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Five Tips to Avoid Overindulging on Thanksgiving

iStock/Thinkstock(NEW YORK) -- Thanksgiving is every dieter's nightmare: turkey slathered in gravy, candied sweet potatoes with marshmallows, green bean casserole, cranberry sauce and buttery, and calorie-laden pecan pie.

Adults gain about a pound between Thanksgiving and Christmas, and they don't lose it in January, according to experts. That means that, of the pound or two a year that adults gain as they age, half of it happens over the holidays, said Cedric Bryant, chief science officer of the nonprofit American Council on Exercise.

But there are ways you can enjoy Thanksgiving without overdoing it:

Exercise Before or After the Meal

Starting your morning with a turkey trot -- a Thanksgiving 5K jog -- will help offset some of the effects of a big holiday dinner, Bryant said.

An after-dinner walk or jog is even better.

When you eat the calorie- and fat-laden meal, your triglyceride levels become elevated and your blood sugar spikes. This can lead to a feeling of malaise. Over time, it can contribute to metabolic disorders and type II diabetes.

Light exercise before the big meal decreases your triglyceride levels -- the fat in your blood -- by 25 percent, Bryant said. Exercising after dinner will decrease triglycerides by 70 percent.

The exercise will also help peripheral tissues, such as muscles, respond to insulin, which controls blood sugar, he said.

Don't Worry About Disappointing the Host

Research at the Cornell University Food and Brand Lab showed that people often overeat at dinners because they're afraid of offending or disappointing the host or hostess, said the lab's director, Brian Wansink, who authored the book Slim by Design: Mindless Eating Solutions for Everyday Life.

"One easy way to do that is just only eat the stuff that’s homemade," he said. "The hostess isn't going to be offended if you don’t eat the peanuts or the nuts before dinner or you don’t eat the dinner rolls she bought. She’s going to be annoyed if you don’t eat the dressing or the turkey."

Hosts in Wansink’s research never remembered how much guests ate, but remembered whether they went back for second helpings, he said.

So, start the meal with extra-small portions, Wansink suggested. That way, when you go back for seconds, you're not overeating.

Make a Few Thanksgiving Swaps

A few simple substitutions can go a long way on Thanksgiving, Bryant said.

"Choose white meat over dark meat," he said. "The white with no skin is going to be about half the calories and probably 1/6 to 1/7 the fat of dark meat with skin."

A six-ounce serving of skinless white meat is only about 180 calories and 3 grams of fat, Bryant said. By comparison, the same serving of dark meat with skin is 370 calories and 20 grams of fat.

Choosing pumpkin or apple pie instead of pecan pie will save about 150 calories, he said.

If you're hosting Thanksgiving, serving steamed green beans instead of green bean casserole will also save guests about 100 calories, Bryant said. And serving sweet potatoes with just sugar and spices is better than serving it candied and loaded with marshmallows.

Start at the Healthy End of the Buffet

People load up 60 to 65 percent of their plates with the first three things they see at the buffet, Wansink said. To save calories, start near the salad and vegetables.

And if you're hosting the dinner and want to save your guests from overindulging, keep the buffet away from the table so people have to consciously get up to get second helpings. People who served themselves from a buffet ate 20 percent less than people who served themselves from the middle of the dinner table, he said.

"Thanksgiving is one of the greatest American holidays of the year," Wansink said. "It's probably not the best time to start your diet. To help, eat a little bit less but still enjoy the holiday."

Eat Slowly and Drink Water

Bryant said absently "shoveling" in food as you catch up with relatives is bound to lead to overeating. Instead, remind yourself to eat slowly and stay aware of what you're eating.

"Give you brain an opportunity to catch up with your appetite," he said.

Another helpful trick is to drink water throughout the day.

"Hunger cues and your hydration cues can become confused," Bryant said. "Making sure to address hydration can certainly help to curb the appetite."

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Why Your Older Brother Still Gives You Noogies on Thanksgiving

Tanya Constantine/Blend Images/Thinkstock(NEW YORK) -- It’s only natural for adults to slip back into their childhood personas when they get together with family, said Dr. Joe Shrand, a psychiatrist and medical director of the CASTLE treatment center in Brockton, Massachusetts.

"You develop patterns of behavior within the family hierarchy that are a way of jockeying for attention without directly competing in the same way," he said. "These patterns don’t just go away when you grow up and move away from home."

