The Darker Side of Your Tan

Want see a plastic surgeon break out in a cold sweat, shutter and look really
concerned?  Just tell him that you own use a tanning bed or look forward to laying on the beach during your vacation.

I see the ravages of sun exposure on a daily basis and it’s not a pretty
site.  I see signs of accelerated and premature aging with wrinkles, pigmented spots, and loose inelastic skin.  I see melanoma, an often times fatal skin cancer.  I see basal and squamous cell carcinomas, skin cancers requiring surgical excisions.  So when I see a tanned or burned person, I see damage to the largest organ, the skin.

UV or ultraviolet radiation produces free radicals within the skin that are very damaging to its DNA.  Once it is damaged, the cell attempts to
repair its DNA.   If the damage is too great to repair, a single abnormally dividing cell can turn into cancer.  On top of this, UV radiation impedes the skins immune system so that abnormal cells are not recognized and allowed to proliferate.  Finally, we know that UV radiation breaks down collagen in the skin causing wrinkles and loose skin.

If  you do get a sun burn, cool the skin with washcloths, take ibuprofen, and eat a
large amount of antioxidant rich foods such as blueberries, strawberries or any
other highly colored fruit.

UV radiation is classified by its wave length in nanometers (nm) into three types: UVA (320-400 nm), UVB (290-320 nm) and UVC (100-290 nm).

UVA penetrates deep into the skins dermis and is relatively constant throughout the  day and seasonal changes.  UVB affects the outer layer of skin, the epidermis, and is the primary agent responsible for sunburns. UVB is the most intense between the hours of 10:00 am and 2:00 pm when the sunlight is
brightest.  UVC is absorbed by the  atmosphere and does not cause skin damage.

The best way to prevent skin cancers and premature aging is to limit your exposure from UV radiation by avoidance:  shade, wide
brimmed hats and clothing.  Think of sunscreens as a adjunct to shade, not a first line of defense.  When you’re the beach or lake, or sporting event, find some shade like an a tree, awing, or umbrella.  Wear a wide brimmed hats and
sunglasses and as much clothing as you can tolerate such as long sleeved
shirts.  There are light weight clothes available that have special UV radiation blocking properties.

Suncreens are graded by SPF or Sun Protectant Factor.  It is the amount of UVB radiation that is  blocked compared to normal skin.  For example, an SPF of 15 makes the skin surface 15 times more able to absorb UVB than normal skin.  Look for broad-spectrum UVA/UVB sunscreens with an SPF of at least 30 and
contain avobenzone, titanium dioxide, zinc oxide, or micronized titanium dioxide.

Buyer Beware: Getting a sunblock with a SPF higher than 30 does not significantly improve the ability to block UV rays, in other words, expensive high SPF creams are not worth it.

Sunscreens should be used liberally in situations were you will be in the sun such as boating, swimming and sports.   It takes 20-30 minutes for sunscreen to be absorbed by the skin, so it should be applied at least a half an hour before going out.   Sunscreen should also be reapplied at least every 1 to 2 hours or immediately after swimming, sweating, or toweling.  The easiest way to apply sunscreen is through a spray formula.  This is particularly helpful in children who should always be protected when outdoors.

If you can’t wear a hat and/or sunglasses, then a waxed based sunscreen which
looks like a large lip gloss stick work best around the forehead and eyes.  This formulation avoids running of the sunscreen in the eyes which can be quite painful.

What about tanning beds, aren’t those safer than the sun?  In 1997 the American Medical Association and the American Academy of Dermatology asked
the Federal Trade Commission to ban the sale and use of tanning beds and
sunlamps.  In 2009, the World Health Organization classified tanning beds as “Carcinogenic to humans”.  Yes my dear, it’s that bad.

Doesn’t using a tanning bed to get yourself “ready” for a trip toward the equator   seem ridiculous now that you know the whole story?Just follow the step outlined above when you get to your sunny destination.  You can still have a great
time without damaging your skin.  If you need that darker sunkissed look, there are creams and sprays widely available.  That’s what I do.  They have come a long way since the orange Q-tan days and look natural.

