As Science Advances, the Tools Used by Local Docs to Delay the Onset of Aging Continue to Improve
By J.P. Faber
There are many theories as to why we age. But most agree that, as we grow older, our cells become damaged as they replicate, both naturally and from exposure to environmental stress and pollution.
And then there are types of aging. There is outward aging – how we look – and inward aging – how strong, healthy, energetic and smart we are.
Today’s doctors who deal with aging, both inside and out, have an increasingly sophisticated arsenal of tools to combat the impact of time. With its appreciation for beauty and health, as well as more disposable income than most cities, Coral Gables is peppered with the offices of professionals in the business of fighting aging.
What, then, are some of the options? And what exactly are we talking about?
Anti-aging medicine is a term many doctors dislike – simply because doctors cannot reverse aging. Some prefer to call it age management medicine, others regenerative, or alternate, or holistic medicine; those in the purely surface game are happy with cosmetic medicine, as in cosmetic dermatology or cosmetic dentistry.
Regardless of terminology, the strategy is the same: to slow down and soften the aging process, and to make you feel and look as young as you can at any age.
“The question is, how can we maintain our activities of daily living, our cognitive functions and our independent living as we age?” says Dr. Charles Mahl, who practices regenerative medicine from offices in the Colonnade building on Miracle Mile. “We have to handle stress, resist disease, and balance our mind, body and spirit to have what I call a healthy lifespan,” he says. “As physicians, we have many ways of correcting imbalances in the body and restoring functioning to what we call ‘optimal’ for an individual.”
Like many other physicians who practice regenerative medicine, Mahl believes that most of the chronic diseases of today – which hobble us as we age and ultimately kill us – are caused by excess inflammation, in which our immune system goes off track as it attempts to combat foreign pathogens and repair damage. This is most clearly seen as the cause for arthritis, in which swollen joints cause pain and loss of function.
Mahl combats these with a tool kit that includes stem cells, platelet rich plasma and prolotherapy, all non-surgical injections that reduce inflammation and stimulate the body’s natural repair mechanisms. Because he has had such success in treating painful knees, backs, and shoulders, he is currently the president-elect of the American Association of Orthopedic Medicine.
We have to handle stress, resist disease and balance our mind, body and spirit to have what I call a healthy lifespan…Dr. Charles Mahl
Dr. Daniel Campos, who works in a two-story house-cum-office on Douglas Road, takes a more systemic approach to aging, and believes that most of what we experience as ‘aging’ – i.e. loss of mental clarity, loss of energy, loss of sex drive, irritability, loss of muscle and bone mass – is largely due to a reduction of male and female hormones as we get older. He believes that prescribing drugs for things like depression or erectile dysfunction deals only with the symptoms.
“It’s all about the hormone imbalance, which is what so many symptoms come down to,” he says. “In men, it’s testosterone. In women, it’s estrogen, progesterone and testosterone.” After careful blood tests and lifestyle screening, Dr. Campos will prescribe hormones for aging patients to bring their levels back to what they were in their 30s and 40s. While this does not increase our longevity, it means maintaining youthful levels of energy and mental clarity until near the very end.
“I don’t believe in living forever. I believe in living well for as long as you can,” says Dr. Campos.
“Most people who are 40, 50, 60 [and older] are low in testosterone, at least lower than what they need,” agrees Dr. Victor Shabanah, who practices bio-identical hormone replacement in an office building adjacent to Coral Gables City Hall. “This is the cause of many symptoms, from low energy to problems with memory and mood… If you get depressed and go to a doctor and he prescribes an antidepressant, that’s the last thing you need. It’s a poison. Most depression comes from low hormone levels – but they never check these.”
It’s all about the hormone imbalance, which is what so many symptoms come down to. In men, it’s testosterone. In women, it’s estrogen…Dr. Daniel Campos
Dr. Shabanah uses topical creams or injections to correct hormone deficiencies, whereas Dr. Campos implants a pellet that slowly releases the hormones. Dr. Shabanah also prescribes human growth hormone, or HGH, which can have a tremendous impact; Dr. Campos shies away from HGH because he fears that it might cause a hidden cancer to expand.
In addition to supplements and injectables, virtually all doctors who practice age management agree that certain basics are required for those who want to stay young, and that among these are regular exercise, adequate sleep and proper nutrition. Some feel that exercise is the most important leg of the triad, while others feel that nutrition trumps everything else. Or, as Hippocrates once said, “Let food be thy medicine and medicine be thy food.”
Dr. Michael Forman, a clinical nutritionist who practices just outside of the Gables, believes the food we eat today has only a fraction of the nutrients that food provided in the mid 20th century, before industrial farming depleted the soil. He does not approve of hormone replacement therapy, but rather feels that proper nutrition – including supplements – will restore the organs that produce the hormones in the first place.
“It is better to restore the [hormone] factories,” he says. “Hormone replacement therapy is the same thing as giving someone a wheel chair.” Instead, Forman examines his patients for organs that are failing, and then brings those back with nutrition and nutritional supplements. “I examine every organ, your blood work, your whole medical history, and determine which organ is the weakest and restore that. And as that comes back, everything else comes back.”
Like most doctors involved in age mitigation, Forman does not believe that aging, per se, is inevitable. “Death is preprogrammed, but the quality of life between now and then is an open game.”