Whether you're the CEO of a large company or a famous actor, Shrand said, that means you might be traveling back in time as you return home for Thanksgiving. Your first relationships are with your family and, presumably, you had at least 16 years to practice within the family dynamic before leaving home, he said.

Surrounded by childhood family and friends, you might revert to your childhood identity as the funny one, the instigator or the victim because the behavior is familiar and ingrained.

Likewise, family members tend to view you the same way they have all your life, even if you've changed, Shrand said.

Jeff Brown, a Harvard psychologist, said he considers playing the part of your childhood self at family get-togethers a form of regression.

"We go back to a time in life when we were forming our first memories," he said.

Lapsing back into behaviors based on good memories and temporarily assuming your place in the family pyramid isn't necessarily a bad thing, Brown said. As long as you enjoy the inside jokes and reliving past antics only your siblings, parents and cousins can dredge up, there’s no harm. But if your role is based on unhappy recollections and negative stereotypes, it can be damaging.

"If it’s embarrassing to be treated a certain way, you have to remind yourself that you can’t control others but you can control how you react," he said.

Brown advised not rising to the bait if you’re not fond of the way relatives treat you or how you tend to act when you're around them. If the dynamic is unpleasant or even unhealthy, consider skipping family gatherings altogether.

But, Shrand said, whenever possible, it's best to see the humor in your situation.

"Don't take it too seriously," he said. "It's really funny when an older sibling talks over you at the dinner table because he knows more than you do -- or thinks he does."

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Why the Thanksgiving Turkey Isn't What It Used to Be

Digital Vision/Thinkstock(NEW YORK) -- The turkeys the pilgrims probably encountered when they stepped off the boat were of the wild variety. They were long, lean and somewhat gamey from a life of foraging and fleeing predators.

As for the large-breasted, plump-limbed Thanksgiving turkey we enjoy today, it's a triumph of modern technology.

In the late 1920s, breeders began tinkering with domesticated turkeys, which still resembled their wild cousins, so that they matured faster and grew larger. The nickname for one popular breed was “bronze Mae West,” according to Modern Farmer, but the industry eventually agreed on calling them broad breasted bronze.

Keith Williams, a spokesman for the National Turkey Federation, said the turkey industry really got cooking in the 1940s and '50s when farmers realized they could raise turkeys similarly to how they raised chickens.

“Rather than hunting through the woods for eggs, they could incubate them and the animals could be safely housed in large sheds,” he said. “This allowed them to raise animals more efficiently and less expensively.”

Thanks to selective breeding and growing techniques, Williams said, farmers can now produce a bird that has far more white meat and larger, more muscular thighs than its ancestors.

Because the skin of darker birds were speckled with colored dots all over after plucking, the industry eventually shifted to a breed known as the broad breasted white, which doesn’t speckle and now accounts for the majority of birds sold.

In the 1930s, the average-size Thanksgiving turkey was between 7.5 and 10 pounds, according to the U.S. Department of Agriculture archives.

Today, families tuck into a bird that weighs an average of about 15 pounds, the Minnesota Turkey Growers Association estimated.

Up until about 1970, turkeys that made it to market arrived in big barrels of ice and were “New York dressed,” Williams said.

“They came with the head, feet and all their organs still intact,” he said.

Most birds sold today come frozen and fully dressed so they are oven-ready, he added.

Nearly 90 percent of Americans will dine on turkey this Thanksgiving, according to the National Turkey Federation. That’s 46 million birds.

One last turkey fact before you slip yours in the oven: Most Thanksgiving turkeys Americans eat are hens. Americans don’t ordinarily eat the male toms except in the form of the humongous drumsticks sold at Disney and other amusement parks which, Williams noted, are often mistaken for ostrich legs.

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What Not to Talk About at Thanksgiving Dinner

Ryan McVay/Photodisc/Thinkstock(NEW YORK) -- It’s the season for a lot of things, but talking about why you're still not married isn't one of them. Thanksgiving dinner only happens once a year, so it's best to leave such uncomfortable conversations for another day, and focus on safe topics like the weather, sports or, most importantly, the turkey -- unless it's burned, but we'll get to that.

Keep table talk peaceful by avoiding these taboo topics:

"Somebody's Hungry!"

