So much of medical testing, from medication dosing to how diseases present, is based on the male body. The symptoms of a heart attack may be vastly different in women than in men, for instance. We can’t achieve parity in medical science overnight, but we wanted to touch base with two doctors at the top of their respective fields to discuss some of the many issues concerning women, their bodies, and how they change as we age. We gained fascinating insights.
At the Intersection of Art and Medicine
Dr. Carolyn Chang, Vice Chair for the Department of Plastic Surgery at California Pacific Medical Center, weighs in on cosmetic surgery now.
On a chilly, rainy afternoon in early February I am set to meet Dr. Carolyn Chang at a French patisserie in Menlo Park. The crowded little spot is bursting at the seams with customers jockeying to get their afternoon caffeine boost. As I scan the room, I see Dr. Chang elegantly clad in Chanel at a side table tucked down a long hallway. Calm, collected, whip-smart, and immaculately turned out, she exudes confidence. It’s easy to see why her patients trust her with one of their most important assets—their bodies. Stanford-trained Chang (she earned her undergraduate and medical degrees, and served her residency all at Stanford—all with honors by the way) was the first female surgeon to earn a fellowship with the late plastic surgeon John Q. Owsley, MD, who pioneered the modern SMAS facelift. She’s spent nearly two decades honing her skills and working with a list of high-profile patients who count on her expertise to keep them looking their best.
During our meeting, we discussed story ideas about what those patients are requesting. Fast-forward six months and a global pandemic, and Chang and I revisited our conversation. While the world has changed around us in so many ways, I am curious to discover what’s changed in cosmetic surgery.
“My schedule is busier than ever,” notes Chang. “Interestingly, clients are coming in for major surgeries—especially facelifts. As a result of COVID, I started offering virtual consults that have turned into bookings for facelifts. It’s fascinating, but it does make sense—people have time at home, no one’s traveling, and schedules are more flexible, which all translates into time heal.”
That luxury of time has been difficult to find in the past, particularly for younger patients (in their late 30s and 40s). Before the pandemic, scheduling a facelift procedure meant taking off significant time from work. Now patients are able to work through the recovery—to hold meetings as conference calls temporarily and then return to Zoom calls, even with a bit of swelling. “The biggest deterrents to surgery,” Chang points out, “are fear and logistics. With the challenge of logistics removed, people who are confident in their decision are moving forward.”
When asked why patients are opting for facelifts versus fillers, Chang explains, “As we age, our facial fat loses elasticity and tissues descend, cheeks lose contour, tissue under the chin falls, and jowls form. Fillers can temporarily camouflage, but the only thing to place that tissue back where it began is a facelift. Fillers work on very young patients, but are much less effective as we get older. They are also costly and temporary. Some women are simply tired of having to go through the time and expense over and over, and for many older women the effects can be less than optimal. When you add filler to the cheeks and the skin is already loose, you can get that “chipmunk effect.” Chang believes that the best and most natural results are achieved through a two-layer surgery that addresses the underlying tissues. “It brings your face back to your face,” she stresses.
Another in-demand procedure at the moment is breast implant removal and reconstruction. Many patients are deciding that surgeries they had done in the past are no longer working for them. They may have had children or simply want a more natural aesthetic. Victoria Beckham and Chrissy Teigen are examples of celebrities who have made this decision recently. “Mommy makeover” surgeries are making a comeback as well. “This surgery typically involves a tummy tuck and breast lift,” notes Chang. As with the other procedures, the time factor is a big decision right now for women looking into this option. Many have a spouse or partner at home to help in the recovery process.
When asked about the biggest trends in cosmetic surgery now, Chang answers, “Clients are getting younger. They are educated professionals who want to look their best. They are coming in for procedures, starting in their 40s. The best, longest-lasting results come from early intervention.” It’s unusual for a plastic surgeon to focus on the face and body, but Chang adds, “Since graduating from Stanford and opening my practice, it was important for me to offer both.” Chang does look at her patients as a whole and wants them, first and foremost, to be educated. “I want them to know the pros and cons and offer realistic expectations,” she says.
