CoolSculpting and cognitive dissonance

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A Miami billboard promoting CoolSculpting. Photo by R. Bosshardt

Ironically, It is the holy grail of plastic surgery. I say ironic because it is not really surgery at all. What is it? It is the removal of unwanted fat and tightening loose skin without having to go through an operation with its attendant costs, risks, postoperative pain, and scars. Surgery, of course, can remove large quantities of fat and tighten skin as nothing else can but has all of the aforementioned issues, making it an unattractive option for many people.

 

The gold standard has been, and remains, liposuction in one of its many iterations: standard, tumescent, ultrasound-assisted, radio wave-assisted, water-liposuction, laser-assisted, and others. Of course, liposuction is surgery and, although it does not leave extensive scars, it requires a period of recuperation. It also has risks (irregular contours, insufficient or over removal of fat, leaving behind loose skin, injury to structures in the field of surgery, anesthetic complications, and even life threatening problems) and carries no guarantees.

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There have been a number of procedures promoted for non-surgical fat removal. One is mesotherapy which is injection of small amounts of various medicine concoctions to “melt” fat. It can work, but requires multiple injections to the area and is really only effective for very small areas, such as under the chin. Endermologie was a process of applying suction to an area while simultaneously running a roller over the area. This did not work at all and those machines have vanished; no one does this anymore. Light-based devices (photolipolysis), such as Zerona, have no little data to support their effectiveness and have a lot of complaints against them.

 

Into this void enters CoolSculpting which utilizes fat freezing or cryolipolysis. The premise behind cryolipolysis is intriguing. The idea is that you can apply enough cold to an area of unwanted fat to kill fat cells without harming the overlying skin. The dead fat cells break down and are cleaned up by the body’s natural mechanisms for removing dead cells and debris from an area of injury. The unwanted fat goes away and, voila, the unsightly bulge is smoothed out without any discomfort, down time, scars, or risks. Hooray! Problem solved.

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But wait. It turns out that things are not quite so simple. In medicine they never are. There are a few niggling problems with cryolipolysis. Freezing fat is not painless. Reports of pain range from mild to excruciating and there are many reports of severe pain in the hours and days after the procedure. Nerve damage in the skin can produce numbness, hypersensitivity, or pain lasting from weeks to months.

 

How much fat is actually removed is uncertain. If you look at before and after photographs posted on sites marketing CoolSculpting, you will think that it removes massive amounts of fat. It doesn’t. For one thing, you can only treat small areas at a time. For another, it usually takes more than one treatment to do an area properly. The results shown in some ads should challenge anyone’s credulity. I saw the same thing with before and after photos of the Lifestyle Lift and we know how that went.

 

Then there is the perpetual problem of what happens to the skin if only fat is removed. If the skin has good elasticity, it will retract. This is the ideal situation but the majority of patients are far from ideal. If the skin is lax, it will be more so when the fat is gone and the cosmetic outcome will suffer accordingly.

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One thing that is not widely discussed outside of plastic surgery message forums, and certainly not by the company, is the problem of paradoxical adipose hyperplasia. This is the rebound effect that sometimes happens to an area of cryolipolysis. Basically, the bulge returns with a vengeance, often larger than it was originally. The cause is uncertain. Some believe that remaining fat cells enlarge. Others feel it is an accumulation of fibrous tissue. One very plausible explanation is that when the fat cells rupture after cryolipolysis, they release chemicals, enzymes, etc. that are not intended to be outside the cell and can stimulate an intense inflammatory response in the surrounding tissues.

The frequency with which this occurs is impossible to determine as there are no good, long term studies but appears to be on the order of ten percent or less. We just don’t know because the company underplays this when promoting the device. What we do know is that PAH is very difficult to treat. Traditional liposuction to the area is often ineffective and even surgery is difficult due to the scarring of the fat.

Of course, the bottom line is: does it work? Yes, I believe it does, on some patients, to a limited degree, in some areas, at some times. I took some time to review results on www.realself.com. The overall rating for CoolSculpting is 81% positive, which should be reassuring. I noted quite a few thumbs down and uncertain ratings, however. What was really interesting was some of the reviews from patients that were satisfied with their results. Many posted before and after photographs. In many of them, I was unimpressed with the results and in some, there was no visible improvement. I am sure some positive reviews are the result of cognitive dissonance or what I like to call the “Emperor’s New Clothes” phenomenon. When we have spent a lot of money on something, it is difficult to admit that we have thrown our money away on something worthless, so we rationalize or flat out deny the lack of worth.

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What cognitive dissonance means is that some patients will convince themselves they have a good result when there is really little to no objective improvement.