Bottom line:  Protect your skin and give up the darker side of tanning!

To the Best of your Health,   Dr. Sev

REALLY RARE: BREAST IMPLANTS CAUSING LYMPHOMA

Not so rare:  breast cancer, implants or not

 

 

Through the eyes of my patients:   I was watching the Nightly News with Dianne Sawyer last night who reported on a new FDA announcement regarding breast implants.  There was the typical sensationalism and I tried to watch the story through the eyes of my breast implant patients.  Even though the report acknowledged how rare this possible association is, patients probably only heard the words “breast implants” and “cancer”.   So I wanted to write this blog to ease concern about this new breast implant issue hitting the headlines:  The US Ford and Drug Administration (FDA) announced yesterday that silicone and saline implants may be associated with a rare type of cancer called anaplastic large-cell lymphoma (ALCL). 

 

Perspective in numbers:  The FDA identified a total of 34 cases of ALCL in the past 25 years in scar capsules surrounding silicone and saline implants.  To put that into perspective that is 1 in 500,000 women with breast implants.   It is more common to get struck by lightning.  In comparison, the lifetime risk of getting breast cancer is 1 in 8 women.  That’s 12 % of women!  So getting breast cancer whether a women has implants or not is 25,000,0000 times the apparent risk of developing ALCL around breast implants!!  

 

What the FDA report stated:  Before the media hypes this issue up in your mind, here are actual quotes from the FDA study: “Based on available information, it is not possible to confirm with statistical certainty that breast implants cause ALCL.”  “The FDA believes that the totality of evidence continues to support a reasonable assurance that FDA-approved breast implants are safe and effective when used as labeled.”  “Health care providers should be aware ALCL in women with breast implants is a very rare condition.”  “The FDA does not recommend prophylactic breast implant removal in patients without symptoms or other abnormalities.”

 

The good news:  In the few cases that have been treated, this condition appears to be treatable with simple removal of the scar capsule and fluid that develops around the implant.  So eventhough it looks like ALCL under the microscope, it doesn’t behave the same way that other ALCL cases behave.

 

What you should do if you have breast implants:

1)  Enjoy!  Our patients who have had breast augmentation  at the Indiana Plastic Surgery Center  have improved self esteem and body image and being able to wear clothing and bathing suites with confidence giving years of joy.

2)  Continue monthly self breast exams as you should looking for lumps or bumps.  Remember, breast cancer will occur in 12 % of all women and this is really something to watch for.  Early detection leads to the highest survival rates.

3)  If a breast implant tightens or becomes firm, don’t panic.  This is most likely capsular contracture which is scar tissue normally develops around the implant thickens and hardens.  See your plastic surgeon for an evaluation for this treatable condition. 

4)  If a breast implant or breast seems to enlarge a year or more after having surgery, this is very unusual and should be evaluated by your plastic surgeon.  The women who had these rare cancers in the FDA review typically developed a fluid collection around the scar capsule of the implant.  The good news is that when these rare lymphomas arise around breast implants the patients have responded nicely to treatments such as removal of the implant and surrounding scar capsule.

 

Bottom line:  If you are a women with or without breast implants, your lifetime risk of getting breast cancer is 12%!   Don’t focus on a rare possibility of an association of breast implants with the rare type of lymphoma.  Instead, focus on early detection of the most common cancer in women through monthly breast exams, yearly doctor visits, and mammograms.

As always, the best of health…   Dr. Sev

Lips that Last

before and after courtesy SurgiSil

Overly thin lips can really detract from an otherwise nicely balanced face.  Patients often request injectable fillers to enhance their lips.  Fillers are a straight forward way to enhance the lips, but with one major draw back: that they don’t last.  Is there a permanent option for the lips?

