the kilograms. A visit in a clothes shop may be very pleasant 3 months after the surgery.

A forty-year-old woman who takes care of her health and physical appearance may look at her life optimistically, feel attractive and well. It is very much so that we are those who are responsible for our own lives. The same can be applied in terms of physical appearance.

Jerzy Kolasiński, M.D. Ph.D.

It′s been already fifty years

Fifty years of my wonderful life have passed. It is even difficult to figure out how quickly it passed. I must admit that I have achieved a lot so far, and I am very happy because of that. I married a wonderful man. We have been together for 25 years, and till now, we are good partners and friends. We have two adult children, a daughter aged 24 who studies law in Great Britain and a 19-year-old son who starts his medicine studies in Cracow. My husband and I live rather busy life. We live in Poland permanently, but working in many companies forces us to go on business trips very frequently. My husband practically spends the whole weeks in Germany. We are only left with free weekends. Then, the time we have is reserved only for us, and at least three times a year, we spend together two-week-long wonderful vacation in the house in Spain. However, despite so many duties and chores, we show each other huge sensitivity, and we spent our free time together most often. Our children practically lead their own life already and visit us only on Christmas time and vacation.

For many years of conducting various companies, I had to participate in numerous business dinners and banquets. It soon resulted in putting on some weight. I have always led a very active life, however, it was not enough to maintain a perfect shape. I started looking into the mirror critically more often and valuing my shapes. Finally, I decided to help myself and lose a dozen or so kilograms. Another incentive was that from time to time I also suffered from breathlessness and heart palpitation. At night I often woke up wet of sweat. For several months I also noticed scant bleeding. I realized that I was entering the time of menopause. My relatives told me more often that I was becoming more unbearable and too sensitive. I decided to change that. I started my therapy from the visit at the endocrinologist’s. The doctor, after having talked to me, prescribed me hormone examination. After another visit I got some medications in pills prescribed and something in plaster. I took one pill a day. The pieces of plaster were to be glued once a week at my buttock. After one-month therapy I felt much better. More cheerful and with a greater enthusiasm and energy, I came back to my responsibilities. But three months later, my weight increased a little bit. I got worried. I didn’t want to gain weight. Besides, I had already had to put away some of my favorite costumes and suits into the wardrobe simply because they were too small for me. The change of my weight was also noticed by my husband. It became even the reason of various jokes about me. I had to do something with that. Thus, I asked for help an internist specialized at obesity problems. The doctor advised me to change my diet, take long walks and attend some aerobics classes once a week. According to his advice, I changed my diet immediately. During my business dinners and banquets I delighted only in a set of vegetables and fruits. I limited the use of alcohol although I loved red wine. I also bought a dog to force myself to take daily walks. We have never had a dog at home. I also took up some aerobics classes for women after 50 once a week, during which our trainer forced us to be in sweat. I didn’t wait for the effects long. After six months of restrictive routines, I weighed 23 kilos less. It was a great success for me, but my happiness didn’t last long. Although the shape of my body improved, droopy and flaccid skin was not satisfactory. I started thinking intensively what to do with it. My face was sad and the upper eyelids were dropping strongly. Sometimes it was even difficult for me to choose a proper make up that would hide all the shortcomings. The rest of my body also needed improvement. Big dropping breast had to be sustained by a massive bra, and flaccid abdominal skin was falling over the thighs as a dermal fatty fold. I looked at myself with dissatisfaction. I knew that one of my friends underwent the corrective surgery of the abdominal and face a few years ago. I called her and asked her to give me the address of the clinic as well as the name of the surgeon who performed the surgery itself.

The same day I scheduled an appointment to consult with the doctor. After one week, I was sitting in a doctor’s office talking with a nice doctor. The surgeon informed me on possible corrective surgeries I could undergo. I asked many questions. First of all, I wondered whether it was possible to undergo such surgeries without any risk being at my age. I learned that if there were no other symptoms apart from my menopause ones I could undergo such surgeries. The doctor suggested me undergoing the lift-face simultaneously with the correction of the upper eyelids, whereas, the second surgery, i.e. the surgery of raising and reducing breast was to take place afterwards, and, finally, I was to have the correction of the abdominal covering. I was extremely interested in my face. That is why we started the correction from it. The first surgery was planned in two weeks time. All the required examinations I had already done, so it enabled me to have an appointment so fast. Under a local anesthetic, the doctor incised the skin of my face and corrected the upper eyelids. After three hours of lying in the surgery room, I was taken to another room where I had to spend two hours more having cold dressings on my face. I looked rather silly with all the stitches on my face. When I came back home next day, my husband was already waiting for me. He wanted to accompany me during my convalescence very much. However, on seeing me, he worried about the size of the dressing. Nevertheless, he supported me bravely all the time. On the second day after my surgery, I could notice numerous bruises in the region of my eyes and cheeks as well as swellings. Five days later the doctor removed the majority of the stitches and took off the dressing. The swelling disappeared almost completely, however, the bruises were still visible. I had to wait two days more until all the bruises and swelling disappeared completely. Two months later, I had an appointment to undergo another surgery. This time I underwent the corrective surgery of the breast. I arrived at the clinic on the scheduled day. First, my surgeon and I discussed and valued the effects of my face correction. The improvement was significant and postoperative scars were totally invisible. There could be some slight irregularities noticed in some parts, but they all could disappear after another two months. The doctor calmed me down saying that it was typical of the skin to need so much time to regenerate and rebuild.

The surgery of raising and reducing breast was more complicated one. I underwent the surgery in a general anesthetic, so, actually, I don’t remember anything. I had the feeling of waking up on the next day feeling a soft pain in my breast. After the surgery my breast was toughly wrapped and I also wore a sport bra. Two days later I felt much better and went back home. In the subsequent period of convalescence my husband accompanied me, too. ‘He is a wonderful man’, I thought to myself. The traces of the surgery in the form of swelling, pains and bruises were visible for the next two weeks. Afterwards I went for a control check-up. My breast did not have the final shape for sure, but the doctor was satisfied with the job he had done. The scars were slightly pink, but I knew at that time that they would become almost invisible after some time.

The next meeting with my surgeon took place again in the surgery room. This time I underwent the correction of excessive dermal fatty fold. The only remaining signs of it was a huge scar in the region of the hypogastrium. Next day after the surgery, during the change of my dressing, I had a chance to see an early effect. In spite of a fresh scar I already liked the new shape of my body. For the next six weeks, I had to wear a special pressure belt.

Then, I just needed to be patient and wait for the final results of the surgery. I was to meet the doctor in two months time. These were, I guess, the most difficult and the longest days in my entire life. Every day I looked impatiently into the mirror. My face looked younger, the breast firm and prominent just like 20 years ago and my belly, ‘what belly?’, you may ask. My new shapely waist and prominent thighs just like at the age 30. Christmas was coming and my kids, who didn’t know anything about my corrective surgeries, came back home as usually. One evening during the dinner my son looked at me carefully and said ‘you know, mum, you look 20 years younger’. Yes, I felt young and beautiful. The same evening I called my surgeon and thanked him.

Wanda

Elapsing time is not indifferent to the woman’s organism. Usually at the age of 50 there appear some symptoms informing her about the expiration of hormonal functioning of the ovaries. It is an extremely difficult period in women’s life. In order to survive it, sometimes a strong will and the consciousness of undergoing changes is insufficient. A strong emotional tie with the husband, i.e. his help and tenderness are extremely important is this case. Sometimes it happens that still it is not enough and there comes the need to consult with the doctor. A vicarious hormonal therapy is often used, then. Although some elements of the treatment still arise lots of controversies, there are many women for whom the therapy is the best solution ever to alleviate the symptoms of the transitional period.

With age numerous changes appear in the physical appearance and the figure itself. Some defects are usually the result of a woman’s neglected duties. An excessive influx of calories results in the overgrowth of adipose tissue in the region of thighs, abdominal and chest. While comparing the level of gland tissue to the level of adipose tissue in woman’s breast, it turns out that with age the later overweighs the former. Women whose breast was huge while being young that usually was their attribute, in the mature age it can be the cause of pains in the backbone. Moreover, huge breast unables comfortable body movements. It is extremely difficult to practise jogging or play tennis in such cases. The corrective surgery is, thus, the best solution. There are even countries where the cost of such surgeries is often reimbursed by national health funds. The breast reduction surgery* is a massive operation thanks to which it is possible to restore the attractive look of the breast and reduce their size. However, the side effects are remaining scars. They usually remain around the areolas and vertically downward. Most of the reduction can be performed thanks to the so called vertical method. If the surgery is performed on a very large breast, then it is necessary to make transverse cuts that, finally, result in a scar in the subpectorial fold. Women who are highly motivated to undergo the surgery, the matter of scars is no longer a problem for them. Moreover, after a lapse of time, the scars become pale and less visible. The breast reduction surgery is one of the most difficult surgeries in the field of plastic surgery. It is performed under a general anesthetic and it usually lasts many hours and larger number of complications is possible afterwards. The period of convalescence is also longer and one should wait a few weeks to have the breast natural look restored. However, the final result usually compensates the size of sacrifice. The patients who underwent the surgery belong to those whose the degree of satisfaction is usually very high.