 

Cognitive dissonance is not limited to patients; physicians don’t want to think they spent over a hundred thousand dollars on a machine that doesn’t work very well. I had to come to grips with the fact that our “non-invasive” laser for stretch marks and scars was a total bust, to the tune of nearly one hundred thousand dollars. I no longer use it or promote it.

 

If you choose to pursue CoolSculpting or some other form of cryolipolysis, be sure you do your homework, read all the reviews you can, and research who is doing it carefully. It is often done in “spas” with no physician on site. Beware of glib answers to your questions about risks and results. Be very wary of promises of amazing results. Ask how many procedures you will need and know the costs up front. Ask about re-operation rates. Do not expect any guarantees. Finally, if you get a poor result, understand that it may not be fully correctable, even with real surgery by a real plastic surgeon.

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Park Hill Townhomes on Park Avenue Face Casa Feliz and Winter Park Golf Course

By Mark Baratelli

Park Hill is a new development featuring 10 three-story townhomes priced at $2.6 million to $3.2 million on roughly an acre at the southwest corner of North Park Avenue and Whipple Avenue across the street from the Winter Park Country Club and Casa Feliz.

The homes are situated on the former 18-unit Spanish Oaks Apartments and the eight-unit Golfview Apartments, both built in the 1960s and 1970s. The developers paid $5.2 million for the property

Seven of the 10 homes will front Park Avenue. Each townhome includes 3,300 to 4,300 square feet of living area, private elevators, first floor courtyards and covered rooftop terraces with summer kitchens. The complex is surrounded by a decorative iron fence with gaslights topping brick columns. The walkways are bluestone.

Prices start at $2.6 million for the 3,300-square-foot units and $3.2 million for the 4,300-square-foot units.

The architect is Maitland-based Slocum Platts. Slocum delivered a design that “buyers in the upper stratosphere will appreciate” says the brochure.

The interiors will be done by Mark Rash Interiors.

Photo Credit

Photo Credit

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The homes are situated on the former 18-unit Spanish Oaks Apartments and the eight-unit Golfview Apartments, both built in the 1960s and 1970s.

The homes are situated on the former 18-unit Spanish Oaks Apartments and the eight-unit Golfview Apartments, both built in the 1960s and 1970s.

The homes are situated on the former 18-unit Spanish Oaks Apartments and the eight-unit Golfview Apartments, both built in the 1960s and 1970s.

Life in Wine with the Dauntless @JeanKReilly, a Master of Wine!

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The Mount Everest encompassing all things wine is Master of Wine or Master Sommelier, a distinction earned only by the most tenacious and fearless women and men with an insatiable quest for knowledge. Personally, I consider them the modern age explorers, think perseverance of an Iron Man winner such as Mark Allen and Natascha Badman, and stealth like Chanakya and Vishwanathan Anand. MW or MS is a novel blend of doctorates such as PhDs in Law, MBA, Language, & Journalism all entwined together with an unparalleled combination of fearlessness and faith.

354 MWs across 28 countries in the world, out of which 41 MWs reside in the US, 15 of which are women, and only 1 lady MW in Florida, to be precise Orlando. Needless, to say we are honored and humbled to introduce Master of Wine Jean Reilly to our fellow oenophiles and WSET Diploma students (including yours truly), aiming to follow the foot steps of these high achievers.

RP: Master of Wine, eh? What precisely does it mean and tell us about your arduous journey into becoming one of the 15 women MWs in the United States.

MW Jean Reilly: Becoming a Master of Wine took me 7 years, $100,000 and an incalculable amount of blood, sweat and tears. There are no courses to take when studying for the Master of Wine title, it’s more of a DIY venture. The exam is a 4-day long intellectual marathon. Half of the day is spent on essay questions, such as ‘Assess the role of oxygen in the maturation of fortified wine,’ or ‘Discuss the impact of climate change on the global wine business.’ There is also a blind tasting of 36 wines. Students are expected to divine the grape variety, the country, the region in that country the wine comes from and possibly the town or vineyard if they’re important. And more detailed questions as well, such as the weather during the year the grapes were growing, the temperature the wine was fermented at, the type of vessel it was matured in, etc. When I started, no American had passed in 4 years, so it was a daunting prospect. But also fun; while cramming for the exam was difficult, I had a great time running around vineyards on five different continents, interviewing winemakers and viticulturalists. By the time I passed the exam, I had visited over a thousand wineries and also worked in Burgundy and New Zealand during the harvest.

RP: Why wine? What drew you to wine and how did your career unfold?