The Perma Facial Implant (surgisil.com) is a lip implant made of a solid soft silicone.  These are placed within the muscle of the lip though small incisions at the inside corners of the mouth at the Indiana Plastic Surgery Center under local anesthesia.  The recovery is 4 to 7 days before being socially presentable. 

Some patients like to “try” what a lip augmentation will be like by using a filler “trial”.  This is “OK” to do, but this is not really comparing apples to apples.  The fillers mainly augment the edge of the lip.  The implant augments the entire substance of the red part of the lip and is actually a more natural appearing lip.  I feel so confident in the results of the permanent lip implant, I generally discourage the filler trial as an unnecessary step and cost. 

There should be a distinction in silicone injection verses silicone implantation.  Liquid silicone injectables are not FDA approved and generally from questionable sources.  Do not ever use them!!  The Perma Facial Implants are a solid form of sterile silicone, FDA approved (in 2007), and safe to use.

Patient’s considering lip augmentation are often concerned that they not be made too big sighting actresses with extreme cases (many of these are likely injected). The Perma Facial Implants come in a range of thicknesses and lengths.  Be sure to talk with your plastic surgeon about your desires so that an appropriate implant size is used.

A longing for nice legs… options for improvement

Liposuction of outer thigh by Dr. Sev

The most common complaint with women in regard to their legs is telangectasias also known as spider veins. These are the very small red to dark small vessels located just below the surface of the skin. They are easily treated with either sclerotherapy or laser treatments.

Sclerotherapy is done with a very fine needle injecting a sclerosing agent within the lumen of the spider vein vessel. This causes a chemical irritation of the inside vessel wall causing it to collapse on itself thereby not allowing blood flow within the vessels wall. Laser therapy is a color based process were the laser energy is absorbed by the color of the spider vein. This causes a localized burning of the vessel and occludes it.

Both processes require about 2 to 3 days of limited activity and a week of compressive stocking wearing.

Cellulite is another concern of women and unfortunately, there are no great treatments for this. There is endermology which is a process that pulls the skin and fat into a vacuum roller mechanism. This has been combined with radiofrequency in recent years. Multiple treatments, 10 to 15, are required and a maintenance program is needed. This tends to be expensive and time consuming for the patient with non permanent results.

Another less expensive option for cellulite is made by Prescribed Solutions called “Body of Knowledge”. This is a cream placed on the skin twice daily. This is sold through our Rejuva Medspa. We have patients “coming back for more” which would indicate it works. Certainly, all products don’t work for all patients.

 Loose crepe skin is a typical concern of patients with history of UV exposure (sun tanning, tanning beds) and/or smokers. No easy answer here. Thigh lifting can produce reasonable results in the upper thighs and buttocks. Unfortunately, the there are no answers around the knee. Thigh lifting doesn’t transmit down to the knees well enough and excess skin excision produces unsightly scars.

Varicose veins is commonly considered a medical problem if there is pain and discomfort. These are the large veins under the skin were the valves that used to keep the blood flowing back to the heart fail and lead to back up and budging of the vessels. Vein striping and laser or radiofrequency ablation are procedures typically done in an office or outpatient setting.

Finally, there is the unwanted areas of excess fat deposits, most commonly in the thighs and around the knees.  Some women have these deposits despite being within or near ideal body weight. The best option here is liposculpture, also known as liposuction. There are laser and ultrasonic devices available but I feel these are no better in terms of results than already available techniques. The typical difference is they are much more expensive (to cover the cost of these expensive devices). Bottom line, “buyer beware” when it comes to new technologies in general, even if you see it featured on your favorite talk or news show.

The Best of Health,   Dr Sev

Ultherapy: How “little” of a lift are you willing to accept?

Surgical eyelid lift by Dr. Sev

Yet another “breakthrough” in skin lifting and tightening has emerged.  The Dr. Oz Show featured Ultherapy™ in a segment of “How to Look 10 Years Younger in Less Than 30 Minutes!” on November 11, 2010.  With all due respect to Dr. Oz and the phenomenal work he has done for preventative healthy living, perhaps the show should have been called “How to Look 30 minutes younger in 30 minutes”.  I am joking to make an important point; read on.