An excessive amount of the skin and adipose tissue accumulated in the region of abdominal constitutes a similar problem. Usually as a result of weight loss, the dropping of those body parts occurs which, consequently, causes many life problems. Not only does the figure have an unproportional shape, but also there happen some very serious diaper rush in the region of the hypogastrium. It usually happens during summer on extremely hot days. Just as abundant breast, also a droopy abdominal reduces the capability of comfortable movements. It is almost impossible to practise sport not to mention running on the beach. The intimate life is disordered and she cannot expect huge tolerance on the part of the partner. The skin and adipose tissue reduction surgery is usually connected with the plastic surgery of the fasciae and abdominal straight muscles. This is why it is called abdominoplasty*. This surgery similarly to the breast reduction one is performed under a general anesthetic. The biggest risk is connected with embolism syndromes, so it is extremely important to prevent them . The patients before the surgery are given certain doses of micromolecule heparin. They can walk in the first 24 hours after the surgery. The vision of a belly makes the patients feel optimistic. Usually a new recreated navel can enjoy its natural shape and slender longer figure allows to make plans concerning the change of cloth size. The stay in the clinic lasts usually two days. It is recommended to wear a pressure belt for the following four weeks after the surgery. It sometimes happens that one week later a certain amount of chyle accumulates under the skin that can be easily removed by means of simple tapping of the needle. The scar remaining after the surgery is straight and lies horizontally a few centimeters below the navel. However, it can be easily hidden under the underwear or bikini. So, one can take a walk on the beach with a nice smooth uncovered belly. Similarly to the breast reduction surgery, the patients who underwent abdominoplasty belong to the patients most satisfied patients with the possibilities offered by plastic surgery.

According to many opinions, face-lift is the symbol of plastic surgery. It is mainly used to correct the changes that occur in the fascia system and in the skin while getting older. A gradual dropping of face tissues like skin, adipose tissue or muscles are the result of flaccidity of face fasciae and constant gravity. As a consequence, the face makes an impression of tiredness and seriousness. The shape of the face from an oval and harmonous one becomes droopy with enhanced downwards cheeks and double chin. There are lots of corrective surgeries of this condition. They all come down to strenghten and raise the fascia system of the face and adipose bodies of the cheeks and the zygomatic arch. Face ‘lift usually refers to the 2/3 of the lower face. The cuts run most often on the border of the cheeks and ears, in the region of the temples and behind the ears. After having a certain layer of the skin prepared, the surgeon performs the plasty of the fascia system called SMAS. There are many techniques of performing the surgery. Recently, the invasive technique of face ‘lift called MACS-lift is gaining popularity especially among European women. It is performed under a local anesthetic and is usually connected with the liposuction of adipose tissue of the chin. The patient stays in the clinic 24 hours, whereas the dressing is worn for 2 or 3 days afterwards. As after any type of surgery, the patient needs to put up with the swelling of the face that remains usually one week. What counts most for the Europeans is a short period of convalescence allowing to come back to work within 7-10 days. Of course, the scars are pink then, but they can be easily covered by a special make up and haircut. The efficacy of the surgery is estimated to last 10-15 years. After this period, further flaccidity of the face occurs. However, the period itself is so long that the patient undergoes another surgery without any fear.

In recent years due to the growth of popularity of using a toxin of Clostridium Botulinum (such as Botox or Dysport), the forehead-lift is performed rarely. That massive surgery was replaced with the injections of the toxin performed every six months. Their great advantage is little invasion and the possibility of immediate return to daily routines.

Nowadays, a fifty-year-old woman does not have to face classifying her into the group of less attractive representatives of her sex. Thanks to her vital energy lying deep in her mind as well as modern plastic surgery she can bravely fight for the best place in the ranking among other women.

Jerzy Kolasiński, M.D. Ph.D.

* Under no circumstances can the surgery be performed if one smokes. The patients who are planning breast reduction surgery, abdominoplasty or face-lift have to give up smoking unconditionally two months before the surgery.

We set up a schedule for medical examinations

When we are young, full of energy and the joy of life as well as great plans for the future, actually, we do not have time to bother ourselves thinking about pain and diseases. Such issues seem to be too remote or even unreal. However, with age we are becoming aware of the fact that such unpleasant sides of life also refer to us. Let us take a narrow window of opportunity and, in advance, think of possible ways to prevent and detect diseases which may reveal in our body while getting older.

One of the branches of contemporary medicine, the so called ‘anti-aging’, has created a list of essential minimum of medical examinations for women in specific age groups.

At the age of 30 let us devote some time to undergo some of the diagnostic examinations. Let us start with the easiest ones connected with blood testing. It is worth analyzing the blood picture, blood culture, blood-sugar on an empty stomach as well as lipidograph, i.e. total cholesterol, HDL (high density lipoprotein), LDL (low density lipoprotein) and triglyceride. It is important to remember to have those tests undergone at least once a year. The obtained results will provide us with a lot of information on possible anemia, inflammatory state not to mention tumor. Continuing the discussion, let us mention carbohydrates disorders (intolerance to glucose, diabetes) and lipoid ones, namely some premises to suffer from atheroma and another disease strictly connected with it, namely heart hypaemia. Once a year it is recommended to have general urine test done.

High blood pressure is becoming a more widespread disease, and it refers to younger and younger women. Let us control our blood pressure at least twice a year since a thirty-year-old woman with a detected hypertension is not a surprise for a doctor. Let us remember that the upper norm limit is blood pressured equaled to 140/90 mm Hg.

The next comment refers especially to women who smoke. However, each and every one of us should think of having the chest x-rayed at least once in a two-year-time.

Extremely vast amount of information can be obtained due abdominal examination by means of ultrasonography. It should be performed once in a three-year-time. We will find out a lot about the condition of our internal body organs such as liver, bile ducts and kidneys.

I do hope that none of us has any doubt that commits a huge crime resigning from annual check-up at the gynecologist who is supposed to check reproductive organs, breast as well as a sample for cytology test should be taken.

Our breast, indispensable attribute of our beauty is , unfortunately, also the source of very serious and dangerous diseases. Let us not forget them! Medicine gives us the possibility to control them by means of mammography and ultrasonography. As thirty-year-old women let us undergo ultrasonography examination every second year. Our hand is an extremely useful diagnostic tool to check our breast, too. Thanks to it, up to 80% of women detects some irregularities in their mammas. Everyone of us should undergo such a control every month in the first part of the cycle.

Let us also take care of our organs thanks to which we may perceive the surrounding world. Once in a three- or five-year-time let us check the condition of our sight and hearing.

We are becoming older and more mature, but still professionally active and often also happy wives and mothers. We cross the threshold of the age of 40. Year after year goes by. Nonetheless, we should still continue the medical examinations done during the last decade. We continue checking the same blood parameters as well as blood pressure, breast roentgen and ultrasonography examination of the abdominal. Let us add also cardiogram-the examination that will allow us to control our heart. It should be done once a year. It is the matter of concern especially for those who know that their relatives suffered from cardiovascular diseases.

Our breast should be under strict control now. Apart from monthly self check-ups and annual ultrasonography test, it is time to take advantage of mammography. It is especially advisable for women undergoing menopause and just after it. Entering the age between 40 and 50 let us do it every two or three years.

We are entering slowly the age at which we should be interested in the condition of our bones. Let us plan the examination of the femoral neck density once in a three-year time to check whether we have not become the victims of osteopeny or, even worse, osteoporosis. Let us put an end to the era when the break of one of the vertebrae was a sign of an advanced disease.

Let us also start preventing the development of tumor of the anal passage, the large intestine or other inflammation diseases of these organs. Let us decide to undergo the examination per rectum (via the anal passage) once a year and a more detailed endoscopic examination (sigmoidoscopy or colonoscopy) this time once in a five-year-time. At that point we should visit a recommended proctologist.

