August 7th, 2011
In the late nineteenth and early twentieth centuries quackery was personified by the Snake Oil Salesman. Just what was he? And, for that matter, what is Snake Oil? Snake oil is a traditional Chinese medicine made from the Chinese Water Snake (Enhydris chinensis), which the Chinese used to treat joint pain. When translated to our culture, it was never effective in controlling pain or anything else for which it was eventually sold. Therefore, the most common usage of the phrase is as a derogatory term for quack medicine. The expression is also applied metaphorically to any product with exaggerated marketing but questionable and/or unverifiable quality or benefit. In simplest terms, the Snake Oil salesman was a peddler who sold an unproven remedy for medical problems people had. They preyed on the unsuspecting who desperately wanted a cure for what ailed them, even if none existed.
Are there such people today? We would like to think not. We live in a scientific society and are sophisticated and knowledgeable. It should be hard to fool us. Besides, the FDA (Food and Drug Administration) was created in 1906 just to protect us from such. The unfortunate answer is that they are everywhere, just in different guise.
Today, exaggerated marketing for therapies, procedures, diets or products abound. These transcend all of medicine, but a large percentage of them are in the areas of cosmetic rejuvenation and lifestyle enhancement. This is partially because these areas are where people are already willing to spend their own money. The question is why they still exist. The answer lies in two basic facets of our present society and how complex it has become. We all need shortcuts in making decisions. Otherwise, we would never get anything done. One of the shortcuts we use is to trust authority. This works well as long as we are trusting real authority and what that authority is telling us is, indeed, factual. If the authority is not who he claims to be, or what he tells us is not factual, our shortcut fails us. The other problem is the sheer complexity of medicine itself. Here, the shortcut of consistency fails us. If a therapy or ingredient can do one amazing thing, to be consistent, we tend to believe it can do many other related things, when, in fact, it cannot.
Excellent examples of the latter are lasers and stem cells. Because lasers are extraordinary machines for some procedures, like resurfacing the skin to rid us of wrinkles or spots, when told they can also tighten loose skin and improve facelifts, breast lifts, tummy tucks or liposuction, we tend to believe they can. The truth is, they cannot tighten skin and those procedures done with the laser are no more likely to give a good result then those done other ways. Unfortunately, many of these myths get perpetrated by normally real authorities who have relied on another “authority” (the company selling the machine and the hype around it) without first checking the real data available.
Stem cells, too, are amazing cells and have fantastic, though yet to be proven, potential. Because Stem Cells have been found in liposuctioned fat, there is now a readily available source of them. Even then, they are quite sparse, concentrating them is very difficult and there is no data yet about what they are really capable of doing or, even, how to use them. Unfortunately, everyone has jumped on the Snake Oil Wagon and is touting wonderful rejuvenation, including Facelift, from the few cells injected, even without data that they make any difference.
In a similar vein, multiple hormonal therapies are offered based on one of their properties. Though not as popular as it once was, HGH (Human Growth Hormone) has been touted to build muscle and reduce weight. These are things it does help do, but only in conjunction with an exercise program and proper diet, which will accomplish your goals without the exogenous hormone. The new Snake Oil is HCG (Human Chorionic Gonadotropin) for weight loss. Again it is probably the accompanying diet alone (or the cost of the injections that cause you to adhere to the diet) that accomplishes your goal. The main problem with both these is the ancillary, unwanted effects they cause.
There are also multiple other unproven therapies out there, like Telomere Analysis, Mesotherapy, Ozone therapy, Platelet Rich Plasma for hair restoration and other things, and a multitude of “Marvelous” machines. These are all proffered by “authorities” in the field of cosmetic rejuvenation and lifestyle enhancement. They all have fancy certificates attesting to their expertise. The real question, as I said in a previous article, is who grants the certificate and, therefore, how much expertise do they really have.
So, since our normal shortcuts can fail us in this area, what do we do? To start, we need to question the expertise of the “authority.” How did they learn to do what they do, and who granted them their authority. Was it an American Board of Medical Specialists Board, such as the American Board of Plastic Surgery, or some other invented “Board?” Next, ask about the scientific data supporting the treatment, procedure or product. Has it been shown in multiple comparative studies to really be superior and to do what is claimed? Is the data specific for how it is now being used? If there are pictures, ask if they are typical and what else was done between the before and after. Also ask if the pictures are of the practitioner’s work. Remember, if it seems too good to be true, it frequently is.