During the show, Dr. Haideh Hirmand, who serves on the New Technologies Task Force of the American Society for Aesthetic Plastic Surgery, said that while the treatment is not a replacement for traditional surgery, this new, non-surgical procedure for sagging skin is “sci-fi meets beauty.”   She told Dr. Oz that this is “the first time as a surgeon that I’m really excited about a technology that’s non-invasive.”  The FDA approved this technology for facial and neck skin treatment.

Dr. Hirmand described Ultherapy as totally different from other cosmetic procedures because it reaches surgical depths without disrupting the surface of the skin. Because it uses ultrasound, the treatment can be performed in the physician’s office without anesthesia.  “There is no downtime and no scarring,” she said, “both of which are real benefits to the patient.”   Did she mention “no results”? Ok, I am being facetious, but let me explain.

This all reminds me of the Thermage™ treatment that was featured on the Oprah Show on two occasions in 2006.  It was touted as the “non-surgical facelift”.  It was also FDA approved.  Sounds too good to be true?  That’s because it was.  How many people do you know who had Thermage and looked years younger, like they had a face lift?  Don’t you think that this technology would be commonplace if it did produce the results that were advertised?

I learned this the hard way.  After the second Oprah airing of Thermage, our office phone rang off the hook asking “do you have Thermage?”  After researching it and seeing some seemingly impressive before and after pictures from the company, we bought the technology for $65,000.  After doing 10 patients, I stopped offering it.  Not only did it not meet my or the patient’s expectations (most could not see a result in their “after” photos), it was very painful.  It still sits in a back closet, never to be used again but a reminder to me when I evaluate new technologies.

There are numerous technologies out there that claim “skin tightening” or “non surgical facelift”, or “painless”.  They range from radiofrequency, to laser, to ultrasound.  All of these “work” by superheating tissues, which, like a burn, causes the body to respond with increased production of collagen.  This can have a subtle tightening effect but none come even close to plastic surgery.

Surgical facelift by Dr. Sev

Many companies use the scary cliché “under the knife” or “scarring” or “costly” to compare their technologies to plastic surgery.  Yes, I use a scalpel, but this gives excellent results because excess skin is removed and deeper tissues are directly suspended.  And there is no doubt about the results in my before and after pictures.  I perform most facial plastic surgeries in the office setting, using oral sedation and local anesthesia which keeps the cost at least half of those done in ambulatory surgery facilities.  (Our typical face and neck lift is about $5000).

There are technologies that do work for sunspots, redness, spider veins and complexion issues.  These include Intense Pulsed Light and Fractionated Lasers.  Fort Wayne men and women love these technologies, because they improve the texture and discoloration of skin, although with minimal or no skin tightening.

Ultherapy’s home webpage says “Do you want a little lift”? Look at their own before and after pictures (likely the best ones they have). They’ve got one thing right: there is a little lift.   I guess the question is how little of a lift are you willing to accept for procedures costing up to $4000?

To your health & beauty,

Dr. Sev

Stress: The wrinkles you have earned but wish you never had…

Have you ever noticed someone who ages dramatically in a relatively short period of time?  We see it in movie stars, Presidents, and yes, sometimes Mom.  Your mother’s “wrinkle genes” may not be the best predictor of how you will age.

A recent study in the medical journal of the American Society of Plastic Surgeons (ASPS) reveal that environmental factors can add years to a person’s perceived age.  In the study led by Dr. Bahaman Guyuron, MD, the pictures of 186 pairs of identical twins were studied by an independent panel recording the difference in perceived age between the two siblings.

The results showed that a twin with the following histories were rated as older appearing:   Smoking, alcohol use, antidepressant use and/or history of divorce.  These factors have one thing in common:  they all involve stress.

There are many diseases that are linked to stress, anxiety and depression.  The aging process appears to be, as well.  Here are some things to consider in decreasing stress and anxiety in making you stay younger and live longer:

• Read books by Wayne Dyer, Deepak Chopra, Eckhart Tolle and others.  These modern day spiritual teachers can really help with the overall anxiety of life.