It is better to restore the [hormone] factories. Hormone replacement therapy is the same thing as giving someone a wheelchair…Dr. Michael Forman
The question of our appearance is more than vanity, say the doctors who focus on how young we look. What is the point, they say, of feeling young when you don’t look that way?
“Aging is a cruel process, because we never look like how we feel,” says cosmetic dermatologist Dr. Oscar Hevia, whose mid-rise offices overlook the Granada Golf Course. “And this is not just about vanity. This is also about the work place, too. People respond to you by how you look. They will respond one way if you look beat up, another if you look fresh.”
Dr. Hevia says that Botox is still the most popular treatment for wrinkles, followed by synthetic fillers that restore lost volume in the face. Both possess the advantage of providing a non-surgical approach with immediate results. “Between the use of fillers and Botox, you can avoid surgery for years,” he says.
Aging is a cruel process, because we never look how we feel. And thisis not just about vanity. This is also about the work place, too. People respond to you by how you look…Dr. Oscar Hevia
When surgery is called for, however, Coral Gables is home to some of the best plastic surgeons in Florida. Among them is Dr. Daniel Careaga, who has practiced for years in a clinic on Le Jeune Road and is now relocating to a state-of-the-art clinic on Alhambra Circle.
“We’re living longer and healthier, and the quality of life is going up,” says Dr. Careaga. “People are feeling younger longer, and it’s only fair that they look the age they feel.”
Dr. Careaga is among the plastic surgeons who are now using a patient’s fat to restore volume in the face, part of a recent learning curve that moved plastic surgeons away from the pull-and-stretch techniques of yesterday.
“We used to think that aging was just gravity. But the truth is that it’s volume loss – of tissue and even bone mass,” says Dr. Careaga. “It’s not just about pulling and stretching any more. You do not restore youth that way.”
Restoring a youthful appearance is actually a balance between tightening lose skin and replacing volume, says plastic surgeon Dr. Stephan Baker, who practices in an office tower adjacent to the Shops at Merrick Park. “We have learned over the years that if you only tighten up, you only get a certain look. If you add fillers, it enhances the look… to rejuvenate effectively it’s a combination of the two. That is the magic formula.”
The choice in modern facial surgery, says Dr. Baker, is whether to use a ‘synthetic’ filler such as Juvederm or Restylane, or whether to use fat that is taken from a patient’s body with liposuction. “Cost-wise, fat is very effective. The fat is free, so you are only paying for the procedure.” Fat can also last longer, since it is your own natural tissue that becomes part of your body. But it is also less predictable, because some may be absorbed in the weeks following a procedure.
Both plastic surgeons and cosmetic dermatologists have other tools, as well, including lasers for what is called ‘facial ablation,’ the modern equivalent to a chemical peel. In such a procedure, the surface of the skin is burned away, only to grow back smooth and healthy looking. Dr. Campos, who is a proponent of combining age management medicine with cosmetic dermatology, uses lasers for skin rejuvenation – with the only caveat that you should avoid the sun for several months after the procedure.
A final part of the puzzle is the appearance of your teeth, something that can be the Achilles heel of age reversal. Dr. Angel Velazquez, who practices cosmetic dentistry in an office across from the Douglas Entrance complex, says that the look of your teeth is fundamental to a youthful appearance and the mental state that accompanies it.
“Your smile is your presentation letter, the first impression you bring to people,” he says. “When people have bad teeth – misaligned, dark, yellow – they don’t look well or good. That gets into the psyche of the person, and they lose confidence.”
We used to think that aging was just gravity. But the truth is that it’s volume loss of tissue and even bone mass…Dr. Daniel Careaga
The science of a youthful looking smile has become extremely precise, says Dr. Velazquez, right down to the shape of the teeth (square teeth make people look older, rounded teeth make them look younger) and the amount of gum that shows when you smile (showing a bit of gum makes you look younger). And then there are the issues of balance, harmony and tooth color. “Not everyone wants to be ultra-bleached white,” he says. “You have to even think about the tone of the skin [when choosing tooth color].”
As for the future of age management and regenerative medicine, there are numerous methodologies in the pipeline as scientists work to solve the secrets of aging. Among those currently being researched – including at the University of Miami – are procedures that involve extracting stem cells from your fat, blood or bone marrow, and then ‘culturing’ or reproducing them by the million so they can be reintroduced to the body via an IV drip. Early clinical trials show that these stem cells migrate to the most damaged areas of the body – your lungs, if you have COPD, for example – and then repair them.
Scientists are also looking at something called the telomere, the tiny connective strips that holds together the chromosomes in our DNA. These strips shorten as our cells reproduce, eventually falling apart and causing our cells to die. Scientists are looking at ways to prevent these strips from getting shorter, since this may hold the key to how cellular death is programmed into our systems.
For now, the essence of the anti-aging movement comes down to the simple concept that, as we grow older, we do not need to age – at least not like we do today, with a slow descent into frailty and senility. The idea is to maintain a vigorously healthy mind and body until close to the end – and thereby enjoy our lives for as long as possible.
“If you don’t smoke, drink too much or use drugs, and you exercise and eat well, I think you can age gracefully and enjoy yourself at any age,” says Dr. Mahl. “It’s all about maximizing the healthy life span.”