MW Jean Reilly: I was always interested in wine. My parents drank French wine with dinner when I was growing up and I can remember sneaking sips out of their glasses when they weren’t looking. Then I lived in Paris for a year when I was 19; wine is just part of the lifestyle there so that’s when it really got into my blood. In my early twenties, I picked up a book on wine (partly to keep my then boyfriend from lording his superior knowledge over me) and I was hooked. I read as many books as I could find and tasted everything I could get my hands on. I was in banking at the time and continued in that path until 9/11 when I decided I wanted to do something different. I had been writing a column about wine while I was in finance so I expanded that to a full-time job, which gave me an opportunity to further my education by asking really geeky questions at the wineries I visited.

RP: Does being a woman pose a challenge in the wine industry?

MW Jean Reilly: The stereotype of a wine expert is a white man, with white hair, wearing a tuxedo. However, I have found people in the wine business to be very open and helpful. There is also research that suggests that women are more sensitive tasters than men; perhaps this is why a dramatically increasing percentage of the new Masters of Wine are women.

RP: Tastings: Be it blind or open, what criteria does one utilize to assess a wine? And does price matter?

MW Jean Reilly: There are many things we look at when assessing the quality of a wine. The concentration is one of the first things any wine drinker notices. The amount of time the taste of a wine stays in the mouth (the ‘finish’) is also very important; a wine that has a 10 second finish gives you 10 times the pleasure of a wine with a 1 second finish. And then there’s what we call ‘complexity’, which is just a function of the number of different aromas and tastes.

In wine, there certainly is a correlation between price and quality, particularly at the moderately-priced end of the spectrum. However, when you spend over $100, you are usually paying for scarcity and prestige. I think the $15-$25 bracket is one of the most exciting right now, with many wines delivering enormous value.

RP: Wine Pairings: is there a trick behind a successful dining experience?

MW Jean Reilly: My best advice for anyone who wants to understand food and wine pairing is to try at least two different wines with every dinner. You don’t have to be part of the Walton family to do this without extra expense; there are loads of wine preservation devices on the market now, including Coravin and VacuVin, that make this more practical. The single most important aspect of food and wine pairing after having fun with it is to be willing to experiment. I often do employee or client appreciation events around food and wine pairing and one of the biggest ‘ah-ha’ moments is always when someone tries a red wine with a dish normally paired with white wine. Don’t be afraid to try a Beaujolais with halibut and a Chardonnay with a steak. Be bold and listen to your palate.

RP: Are wines considered fashionable? What are the latest trends in the wine business?

MW Jean Reilly: Wines continue to grow in popularity in the US. Recently, it is the ever-curious Millennial generation that has been driving the growth. They are more open to trying new things, which has led a much broader range of wines appearing on the market. We have yet to see what the iGen thinks about wine the first of them are just turning 21 but I think this trend will continue for quite some time.

Ros is one of the trendiest wines right now. The Millennials missed the White Zinfandel craze and so were quick to appreciate that there is a world of high quality ross out there that are dry, food-friendly and just plain exciting. There is also a trend to making white wine in the way it was made several thousand years ago (and still is in some parts of Georgia and Armenia). These wines are fermented with their skins, in the same way as red wine. The result is a gold colored wine called an ‘orange wine.’ Often they have less sulfur added. Sometimes these hollaback wines are enticing; other times, well, let’s say that a little modern know-how is not always a bad thing.

RP: As an MW, you also assess spirits? Gin, vodka, whiskey etc

MW Jean Reilly: I love both spirits and beer almost half of the events I do for corporate groups at Masterful Wine Events revolve around spirits or beer. If there were a ‘Master of Spirits’ title, I would be studying for it. I just started offering spirits classes at Slate Wine Academy and I am really looking forward to engaging with the spirit-loving population.

RP: For people considering a career in the wine industry, especially through the WSET program, what piece of advice would you offer them?

MW Jean Reilly: The wine industry is full of career-changers Americans just don’t turn 21 and say ‘what I want to do is work with wine!’ But before launching into a career in wine, you have to do 2 things. First, you need to understand the structure of the wine industry. Due to regulations dating to the repeal of prohibition, it is quite convoluted and it takes some study to figure out where you might find a good fit.

Then, you need to learn about wine. I teach classes that lead to professional certifications through the WSET, which are the most academically rigorous and the most recognized in the industry. One thing I would caution people is to start at the right level. If you have been in the industry, you’ll want to skip Level 1. If the school you contact tells you that everyone has to start at the lowest level, run the other way; that’s just not how education works. There are also numerous other certifications out there. Having one of these certifications really gives you a leg up when you’re looking for a job.

RP: Wine Education: Tell us how it can be helpful especially to the emerging market of millennials.