• Exercise often.  Exercise releases natural endorphins that bind to receptors in the brain giving the feeling of well being, and we know that exercise is healthy.

• Get a pet! People with pets have been shown to live longer.  Just the act of petting a dog increases the levels of oxytocin in the owner and the dog!

• Do nice things for yourself, like, lets say, plastic surgery!  Looking better makes you feel better.  Feeling better means you are less likely to be stressed and less stress means less aging.

To your Health & Beauty,

Dr. Sev

Holiday Weight-Gain After Liposuction

In a recent study, over 200 patients who had undergone liposuction were surveyed for post-liposuction weight gain. It’s a hot topic this time of year because, even though liposuction permanently removes fat cells in the treated area, patients who overindulge during the holidays will gain weight.  This may be a result of the liposuctioned area not bulking up as much as it used to with overall weight gain.  This can lead to other areas of bulking, and overall worsening health.

The study showed that 25% of liposuction patients had lost weight and 32% had maintained their weight at the same levels as at their procedure. Translation: over half of liposuction patients either maintain their weight or lose more. This is great news! Unfortunately, 43% of patients in the survey gained weight. The greatest time for weight gain was in the 6-month period after their initial procedure and was primarily due to a lack of exercise!

With the holidays coming up, I’d like to share some tips for getting through them without packing on the pounds. Whether you’ve had liposuction or not, it’ll be worth the effort to welcome 2011 without extra baggage!

·      Eat before you leave

Whether you’re going to a dinner at someone’s home or a restaurant, or to a party, there will be lots of food. If you enjoy a small turkey sandwich on whole grain bread prior to leaving the house, the protein and carbs will keep you from going crazy later. You can still enjoy small portions of the foods you love (and everyone will admire your will power!)

·      Be watchful of alcohol

Alcoholic drinks have lots of empty calories, and they tend to dehydrate your skin, and the more you drink the more likely you’ll loosen up and eat too much. For every alcoholic drink, have a cold glass of water. It’ll keep you from overdrinking and overeating and it will hydrate you as well, helping stave off that morning hangover!

·      Get your zzz’s through the holidays

Studies have proven that when you get too little sleep, the hormone Grehlin increases, causing weight gain regardless of diet and exercise. It’s important to get your zzz’s so you can look your best, too!

·      Focus on Colorful Foods

Green and red veggies and fruits are your best bet when you’re at the buffet table or restaurant.  These are full of antioxidants and vitamins that will fill you with fewer calories.

·      Indulge on a Smaller Scale

To keep your weight down during the holidays, feel free to enjoy everything—just take less. If you choose smaller portions you can still take pleasure in all the goodies!

Feel free to share your best holiday weight-maintenance tips! We’ll post them on our Facebook page!

To your health & beauty, Dr. Sev

How To Spell Migraine Relief: B-O-T-O-X

Just yesterday, Michelle, a Botox patient, told me that she has not had a severe migraine headache for the last 10 years that she has had treatments for her frown lines. She tells me that when she begins to see the wrinkles return, she begins to have more slight migraines.  Michelle says her migraine headaches used to “lay me out” for up to a week.  She is so happy with her Botox treatments, both for the cosmetic improvement and in stopping her migraines from recurring.  I have heard this time and again.  What is going on?

Recently, the FDA approved the use of Botox for migraine headaches. This has always made sense to me from a anatomical standpoint.  Botox works by paralyzing muscles involved in facial animation.  The most common area is the corrugator or frown line muscles located above the eyebrows.  Botox is injected into the muscles, the muscles relax, and so do the creases in the skin they cause.

There are two cranial nerves that pass through this frown line muscle.  These are sensory nerves that travel directly to the base of the brain.  So with tense muscles around these nerves, there is an irritation that can develop into a migraine headache.  With Botox, the muscle is relaxed and the nerve irritation is reduced.  There are other areas of muscle irritation that leads to migraines in the temple and at the back base of the head.  These can also be treated with Botox.