Sure, people like to indulge on Thanksgiving, but that doesn't mean you need to point out when someone clears their plate or grabs an extra helping of stuffing.

"You want to avoid commenting on how someone eats," etiquette expert Daniel Post Senning of the Emily Post Institute said. "The compliment doesn't always get received that way."

"But you can always compliment the chef," he said. "You can say how good you feel, how good the food was, how full you are."

Religion, Politics and Money

These should be no-brainers: Religion, politics and finances are definitely topics you'll want to avoid during a holiday celebration.

"You just want to be careful," Senning said. "It's not that you're never allowed to talk about these things, but you need to be prepared for people to have legitimate and valid differences of opinion. By definition, that's what makes these potentially controversial."

For some families, heated discussions about politics are almost a holiday tradition. If that's the case, just save those for after dinner, so people who don't want to partake can be left out.

Sex and Relationships

We've all heard the stories of people whose families' use holidays as an opportunity to nag about when they're getting married. Or engaged. Or having kids.

Senning says such "probing questions" should be off limits, but understands they can be hard to avoid when family is around.

"Of course, this is family, people are going to pry," he said. "A great tactic is to turn around and ask someone else what they think, if a conversation is starting to feel a little too personal. Steer the conversation toward safer territory."

When the Food Is Bad

Is the turkey overcooked? Pretend it isn't, and compliment the chef on the mashed potatoes if anyone asks.

"Keep the focus positive," Senning said. "You're there to celebrate."

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There's a Whole New Set of Wrinkles to Worry About

Image Source Pink/Thinkstock(NEW YORK) -- Frown lines. Crow's feet. Dynamic expression lines. It's enough to send a person running to the Botox needle. And now there's a whole other wrinkle to worry about. The kind that happen while you sleep.

It turns out the notion of "beauty sleep" might be a farce, according to Dr. Goesel Anson, a board certified plastic surgeon.

"Sleep wrinkles are created by the distortion of the face when it's pressed into the pillow surface night after night," she said.

But, unlike expression wrinkles, which can be treated by Botox and fillers, Anson said sleep wrinkles can only be prevented. It's a sentiment that's echoed by the American Academy of Dermatology, which suggests sleeping on your back to reduce premature skin aging. Sleeping on your side or your face causes the lines you may notice on your face when you wake up in the morning, the Academy said on its website.

"In time, these lines turn into permanent wrinkles," she said.

In other words, not even sunscreen can help you here.

Anson said most people move an average of 20 times per night. To prevent this, she created a $180 sleep pillow to prevent mushing of the face during sleep. The JuveRest sleep wrinkle pillow is especially helpful for side and stomach sleepers, the website says.

But do sleep pillows really work? It's definitely possible, though Dr. Lisa Donofrio, associate clinical professor in the Department of Dermatology at the Yale University School of Medicine, said it would "take many years to evaluate their true efficacy."

"The pillows could work," she said, "by re-distributing pressure and preventing creasing. These pillows seem to help."

Donofrio said she recommends the enVy pillow to her patients.

Dr. Patirica Farris said pillows that encourage back sleeping are "definitely beneficial. We see lots of sleep lines that develop on the sides of the cheeks and around the mouth that can be directly attributed to lying on the face."

Another suggestion? "Using linens that are satin and slippery makes you less likely to develop wrinkles," Farris said.

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Babies Can Retain Happy Memories

Wavebreakmedia Ltd/Thinkstock(NEW YORK) -- Do you remember anything from when you were five months old? No doubt, you don’t.

In fact, babies that young would be hard pressed to recall things that happened from hour-to-hour. However, Brigham Young University psychology professor Ross Flom says that infants as young as five months old are capable of remembering things that make them happy.

Flom says her study is the among the first to measure how emotions influence memory. To do so, the babies first heard a person on a computer speaking in either a happy, neutral or angry voice. That voice was immediately followed by the visual image of a geometric shape.

The infants were later tested by showing a new shape and one of the old ones. The researchers then watched the babies' eye movements and how long they spent staring at an image.

Invariably, the babies focused more on shapes that they associated with positive voices than the ones linked to negative voices.

Flom says that by heightening the babies' attentional system and arousal, “We heighten their ability to process and perhaps remember this geometric pattern.”

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Yogurt Shown to Reduce Risk of Developing Type 2 Diabetes

George Doyle/Stockbyte/Thinkstock(NEW YORK) -- Not a yogurt fan? Here’s information that make might you one.