We are getting closer to a very unpleasant moment in our life, namely menopause, that most often occurs on the verge of the age of 50. Some unpleasant symptoms may occur even a few years before the last period. And it is not the end since just after menopause the symptoms are still present. The best solution seems to be hormonal therapy. There is, however, one problem whether to use it or not. We may be even more anxious on hearing how many controversies arise among the scientists themselves concerning the advantages and disadvantages of the therapy. Nevertheless, we are not dismissed to discontinue the planning of our examinations so that our body would be under constant control. Let us do what we have been doing during the last 20 years. We will have to intensify, however, some of the examinations. Let us devote more time to our heart and undergo cardiogram tests every year.

An extremely important issue at this point is our breast. Let us control the breast by means of mammography every year. Also the risk of osteoporosis increases with entering the period of climacteric. We need to be conscious of the condition of our bones, so let us visit the laboratory of densitometrics once in a two-year-time.

I have just presented a draft of our health duties concerning only diagnostic examinations. It is extremely important part of our health activities. Let us think it over. In the vast majority of cases, the success of early diagnosis, prophylactic and successful therapy depends only on us and our life discipline. I would like to mention that the presented above schedule concerns only healthy women who do not need to be under regular control of specialists and connected with it more intensive schedule of examinations and treatment.

Many of us may be terrified how much should be done as far as the implementation of this schedule is concerned. However, I may assure that it is a very small effort in comparison to those which should be taken while treating diseases in advanced stages simply because earlier there was not time for minor examinations.

Anna Modelska-Ziółkiewicz, M.D. Ph.D.

The post Women: 30, 40 and 50 years old first appeared on Kolasiński Clinic.

I come from a small town situated about 100 km of the capital of the Wielkopolska region. After I graduated from Primary School I moved to Poznań for good. It was in Poznań where I continued my education in a Vocational School and at the same time I picked up a job as a driver in a transport company. Since then I did not live with my parents. I rented a room at an older landlady in the city center and actually I did not have either money or time to cook for myself. So, I used to be a very slim young man. I visited my parents from time to time usually at Christmas time and other family reunions. Every time I visited my parents, my mother gave me a huge amount of home-made food. However, it was not huge enough to cause a few spare kilos in my weight.

After a few years when I graduated from my school and passed my final exams, I met a girl, fell in love with her and finally I got married. According to the tradition, my marriage welfare helped me to gain a few kilos. My wife graduated from Gastronomic School so she could cook very well. She also had a talent for baking cakes. After a few years of working in the transport company I decided to set up my own business. I bought a few years old car and started working as a taxi driver. My sitting lifestyle, limited physical activity and quite a good salary resulted in my gaining weight. At the age of 45 being, 178cm high I weighted 120kg. I felt really heavy and it was more difficult for me to move smoothly. Sitting job, enormous home meals and lack of physical activities influenced my horrible mood. My knee joint, calves and feet hurt me, and I had huge difficulties to come up to the second floor because on the first floor I was out of breath. Many times after even slight house works or a longer Sunday walk I felt very tired and weak. I decided to visit a doctor and consult my troubles. The diagnosis was very easy and fast. My obesity was the main cause of my troubles. At the very beginning the doctor measured my blood pressure that turned out to exceed the norms at my age. She also asculated my heart beats and said that it was overworked and needed treatment. My knees, claves and feet hurt me due to excessive weight. The only way to get rid of them was to lose weight. How can I do it? , I thought. The doctor prescribed me 1000kcal diet, walks and bike riding and weight control in four weeks time.

I came back home and together with my wife we established a schedule. At first we decided not to eat sweets. It meant no cakes, cream cakes, sponge cakes and ice cream. Instead we were to eat fruits and vegetables, yogurts and sweetener instead of sugar. I also needed to give up eating my favorite marmalade and home made preserves. It was all possible to implement but I also needed to reduce food doses. According to the saying – Eat the whole breakfast, share your dinner with your friend and give your supper to your enemy. I needed to give up eating soups with milk added, knuckles of pork, bigos (our traditional dish) and fat meat poured with juicy sauces. How shall I do it?, How can I change the diet completely at my age and start starving? , I thought. For one month I followed the doctor,s prescriptions with a great effort. During the first few days I felt weak. It was difficult to concentrate at work. I was very sleepy. I suffered from constant headaches and I was very irritated. I did not want to work, not to mention walk or bike riding. In the meantime I bought scales to have the control over my weight every day. So one week lapsed. As soon as the week finished, I noticed that to my surprise my weight did not differ significantly to the original one a week before. I thought, I am torturing myself and nothing . I wanted to give up and accept myself as I was. However, my wife advised me to be patient. She read in some women magazines that it was something normal and after a few weeks the positive results could be visible. The second week was easier. Probably my organism accustomed to the new situation and I had the feeling that I am not so tired and sleepy, and I did not suffer from any headaches anymore. After four weeks of my dieting I went for a control visit. Weighing again and – only 5 kilos less. It is a very good result, I heard from the doctor. I was a little bit comforted. Maybe there was a chance for me? At least I had my own motivation. I was still very young and I wanted to change my appearance.

Christmas and New Year was coming. The atmosphere at home was filled with intensive cooking preparations. My wife prepared my favorite dishes like bigos, turkey, pierogi, sponge cakes and cream cakes. I was worried a little that my strong will would get weakened a bit. But, on the other hand, I could not impose my diet on the rest of the households not to mention the guests who could visit us. During the first few days I followed the doctor,s recommendations. However, I was so strongly encouraged by my household that I could not bear it anymore. I came back to my old bad habits comforting myself that from the 2 of January I would come back to my diet. Family reunions were also a good occasion to drink some alcohol, which has, the so called, empty calories. In the New Year I weighed myself, and …… phew!. My weight not only came back to the original one but what was even worse, it exceeded significantly the original weight. I weighed then 130kg. All my efforts end up with a failure. It was a real tragedy.

It was very difficult to maintain the diet so I thought of some pharmacological treatment. After a telephone consultation with my doctor I bought a set of tablets and herbs stimulating digestion. Since then I used the diet prescribed by the doctor and the medications. Two months more passed. After this period I went for a control visit and ….. the effect was poor. The weight was less as I weighed 115kg but still I had hypertension, problems with breathing and advanced degenerative changes in my knee joints. I asked my doctor whether she knew some other ways to lose unnecessary kilograms. Maybe an operation was a solution?, I suggested. Pharmacological way of blocking the feeling of fullness did not work in my case. Then, the doctor informed me about the possibility of surgical treatment of obesity and the surgery itself consists in reducing the volume of the stomach which consequently forces the patient to eat often and small doses. Additionally, low calories diet quite fast, radically and safely reduces the body mass. Knowing that I would not manage on my own, I asked for a referral to the surgical clinic and, finally, I went to Zabrze. I consulted my problems with a friendly surgeon who asked me about my troubles in details, applied ways of dieting and examined me. He estimated the condition of my circulation and respiratory system as well as my joints, blood parameters and the so called obesity index. Taking into consideration this index, my age and my general condition he referred me to the surgery. I made up my mind at once. I came back home waiting impatiently the term of my surgery. The surgery was performed quickly and my stay in the clinic lasted two weeks. Since then my life has changed totally. I needed to change my diet, way of working even way of thinking.

Since that moment 9 months have passed and I managed to lose 40kg. It is a very good result and my happiness was even greater. Unfortunately it did not last too long. While looking into the mirror I did not look well. Of course, I was slim but when I took off my clothes, my body was flabby, droopy folds of skin especially in the region of the abdomen, arms and thighs looked horrible. I also noticed some meaningful glances of my wife. Once I asked her about her opinion on corrective surgeries and my undergoing one. She did not support my decision at first. With time, however, she said that we were still a young couple and we would go to Riviera to sunbathe a little. The question was how one can go to the beach with such a strange creature as I was.

In autumn I went to the clinic of esthetic surgery that deals with body corrective surgeries. During the consultations, the doctor listened to my life story and examined me carefully. He admired my determination and courage. He informed me that the surgery would allow to correct the skin on the abdomen. It was called abdominoplasty. The arms and thighs that left a lot to desire could be operated in the second stage. There were supposed to be two huge surgeries. We established together the schedule and terms of meetings. I was to undergo the first surgery in one month time and the second one after three months. This is how I will become young and beautiful again, I thought.
On the appointed day I arrived at the clinic and the surgery was performed on the same day. The effect was visible next day. During the change of the dressing I could notice impressive slenderness of my stomach and waist. It was the day of great joy. After three-day-long stay in the clinic I came back home. I felt great. One week later I went for a control visit and the doctor removed the itches. The operated region was slightly swollen, bruised and numb but looked great. For 6 weeks I carried a special pressure abdominal belt so that the skin could adjust to the new shape of my body.