Tags: Authority, Consistency, Exaggerated Marketing, FDA, HCG, HGH, Laser, Plastic Surgery, Quack, Quackery, Snake Oil Salesman, Stem Cells
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June 6th, 2011
Dr. Buchanan was recrntly quoted on RealSelf.com’s blog as an expert discussing the risks of Liposuction. The quote was from a comment he made elsewhere regarding this subject. To view the article go to the RealSelf Blog Post
Tags: Blog quote, Liposuction, Risks
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June 5th, 2011
Dr. Buchanan recently returned fron Boston where he attended the American Society for Aesthetic Surgery meeting. This is the largest gathering in the world of Plastic Surgeons specializing in cosmetic surgery. The meeting provides in depth education on all aspects of aesthetic surgery. Dr. Buchanan concentrated on new techniques in facial rejuvenation, Injectables, breast reduction and lift and Lipoabdominoplasty (Liposuction combined with Tummy Tuck). Not only did he attend the educational sessions, but could discuss the procedures with other Plastic Surgeons doing similar procedures. Additionally, he could peruse all the new products available to improve delivery the quality of care and results.
Tags: Aesthetic Surgery, breast lift, breast reduction, Cosmetic Surgery, Facial rejuvenation, lipoabdominoplasty, Plastic Surgery
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May 30th, 2011
Dr. Buchanan was featured on the front page of the Highlands Newspaper Memorial Day edition. The article highlighted his service in the early 70’s to the Marines in Vietnam during the US involvement there. The article discusses his experience there and how it impacted his abilities since. It also mentions use of these abilities later after the Oklahoma City bombing that resulted in his receiving the AMA Medal of Valor. For more see http://www.highlandsinfo.com/newspaperdownload.htm .
Tags: Dr. Buchanan, Highlands, Memorial Day, NC, Vietnam
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April 7th, 2011
Lynne Girard, Medical Esthetician for the Center for Plastic Surgery, in Highlands, North Carolina, was recently on the Expert Roundtable at a hands-on wellness weekend sponsored by The Old Edwards Inn in Highlands. The symposium focused on the art, science and inner wisdom of skin, beauty and confidence. The 3-day retreat drew a crowd of people who were eager to hear the panel discussions, as well as view individual demonstrations on health, fitness, lifestyle and anti-aging options. The Center for Plastic Surgery generously donated a beautiful basket with Obagi products and gift certificate to introduce the advantages of anti-aging through proper skin care.
Tags: aesthetician, anti-aging, esthetician, fitness, lifestyle, Obagi, Old Edwards Inn, Skin Care
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April 7th, 2011
As Plastic Surgery becomes more popular, many misconceptions arise. Part of this is due to popular media that does not always research their subjects thoroughly before publication and how TV and the movies portray it to make their plots work better. I thought that I would try to deal with some of the most prevalent ones.
1. All “Board Certification” is the same. In fact, it isn’t. If I wanted to create a
“Board,” say for “Laser Zit Removal,” it would cost me just a few dollars in Raleigh. I could then issue “Board Certification” to anyone I wished. The original Boards, of which the American Board of Plastic Surgery is one, are certified by the American Board of Medical Specialties (ABMS). The only other Board certifying any cosmetic surgery is the American Board of Otolaryngology for facial cosmetic. The American Boards of Facial Cosmetic Surgery and Cosmetic Surgery are not overseen by the ABMS. Certification by an ABMS Board requires meeting vigorous, ongoing standards.
2. Only surgeons certified by the American Board of Plastic Surgery can legally do Plastic Surgery. In fact, anyone with a medical or dental license can advertise and perform Plastic Surgery. This is almost always done outside a hospital, since most hospitals require some certification in the procedures performed. Highlands-Cashiers Hospital requires certification by an ABMS board in the procedures done.