Of her own skincare routine, Chang thanks her mother, not just for the blessing of good genes, but for impressing upon Chang the need for a good moisturizer. “I think I was 4 or 5 when she started putting a very thick, greasy Elizabeth Arden cream on me—while I don’t use that anymore, I do believe in the power of moisturizer. I make sure to cleanse my skin, religiously remove my makeup at night, and wear sunscreen. Keeping it simple and consistent is what works best for me.”
An Important Women’s Health Question Answered
Dr. Leslee Subak, Chair of the Department of Obstetrics and Gynecology at Stanford University School of Medicine, discusses what’s up down there.
Dr. Leslee Subak’s path to medicine was not a direct one. The Cleveland, Ohio, native first wanted to be a geologist, but graduated from Dartmouth with a degree in economics and headed to Manhattan to work for a commercial bank in asset lending. “I had an apartment in the East Village,” she recalls, “that was inexpensive back then, and I would walk 50 blocks back and forth to work each day.” Along her commute, Subak was fascinated by the ever-changing posters outside the Chelsea Women’s Health Collective. “The signage was pretty progressive for the time, discussing topics like STDs and contraception. I was fascinated and decided to volunteer. I soon realized that women’s health was really the field for me. I quit my job and went back to school.”
She earned her medical degree from Stanford and went on to a distinguished career as a scientist, clinician, and educator at UCSF. In 2017, she was tapped by her alma mater to return and take on the role of chair of the Department of Obstetrics and Gynecology, a post long held by Dr. Jonathan Berek. Today, Subak is a champion for women’s health and her patients. “Stanford’s medical mission is to predict, prevent, and cure precisely,” she notes. “It’s a philosophy that I believe in wholeheartedly.”
Subak’s research has made her an expert in pelvic health. Gentry asked her to discuss this sometimes uncomfortable topic.
STEFANIE LINGLE BEASLEY: Why should we care about pelvic health?
DR. LESLEE SUBAK: About half of all women have concerns about pelvic health. Our overall health is compromised if we leave this area unchecked. Incontinence, one of the biggest subjects within pelvic health, affects 25% of young reproductive-age women, 50% of menopausal women, and over 80% of women over 80—that’s a huge amount of people. And those are just the physical statistics. The economic costs are huge as well. Urinary incontinence costs over $60 billion a year—that’s more than the direct cost (money exchanged) of all cancer care for women in the United States. And the majority of that cost is borne by women, particularly older women who can least afford it, in the form of pads and protection. Many of my patients note that ‘incontinence doesn’t kill you, but it takes your life away.’ The fear of urine loss curtails one’s social and physical activities, which can lead to isolation, depression, even death.
Tell us about the different types.
DR. SUBAK: There are two different types of urinary incontinence: urgency incontinence and stress incontinence. Urgency incontinence is part of overactive bladder syndrome. Your bladder quite simply squeezes too much urine. It leads to waking up multiple times a night, and it’s characterized by the urge to go that can’t be stopped. Picture the image of the woman running to the bathroom. Stress incontinence is the result of the pelvic floor trauma created by vaginal childbirth. This manifests when coughing, sneezing, laughing, stepping off a curb, hitting a tennis ball—you get the idea.
What are the risk factors?
DR. SUBAK: Part of this age and part is vaginal childbirth. Other risk factors include diabetes, obesity, COPD, prior prolapse, and having had a hysterectomy.
What can women do to lower risk?
DR. SUBAK: Medicine has come a long way from our mother’s and grandmother’s era. Many things are now modifiable or preventable. Discussing what’s bothering you and affecting your day-to-day life is key. Speak with your family friends and your physicians. Weight loss can be incredibly helpful, not just for your pelvic health, but it can improve everything from arthritis to heart, lung, and brain function. Fluid management is key as well. Caffeine, alcohol, carbonated beverages, and acidic beverages like orange juice can all irritate the bladder. Pelvic muscle exercises or Kegels can be very effective. If the exercises are too challenging, specially trained physical therapists can help. There are a variety of effective devices, medications, and surgeries now as well.
Most important thing women should know?
DR. SUBAK: I’d like to remove the stigma and bring more awareness to the subject and encourage women to discuss it. There is no reason to suffer in silence. Many patients come sometime in late menopause, after the kids are grown up and when their partner or spouse is in good health. They say, “I can finally take some time to look at my health.” But there’s no reason to wait. Women are natural caregivers, but they need to understand the importance of taking care of themselves along the way.