Another visit in the clinic took place three months later. This time I underwent the corrective surgery of arms and thighs. The surgery was also performed under a general anesthetic similarly to the first surgery. It consisted in excision of the skin by longitudinal cuts along the arms in their internal part, from the axilla fosse down to the elbow, whereas, in the region of the thighs it consisted in a round excision of the skin in the groins. Next day having the body covered with bandages, plasters and a special pressure shorts I came back home. One week later during a control visit, the doctor removed all the plasters, whereas the itches were to dissolve on their own. The effect was really impressive. My arms and thighs were modeled very well. I wore special pressure shorts for the next three weeks. After two months I arrived again in the clinic but this time to praise the effects achieved thanks to the surgeries. The scar on my abdomen was smooth, light and slightly visible. It looked as a gum from the pants that left a trace on the skin. The scars around the thighs were slightly pink whereas in the region of the arms they looked as the itches of the sweater that left its trace. That time we were going for vacation with my family. For the first time since 5 years I could afford to go to the seaside. Our destination was Majorca. We spent there two wonderful weeks. I went to the beach, swimming pool and I learnt to play tennis. I looked very well and I felt fantastic as if I was 30 years old again.

Zdzislaw

Overweight and obesity: epidemics of the contemporary civilization

Nowadays overweight and obesity are the most common topics of our discussions and talks. There is a wide coverage in magazines, radio and TV programs almost every day. The fact is that the problem of an excessive amount of adipose tissue is becoming more and more common not only among adults but also among children. As a result it has become an epidemic in many civilized countries. We meet people with the symptoms of obesity more often and it is becoming more common that the overweight are among us.

However, let us not forget that obesity is a very serious, chronic and dangerous disease. It poses a huge risk of heart diseases, namely ischaemic changes and even heart attack, hypertension, diabetes and lipids anomalies in blood. Also our joints condition worsens due to huge weight they need to bear. We need to mention the competence disorders of veins system of the lower limbs. Gallstones let us know about their presence as well. Cancer is also inevitable in the case of the obese. Together with the increase of weight, the frequency of breast, cervical, large intestine, and rectum cancer also increases. Obese people often suffer from respiratory system diseases, too, especially sleep apnea. Due to the increase in death rate, obesity is becoming a risk factor more dangerous than smoking or alcohol abuse.

Let us analyze for a while the results of some statistic research carried out in the United States. We will analyze the graphs, where the increasing number of obese people is clearly visible. Especially the last 20 years has become the climax of this process. The percent of obese men tripled and at women is more the doubled.

The figures give us some food for thought and some of us, especially the obese ones, may even be encouraged to make a hard decision concerning the modification of their own lifestyle. It is really worth!

Anna Modelska-Ziółkiewicz, M.D., Ph.D.

Who is obese?

In order to answer this question, many scientists and doctors have worked on the creation of some specific procedures and parameters which would facilitate measuring adipose tissue accumulated in our organisms as well as classifying obesity. Contemporary medicine takes advantage of some of those achievements. They are very reliable and are not difficult to carry out and interpret.
The easiest way to measure an adequate body mass is to use the following formula:

For men: (height in cm – 100) – 5%
For women: (height in cm – 100) – 10%

If our body mass is over 110% of the adequate body mass, it means we are overweight, but when the percentage exceeds the value of 120 we are obese. I am sure that probably most of us came across the definition of BMI (body mass index) in some publications connected with the topics of nutrition.
BMI can be calculated on the basis of this uncomplicated formula:

BMI = body mass in kg / height in meters raised to the second power

Right now let us analyze the value we achieved and find it in the table.
underweight < 20 norm 20 – 25 overweight > 25
obesity > 30
extreme obesity > 40

BMI is a very good index. It shows visibly the correlation between the frequency of occurrence of many serious and dangerous diseases as well as the intensification of death cases.
In the case of people whose BMI is higher than 30, we can define the type of obesity very easily by means of measuring the waist and the circumference of the hips. Their numeral ratio is called waist-hip ratio (WHR). According to those two figures one may determine two types of obesity. The table below presents them well.

men
WHR >1.0
women
WHR >0.8 apple type of obesity
men
WHR <1.0
women
WHR <0.8 Pear type of obesity

Let us remember that the apple type of obesity is very unfavorable to our health. It often becomes the cause of hypertension, coronary heart disease, lipids anomalies in blood and diabetes, while the pear type of obesity often results in complications during pregnancy and delivery, the occurrence of breast and cervical cancer, and varices of the lower limbs. This type of obesity weighs down significantly bones and joints.

There is also the possibility to measure the components of the body, namely the proportions between adipose tissue and non-fatty tissue. These measurements, however, require a special equipment based on densitometry and bioelectrical impedance.

When it turns out that we can classify ourselves into the group of obese people, we should not jump to quick conclusions and think of some magical diseases which could create our problem. 95% of obese people has the so called positive energetic balance. It simply means that they eat more than their real needs require.

There remains only slight percent of those whose obesity is the result of diseases. It is usually connected with hypothyroidism as well as to some extend with other endocrinological diseases such as adrenal glands and gonad dysfunctions, genetic diseases or the diseases of the central nervous system. The increase of the body mass can be also caused by some medications. However, it is usually the matter of a few kilograms more and it does not lead to obesity. Certainly, a physician, specialist in this field, should exclude any diseases that may cause such condition in order to select the most optimal way of treatment.

If our body mass index is too high, let us think what we can do to change it. Let us consult the doctor. Let us not be passive looking at our disfigured body. As soon as it is possible let us make a strong decision to implement some changes in our lives instead of consuming another cookie or steak in despair. This pleasure lasts only a second, the consequences, however, need to be taken for the rest of our lives.

Anna Modelska – Ziolkiewicz, M.D., Ph.D.

How to win the battle over some useless kilograms?

Let us be aware that the treatment of obesity should be a complex activity. A balanced and proper diet, physical activities, the change of life style and pharmacological therapy are the issues that should be included in the plan of curing an obese person. It is also very important that the person who decides to wage a fight against obesity should be driven by a strong and long-term motivation to achieve the goals set. A close contact with the doctor is of crucial importance as well, so that the patient could consult in the normal course his/her doubts and problems with the doctor. On the other hand, the doctor should explain in details every element of the therapy and provide the patient with the possibility of frequent sessions.

A diet in the treatment of obesity should be diversified and consist of all necessary, for a human body, ingredients. Carbohydrates, proteins and fat are crucial for the proper functioning of our body and we cannot give up consuming them. We should, however, eat them in reduced quantities.

Let us calculate how many calories we need to maintain the body mass at the same level. We can use the following formula: a proper body mass multiplied by 30. The number achieved from this simple calculation is the number of calories we may consume in a daily and normal diet. If we want to lose some kilograms, we need to reduce this number. When we reduce the food by 7000 kcal, we will lose 1kg of our adipose stock. Supposing one was to lose 1kg within one week, he/she would need to eat 1000kcal less every day. If we want to lose weight faster we need to reduce the number of calories even more. A person who weighs 60 kg and does some moderate physical effort during the day, he/she needs daily 1800 kcal., and if that person would like to lose weight, it means the reduction of calories to 800 kcal daily in order to lose1 kg.

At the very beginning it is worth keeping a diary where one may write down every single food eaten during the day. Looking at the book of calories one may also learn how energetic every product is. Such knowledge can be used all life long to estimate better caloric potential of the dishes eaten. While following any slimming diet, one should give up consuming full-cream milk and dairy products, fat meat and fish as well as cured meat, sugar, sweets and alcohol. It is recommended to drink only low fat milk and dairy products, whites of eggs, also low fat cured meat and fish, vegetables, fruits, all within the recommended calories limit. Generally speaking, a slimming diet should contain 800-1000 kcal daily. Let us not believe in any miracle diets which have never helped anybody. It is worth maintaining the implemented eating habits forever as it will guarantee the maintenance of reduced body mass for a long time.

