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Explore Plastic Surgery – Dr. Barry Eppley » Blog Archive » Treatment Options for Dark Circles Under The Eyes

Dark circles under the eyes is a frequent request for treatment by patients coming in to see for many different issues. The plethora of available treatments on the internet from vanishing and bleaching creams to laser surgery is a testament to the commonality of the problem. it also suggests that most of these treatments are not effective because they simply don’t work or are used on the wrong type of dark circle problem.

Diagnosing which of these causes of dark circles is obviously critical to selecting what may work. in general, dark circles are hard to treat and there is no magical solution. The goal of dark circle treatment should be improvement but do not expect a complete cure. (no matter what the marketing hype says)

If the problem is thin skin, there is little that can be done to substantially thicken it. Vitamin A and C creams and pulsed light treatments may provide some improvement over time. but these are really unlikely to make significant improvements.However, camouflaging the dark with concealers or mineral makeup-based foundations is the most effective and cost efficient approach for thin skin.

Hyperpigmentation is a common cause  and is often seen when substantial lower eyelid bags are present as well. it is a very common cause in dark-skinned patients. When large eyelid bags are present, standard lower blepharoplasty (eyelid tuck) should first be done. this will not make all the hyperpigmentation go away but it will help. A secondary chemical peel, such as 25% or 35% TCA can also be done although there is the risk of causing hyperpigmentation by doing a chemical peel also in some patients. The key is to use melaniin-suppressing creams before and after a chemical peel.  Lower eyelid hyperpigmentation can also be treated by topical creams that contain retin A (exfoliating) and hydroquinone (bleaching) agents. My current favorite is TriLuma cream (available by prescription) because it contains Retin A, hydroquinone, and steroids all in one. this has to be used for several months before any improvement can be expected. in very resistant hyperpigmentation, the use of intense pulsed light (BBL, Broad Band Light) may also be tried but the power setting should be low and careful eye protection done. it will require several BBL treatments to get much improvement.

There are also some cases of dark circles that are due to leaching of blood products (hemosiderin) into the thin lower eyelid skin. Once has to look very carefully to separate this from hyperpigmentation. Topical Vitamin K or creams that contain arnica may be helpful. Pulsed light that is filtered for 560 or 590nm wavelengths may also be effective.

Deep set or hollow eyes as a cause of dark circles requires a surgical solution. The bone on the lower rim of the eye is deficient or flat causing the lower eyelid to indent in. this pulls the lower eyelid in, exaggerating the natural shadowing effect. The area under the eyelid must be built out using either fat grafts, orbital rim implants or fat transposition. Lower eyelid fat transposition is the simplest and most reliable method. by releasing fat from underneath the eye and bringing it out over the rim of the bone, the lower eyelid is better supported and the depth of the hollow is decreased. (as well as the shadowing) Implants also bulk up the bone but the thin skin of the lower eyelid may make it possible to feel or even see them. Free fat grafts are soft and pose no potential problems of infection or feeling them but they are unreliable as to how much will survive after surgery.

The arcus deformity is an often undiagnosed dark circle cause. it is caused by an abnormal attachment of the lower eyelid to the bone which makes the lower half of the eyelid dip in while the upper half is loose and filled with fat which bulges out from under the eye. as one ages, this lower eyelid look worsens creating darker and darker circles. this arcus deformity can be released through a transconjunctival (inside the lower eyelid) approach, allowing fat to balloon out into the dark circle area. in some cases, fat grafts can be added as well to further bulk up the area.

As the many causes of dark circles suggest…there is no one magical solution. That is why there are some many products and methods out there. The key is to knowing why the dark circle are there. Otherwise one is throwing darts at a target…blindly. Improvement in dark circles of the lower eyelid is possible but identifying the cause is critical…something internet products and home remedies do not do.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

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Explore Plastic Surgery – Dr. Barry Eppley » Blog Archive » Treatment Options for Dark Circles Under The Eyes

The Manly Job of the Stay-at-Home Dad

A carefree musician learns to care for two small children — and maintain his masculinity in the process.

The author with his two-year-old daughter, Everly, and one-year-old son, Arlo (Melissa Jordan)

It’s not forthe faint of heart, and like most epic adventures, sometimesit takes all you’ve got just to hang on. such is the life of a modern mandelving into the wilderness of stay-at-home fatherhood.

A few yearsago when my wife, Melissa, and I discussed the possibility of my staying homewith the child we were expecting, I accepted the challenge with a resounding”yes.” Melissa works in marketing for a software company and I am amusician and artist; needless to say, her steady paychecks and benefitsprovided the security our growing family needed.

Behind all of the dangling diaper bags, children’s songs, and dried-up drool is a very capable man.