According to researchers at the Harvard School of Public Health, eating yogurt daily might help lower the risk of developing type 2 diabetes, the most common form of the disease.

Lead author Mu Chen said her research was based on three separate large studies involving a total of 200,000 men and women ages 25-to-75 for as long as 30 years. About 15,150 people overall were diagnosed with type 2 diabetes.

Although dairy consumption itself was not associated with either an increase or decrease in the risk of contracting diabetes, Chen and her team learned that people who ate 12 ounces of yogurt daily, about two regular containers worth, lowered their risk of developing the disease by 18 percent.

Although Chen said there is no definitive proof that yogurt will prevent type 2 diabetes, “Some mechanisms suggest that yogurt is special,” he said. “There is some research suggesting that the probiotic bacteria in yogurt may be beneficial."

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CDC: Majority of Americans with HIV Don't Have It Under Control

Credit: James Gathany/Centers for Disease Control and Prevention(NEW YORK) -- Most of the 1.2 million Americans infected with HIV, the virus that causes AIDS, did not have the disease under control in 2011, according to a new study by the Centers for Disease Control and Prevention.

The CDC says that about 70 percent of those with HIV had not achieved viral suppression. What's more, just 13 percent of Americans ages 18 to 24 had it under control.

According to the government, it's not so much ignorance that prevents people from getting the drug therapies necessary to combat the virus but lack of access to medical care and an apparent indifference to the disease, which can become full-blown AIDS if left untreated,

CDC Director Dr. Tom Frieden said Tuesday that besides people with HIV needing to seek treatment, it's also up to health care systems that diagnose patients to make sure that they get the medications and follow-up treatment if for no other reason but to prevent patients from passing on the infection to others.

The CDC says that antiretroviral medication allows people to live longer by keeping HIV at very low levels, provided it's used consistently. This treatment also cuts the transmission of HIV to others by 96 percent.

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The Real Secret to Self-Control

dolgachov/iStockphoto/Thinkstock(NEW YORK) -- Everyone is susceptible to some form of temptation and a lot of people often give in to it, sometimes with disastrous results.

However, as researchers at Florida State University report, it doesn’t have to be that way, provided you know the strategy for success.

It’s pretty simple, actually: just don’t get into a situation where you might lose your self-control, according to a study published in Personality and Individual Differences.

In an experiment with 38 college students, the participants were told to choose between a crowded student lounge to solve a problem or wait for a quiet lab to become available.

Most of the people ranked with low self-control picked the lounge over the lab while a majority of those with more self-control chose the lab over the lounge. Another experiment with people aged 18-60 yielded similar results.

The bottom line, according to the FSU researchers, is that high self-control is more associated with shunning distractions than trying to overcome them.

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Macy’s, Make-a-Wish Get Special Flute for Teen with Cystic Fibrosis

iStock/Thinkstock(NEW YORK) -- At just 18 months old, Elizabeth Shea was diagnosed with cystic fibrosis, an incurable genetic disease that affects the lungs and digestive system. It can make catching the common cold life-threatening.

Shea’s mother, Marissa Shea, says her now-17-year-old daughter counts every morning as a blessing.

The teen’s regimen includes taking 12 pills with every meal, plus using inhalers and getting regular respiratory treatments.

“I don’t remember never having to take medicine,” Shea said in an interview with Good Morning America.

When Shea was in the 6th grade she discovered a passion that has helped her in many ways.

She took up playing the flute, and, now a high school senior at Western High School in Davie, Florida, she plays in the marching band. “The doctors have told me that playing a wind instrument helps keep the lungs working,” she said.

Shea’s talent landed her a spot to play in the Macy’s Thanksgiving Day Parade in New York, but there’s one thing that she wanted: a top-of-the-line flute.

“It would be kind of hard for my parents to…get the flute for me,” she said.

Make-a-Wish and Macy's teamed up to fulfill Shea’s dream. She got her flute just in time for her trip to play in the parade.

This is the seventh year that Macy's and Make-A-Wish have teamed up for the Believe Campaign to spread holiday cheer to children with life-threatening medical conditions.

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How Many Calories You'll Eat this Thanksgiving

iStock/Thinkstock(NEW YORK) -- There's nothing like a day of solid eating to get you in the Thanksgiving spirit. But as family members catch up, they often don't realize just how many calories they're devouring over the course of the day.