3. All Plastic Surgery is performed in a facility certified as safe. As stated above, many physicians, in order to avoid hospital privileging, do their surgery in an office setting. Many of these facilities have no oversight, since certification of the facility is expensive and requires hospital transfer agreements and physician privileging. Both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery require their members to do all surgery with sedation or anesthesia in a certified facility. Highlands-Cashiers Hospital maintains Gold Seal Approval by the Joint Commission, the oldest certifier.
4. Plastic Surgery is only for the rich and famous. While this was somewhat true in the beginning, most people having Plastic Surgery are just like you. We now have ways of dealing with whatever bothers you that fit every pocketbook.
5. Extreme Makeovers are routine. Though TV has made it seem like remaking the entire body is the norm, in fact, it is quite rare and most people have only one area treated at a time.
6. It is disrespectful to ask the surgeon tough questions. Most physicians expect hard questions. We look upon them as an indication of how involved you are with your care. With surgery, especially, we see it as further proof that you understand the procedure and that your consent is truly informed.
7. It is inappropriate to speak to former patients. While simply giving you the names of patients to call violates patient confidentiality, many patients are quite happy to discuss their procedure with you. We encourage this if you are having trouble deciding about a procedure, as it gives a totally unique prospective.
8. It is inappropriate to ask about results and risks. Not only is this NOT inappropriate, it is imperative that you do. The only way you can decide between several options that are frequently available, is to know everything you can about each. Also, choosing a surgery or procedure really entails making sure the benefits outweigh the risks, The only way to do this is to understand both. It is also important to know what a particular surgeon’s problems have been, as they sometimes vary from surgeon to surgeon. We keep before and after pictures available so you can evaluate the possible results, but you must translate these to what the procedure can do for you.
9. Plastic Surgery procedures cost the same no matter who performs them. Not true. They vary greatly, but you generally get what you pay for. Recently a number of people died or were hospitalized because they sought cheap Botox. The “Botox” used, to reduce the cost, was a nonstandard fake. Where I used to live, a family practitioner did Breast Augmentation cheaper than anyone in town. He did this by using poor quality, non-approved implants in a non-certified, unsanitary OR, and allowing only three visits. If his patients had a problem or question, he told them to “see a Plastic Surgeon.”
10. Plastic Surgery is based on looks, not science. This is really not true. Most Cosmetic Surgery procedures are based on reconstructive ones. All those are based on extensive research. Plastic Surgery has, for many years, led the way in developing new procedures and techniques. Plastic Surgery developed tissue transplant technology in an effort to improve wound coverage. Presently, we have discovered that the fat removed during Liposuction contains multipotential stem cells. Research is trying to determine how we can best use their potential. Even “standard” procedures are changing as we examine our results and change our methods based on those findings. This is why I totally changed my Facelift technique nine years ago. I went to a technique that did not result in the problems I saw with the “standard” one. I continue to evolve it based on further observation.
11. Silicone Breast Implants have not been scientifically proven safe. This was the contention in 1992 when they were withdrawn from the market. After more than fourteen years and exhaustive research that proved them safe, they were released again. There is now more data on these than on almost any other medical device known.
Tags: American Boarb of Plastic Surgery, American Board of Medical Specialists, Board Certification, Extreme Makeover, Joint Commission, Myths, Plastic Surgery, Silicone Breaast Implants
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March 12th, 2011
The Medi-Spa at the Center for Plastic Surgery offers a unique combination of traditional spa services and medical aesthetic treatments designed to actually reverse the skin damage to help you look and feel your very best. Medical Spas like ours are a relatively recent addition to what is available to you to improve your skin. As Plastic Surgeons recognized that surgery alone could not rejuvenate the face, we sought other methods. We soon recognized that advanced skin care was not available in normal spas, but the experience people had there was well worth imitating.
Day spas and resort spas can offer only services that are allowed by their licensing boards. Whatever treatments they do provide cannot actively change the skin cell and the products used cannot be prescriptive. While the treatments they do provide are all that many people with minimal skin damage need, those with more damage require advanced treatments and prescriptive products to make any real difference. Anything less merely camouflages the damage instead of rejuvenating the tissues. A Medi-Spa fills this gap by offering prescriptive products and advanced services under the guidance of a physician.