Early on, Irealized this was going to be a “solo hike.” there were very few men I couldturn to for advice. No one in my family and only one dear friend had been in myshoes. Subsequently, there weren’t many road maps or blueprints for me tofollow — even very few books. Most men seemed to think I was crazy. Someassumed that I was taking the easy wayout of being a traditional male breadwinner. Most guys were simply confused, expressing concerns that I would find it emasculatingto stay home taking care of the children.

I didstruggle with feelings of isolation at first, especially before our daughter, Everly,could speak. there were days when I would answer a phone call in the waninghours of the afternoon and be startled by the volume of my regular speakingvoice — I’d realized it hadn’t been used all day for anything but silly,nonsensical sounds that would make my daughter giggle. 

Meanwhile,spontaneity, a dear old friend of mine, was led out of the door by two tiny hands.In the past, my working hours had been at night, when I took the stage atclubs and coffee houses. during the daytime, I was free to explore, paint, or playmusic. to fuel my creativity, I took the occasional motorcycle ride throughGolden Gate Park or down the Pacific Coast Highway. In the evening, I’d ride ina cab through the lights of the city, and the only thing on my mind would bewhether or not to open with the new song I’d written that afternoon. Suddenly, theseunstructured days gave way to carefully planned schedules, built around nap-times,feedings, doctor’s visits, and fragile toddler moods that could easily dip intotantrums.

I took pridein learning my daughter’s routines, the tricks that would get her to eat andsleep, her individual quirks and needs. Yet there were times in the beginningwhen I felt invisible. Whenever people had questions about her care and wellbeing, they almost always were directed towards my wife. This was hard to take.Not only was I not “winning the bread,” so to speak, I wasn’t even beingacknowledged for all of the hard work I was putting into raising my child.People were justifiably amazed that my wife could excel at her job while beinga truly amazing mother. But I felt displaced, or lost in the mix, as questionsabout my daughter’s day-to-day life were directed over my head.

My new role also provoked some peculiar reactions from strangers. At one doctor’sappointment, a nurse was astonished when I told her I was a stay-at-home dad”Really? I’ve never met one before!” she said, staring at me as if I were anexotic animal. In some cases, I couldn’t tell whether the inquisitive looks I receivedfrom check-out clerks were attributable to my tattoos and occasional thickbeard or to the forgotten pink and blue plastic animal and bow-shaped clipsEverly had placed in my hair earlier in the day.

Since thebirth of our son, Arlo, I’ve been drawing even more stares — but I’ve come torealize that not all of them are dubious. some onlookers seem delighted by thesight of a man fully engaged in caring for his children. Oftentimes, anolder woman will ask if I need help doing something as simple and everyday asgetting the stroller out of the back of the van and loading the kids into it.One lady even asked if I needed her help holding Arlo while I was at the selfcheck-out line in the grocery store. I couldn’t help but think that if I hadbeen a mother with a child, the invitation may not have been extended.

It might notlook it to the casual outside observer, but stay-at-home dads are a toughbreed. Behind all of the dangling diaper-bags, strollers, children’s songs, anddried-up drool is a very capable man. A man who can transfer two snoozingchildren, one on each arm, from the mini-van through the heat of theday — unlocking the door to the house and slipping them into their respectivebeds without waking them up. A man who, on little to no sleep, must plan forany and every situation, magnificent or mundane. A man who must learn not topanic through bouts of uncontrollable backseat tears and screams while drivingin bumper-to-bumper rush hour traffic. A man who truly knows the value oftaking a long, deep breath.

Stay-at-homemothers feel these same stresses. But the ways men deal with them are anothermatter entirely. As proud and contented as I feel with my children, and ascomfortable as I am with the choices my wife and I have made, there aredefinitely times when I find myself desperately needing to do somethingspecific to assert my manhood. I daydream about spending weekends with a fewbuddies in the mountains, throwing a hatchet into a tree, or finding the timeto grab a paddle and spend hours of solitude on a river in a canoe.

The non-stopnature of the job is daunting and can feel overwhelming at times. Everly andArlo remind me time and again that toddlers do not wake up slow. As soon as theireyes open, I am on duty and I had better be ready. there is no drive to andfrom work during which I can prepare or clear my mind. there are no peerreviews, no thumbs up from the boss, no lunch breaks, and sometimes hardly anybathroom breaks. and there is little time to dedicate to my passions and hobbies — I’ve learned to set myself to the side for a while.

Still, I findpockets of time. When I was out playing gigs late into the night, I certainlynever considered the possibility that I would one day be hiding away in thefarthest corner of our house, playing my guitar through headphones and singingjust above a whisper so as not to wake my children at 9 p.m. on a Wednesdaynight. I once wrote and recorded albums in a matter of months; now I’m a yearand a half into recording my current album.