Physical activity should be an inseparable element of our diet. It is important to do the exercises regularly. The best option is to do them every day and from 30 minutes to 1 hour. They should be adjusted to the abilities of a patient. The best type of physical exercises are riding a bike, swimming, marching and playing football. No exercises in the gym or of very short and intensive duration are recommended. The exercises should be intensified gradually, always bearing in mind the diseases that accompany obesity, namely hypertension or ischaemic heart disease. Physical activity should be associated with the modification of our lifestyles. Consequently, instead of using an elevator, one should use the steps, walk to the nearest shop and not go by car. Physical exercises have a beneficial effect on our fitness and muscle strength, lipids profile in blood, lowering the blood pressure and better physical efficiency.

Pharmacological therapy is recommended in the case of obese people whose BMI exceeds 30 or with BMI higher than 27 when the obesity is accompanied by such diseases as hypertension, diabetes, lipids disorders, sleep apnea syndrome or obesity of apple type.

One of the medications available is Orlistat (Xenical), an inhibitor of steapsin and stomach lipase- enzyme that decomposes fat. As a result, the digestion and fat absorption is blocked. 30% of fat eaten is excreted from the body in an unchanged form together with excrement. Additionally, the medication lowers the level of cholesterol in blood.

Another medication that should be paid attention to is sibutramina (Meridia). It works by blocking a reversing uptake of two neuromediators serotonin and noradrenaline. The patient has the feeling of fullness and his/her metabolism also increases. This double effect reduces body weight to a large extend. The patient does not feel any hunger, and additionally his/her organism uses the energy obtained from food much faster. It has also been proved that this medication effects beneficially the level of glucose in blood and lipids profile. It is necessary to control blood tension and the frequency of heart beat while taking this medication.

Let us remember that fight with overweight or obesity is a long-term action. The general change of lifestyle that we implement should help us to lose weight and should be continued throughout the whole life. If we lose weight, we should not come back to our old habits afterwards. The happiness we feel after we have achieved success, attractive and healthy-looking body, greater physical fitness, excellent mood will all be a strong motivator to stick to the habits. I do encourage everybody to start the fight with obesity because there is no man in the world who cannot lose weight. Just do some effort in a rational, patient and slow way and I can assure you that it will change into the joy of your life. Warmer and sunny days are coming, which will give us more strength and motivation for sure.

Anna Modelska – Ziolkiewicz, M.D., Ph.D.

Surgical treatment of obesity

The indication to perform a surgical treatment of advanced obesity is exceeding the value of BMI-Body Mass Index more than 40 kg per sq m of the body mass. Extreme obesity can pose a real danger for one,s health and life. The patients with huge obesity die earlier suffering from numerous diseases of heart, circulation and respiratory systems, problems with bones and joints and even cancer. The return to the proper weight and its maintenance can restore the proper predicted life expectancy since the death rate of the obese increases with the increase of BMI to the value of even three times larger in comparison to the control population of a proper body mass.

It was not until recently that the surgeons were quite skeptical as far as surgical treatment of obesity is concerned. It was the result of unsatisfactory results of the performed surgeries the aim of which was to increase the excretion or the limitation of food absorbed. In the last decade the results of research performed for many years and observation of the patients who underwent surgical treatment of obesity were published. There are more and more good and very good results.

There are usually young people, between 20-45 years of age, who are classified to undergo a surgery, suffering from the diseases which can be eliminated, alleviated or prevented due to the surgery. They are usually the following: ventricular diseases, atheroma of brain vessels, diabetes, sleep apnea syndrome, cardiomyopathy, effort breathlessness, hypertension, infertility, calculosis of gall bladder, incompetence of vein system of the lower limbs with lepers and degenerative problems of the joints.

We can differentiate two basic types of obesity. Abdominal obesity (the so called apple type), which is usually accompanied by ventricular diseases, atheroma of brain vessels, insulin-dependent diabetes and hypertension. The second type of obesity is of gluteal and femoral type (the so called pear type) which is usually connected with veins changes in the lower limbs and degenerative problems of the joints. However, those with the abdominal obesity are prior to undergo the surgery due to the diseases.

The results of the performed surgeries are estimated on the basis of a currently gained weight of a patient with his/her proper weight. Very good results are those where there are no fatal cases, the number of further complications is minimal and overweight is 0-25%. Good results are those when there is a maintenance of body mass by 26-50% higher than the proper weight. These are satisfying results. Satisfactory results are those when the weight exceeds 50-75% beyond the norm and unsatisfactory ones from 75-100%. If the weight is higher than 100% and higher than the proper value, then it means that the surgery failed.

The surgeries aiming at treating extreme obesity have been performed since 70s. Their main goal is to gain the loss of weight and maintain a constant improvement so that the patient would not be undernourished, and assure the feeling of fullness by following a constant and balanced diet. In the first stage, the surgeries consisting in avoiding small intestinal loops were performed to obtain a shortened passage of digested food and consequently the excretion of the food eaten without the possibility of its total digestion and absorption. However, after such surgeries there were some cases of proteins deficiencies and disorders of carbohydrates absorption with the harmful effects on the lever. Currently, the surgeries of stomach volume reduction are performed (gastroplasty) by installing proper mechanical stitches and bands or gastroenterostomy. After such surgeries there may happen some cases of undernourishment due to the deficiency in calories, but they occur extremely rarely. The sufficient volume of the stomach necessary to digest the food is less than 15 ml.

The patients who successfully underwent the surgery receive food in the form of liquids or the food is grated. In the further stage they can consume constant food, however, they have to have meals often but in small amounts. The patients can have the feeling of fullness in the epigastrium, the feeling of dizziness and the necessity of laying down after the meal may occur. These are, however, typical symptoms connected with the limitation of food taken and the loss of weight.

The loss of weight and what next?

After a great loss of weight from 40 to 60 kg, earlier excessively stretched skin can shrink. In such cases a huge amount of it may droop in the region of the abdomen, arms and hips. In order to improve the aesthetical appearance, the patients undergo a range of corrective surgeries as abdominoplasty (excision of abdomen skin connected with the plasty of straight muscles of the abdomen), skin lift of the arm and hips skin. Those surgeries are extensive surgeries so they are performed under a general unaesthetic and usually consist of two stages. In the case of women there is usually the third surgery, namely breast raising.

An excessive amount of skin and adipose tissue of the abdomen is not only an esthetic problem but also makes life functions difficult. A droopy fold of skin and adipose tissue makes it difficult to practice good hygiene of the intimate regions and the hypogastrium, where skin chafing may occur very often. In some extreme cases it makes even difficult to move. The surgery of skin and adipose tissue reduction in the region of the abdomen is usually connected with the plasty of fasciae and straight muscles. It is a very extensive surgery and is performed under a general unaesthetic. Its most serious risk are embolism complications. In order to prevent them, prophylactic anti-embolism treatment is applied in the form of micromolecular heparin and the patient is recommended to move soon after the surgery. The result of the surgery is visible next day. A new shape of the abdomen, new and more beautiful navel provide such a pleasure that any bruises, induration and pain in the region of the operated regions cannot destroy the happiness. The stay in the clinic usually lasts 3-4 days. Directly after the surgery the patients is provided with a special pressure abdominal belt to model a new body shape, and it is recommended to wear it for 4-6 weeks. The effect is even better as it does not leave huge scars, only a long horizontal, running a few centimeters below the navel one which does not disturb at all. It is very easy to hide it under an underwear or a swimming suit.

The first abdominoplasty was performed by Demars and Marx in 1890. Depending on the skin changes and the amount of adipose tissue of the abdomen region, the following surgeries may be performed: liposuction, abdominoplasty with or without moving the navel, the so called lower abdominoplasty in region of the hypogastrium, which usually women after pregnancy undergo. In the last phase, after a huge loss of kilograms, full abdominoplasty with moving the navel and suturing abdominal straight muscles, which due to weight gain were stretched is performed.

Estimated in adolescence the outline of the arms is changing with age. At the beginning a smooth skin between the axilla fosse and the elbow becomes less elastic with time. The first corrective surgery of arms outline was reported in the 70s of 20thc. The surgery consists in the excision of an excessive amount of skin that droops unaesthetically. We can classify the patients into three groups while taking into consideration Pitman,s classification. The first group consists of people with a moderate amount of adipose tissue in the region of the internal part of the arm, and tensed elastic skin. In such cases liposuction can be performed. The second group consists of those patients who have a moderate amount of adipose tissue and slightly flabby skin. In such cases liposuction is performed as well as the excision of an excessive amount of adipose tissue, leaving circular scar around the axilla. The third group consists of all those people who lost a huge amount of kilograms. In such cases an unaesthetically drooping skin fold needs surgical intervention. The cut is made along long ax in the internal part of the arm starting from the axilla fosse down to the elbow.