At the Medi-Spa, clients can relax and are pampered just as in a regular spa, but are assured that only the finest quality ingredients with proven efficacy are used during any of their treatments. All European Facials include a warming hand treatment, facial skin analysis, steam and a deep exfoliation process followed by extractions of small cysts or other imperfections if necessary. Facial massage, acupressure, and lymphatic drainage are used as needed followed by a custom blended mask suitable for each individual skin type.
Medical grade skin treatments offered in a Medi-Spa setting can also include DermaPlaning, a skin scraping treatment to eliminate dead cells on the surface of the skin, or aggressive Microdermabrasion treatments, a sanding exfoliating process to achieve similar results.
Glycolic and Lactic acid treatments can be used also as a chemical reaction for the elimination of dead cells, and they can stimulate collagen, the building block of healthy skin. In order to achieve the depth of penetration an acid peel must have to do both, an esthetician working under the supervision of a physician is required. They are trained to know what to look for while performing these treatments. This markedly reduces the risk of serious injury or discomfort.
Many times the esthetician will recommend additional treatments that only the doctor can provide, or she may simply suggest a scheduled visit with the doctor to discuss further treatments. These additional treatments can include IPL (intense pulse light) treatments to correct red or brown areas, Laser and deeper chemical peels such as TCA (TriChloroAcetic acid) or Phenol/Croton Oil that can even rejuvenate leather-like skin, or injectables such as Botox, Juvéderm or Radiesse to erase deeper wrinkles and folds.
A new treatment in our Medi-Spa is the Zerona machine. This is the only FDA approved non-invasive body slimming Laser device that can painlessly and without surgery achieve clinically significant loss of fat in just two weeks.
Whether you have put off skin care or body issues in the past, or whether you are new to services that are provided at a Medi-Spa, now is the right time to start taking care of you.
At the Medi-Spa at the Center for Plastic Surgery, you are made to feel pampered and relaxed. Lynne Girard is our highly qualified esthetician who has twenty-five years of skin care expertise and medical skin care training
Call the Medi-Spa at the Center for Plastic Surgery at 828-526-3783, or toll free at 877-526-3784 our caring and friendly staff to schedule a consult or an appointment or for more information.
Tags: advanced skin care, chemical peel, European facial, Medi-Spa, medical spa, Microdermabrasion, noninvasive laser fat reduction, skin damage treatment, Zerona
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January 31st, 2011
Cosmetic remodeling and rejuvenation of the eyelids has changed dramatically in the last few years as we have better defined the anatomy of the area, the forces on these and how changes occur over time. This has allowed us to developed better techniques that provide results that are more natural.
Both aging and inheritance cause cosmetic problems of the eyelids. Those due to aging are, by far, the most common. They result from changes in both the lids themselves and the surrounding tissues. Unfortunately, until very recently, all modification of this area was to treat the external appearance, not to correct the cause, return the tissues to their natural positions, or provide support against further change.
Direct aging of the eyelids results in loose, crinkly skin with all the other signs of aging that the skin in general exhibits. All the other changes are due to aging of the surrounding structures. Several things determine the eventual appearance. The most obvious is gravity. It, and the muscles surrounding and within the lids, constantly pull on the lids and the tissues around the eyes. How these respond depends on the strength of the support structures and their attachments.
The two muscles most responsible for the appearance around the eyelids are the same ones that make us look angry and/or tired. They cause lines between the brows and in the medial lid area and, because of deep attachments medially, the brow to fall more laterally. This worsens the wrinkled appearance laterally and pushes the brow into the upper lid, causing loss of youthful definition of the area.
As gravity pulls on the lower lids, ligaments to the underlying bone cause bulging of the orbital tissue, including fat, and flattening of the cheek.
The fat, and even the bone of the orbit, atrophy with age. This adds to the cosmetic deformity. Previous techniques to rejuvenate the eye removed the fat that appeared to be bulging. Since that was not really the problem, and the residual fat and other tissues continued to atrophy, the eye eventually looked sunken and hollow.
The last change of aging of the lids is stretch of the tendon that attaches the lateral corner of the lids to the bone. This causes the eye to appear less wide and rounder.