But I nolonger have to seek out inspiration, as the kids bless me with it constantly.We spend time almost every day together in the music room, singing intomicrophones and beating on banjos and tambourines. Music is one of my most useful parenting tools: It can overpower my children’s tears and make them wiggleand shake with wild abandon. It’s also brought forth the most intimate musicalmoments I’ve ever experienced, like witnessing Everly’s sleepy-faced joy as Iburst through her door first thing in the morning with a guitar — or softlyhumming “Amazing Grace” into Arlo’s ear as he lay on the recovery table after his heartsurgery.

Being astay-at-home dad uses every skill I’ve ever acquired in some form or another.It has made me more capable, more centered, and more balanced. It has toughenedme up and, at the same time, sweetened my spirit. It has made me less selfishand more patient. It has made me a better man.

Sometimes, itsimply wears me out. The grey hairs are appearing in greater number andfrequency these days, reminding me of an old proverb I stumbled across duringour first pregnancy and recently worked into a song. becoming a father, itsays, “will put silver in your hair, and gold in your heart.” being a stay-at-homedad has revealed this to be an absolute truth.

The Manly Job of the Stay-at-Home Dad

Choosing a surgeon

Dear Dr. Wolf, I am having trouble picking a surgeon for my surgery. I often hear you should pick your surgeon based on skill, reputation and results.  What are your thoughts about picking a surgeon and what would you recommend I do?

I think your question is a very good one in this day of the Internet and “created” Internet reputations. the days of building a solid practice built on the three A’s is over — affability, availability and ability were once the cornerstones to developing an honest practice with longevity.

With the advent of marketing and the Internet, you can now “buy” yourself right up to the top of the list with a great ranking. Add to that the ability to self-promote by hiring

people to write recommendations for you, and you are golden.

So here is my recommendation, and what I think are the most important qualities your surgeon must have for you to have a successful surgery.

The most important quality is ethics. I believe if a surgeon is not ethical, no matter how technically good he or she is, they will ultimately make the wrong decision based on greed and therefore injure patients. If you read the news, the problems that are caused by this are plain to see. Because physicians see patients at very vulnerable times, making the right choice of procedures is equally as important as the technical skills.  

With the advent of less-invasive procedures that have been introduced, I have seen the advent of minimally trained physicians rising to a very scary level. Companies are hiring cosmetic “expert” doctors to unleash their product lines on unwary consumers.

If they were experts, these doctors would be board-certified. they would also be board-certified in fields that pertain to aesthetic medicine, such as facial plastic surgery, plastic surgery, dermatology and oculo-plastic surgery, for example. Often, less-trained physicians claim that it’s only because of turf wars that the medical industry disagrees, but it’s really about patient safety.

Picking your doctor should include asking people about their surgeons, interviewing several physicians about your procedure, and an Internet search just to make sure there are no glaring problems with your possible doctor.

Finally, I would recommend you pick a surgeon who is board-certified in what you want to have done, is not recommending more surgery than you want to have done, and is not afraid to say ‘no’ to something you want to have done.

Carlos Wolf, M.D., is a board-certified facial plastic surgeon who sees patients in Napa and Miami. he may be reached at DrWolfinNapa@aol.com.

Choosing a surgeon

Pet Tales: See Cones soften post-op recovery

Surgery went well for a former shelter dog named “Lucky,” but he really hated that big plastic collar that his family put around his neck to prevent him from licking, scratching or biting his incision.

People call them “cones,” “Elizabethan collars” or “e-collars.” Generally they are made of hard plastic, and owners often hear things that go bump in the night — or day — as dogs bang their collars into walls and furniture.

And so it was with Lucky. The cone obstructed his vision, so he bumped into things. It also made it hard for him to lie down and sleep comfortably. so while mom was at work, one of the kids felt sorry for the unhappy dog and removed the cone.

Turns out there are newer, softer versions that may work better. Cardinal Pet Care’s Viva La Dog Spa is introducing See Cones that it promises are more comfortable and pet-friendly.

These cones are made from softer, more pliable clear plastic that does not inhibit a pet’s field of vision. they retain their shape, thanks to rigid “stays” placed at vertical intervals around the cone.

“These cones don’t scare pets as much,” said Barbara Denzer, vice president of marketing at Cardinal. “There is soft cloth padding around the neck” and Velcro and toggle closures to adjust the fit.

To add fashion flair, See Cones are trimmed around the edges with black or hot pink fleece. they come only in small sizes; the largest one would probably fit a cocker spaniel or a beagle.

