(Courtesy of Medical Service Options Israel Ltd) This panel includes today’s experts in cardiology, internal medicine, gynecology, ENT and plastic surgery. The panel and Q&A was convened by  Dr. Jacob Dagan.

Dr. Tal Dagan MD, MSc, FACS

A leader in the field of ear, nose and throat and facial plastic and reconstructive surgery, Dr. Tal Dagan is the first surgeon to introduce 3D printing technology for the reconstruction of a nose. He developed various techniques for minimally invasive surgical and non-surgical facial rejuvenation, including the liquid (non-surgical) and 90-minute seamless (surgical) face lift. His work was featured on CBS Feature News, Fox News, The Daily News as well as Huffington Post.

Dr. Dagan’s innovative approach is the realization of his refined aesthetic and extensive reconstructive facial surgery experience.

Dr. Dagan has privileges to perform surgery at the Mount Sinai Hospital system and the Northwell Health system including Lenox-Hill Hospital, Manhattan Eye-Ear-Nose Throat Hospital, Staten Island University Medical Center, New York Eye and Ear infirmary and Beth Israel medical Center.

Dr. Dagan sees patients in his Manhattan office on 420 Madison Ave., New York, NY and in New Jersey at the Hudson Regional Hospital Center at 55 Meadowlands Parkway, Secaucus, NJ. Tel: 833-DAGANMD (833-324-2663)

Q: How do I make my 40-50-year-old face younger?

A: There are several factors that contribute to the aging of your skin, leading to a tired and aged look. Look at your parents’ face and you can somewhat predict the way you’ll appear in the mirror in that in-between age when you’re no longer young but have not yet become old either. Certain environmental factors can accelerate the aging process, like overexposure to the sun without the protection of sunscreen lotions, hats or sunglasses. Smoking predictably causes aging changes, like lines and wrinkles from the exposure to noxious substances in cigarettes.

Genetically, we may find ourselves aging gracefully, but often we begin to see what we don’t feel—fatigue, “anger” or “worry” lines around the eyes and mouths, with sagging of the skin of the face most commonly along the jawline and in the skin of the neck.

No matter the anti aging product—creams, moisturizers, hyaluronic acid, vitamins and UV protection—sagging, lines and wrinkles may occur with progressive loss of fat, collagen and other supportive elements in and underneath the skin. These are common along the forehead, in between the eyebrows (the frown lines or “elevens”), on the side of the eyes (crow’s feet), on the sides of the nose (nasolabial folds), or on the sides of the chin jutting from the corners of the mouth (“marionette lines”) and horizontal relaxation lines along the neck and upper chest (Decollete lines).

Depending on when facial aging is addressed, various options exist to reverse it. Relaxing the muscles underneath the skin surface that contribute to the appearance of lines and wrinkles can be achieved with injections of botulinum toxin (better known as botox, xeomin or dysport). This treatment is safe, quick, with minimal downtime and helps to photoshop the wrinkle lines. It requires repeat treatment every two to three months.

When the wrinkles become deeper or etched into the skin, most commonly around the nose (nasolabial folds or the smile “parentheses”), we can use cosmetic fillers. These products vary in price and longevity. They serve to re-volumize and provide support where the skin has little supportive elements. Fillers can last anywhere from three to four months to several years. Long-lasting fillers generally require two to four treatments four to six weeks apart, whereas the shorter-lasting fillers are repeated once to twice a year.

There are various tightening procedures that can be used to improve the skin quality when the changes are relatively more subtle. These treatments include heat treatments like radiofrequency, laser rejuvenation, microneedling and certain peels. The rejuvenative effect lasts several months to several years depending on the severity of the complaint.

There is a limitation in what can be achieved on the skin surface when more advanced aging changes occur such as jowls and deeper folds. These are created by the progressive effect of gravity on the tissues underneath the skin surface of the face and neck as well as hands and other parts of the body. In these cases, the most optimal solution is to reorient and resuspend the tissues underneath the skin surface surgically. Face lift procedures can be done under local or general anesthesia. The facelift procedure has gone through various transformations to create a less-invasive form that is safe, has a quick recovery and achieves long-lasting results.

Mini-lifts usually last for an average of five to ten years but in many cases may last even longer. This type of procedure provides a natural improvement of the esthetic of the face without a “done” look (stretched or windswept appearance). A good mini-lift is hard to find evidence for by inspection even by your own primary doctor after the incisions have healed.

Dr. Yitzhack Asulin MD, MSc, FACS, FACOG

Dr. Yitzhack Asulin, the director of the Institute of Robotic Surgery at Hudson Regional Hospital, is considered one the country’s leading experts in robotic GYN surgery.

He regularly performs removal of fibroids and reconstruction of the uterus, as well as hysterectomy procedures during a same-day surgery, with quick recovery and minimal blood loss. These surgeries are done through small incisions the size of a pea, with great results. Most patients go home the same day of the next day and are back to normal life activity within days rather than weeks.

Dr. Asulin also has surgical privileges at Holy Name Hospital and Pascack Valley Hospital.

Dr. Asulin’s office is located at: 145 South Dean Street, Englewood, NJ | Tel: 201-308-5591

Q: What are fibroids and what is the most efficient way of treating the disorder? Any direct link to infertility?

A: Fibroids are benign tumors of the uterus, but can also be found elsewhere in the abdominal and pelvic cavity.

These are solid tumors, benign the vast majority of the time, that can cause heavy bleeding, irregular bleeding, pelvic pain, pain with intercourse and may also cause urinary incontinence and fecal incontinence.

Fibroids can be genetic, with a strong presence in families. Early in life, fibroids may cause symptoms and heavy bleeding but also may cause some fertility problems, especially if these are found in the uterine cavity.

Treatment of fibroids is conservative at first, with ultrasound and treatment of the symptoms associated with fibroids. Often the treatment is surgical. If fertility is still a concern and future pregnancies are desired, a myomectomy is the treatment of choice, with the removal of fibroids and reconstruction of the uterus. If child bearing is not a concern anymore, a hysterectomy (removal of fibroids and uterus together) is often the treatment of choice.

Historically speaking, this was a pretty serious and morbid surgery, with large abdominal incisions and a long recovery.

Today, robotic surgery has completely changed the course of surgical treatment. We regularly perform myomectomy and hysterectomy using robotic technology, the davinci robotic surgical system.

Please send medical questions for our expert panel to [email protected].