Experts say people often eat more than a full day's worth of calories in one gravy-laden feast, in part because overeating is as much a part of the holiday as the turkey.

"I think people would be frowned upon if they were, quote, 'dieting' on Thanksgiving," said registered dietitian Jamie Pope, who teaches nutrition at the Vanderbilt University School of Nursing in Nashville, Tennessee. "It’s kind of a socially acceptable day to indulge."

It's a commonly held belief that the average American consumes 3,000 calories during the Thanksgiving meal plus another 1,500 on snacks and drinks, numbers that come from the Calorie Control Council, which is the industry group for diet food companies. That's 4,500 calories in all, and about 45 percent of them come straight from fat, according to the council.

"The average person may consume enough fat at a holiday meal to equal three sticks of butter," the Calorie Control Council said in a statement.

But many have contested the 4,500-calorie figure in recent years, including New York Times health reporter Tara Parker-Pope, who in 2012 tried to come up with the most calorie-laden Thanksgiving dinner she could muster, but only came up with 2,486 calories. She concluded the Calorie Control Council's number was a myth.

The Calorie Control Council did not respond to requests for comment.

Cedric Bryant, chief science officer of the nonprofit American Council on Exercise, did his own calculations and said while 4,500 calories for the day may be "liberal," eating 3,000 calories during the meal is probably right on target.

"If you look at how people tend to have that feast mentality for the meal I think that is very likely," Bryant said, adding that if someone had their blood tested after eating Thanksgiving dinner, the fat in it would be elevated for a little while.

Pope said the Calorie Control Council's count seems "inflated," but that doesn't make this a diet meal by any stretch. Pope said the basics of the meal aren't terrible for you, but the embellishments and the second helpings are enough to put the meal over the edge.

A day of overeating won't hurt in the long run, unless it's the start of a six-week holiday binge, she said. Then, the 2 or 3 pounds people gain during the holidays might not come off once January comes around.

Pope recommends people enjoy the festivities but simply be aware of how much they're eating. She said she never recommends weight loss as a goal for the holiday season because between the treats and the lack of exercise because of cold weather and limited daylight, the best that can be expected is weight maintenance.

"You don't have to go hog wild but also realize this shouldn't be the impetus for the loss of constraint going forward," she said. "You don’t want to go paranoid into the holidays. People just have to be aware."

Bryant also recommended going on a run in the morning and taking a walk after the big dinner.

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Tiny Liver Transplant Patient to Taste First Thanksgiving

Courtesy Donya McCoy(PITTSBURGH) -- Born with a rare metabolic disease that rendered eating protein poisonous, 3-year-old Kennedy Stevenson was never able to appreciate a good bite of Thanksgiving turkey.

But all of that is about to change thanks to a liver transplant she received two weeks ago from her mother's Facebook friend.

"She just ate a chicken finger for the first time ever," her mother, Donya McCoy, told ABC News Tuesday from Children's Hospital of Pittsburgh, where Kennedy underwent her transplant and will remain an inpatient through the holidays.

Kennedy wasn't so sure about the chicken, McCoy said, but she loved her first taste of chocolate milk.

"Her eyes got big and she just kept sucking the straw," McCoy said. "She didn't want to stop."

Kennedy was diagnosed with a rare metabolic disorder called S-adenosylhomocysteine hydrolase deficiency. It's so rare that only eight people have ever been diagnosed with it, six of whom are still alive today, McCoy said.

The enzyme deficiency prevents Kennedy from processing protein normally, leading to a buildup of other toxic substances in her system and causing degenerative neurological effects over time, said Dr. George Mazariegos, chief of pediatric transplantation at Children's Hospital of Pittsburgh.

Although other doctors had changed Kennedy's diet to eliminate protein and make it "stricter than vegan," McCoy said they decided that a liver transplant was her best chance for survival because the deficiency was concentrated in her liver tissue.

In the two weeks since the transplant, McCoy said doctors told her the new liver was "kicking butt." Levels of the toxic byproduct that used to build up because Kennedy couldn't process protein are way down, even when she eats chicken and chocolate milk, McCoy said.

"She can now have turkey and stuffing," McCoy said. "It's just going to be really special that she can eat a Thanksgiving dinner."