“Big dogs seem to tolerate” the traditional hard cones better, Ms. Denzer said.

Prices are $12.99 for extra small (5 inches), $14.99 for small (6 inches) and $19.99 for medium (8 inches).

Most cats would need an extra small, Ms. Denzer suggested. Measure pets from neck to nose to get the size. The collars are available online at www.cardinalpet.com/vivaladogspa or at Petco stores.

Veterinarians sometimes supply e-collars for their patients, but Ms. Denzer said it’s often cheaper to buy Cardinal products on your own. she suggests buying or ordering them in advance before you need them.

Cones and collars aren’t just for post-surgical patients. they are also used to prevent dogs and cats from licking and biting wounds and hot spots on their bodies and to keep them from scratching ears that may be cut or infected.

Valentine greetings

The Washington Area Humane Society is taking orders for Valentine cards that feature a picture of a shelter pet with a message from you. Cost is $6. Feb. 3 is the deadline for ordering, which can be done online at www.washingtonpashelter.org or by mail: Washington Area Humane Society Valentine; Box 66; eighty four, PA 15330.

in search of heroes

Nominations for the second annual American Humane Association Hero Dog Awards are now open. Last year’s winner was Roselle, a yellow Labrador retriever who had led her blind owner to safety as the World Trader Center collapsed during the 9/11 terrorist attacks.

There are eight categories: law enforcement/arson, service, therapy, military, guide dogs like Roselle, search and rescue, hearing, and “emerging hero dogs.” That last category is for ordinary pets who do extraordinary things, the news release says.

Last year’s top dog in the “emerging” category was Ricochet, a golden retriever who is thought to be the only dog in the world that does “surf therapy” with special-needs children. Ricochet surfs with children, including quadriplegics and amputees, and has raised thousands of dollars to help them.

A video of Ricochet in action has 3.6 million views on the Internet. You can see it at www.surfdogricochet.com and on her Facebook page.

Wearing a well-fitted life vest, Ricochet surfs in good-sized waves. Sometimes, she surfs by herself and other times she surfs with children. Amazingly, she knows how to shift her weight and ride the waves, even counter-balancing the board to help the children get a better ride.

Go to www.herodogawards.org to nominate a Hero Dog. The broadcast of the 2012 awards will air on Hallmark Channel in the fall.

The 2011 awards, broadcast last October, were such a big hit, there was an encore presentation in December.

first published on January 21, 2012 at 12:00 am

Pet Tales: See Cones soften post-op recovery

Groupon, similar sites target medical services for deals

Sean Doherty, MD, a plastic surgeon at Boston Plastic Surgery Associates, said his group wanted to attract new patients by introducing them to easy-to-perform procedures and treatments. So it did what a lot of restaurants, shops and vacation destinations have done: It offered a deal through the online site Groupon.

Chicago-based Groupon was the first in a growing number of Internet companies offering daily deals designed to be “too good to pass up” for people looking to try a new product, restaurant, hobby or vacation destination. In recent months, the growing list of services has included medical and health procedures.

Here’s the way it works: a company offers a deal — generally at least 50% off — on the Groupon site, but only if a predetermined number of people agree to buy the service. Numerous online sites — Living Social, Daily Dibs and Zulily, among the largest — offer similar “daily deals” by e-mail or a website link. Many sites offer geographically targeted deals or personalize deals based on a customer’s profile.

Buyers of the Boston Plastic Surgery Associates deal could get laser hair removal, skin-rejuvenation treatments or 50 units of Dysport, an injectable wrinkle remover. the best deal was laser hair removal for $129, regularly priced at $800.

Scott Lorenz, president of Westwind Communications, a public relations and marketing firm that works with numerous clients in the medical field, recently has seen an uptick in the number of clients interested in this type of marketing. In February, a dental client ran a deal in Groupon for a second time after the initial offering last fall was successful.

The February deal was somewhat unique, Lorenz said, because it was for dental implants — a procedure that is more invasive and expensive than most deals offered on group purchasing sites. the deal was for 50% off the normal $4,000 price. the group also offered a teeth whitening package at half off.

Other recent deals offered across the country include Lasik surgery, laser hair removal and skin rejuvenation treatments.

Chad Nason, spokesman for Groupon, said that although he could not provide details on the percentage of Groupon’s offerings that are health-related, he could confirm that it’s a growing segment of the company’s business.

“At our core, we’re always going to be a company that wants to get people off their couches and out of their houses to get out and try new things,” Nason said. “But obviously, with the popularity and the incredible group buying power, you’ve seen things, like Botox, that the medical professionals want to use to get new customers, which certainly can work.”