In recent years during the excision of an excessive amount of skin, most often its full depth is not cut but just the epidermis is removed (deepitelialisation) and its lips are simply itched. This, in turn, protects the veins and nerves of the axilla fosse against harmful effects and it also prevents the creation of post-operational veins and lymphatic oedema of distal lying forearm and arm. Thanks to this technique haematomata and other bodies of liquids occur rarely.

The correction of the medial part of the thighs called thigh lift allows to improve the appearance of the upper part of their third part. Similarly, as in the case of the arms, Pitman,s classification can be applied here. So, depending on the amount of adipose tissue and the condition of the skin liposuction can be performed or liposuction together with the excision of excessive amount of skin, leaving semicircular scars in groins. In the case of patients who lost a lot of weight, a cut is made in the internal surface of the thighs going vertically from the groins down to the knees. The application of skin deepitelialisation technique protects important veins and nerves in the region of the groins responsible for the proper functioning of the reproductive organs and the lower limbs.

After the corrective surgeries of the arms and thighs a special pressure dressing is put for 2 weeks of convalescence. However, only after 2 months one may come back to practising sports.

Małgorzata Kolenda, M.D., Ph.D.

The post Problems with obesity first appeared on Kolasiński Clinic.

What is gynaecomastia?, I thought. In those days there was no Internet so I could not obtain any extra information. I was quite curious and I could not sleep all night. However, there was no other solution but to wait patiently for the scheduled appointment at my mother,s known doctor.

On Thursday afternoon my mother and I arrived at the doctor,s office. The doctor examined me carefully and calmed down saying that there was no need to worry. He explained me in details that gynaecomastia at my age (I was then 14) is something natural and is called youth gynaecomastia caused by overgrowth of the adipose tissue in adolescence. It occurs quite often and refers to 30% of the boys at my age. He also comforted me that with my development my excessive breast would disappear and the boy breast would change into a male breast as soon as the adolescence finished. Calmed down I went out of the doctor,s office. I was happy and dreamt that soon I would look like my handsome and well built dad. I also fell asleep fast and quietly that day.

A few years passed since then. I started studying law. Then I had a lot of studies and no time to take up any sport. My body also changed as the doctor promised but not the way I expected. Still slight breast was visible and after more careful examination one could feel some slight swellings over the areola. After I completed the first year of my studies which by the way was the most difficult one and I could not take up any extra sports, I decided to change my lifestyle and devote more time to physical activities. I started visiting the gym regularly. At first once a week, then during next years of my studies twice or even three times a week. The effects of my hard work were visible soon. The shape of my breast changed significantly and the adipose tissue disappeared almost completely. I was very happy. While measuring my size I resembled more my dad. Well-built shoulders, strong breast muscles, flat abdomen with well visible straight muscles of my abdomen, nice and firm buttocks and thighs. Just an ideal man. I was extremely happy about my appearance. Finally, I believed in me. Unfortunately, I was talked to take some medications because as my friends told me they could enforce the effects of my hard work. They offered me a set of medications and supplements which contained a large dose of synthetic protein and slight amount of steroids. I also had to change my diet completely eating mainly chicken or turkey meat adding more vegetables and fruits eliminating carbohydrates and fat. After a few months my appearance looked even better. However, my happiness did not last long. I was really scared on detecting that on both sides under the areolas and nipples larger swellings than at the beginning of my adventure in the gym. I started to get worried. Was there anything wrong?, I thought. First I asked my friends than my trainer whether they suffered from similar symptoms. Unfortunately they did not know anything and could not help me. Then I reminded myself that when I was a teenager I also had problems with breast. I decided to visit the same specialist as it was 10 years ago when I went with my mother. To my surprised he remembered me very well. The doctor examined me carefully and again detected gynaecomastia but this time it was caused by overgrowth of the gland tissue, not the adipose tissue as it was earlier. While noticing the changes of the shape of my breast he asked me whether I had taken any anabolic drugs. I needed to admit that I took some slight doses in the gym. The doctor informed me that the best solution would be to stop taking the supplements and medications that were one of the causes of gynaecomastia and recommended me to visit a surgeon as the overgrowth tissue could be removed surgically.

As soon as I came back home I started searching in the Internet for some information on surgical treatment of gynaecomastia. I found some addresses of some clinics and scheduled and appointment. When I arrived at the clinic a few patients were already waiting there. After several minutes it was my turn, and I entered the doctor,s office and met a friendly doctor. I took off my jacket and shirt as he ordered. The doctor examined me and said there was no other solution but to excise and the excised material sent to further histopathological examination to be sure that it was not a dangerous change. Actually I made up my decision at once. I needed to perform other examinations like blood and urine tests, the heart beat test and have my lungs x-rayed.

A few weeks passed. On the established day I arrived at the clinic and I must admit I was a little nervous. I did not eat that day as the surgery was to be performed under a general anesthetic. The surgeon examined me one more time and circle the places of the operation. The surgery lasted 1,5 hour. I knew it consisted in suction of the excessive amount of the adipose tissue from a slight cut in the subpectoral fold. In the case when breast gland is of quite huge size, the incision may be enlarged to 5 mm or additionally, semicircular cut down on the border of the areola with the skin surrounding. Just after the operation I woken in a good mood. I wore a special pressure dress, namely a vest that stick firmly to my breast. Next day I came back home.

After a week I went for a control visit at the clinic. The operated places were swollen, bruised and hurt me. In the subpectoral fold, almost invisible 3 mm cuts were covered with a plaster and from the semicircular cut the doctor removed the itches. The special dress although not so much comfortable I needed to wear 5 more weeks. After a week I started massaging the operated regions to fasten their healing. After one month I could come back to the gym. The first effects were visible after 6 weeks. The results were really good. Under the areolas no swellings could be felt and the traces after inserting needles in the subpectoral fold and cuts in the areolas disappeared quickly. I felt like a real man. Then I decided to change my lifestyle and I started eating everything that my mother was preparing for me, and the exercises in the gym limited to once a week. Every day before going to school I practiced push-ups. After several weeks I could do 100 push-ups. To be in a good shape it is enough.

Michał

A properly-developed breast of an adult man contains scant amount of gland tissue situated just under the mammal and areola that can be usually detected with fingers or just felt under the fingers as a slight swelling. The male areolas together with the mammilla is from 2-4 cm long in its diameter and is situated at the level of 4th intercostals space, 4th rib or slightly lower. The gland can have a form of a slight swelling located just below the areola or just a split gland tissue grown with adipose tissue without its detectable limit. The largest growth of gland tissue occurs in the case of men taking anabolic drugs. Whereas, the growth of adipose tissue occurs in the case of the men with overweight.

By definition gynaecomastia is uni- or bi-lateral growth of gland tissue and adipose one in the case of men that results in breast growth that finally resembles female one. It is a purely cosmetic and psychological problem. Many men, especially young men, find the presence of huge breast very embarrassing. Especially during summer sunbathing and swimming is connected with showing one,s breast. Also many women pay attention to that part of men,s body.

The name itself derives from Greek gyne meaning a woman, and mastos, i.e. female breast. 32-36% of adult men suffer from gynaecomastia. Usually it is something natural and proper. Gynaecomastia occurs in the adolescence at young boys as well as in male,s menopauses at men at older ages. In both cases we have to deal with overgrowth of gland tissue. The growth of adipose tissue accompanied by obesity can be one of the reasons of gynaecomastia at various ages. Gynaecomastia refers to 38,7% of boys at the ages from 13-17. It achieves its climax at the age of 14. There is also gynaecomastia that occurs together with some genetic diseases as the Klinefelter,s syndrome as well as other diseases related to gender hypoplasia (hypogonadism), endocrinological diseases as well as post alcoholic cirrhosis.

It is estimated that enlarged breast at young men is most often diagnosed as gynaecomastia and at older men obesity or changes connected with testicles tumor. Not rarely cancer occurs. Hyperplasia, i.e. smooth growth of gland tissue consists in moderate proliferation of the canals, the so called out-taking canals of the breast and the growth of the fibrous tissue. It is commonly believed that the factor responsible for stimulating this process are estrogen circulating in blood or similar to estrogen substances.

The classifications of gynaecomastia according Simon, Hoffman and Kahn are most often used classifications. According to them male breast can divided into the following categories: small, moderate, significant and big. The last ones usually require plastic surgery connected with the excision of its excessive amount. Pitanguy additionally divided gynaecomastia into fat and gland one. However, this classification is difficult to estimate before the surgery.