To reverse these changes, we first look at what has caused your problem. If the brow is the cause of your upper lid problems, then a brow lift may be all that is needed. If there is still too much skin in the upper lid, then removal of the excess usually solves the problem. Previously, when we avoided the brow and just removed skin and fat, we actually made the problem worse, since removing enough skin to make a difference, actually pulled the brow down further.
Instead of removing fat as we did until just a few years ago, I use the fat to fill areas of tissue loss. In the lower eyelids, instead of simply removing what appeared to be excess skin from below the lids, I now remove it mainly beside the eye after elevating the eyelid and the entire cheek. This tissue is stabilized to the bone to keep it from falling again. The corner of the eye is also resuspended to bone in its normal position. This not only returns the youthful appearance to the eye, but is safer than the older procedures.
Congenital problems are due mainly to abnormalities in the amount of fat in the lids or the way the upper lid muscle attaches to the skin. Fat can be either too plentiful or lacking. Lack of proper muscle attachment causes droop of the lid or an exaggerated oriental appearance. The problem determines the correction.
Tags: aging, Blepharoplasty, brow, brow lift, congenital, Eyelid, eyelid lift, lower blepharoplasty, natural correction, rejuvenate, Upper Blepharoplasty
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January 12th, 2011
Dietary advice may not sound like something you would get from your Plastic Surgeon, but it is a natural extension to what we do, which is lifestyle enhancement. One of the best lifestyle enhancements is to have the proper waist.
Food is one of the most powerful drugs around. It creates a hormonal response. Controlling this response is necessary to achieve proper health. “Diets,” intended to do this do not work. One of the main reasons for this is that our brain becomes accustomed to a specific taste. When you “go on a diet,” you still crave what you like and eventually revert to that taste. This results in the classic “yo-yo effect.” The trick to losing waist is to change what you like. Instead of dieting, make one little change each meal and each time you visit the store until your waist is <32 inches if you are female, or <35 inches if you are male.
An example of this is going from drinking sweet tea to drinking tea with no sweetener. Start by using ¼ to ½ tsp of sugar less, and drink your tea that way for several days. Then remove another ¼ to ½ tsp and drink it that way for a while. Continue this every several days until you are drinking unsweetened tea. Do not substitute a sweetener, as you will not change your taste. Do the same thing with foods. As an example, for pasta, switch some white pasta for half as much whole wheat and cook it a half minute less. Keep repeating this until you have half as much pasta that is all whole wheat and very al dente. You have changed the quality of the pasta by substituting whole wheat and by cooking it less. Both make it harder for the bowel to extract sugar. By doing so, your blood sugar will not rise to where you excrete insulin, which drives the sugar into the cells as fat. Additionally, you have cut your preferred portion in half. This changes both the quality and the quantity of your food. Doing either by itself will not achieve your goal.
Learn to recognize the proper proportion of the foods types and the proper portion size of each. For most people, Carbohydrates make up 70-80% of the calories in each meal. CARBOHYDRATES should constitute only 40 % of the calories. PROTEIN and FAT should each make up 30 % of the calories. It is the fat and protein that make you feel satiated. Therefore, you can feel satisfied with less.
Reduce Saturated fat (found in animal fat, and Dairy) and eat NO trans-fat. The low fat emphasis a few years ago actually made us fatter. Good fat is essential in our diets. When companies removed fat indiscriminately from products, they substituted sugar. This is absorbed rapidly from the GI tract, driven into the cell by insulin, and converted to fat.
Eating five (5) small meals a day (or three [3] meals and two [2] snacks) maintains a steadier metabolic rate along with drinking at least eight 8 oz. glasses of water to aid in efficient digestion. Generally a protein serving should be no larger than a pack of cards (3 ounces). The remainder of the center of the plate should be high fiber, low glycemic carbohydrates, and the proper fat. Avoid as much as possible any carbohydrate over eighty (80) on the Glycemic Index (available on the internet or in many diet books).
Eat non-processed food. The fresher and more colorful the better (more nutrition and antioxidants). Buy Groceries from along the outside walls. Do not go down the aisles except to buy staples, such as spices.
Use NO ADDED SALT and observe the amount in purchased foods. Gradually reduce your salt intake as you did your sugar.
If you want a dessert, choose less sweet ones with protein and fiber and reduce calories elsewhere. Instead of right after a meal, use it as a snack.