Nason said most of the Groupon clients look at offering the deals as a marketing expense. each deal is negotiated on its own terms, but generally the company and the client offering the deal split the revenue received from the deal in half. If the service is being offered for 50% off the normal rate, most clients walk away with one-quarter of the normal per-unit-of-service revenue.

The medical deals offered so far through Groupon and similar sites have been for noninsured, cash-paying services. Does it make sense for, say, a family physician, internist or pediatrician to use such online sites?

Legal issues for physicians

David Harlow, an attorney from Newton, Mass., said the service is not for everyone. Physicians need to be careful of the line between elective, out-of-pocket services and those covered by traditional or federally funded insurance. Crossing the line could violate anti-kickback laws, he said.

Because of the split of revenue between the physician and the advertiser, like Groupon, revenue would vary based on volume of business, “and that is basically a no-no if the payer were a federal health care program,” Harlow said. even if it’s a federally covered individual paying for the treatment out of pocket and the physician is enrolled in a federally funded program, there could be legal risks, he said.

In addition, private insurers always want to get the best possible deal, and there could be stipulations in their contracts guaranteeing that they have the best price. In a worst-case scenario, the physician could be forced to offer all services at the reduced price offered on the group buying site, attorneys said.

If done properly, offering services through an online group discount site could be a way to fill empty slots in the calendar or build word-of-mouth referrals and volume — if it’s OK with you to offer the service for half price, he said. but the question is whether the one-time deal would be a blip on the radar or whether it would help build your practice.

If done incorrectly, offering such a deal actually could harm your business if you’re not equipped to deal with the increase, experts said. Stories abound of businesses overwhelmed by people who bought deals online and had trouble collecting their products or services.

Nason said part of Groupon’s negotiation process is a consultation to ensure that the business is prepared to meet the demands. “We take a lot of pride in making sure everything is on the up-and-up.” He said Grouponturns away seven businesses for every one it accepts.

Dr. Doherty’s group set a limit on each discounted service so that the practice wouldn’t be overwhelmed. Although his practice hasn’t lost money on the deal, the full benefits have not been realized, because many of the purchasers have not come in yet. the hope is that when those patients arrive, they’ll be happy enough with the practice to come back.

Dolan is a business reporter. She can be reached at 312-464-5412 or by e-mail (pamela.dolan@ama-assn.org).

The print version of this content appeared in the March 14 issue of American Medical News.

Copyright 2011 American Medical Association. all rights reserved.

Groupon, similar sites target medical services for deals

Worst Fitness Gimmicks of 2009

Worst Fitness Gimmicks of 2009

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"Vibrate your way to a WHOLE NEW LIFE!"Vibration Plate Exercise

Marketing

There are a few companies which produce vibration plate machines for a variety of users.  Some of these companies produce products geared for high end gyms, athlete training and rehabilitation amongst other uses.

Regardless of the actual scientific valid uses of any fitness machine, if it looks cool and it has a use for someone, it can be the ticket to a whole new life in minutes a day, and that is how vibration machines became one of the worst fitness gimmicks of 2009.

Marketed as a machine in which you simply have to stand or sit on for x minutes a day to get results is the recipe for 2 things:  1.  making a lot of money off people who don’t know the any better and 2.  Being laughed years down the road as a worthless gimmick.  For the people who bought paint can shaker belts in the mid 1900s to lose weight, a vibration plate may be the next step.  Only time will tell.

 Product

 

Vibration plate machines come in many shapes and sizes.  most have a plate which covers a motor and some sort of handlebars coming up.

Many exercises can be performed off the plate just as they can be performed on the floor for (unproven) added benefit but exercises is not what people want to do.

You will often see people standing, sitting, and lying motionless on these vibration plates in which the only thing that is moving is the fat jiggling on their bodies.

Althogh useful in some situations vibration machines are one of the worst fitness gimmicks because of the marketing and the idea that vibration does anything better than standard weight training and cardio exercises.

What also makes vibration plate machines one of the worst fitness gimmicks of 2009 is the price which ranges from expensive to astronomical.

Price Vibration Plate Exercise Machines on Amazon.com

"the first Resistance Toning system for the Neck, Chin & FaceNeckline Slimmer"  

Marketing

even exercising small muscles which do not directly relate to exercises in the gym deserve a mention in the worst fitness gimmicks.

the myth of spot reduction come into play as they claim the neckline slimmer tightens skin by working the underlying muscles.

The commercial mentions nothing about weight loss to reduce overall body fat levels seemingly sending subliminal messages to overweight people who think this nodding gadget will get rid of their double or triple chin.

The final and most important selling point of this fitness gimmick is that it gives results in "as little as 2 minutes a day" which is almost required to sell any gadget related to building muscle or losing fat in 2009 and before.