The only way of treatment of gynaecomastia is surgical removal of excessive amount of adipose or gland tissue. Gyneacomastia was first mentioned in 625-690 (Paulus Aegenta). However it was not until the 20thc. that gynaecomanstia could be treated properly thanks to some advances in surgical techniques. In the first stage a cut around the areola was made or via the areola and mammilla. In the year 1928 Dufourmentel described a cut on the border of the areola and the surrounding skin. His article, however, was not made popular and the technique was rejected. Next years Webster specified semicircular cuts inside the areola that left slight almost invisible scar. The technique allowed to leave sufficiently thick layer of tissues below the areola that prevented its collapse and deformation. Careful preparation prevented from eventual post-operational irregularities. For the following years many combinations were tested concerning the placement and shape of the skin cut. Balch in order to avoid any scars in the region of the chest, proposed surgical approach from under the armpit.

In the case of big and falling breast, the excision of gland and adipose tissue is made with simultaneous plasty, i.e. removal of the excessive amount of skin and eventual moving of the areola with the mammilla upwards.

The breast gland in gynaecomastia consists of gland and adipose elements and the surgical procedure depends on the excessive amount of one or the other. Every men with gynaecomastia detected undergoes ultrasonograph examination of breast. In the case when adipose tissue is bigger, it is enough to remove the excessive amount of the tissue by liposuction. However, when gland tissue is bigger, the surgical procedure should consist in removal of the whole gland. In this case liposuction is ineffective.

Nowadays thanks to the advancements in plastic surgery, the surgical treatment of gynaecomastia consists in the first stage on suction of adipose tissue and finishes with it if the growth does not refer to gland tissue. However, when after liposuction have been performed, and under the areola a swelling is still felt, then the surgery is expanded. Then in the subpectoral fold under the armpit or on the border of the areola and the surrounding skin a cut is made from which the gland is removed. In the case of huge and falling breast, the excessive amount of skin is removed and the areola is moved upwards so that the excessive amount of falling skin would not be left after the surgery leaving unaesthetic effect.. This plasty is performed extremely rarely as during liposuction the skin shrinks significantly by stimulation of its elastic fibres.
After every surgery the removed tissue is examined histopathologically to exclude neoplastic changes. The operated regions are covered with sterile dressings and a special pressure dress is put on the breast and the patient needs to wear it for 4-6 weeks. Directly after the surgery such symptoms as swelling, bruises or pain may remain for several weeks. Some hardening and swelling of the operated regions vanish about 12 week after the surgery.

Liposuction surgery facilitated the treatment of gynaecomastia in the case of men. It allows for a careful and gentle removal of the excessive amount of adipose tissue and gland tissue. On the contrary to the traditional surgical methods it does not leave any irregularities or unaesthetic scars.

Małgorzata Kolenda, M.D., Ph.D.

The post Gynecomastia – I had breast like a woman first appeared on Kolasiński Clinic.

Being a 14-year-old girl with the height of 173cm, I weighed 86 kilos. Up to that moment I knew I was a little plump. I ate a lot and I could never say “no more” to myself. My father was not a good example at home either since even now he eats huge meals several times a day. My second bad home, as well, was the home of my aunt, who was at the same time my godmother, home. She could cook delicious dishes very well. However, her speciality was baking. I simply loved her soups thickened with substantial amount of flour as well as her layer cakes with a huge layer of cream. I also devoured enormous amounts of ice cream, just as much as I could. And what I was left with, then? Only my worries.

I became a growing girl who instead of gaining boy’s interests evoked only their laugh and sneering cutting remarks. Well… I was always different. I attended another school than my friends from the neighborhood. I read a lot, played several music instruments, swam well and ice skated. I was physically strong, intelligent and I had wonderful long black hair.

Then, it came the time of high school. I was a good student. I broadened my knowledge and got good grades. I was tolerated somehow. I was a good friend, you know, the one you can always count on. The girls made friends with me eagerly, but the boys … No comment on that. I felt awfully. I used to cry during some lonely evenings and just think of my life. Finally, I decided to change something. An additional incentive to change was the beginning of thoracic spinal column dysfunction. The pains in my backbone forced me to pay a visit to an orthopaedist. Soon it became the beginning of a new me. One sentence, but how harmful at the same time, said by the doctor was enough: “Either you lose at least 15 kilos or you will end up in a wheelchair”. That evening and night I thought a lot about it. I couldn’t sleep. “How come, I am only 15 and I am to be a cripple till the rest of my life. NEVER” I thought, So it began running, doing physical exercises, changing my diet. I put aside sweet, fat, floury and heavy food. I counted the calories eaten during the day. Only 1000 kcal and not a single calorie more was allowed. My friends were supporting me in my fight. During every birthday party I attended when everybody else was eating layer cakes and ice creams, I had a huge plate full of fruits especially prepared for me. It was not easy to change my eating habits. When I was 18, I managed to lose about 22 kilos (by the sweat of my brow). It was not a short-period loss of weight, but it lasted. After I started my studies I weighed just 64 kilos. According to other,s opinions I looked nice. Boys started being interested in me and, actually, everything seemed to be ok. But, I personally was not satisfied with the shape of my body. Every time I looked into the mirror I could only see hefty calves (the result of intensive basketball trainings and jogging), not too slim thighs and knees. However, my biggest problem was my little belly or rather a little droopy belly. For sure, I didn’t have the measurements of a top model that would guarantee me winning a beauty contest. So, then I changed the set of my exercises, paying more attention to those parts of my body. My day schedule looked as follows: the gym, fruits, vegetables and water. At the age of 25 and the height of 174 cm I weighed 56 kilos. My legs were long and shapely with clearly visible three meaningful gaps between them, the belly flat or even hollow, so to say. Everything was perfect. But… so what?. After several months my enthusiasm subsided as a result of some hormonal changes. I don’t deny. I got scared a lot. I didn’t want to suffer from anorexia not to mention dying of hunger. So, on the same day I went with my friend for a huge ice cream dessert with a huge amount of whipped cream.

Too huge a loss of body fat results in the lowering of female hormones production and, by the same token, menstruation disorders. I wanted to be slim but not for the price of losing my femininity. I regained my overly lost kilograms and got my weigh stabilized at the weight of 60 kilos. Fortunately, everything went back to normality and I didn’t need to go to a gynecologist, endocrinologist or psychiatrist. I was made to get used to my well built knees, thighs and belly.

After several years, being 28 years old I read several articles on a liposuction. Media were writing about the surgery called liposuction, and TV showed often interviews with the patients who underwent it. So did I see a ray of hope for me. “Maybe it is the solution” I wondered. Not telling anyone, I had an appointment with a plastic surgeon to consult with. I was surprised that he didn’t make fun of me. He agreed with me that there were some parts of human body where the body fat is simply impossible to be reduced (due to dieting or exercises). The only effective way is its surgical removal by means of suction.

I made up my mind. After the surgery I had to wear a special elastic dress for several weeks the aim of which was to model the skin, so that it would fit my new shape. When it comes down to young people, the skin is firm and elastic so it gets modeled easily. During the very first days I could feel in the operated regions some stinging pains, itching and small pain. The nights were the worst. It was extremely difficult to lay down in such a way not to press the operated regions. Those additional trousers were not comfortable, too. But if you want to be beautiful, you must suffer first. For the whole week, every time I looked into the mirror, I just saw some bruises which were changing their colors into navy blue, green, yellow just like the rainbow. However, the sufferings ended quickly. After several days I could return to my daily routine. After 10 days, despite a slight swollen of the operated regions, I could see the change. I was extremely happy. I think that then I succeeded the second time. The final effect could be seen, as the doctor said, only after 6 weeks. The body was soft, didn’t hurt and it had that new and beautiful shape. There were just several tiny scars not so much visible after the skin was incised that reminded me of the undergone surgery. “If only all those who not so long time ago were laughing at me could see me” I thought.

Right now I don’t torture my body. I weigh as much as I want about 62 kilos and I eat everything I want with just one restriction, i.e. in reasonable amounts. I am satisfied with my physical appearance. And the boys (now men) who once used to tease me, now strive for my look.

Thanks to all those changes that took place, huge internal changes happened too. I became more cheerful and I got rid of all my complexes. Now, I don’t need to look with my head put down while walking down the street, but I can hold my head up high and scream: I DID IT!!