MW Jean Reilly: People who like wine always end up getting more pleasure out of it when they learn more about it. Starting with a good book is a great first step. But if you want to learn about tasting wine and understanding the terms people use to talk about wine, you really need to take a class you can’t learn to taste from a book. There are loads of options out there from the $25 2-hour wine classes at Tim’s Wine Market which are an incredible deal- to more challenging certification classes like the ones I offer at Slate Wine Academy. The millennial generation is much more knowledgeable about wine than earlier generations so those who don’t know much may feel left out. And of course wine knowledge is very important in business entertaining. As a junior employee, being wine savvy can bring you to the attention of senior management. Before I left the world of finance, I can remember being invited to several dinners with the president of my company just so I could pick the wine and talk about it with the customers he was entertaining.

RP: We heard through the grape vine you are also a certified sky driver? Tell us about it?

MW Jean Reilly: I did my first skydive in 2005 after working at a winery in New Zealand during the harvest. I learned an amazing amount but it was absolutely grueling. I was working 13-hour days and I didn’t have a day off until I’d been there three weeks. So I guess you could say I needed something extra to help me unwind. When I finally became a Master of Wine in 2010, I had some spare time for the first time in 7 years and decided to get certified. Now I have several professional licenses that allow me to teach skydiving and also put on skydiving shows at unorthodox places like resorts or golf courses. Sometimes, I even get to arrive at a wine tasting by parachute. I think in addition to the adrenaline rush, what appeals to me is that it is a great stress-reliever. You’re never thinking about what’s going on in the office when you’re in freefall!

RP: We have to ask what is your favorite wine?

MW Jean Reilly: I have thousands of favorite wines and I get asked that question frequently. Over the years, I have learned that my answer should depend on what I think the best bottle in the cellar of the person asking the question might be; they’ll usually take it out and share it with me if I can name it. So, Rashmi, I think my favorite wine is . . . the Rangen de Thann Riesling from Zind Humbrecht?

Here’s how you can enroll in MW Jean Reilly’s classes Slate Wine Academy.

For Wine Tastings and additional seminars check out Tim’s Wine Market with5 locations including Orlando -1223 North Orange Ave Orlando, FL 32804. location phone407-895-9463.

Florida residents employed in an industry related to the production, sale or service of alcoholic beverages, wishing to advance their knowledge of fine wine, craft beer and/or distilled spirits or obtain recognized certification of professional expertise can apply to The Merendino Foundation for scholarship assistance.

Curry Yogurt Chicken Kebabs

Curry Yogurt Chicken Kebabs (photo courtesy Dairygood.org)

Curry Yogurt Chicken Kebabs (photo courtesy Dairygood.org)

Curry Yogurt Chicken Kebabs is aFourth of July menu winner from Dairygood.org. Not only does it showcase Florida dairy products and Fresh From Florida flavors, it’s also an easy,delicious andlow-fat main dish option. Withjust2.5 grams of total fat and 0.5 gram of saturated fat per serving,this dishwon’t weigh you down during a day of celebrations. Our countdown to food and fireworks continues tomorrow with more great nibbles and noshes.

Curry Yogurt Chicken Kebabs

Yield: 4 servings (2 skewers plus 1/4 of the dipping sauce, per serving)

Marinade:

1 (8-ounce) container plain fat-free yogurt

1 lime, zested and juiced

1 tablespoon freshly grated ginger

1 tablespoon curry powder

1 jalapeno pepper, minced

Glaze:

1/2 cup plain fat-free yogurt

1/2 cup local honey

3/4 teaspoon salt

1/2 teaspoon cinnamon

Dipping sauce:

1 (8-ounce) container plain fat-free yogurt

1 lemon, zested and juiced

2 teaspoons ground cumin

1/4 teaspoon red pepper flakes (optional)

1/4 cup freshly chopped cilantro

1 teaspoon freshly minced garlic

2 cups chopped seedless cucumber

1/2 teaspoon salt

Kebabs:

8 wooden skewers, soaked in water for 1 hour (or substitute with metal skewers)

4 boneless, skinless chicken breast halves, cut into 1-inch cubes

2 red bell peppers, cut into 1-inch pieces

1 red onion, cut into wedges

2 cups pineapple wedges

1. For the marinade, stir all ingredients together in a small bowl; set aside.

2. For the glaze, stir all ingredients together in a small bowl; set aside

3. For the dipping sauce, stir all ingredients together in a small bowl. Refrigerate until serving.

4. For the kebabs, thread each skewer with alternating pieces of chicken, peppers, onion wedges and pineapple. Place skewers in a glass dish (or large re-sealable plastic bag) and pour marinade over to coat. Cover and refrigerate for 2-4 hours.

5. Preheat broiler and line a broiler pan with aluminum foil. Lay skewers on pan and lightly brush with some of the glaze. Broil skewers about 5 minutes, then brush with remaining glaze. Turn skewers over and cook 5 minutes or until

chicken is cooked through and edges are browned.

6. Serve hot or cold with dipping sauce.

SOURCE: Dairygood.org