Product

 

Only those who inexplicitly spent the $19.99 to buy the plastic covered sprig known as the Neckline Slimmer will be able to tell you how long it took for it to get thrown in that box destined towards the attic or dump.

For now all you can do is watch the commercial over and over again and nod your head to reduce your triple chin in 2 minutes a day.

Price the Neckline Slimmer on Amazon.com

"the Premiere Workout System"Fitness Disc  

Marketing

You can see on the shopping channel commercial below all you need to know about the fitness disc.  they have the former pro bodybuilder and fitness model talking about how he uses it which of course is basically saying that if you buy one of these pieces of junk you will be fit

A rotating disc to stand on with a bar which splits in two is marketed to be a "full body" or "total body" workout that targets the problem areas when in fact it is nothing more than a 100% complete waste of money.

Product

 

The disc simply rotates when your twist your legs which is exactly what has been out for 20+ years.  this time it has a bar in the middle which comes off and splits in two.

You can twist to your delight as you wave your arms around like you’re missing an X chromosome.

The only thing more shocking than the utter worthlessness of the Frank Sepe fitnss disc is the price which is a downright joke.

Price the Frank Sepe Fitness Disc on Amazon.com

"the Rapid Short and Powerful Thrust of the Shake Weight Ignites Muscular Activity in your Entire Upper Body!"  

Shake Weight

Marketing

Six minutes a day is all you need to get the body of your dreams with the shake weight!

Watching the commercials you will see how the women’s video states they are "designed specifically for women" and it repeats everything women want to hear while the men’s video shows basically the same exercises yet says completely different things geared towards men.

Shake weights claim to use "Revolutionary new technology called dynamic inertia" which is a statement that probably has Galileo turning in his grave.  Claiming to do 240 reps per minute is another asinine statement because holding a static position is an isometric contraction which is a single repetition as long as the joint angle is maintained.

 

Product

While shake weights may not be 100% worthless everything claimed in their marketing is complete utter nonsense to put it lightly.  the videos basically saying you will look the models in 6 minutes a day is the classic way to sell fitness products to the ignorant man or woman sitting on the couch with a remote control and a credit card.

As you can see the shake weights are nothing more than a weight suspended by springs in between the 2 ends of a dumbbell which if shakes force your muscles to hold a static contraction.  the problem with the idea is regardless if the weight is shaking or not, it is still a static contraction which only has affects at that joint angle.  you could hold the same angle without any shake weights and contract your muscles to get the same muscle work.

Interestingly enough, while not marketed this way, the shake weights could provide a nice tool for trainers and personal trainers who specialize in rehabilitation as they could be used for strengthening the muscles which strengthen joints.  the Bodyblade was another product some years ago which was marketed similar to the shake weights as a "minutes a day" gimmick but has been used extensively in rehab situations.

Price the Similar Bodyblade on Amazon.com

those who Can’t use the Fork & Knife properly, simply go under the KnifeAb Implants  

Marketing

While there may be commercials from plastic surgeons on your local television there is not as much in your face direct marketing for cosmetic procedures designed to change your body.

Pick up any pop culture magazine, watch reality TV shows, or even your local news and stories of common as well as bizarre cosmetic procedures were on the rise in 2009.  Starting with botox and collagen for the face people then often hear about procedures such as butt implants, to calf implants, to ab implants (pictured) to liposuction.

The most enticing thing about surgery and implants is the benefits seem to be instantaneous.  no 12 week long workout programs and low calorie diet required.  no sweating for 2 hours a day in the gym or refraining from eating the foods you want, you go to sleep, wake up with a new physique.

Service

 

While cosmetic procedures designed to improve the way your body looks may seem harmless and simple they rarely are.

Cosmetic surgery is just that, surgery which is very invasive and unhealthy for your physical health. 

popular new cosmetic procedures cost astronomical amounts of money also raise the likelihood a doctor with little or no experience in the specific surgery and/or implant getting blinded by the earning potential and cause more harm than good with botched surgeries.

Regardless of whether the surgery is "successful" or not, there is still an often painful recovery process that is never as pleasant as you were told.

If the surgery turns out to be unsuccessful what’s next?  you guessed, more surgery as corrective surgery is often just as profitable for plastic surgeons.

also see

Top 5 Worst Fitness Gimmicks of All-Time

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Worst Fitness Gimmicks of 2009

Knoxville Plastic Surgery Insider » Plastic Surgery Rebates: Why I Have Mixed Feelings About Them

Have you seen offers of $100 off Juvederm, or $50 off Dysport or Botox? Ever wonder where all this comes from? They’re rebates (something relatively new for medicine and plastic surgery). it looks like they’re here to stay, but I have mixed emotions about them.