July

Modeling and not slimming

Georgio Fischer was the first in the world to perform a surgery called a liposuction. It required a great courage and imagination to mark the beginning of such an innovative branch of plastic surgery that nowadays is known under the name of “figure modeling” as, in fact, the liposuction is not aimed at slimming a patient, but rather fitting his/her figure to his/her expectations. The adipose tissue is accumulated in various regions of the body depending on the sex and age. Unfortunately, it happens very often that despite the most genuine will and dieting efforts, it accumulates in larger quantities in the region of hips, thighs and knees in case of women, or the abdomen and waist as in case of men. Very frequently even the most draconian diet and physical exercises are not able to reduce the body fat from those regions. The only possible solution left in such cases is the liposuction. The above mentioned procedure consists in removing a certain layer of the adipose tissue by means of a probe connected to an aspirator. The probe plays in this case a role of a sculptor’s chisel that millimeter by millimeter removes unwanted layers of fat. Moreover, performing the surgery in the superficial layer effects stimulatingly the collagen synthesis which, consequently, results in firm skin and its adjustment to the reduced body contour. Not only does the contemporarily performed liposuction leave minimal, almost invisible, cicatrices, but it is also extremely safe. Thanks to the so called “wet technique” introduced by doctor Jeffrey Klein, the danger of creating emboli syndrome after the surgery is considerably reduced. This technique also reduces reasonably cyanosis as well as the pain of the operated places.

A surgeon who undertakes to perform the surgery of liposuction must possess a precise artistic sense as well as a huge experience in dealing with thin probes.

During the postoperative period, a patient must wear a special pressure dress for the period of 2 up to 4 weeks. It reduces oedema and facilitates proper adaptation of the skin to the reduced body measurements.

Today performed lipoplastic surgeries give a great satisfaction not only to the patients but also to the doctor.

Jerzy Kolasiński, M.D. Ph.D.

Abdominal plastic surgery – a solution for a droopy belly

In the case when the abdomen is large and droopy as a result of dieting, when a dropping fatty-dermal fold is created, even the best performed liposuction is of no use. The only alternative left is then abdominal plastic surgery. The surgery consists in cutting out the excess of skin and adipose tissue. The mentioned procedure is usually performed together with the plastic surgery of the abdominal muscles and the suction of body fat from the regions of epigastrium and waist. In most cases a new and even more beautiful navel is created. The patients stay in the clinic 3 or 4 days, however, from the very first day they are able to go for a walk or do some breathing exercises.

Abdominoplasty is a massive surgery which lasts from 3 to 4 hours. After the surgery, the belly regains a nice shape, and a long and crosswise cicatrix remaining in the region of the hypogastrium can be easily covered by the underwear. Thanks to this surgery, a lot of female patients can show up again on the beach in a bikini. The poll carried out in our clinic indicates that the patients who have undergone the surgery are extremely satisfied with the results that have been obtained. An average satisfaction degree amounts to 9,25 points out of 10 points.

We have also worked out our own method of abdominoplasty in the clinic that considerably reduces the number of complications and improves the aesthetics of the surgery.

Jerzy Kolasiński, M.D. Ph.D.

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Guillermo Blugerman, MD, Argentina, and Jerzy Kolasiński, MD, during the gala banguet of the American Academy’s 25th Anniversary Scientific Meeting

The JW. Marriott Desert Ridge Resort & Spa – the venue of the American Academy of Cosmetic Surgery’s scientific sessions

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Professor Dato Harnam, world famous scientist and clinician, organized the conference which became a great intellectual as well as travel adventure.

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Macrolane can be applied to improve the shape and volume of numerous body surfaces with an exception of face. The pharmaceutical is safe, biocompatible and resorbable. The tissues show persistence of the substance for 18 up to 24 months depending on breasts condition, patients’ age and her lifestyle as well as physical activity. When applied in order to enlarge breasts, the treatment increases the size of the breast by one size. In order to maintain the effects, complementing treatment should be applied every year.

On November 15 Dr Małgorzata Kolenda participated in a professional training on the methods of Macrolane application, which was organized in Warsaw. By the same token, she has become one of the few surgeons in Poland who has been granted a certificate of specialty training, which allows to perform such medical procedures.

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Cell Mesotherapy Course in Warsaw

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During film sessions, the symposium participants had an opportunity to go into the matter of the latest surgical techniques. Also, numerous lectures and discussions enabled the participants to exchange their views on esthetic surgery.

Dr Jerzy Kolasiński took part in the symposium as well. It is worth noticing that this year the group of Polish doctors has been much more numerous than as it was during the previous years. It shows how well this area of medicine is being developed in Poland.

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The beautiful weather in Valencia was an incentive to leave the conference rooms and visit this impressive city located at the Mediterranean Sea.

Prof. Michael Perring from London, Dr Anna Modelska- Ziółkiewicz, Prof. Jurgen Schiefelbein from Berlin.

Dr Ramon Vila Rovira from Barcelona with his wife , Prof. Maciej Kurpisz, Prof. Juan Carlos Mendez Mendel from Venezuela and Prof. Jurgen Schiefelbein from Gran Canaria.

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Casualty Surgery Symposium of the Wielkopolska region

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Photo 1. The group of course participants – most numerously represented by the group of Polish surgeons. The second man from the left: prof. Per Heden, behind him dr Ludomir Lembas, next dr Tomasz Kasprzyk, dr Jerzy Kolasiński, dr Małgorzata Kolenda and others.

Photo 2. In the operating theater during breast augmentation surgery. The surgery was performed by prof. Per Heden.

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The following day, September 3, the Global Council of HRS Societes Meeting was organized. It was the meeting of the presidents of particular societies of hair restoration surgery from the entire world. The Polish Society was represented by Małgorzata Kolenda, MD (present president of the Polish Society) and Jerzy Kolasiński MD (its former president). The meeting participants exchanged their experience in terms of particular Societies’ activities in different parts of the world.

On Thursday, September 4, the session started. The first important event was a general assembly of the ISHRS during which a new board was elected. It is a pleasure to inform you that Jerzy Kolasiński won second term. The following days were abundant in lectures, reports, panel discussions, courses and presentations of the patients. They confirmed a huge progress which had been made in terms of hair restoration surgery in recent years. A full coverage of this event can be found on the first page. Dr Kolasiński was also a lecturer. He provided a course on extremelly difficult cases of alopecia, and one of the most interesting plenary sessions on the comparison and contrast of the two basic methods of hair transplants extraction, namely strip technique and FUE. He also presented his research paper on the application of the Trichoscan technique in the process of evaluation of the donor area. The paper aroused a huge interest the result of which was a proposal made by Walter Unger, MD, who asked dr Kolasiński to write a chapter on the evaluation of the donor area in the latest edition of the book titled Hair Transplantation.

The Society’s Annual Meeting was accompanied by numerous get-togethers which are the best way to integrate the medical world. The whole event ended with a formal banquet during which many prizes and honorable mentions were awarded. On saying goodbye, the following day, everybody wished to see each other next year, in Amsterdam (the venue of the next ISHRS assembly) , and in Poznan at the next year’s ISHRS workshops.

Global Council of HRS Societes Meeting – from the right: dr Małgorzata Kolenda and dr Jerzy Kolasiński

Dr Jerzy Kolasiński presenting his research at the Annual Meeting

Old friends’ meeting, from the left: dr David Perez Meza, dr William M. Parsley (new president of the ISHRS) and dr Jerzy Kolasiński

Annual meetings are an excellent occasion to socialize, from the left: dr Bessam K. Farjo (outgoing president of the ISHRS), dr Melvin L. Mayer, dr Małgorzata Kolenda, dr Jerzy Kolasiński and dr David Perez Meza

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The workshop itself also provided a great opportunity to socialize with the doctors coming from all over the world since the International Society of Hair Restoration Surgery is like one big family sharing both common interests in hair restoration surgeries as well as affinity between the Society members. Thus, the fact that Rome, the Eternal City, is the best spot to organize this type of meetings is unquestionable.

The Kolasinski Clinic Team in Rome by night. From the left side: Hanna Perz-Rodykow, dr Jerzy Kolasiński, Mariola Reszke

The Kolasinski Clinic Team is performing a demonstration surgery. From the left side: dr Jerzy Kolasiński, Mariola Reszke, Hanna Perz-Rodykow. The IDI ward nurse is helping the team. (from the right side)

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Form left: dr Jerzy Kolasiński and dr Claude Lassus – conference host

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Special thanks to ArtiMed Company – distributor of Allergan breast protheses in Poland whose help made the trip possible.

Starting from the left: Dr Jerzy Kolasiński with the workshop host Dr Constantin Stan.

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The winners of this year’s WPROST weekly ranking. The first on the left –Jerzy Kolasiński, M.D.

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