The FDA approval is for patients who have at least chronic migraine headaches: 15 migraine headaches in a month lasting at least 4 hours.  This is the group of patients that was studied.  The FDA points our that Botox has not been shown to work for patient who have 14 migraine headaches or less a month.  This doesn’t mean that it does not work for these patients, it means this group of patients have not been study yet.  Anecdotally, most of my migraine sufferers have a decrease or cessation of there migraines, even if the migraines occur only “once in a while”.

Another development for treatment of migraine headaches is surgical treatment. I perform corrugator muscle removal for permanent decrease in the frown lines in my Fort Wayne plastic surgery office.  It turns out that removing a part of these muscles around the sensory nerves and replacing this area with fat graft is successful in decreasing migraines in over 90 percent of patients.  Again, like Botox, a cosmetic procedure that can help with a medical problem.   Although often an uphill battle, particularly because these are relatively new procedures for migraine headaches, insurance may cover Botox or surgery for medically documented migraine sufferers.  The best place to start is a neurologist to make the diagnosis and referral to a plastic surgeon who performs these procedures.

The Beauty Paradox

Most women are brought up to strive toward being authentic and true to themselves, but our culture encourages the denial of aging. It seems to be a paradox.  How does one reconcile a desire to be authentic with one to look more youthful and/or more beautiful?  These are real questions that each woman considering plastic surgery is confronted with.

Women are by design, beautiful and, by design, want to be beautiful.  I watch my wife and daughter do their hair, put on make up and jewelry, and wear nice clothing; all to look beautiful.  As I watch my mother age, I see that she continues this quest.  But, like my mother, some women feel that the hairstyles and color, make up, and jewelry just doesn’t make them look as young as they feel inside.  And yes, my mom had a face and neck lift.  I feel that my mother is able to project her authentic youthful self with ease.   Her youthful look matches her youthful person.  I would say she is being authentic to herself.

Now the aging question! I hear some women who are with a friend deciding on plastic surgery in my Fort Wayne office say that instead of plastic surgery ”I am just going to age gracefully”.  I think that is wonderful.  I do notice that the ones who say this are often in great shape, have a youthful appearance, and are particularly beautiful, inside and out.  Their outward appearance seems to match their authentic beautiful self.   For some, aging gracefully is looking as good as they can as they age, which may include plastic surgery.   And then there are those special people who are completely content with the way they are, inside and out, and accept aging and the physical changes it entails.

I do encounter those who feel emphatically that plastic surgery flies in the face of authenticity.  My answer is, if it does, then so does hair styling and coloring, make up, jewelry, and nice clothes.  These are all ways of making oneself appear more beautiful allowing authentic beauty to shine through.

Prioritizing Facial Procedures: Which Should Be Done First?

I have always said, “Beauty is in the eyes of the owner”. Since you “own” your face and look at it every day, the most important aspect of facial rejuvenation is what bothers you most.  The plastic surgeon’s job is to recognize this and then to suggest other areas that may enhance your youthfully harmonized result.  Let me explain.

The eyes, cheeks and lips, chin and neck are three distinct facial components that can age differently in different people.  Oftentimes a patient will come to my Fort Wayne plastic surgery office wanting a face and neck lift.  If the patient’s eyelids are droopy, but are not addressed during the procedure, after surgery the eyes may actually look even older in reference to a more youthful looking face and neck.  If the patient’s lips have deep creases, this will be more obvious after the cheeks and neck are smoothed and lifted.

So when you sit down with your plastic surgeon, it’s important to discuss the specific areas that are bothering you most but to be open to other areas that may be giving your age away.  An additional procedure like blepharoplasty (eyelid lift) or dermabrasion of the lips may be more affordable than you think and will help balance the more youthful age of your face.  If you can’t do it all, then less expensive noninvasive options may be available to improve the areas that you can come back to later.