Why Rebates?Why do companies offer rebates?

Dead Space 2 Review from GamePro

  • by Tae K. Kim
  • January 25, 2011 09:00 AM PT

No, it isn’t as scary as the first, and if you’re disappointed by that, you need to let it go because Dead Space 2 isn’t about running from the Necromorph menace — it’s about confronting it and hopefully sending it back into the dark corner of space it emerged from.

  • GamePro Score

It was interesting to see the fan reaction to the pre-launch marketing push for Dead Space 2; the universal sentiment surrounding the trailers and first-look screenshots seemed to be, “It doesn’t look as scary as the first one,” and that apparently was just about the worst possible thing that could happen. I was of that mindset going into the review as well — I thought the first Dead Space had done a masterful job of being genuinely creepy thanks to an atmosphere thick with dread and foreboding, two horribly underutilized elements in gaming narrative.

But as I began to delve into the second chapter of this space odyssey, I realized that I wasn’t really scared at all; if anything, I was walking around the space station like I owned the place, stomping Necromorphs the way a seasoned exterminator steps on any roaches who happen to scurry underfoot. but rather than be disappointed by the lack of scares, I accepted it as a logical evolution of the storyline, and really, so should you.

It’s easy to excuse Visceral for dropping the “Tin Man” role Issac Clarke played to such critical acclaim in the first Dead Space because it doesn’t make sense for him to lumber around in a metal suit in search of a heart a second time. Having survived the first nightmare, he’s now better equipped to deal with the Necromorph outbreak in the same way Sigourney Weaver’s Ripley was better able to handle the Aliens in the action-oriented second installment of that classic sci-fi franchise.

So no, Dead Space 2 isn’t nearly as scary as the original, and yes, it’s way more focused on action, but do whatever you have to do to convince yourself that this is a good thing because it is. See, the first Dead Space succeeded in scaring us because we were dealing with the unknown. Issac, and by extension the gamer controlling him, was up against an unfamiliar enemy who was playing by a set of rules you hadn’t fully learned, which was why every corner, every dimly lit hallway, and every seemingly innocuous air vent posed a viable threat. when every shadow hides a potential death, you learn to fear the darkness.

But if you walk through the valley of death and defeat the monsters that call it home, the shadows stop being so menacing, which is why Issac Clarke, and by extension the gamer controlling him, stops running from the Necromorphs and faces them head on in the sequel. That doesn’t make the game worse than the original — just different. and while many fans will be turned off by the switch in design philosophy, those willing to give the game a fair shot will find plenty to like about the bigger and badder sequel, even if the chills you get are mostly of the cheap, “zombie dog crashing through the window in Resident Evil 2″ variety.

Gamers who loved dissecting Necromorphs will be especially pleased as the gameplay hasn’t changed much; if anything, outside of a few small improvements and tweaks, the gameplay hasn’t changed at all. It’s hard to even pinpoint the biggest addition because they’re all mostly cosmetic; the sum of their parts, however, does make the game much more fun to play. there are a handful of new weapons, like the javelin gun which fires spikes that can impale enemies onto walls and electrocute them to death; the Locator System has been upgraded to not only point out your next objective, but the nearest shop, save point, and work bench — a really useful upgrade which I used a lot; and new inventive enemies offer some interesting opportunities for you to play amateur surgeon — the little gray screech babies are the best.

There are also a handful of fun new twists to the standard “shoot their legs then stomp their heads” gameplay, including space station windows that can be broken to suck enemies out into space and metal spikes which can be shot with telekinesis to impale Necromorphs onto walls. the perspective bending zero-gravity segments are also gone, with Issac simply using small booster rockets built into his suit to zoom around, and the bothersome segments where you have to race around in a vacuum while your O2 levels slowly tick down have been diminished, keeping the action flowing smoothly from one level to the next. Power nodes can be purchased in stores, making upgrades less of a painful “Sophie’s Choice” ordeal, and Issac can don new outfits like the beefy Security Suit and the sleek, mecha-anime Advance Suit.

The new multiplayer component also adds value, and although I was only able to play about two hours of it before launch, it was enjoyable enough that I will definitely log a few matches when the game launches. while it isn’t anything groundbreaking — the matches I played all featured the human faction trying to achieve objectives while the necromorph army did everything they could to stop them — the experience is novel enough to feel like it’s something new and unique.

The human faction relies on superior firepower and copious item drops to compensate for the necromorph faction’s overwhelming speed and sheer strength of numbers, but the competitive balance is fairly even and makes for some thrilling moments. Dead Space’s lumbering, methodical nature isn’t ideally suited to the fast, chaotic pace of multiplayer, but it’s a fun feature that complements the single-player component nicely.