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New Beauty Tool Sterilizes Makeup Brushes, Cuts Drying Time in Half

Brush Medic(NEW YORK) -- You wash your hair, body and clothes on a regular basis. But how often do you wash your makeup brushes?

Now, one product is vying to make the pesky task of cleaning your brushes an easier one.

It’s called Brush Medic, and it’s said to eliminate 99 percent of dirt and bacteria through a UV sterilizing system.

"It was really my wife’s idea who’s a makeup artist at a large cosmetic store," says Billy Turner, co-founder of Brush Medic. "One night she was saying how it took way too long for the brushes to clean and dry, so we created something that would kill bacteria and take less drying time.”

How it works is you start by cleaning your brushes with soap and water. Or, try the Brush Medic Quick Clean Wipes. "They are alcohol free, so they won't damage your brushes," Turner says. Finish by placing them in the Brush Medic machine for a deep cleaning.

In addition to a bacteria free cleaning, the system promises a drying time that’s up to 10 times faster.

In the future, the company hopes to expand its reach to professional makeup artists.

“We are developing a larger product that we think would be great for commercial brands," Turner says. "We'd like to spread the word throughout the makeup industry.”

One expert agrees that Brush Medic can be a useful tool for beauty buffs everywhere.

“Your makeup brushes should be cleaned every single day," says green beauty expert Sophie Uilano. "If you don’t clean your brushes, you’ll absolutely break out.”

“The problem with brush cleaners is that they are highly toxic, so this is a fantastic solution," Uilano says. "Brush drying time is also an issue, so it’s great that it cuts that too."

The Brush Medic Pro will be available exclusively at Customers can preorder the system for a price of $199. A mini version is sold for $99.

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New Procedure Dubbed 'Inside-Out' Face Lift Claims to Smooth Skin

iStock/Thinkstock(NEW YORK) -- There’s a new treatment for saggy, creased skin around the mouth that works from the inside out to tighten soft tissue and produce a smoothing effect on the surface.

Dr. Christine Lee, a dermatologist, helped pioneer a new treatment that’s known as the inside-out face lift.

The procedure uses a laser that delivers targeted heat from inside the mouth, Lee says.

Jacki Adams, a popular model during the 1980s, has posed on the covers of magazines including Vogue and Elle, but years of outdoor sports exposed her face to days of wind and sun.

With plans to return to acting, Adams hoped to smooth out some facial lines.

"I prefer to look good for my age, rather than look another age,” she said.

Adams visited Dr. Lee at her Walnut Creek, California practice, The East Bay Laser & Skin Care Center, Inc.

"When you go inside the mouth, what it does is causes immediate contracting, and that tightening makes this nasal labial folds by the side of the mouth seem like they're plumping up," Lee said as she performed the 30-minute procedure.

ABC's Good Morning America spoke to some doctors who were skeptical of the procedure. They said patients could get better results from lasers used directly on the skin, or from less expensive treatments such as fillers.

“The general consensus is that with laser therapies, that is best accomplished from the outside in not the inside out, but again, it’s a new procedure. I think people should proceed with caution until we know more,” ABC News’ Dr. Jennifer Ashton said.

Lee says her procedure “has some of the same effects a filler does but appears much more natural, and you're not having to inject a foreign substance in your face.”

Her patients undergo several treatments that cost about $1,500 per session. Results can last for months, she said.

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Vitamin D Supplements May Not Be for Everyone

areeya_ann/iStockphoto/Thinkstock(NEW YORK) -- A new study says that the vitamin D supplements many Americans take at a doctor's recommendation may not be quite as beneficial as they believe.

According to a study conducted by the United States Preventive Services Task Force and published in the journal Annals of Internal Medicine, there is insufficient evidence to determine whether screening for vitamin D deficiency in adults not showing symptoms of a deficiency is more beneficial or harmful.

Vitamin D can be found in in certain foods, and can also be obtained by the conversion of ultraviolet rays from the skin that come in contact with bare skin. Previous studies have shown that low levels of vitamin D may be linked with increased risk of diabetes, cancer and heart disease.

Patients with kidney disease or bone disease, as well as elderly patients, should still take vitamin D supplements if instructed to do so by their doctor, the study said. However, researchers believe that many people may not stand to benefit from vitamin D supplements not recommended by a physician.

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