As a gaming experience, Dead Space 2 is pretty awesome, and has a lot to offer over the course of the nine hours it takes to reach the end. Complaints are few and far between, but the two biggest issues I had were the meager number of show-stopping moments that left you muttering “Holy shit,” and the thin plot, which recycles a lot of the tropes found in the first game. Issac once again spends the entire game cluelessly following the orders of one NPC after another, and finds himself falling for some of the same old tricks he’s already fallen for; I also wish he had gotten a grip instead of shambling around in an emotional daze the entire game. the game doesn’t do nearly enough to delve into the mystery of the Marker and the origins of the Necromorph menace, either, and while there are some allusions made to the nature of the Marker’s signal, anyone hoping for meaningful answers will have to wait for the inevitable third installment.

But Dead Space 2 isn’t necessarily about understanding the Necromorph threat so much as it is about finally giving Issac a chance to stomp — literally and figuratively — those who have wronged him in the past. He’s been pushed around by the disgusting, mutated Necromorph army, the sinister bureaucrats of EarthGov, and the dogmatic zealots of the Church of Unitology long enough, and in a nod to the facetious “This time it’s personal” tagline which is jokingly attached to every sequel, he’s been given the opportunity to give them all a taste of the underside of his heavily armored boot.

The fact that Visceral boldly ignored the fan fervor and pulled the franchise forward in a logical and thrilling direction is commendable, and even though they’ll get their fair share of close-minded bitching that the game fails to live up to the gory heights of the original, it’s still a worthy follow-up to the tense opening chapter.

PROS: Small yet meaningful tweaks like the Advanced Locator make the game much more fun to play; the evolution of Issac Clarke as a character is nicely handled; the action still fits into the trademark Dead Space mold. CONS: There’s a noticeable lack of major moments; the boss fights are fairly weak; there isn’t enough in the way of meaningful plot developments or answers to major questions.

<a href="http://www.gamepro.com/article/reviews/217888/dead-space-2/tag:news.google.com,2005:cluster=http://www.gamepro.com/article/reviews/217888/dead-space-2/Tue, 25 Jan 2011 17:08:54 GMT 00:00″>Dead Space 2 Review from GamePro

Cosmetic local dentist Marketing : Tips on How to Get More Case Acceptance in Your Practice

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In cosmetic local dentist marketing, cosmetic local dentists often have difficulties on how to make their patients accept the treatments that they offer them. I’ve talked to a handful of people (who are cosmetic patients), whom, after I explained what I do for a living, they started telling me that they have all these questions about cosmetic procedures, and they’ve been wanting to go to their local dentist. But the thing is they haven’t. what could be their reasons for not accepting such treatments offered in cosmetic local dentist marketing? There could be two reasons for this. One is that they would really like to go and give their local dentist money for the cosmetic procedure, but they just don’t feel any urgency to do it. Or the other reason could be that they just keep forgetting! being in the field of cosmetic local dentist marketing, you should be able to come up with some techniques on how to get more case acceptance from your patients.

Keep Reminding them!

In cosmetic local dentist marketing, you need to follow up your cosmetic patients with multiple mailings, postcards, etc., to keep reminding them. So you are going to contact your past patients, and tell them you have a new service, and you would like their help in previewing it. Or, that you want to get together for their 6 month recall. You should start this immediately! do not wait until you feel you are ready to do so. Just start! This will cost you very little, and what is important is that this will be great for your practice. You will start getting people calling for their recall, which will reactivate them and get them in so you can help them with any other questions they may have.

No more Procedures as a Way to Describe what You do!

You must stop describing what you do, in terms of what you sell! ( Just like saying, “Well, I’m a local dentist who does cosmetic work… or I have my own dental practice…”).Rather, you must start describing what you do, in terms of what you do! Which is now going to be something like, “ I help people have a healthier, whiter, more beautiful smile.”, or,” I assist people in getting cleaner, healthier teeth while they experience pain-free local dentistry.” anything like this could be very helpful. You see, the big challenge is really from your end, on how you think about yourself. If you really want to stop pushing procedures, in order to get more case acceptance, you have to totally re-frame how you think of what you do! Remember: the key here in cosmetic local dentist marketing is that people don’t care about what you do; they want to know about the emotional benefits that it will give them. and that’s it!

So, if you really want to have more case acceptance, first, keep reminding your patients through multiple mailings, etc. and second, start describing what you do, in terms of what you do! keep these in mind, and you’ll be on the road to success in your cosmetic local dentist marketing business!

Cosmetic local dentist Marketing : Tips on How to Get More Case Acceptance in Your Practice