Once you are on a proper diet, exercise at least three (3) hours per week, including muscle building types of exercise. This further speeds loss of waist. If you are not on a proper diet, exercise will do you no good. The wrong diet, as mentioned, causes the body to absorb sugars rapidly. The secreted insulin not only drives the extra sugar into the cell, it blocks both glucagon and growth hormone that are released by exercise from pulling fat from the cell.
To find out more about how you can improve your lifestyle or your outer self, call the Center for Plastic Surgery for a consultation at 828-526-3783.
Tags: carbohydrate, diet, dieting, enhancement, exercise, fat, lifestyle, low glycemic, muscle building, processed food, salt, saturated fat, sugar, waist
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December 24th, 2010
The majority of what is generally considered skin care are habits passed down from one generation to the next or products containing a minimally or non-effective form of the latest ingredient shown to improve the skin. Almost none is based on a thorough understanding of the skin, its aging or how to reverse this aging. In fact, most of what we do to our skin is actually harmful. Take, for instance, moisturizers. Almost everyone uses them because we have been told that we should. In fact, moisturizers are one of the worst things we can put on our skin. They disrupt the normal protective barrier by modifying the surface lipid content, and they weight the skin down, markedly accelerating wrinkle development. More of what we should do instead later.
Skin ages in two distinct ways. First, certain changes occur to all of us. For one, our cells just stop or markedly reduce the efficiency of actively renewing the structure of our skin. This generally occurs around 30 years of age. Our genes determine the time this occurs and the speed of other aging effects. The second type is “solar aging.” This is the direct result of sun damage. Our habits affect both. Studies of twins demonstrated that certain skin care methods, sun exposure, and smoking markedly increased skin aging. Sun exposure causes predictable changes to the skin. Smoking speeds these changes about 20 fold. Improper skin care can also increase these changes.
Sun damage causes:
• Thickening of the outer dead cell layer. This is, in childhood, very thin. The thicker this layer is, the dryer the skin feels.
• Loss of moister of the living layer
• Spotty distribution of pigment (freckles, dark areas and spots)
• Change in the cell nucleus in the layer of reproducing cells. This can lead to rough spots or skin cancers.
• Loss of the normal blood supply of the skin. When this happens, the aging process speeds up.
• Production of abnormal small blood vessels. This is a form of “Rosacea.” The only effective treatment for this is an IPL (Intense Pulsed Light) or Laser.
• Loss of collagen, the support of the skin. This, together with the weight of the outer dead layer, results in wrinkles.
Our genes determine which of these predominate. Thus, one person may show mainly spots and another, wrinkles. The trick is to determine what problem exists and how best to correct it. Once corrected, we need to prevent any further damage. Therefore, a part of any skin care regimen should be protection from further sun damage. Presently, there is only one product that blocks both UVB (causing sun Burn) and UVA (causing skin Aging) and is practical. This is micronized Zinc Oxide (which goes on clear). You need to apply this only once a day unless you wash or wipe it off. You should use a product containing at least 5% of this every day, since UVA is present all day, every day. An article in Oprah Magazine described sunblocks as “the closest thing we have to a Fountain of Youth.” In addition, the young need only a good cleanser and something to return the skin pH to normal after washing. Some pH balanced Toners will do this. However, we prefer products like Vitamin C Serum or Prevage MD®, since each is also an antiinflammatory and an antioxidant, thus also providing further sun protection.
Once the dead cell layer thickens and the skin begins to feel dry, we need to add a step to reduce this layer and restore the normal moist feeling of the skin. You can do this with regular use of alpha hydroxyl acids (AHA’s) that are in many over the counter products, or frequent micro-peels, dermaplaning, or microdermabrasion. All these are available in our office and Medi-Spa.
As the amount of sun damage increases, we must address the other problems. Several products can reduce spots. Many work well for minimal spots, but the ultimate spot remover is hydroquinone. Occasionally a peel can increase the color correction. Although several magazines have touted retinols as conjuring up “a prettier complexion while you sleep,” only prescription Retin-A (tretinoin) has actually been shown to do so. It reduces the stickiness of the dead cells, vascularizes the skin, and causes thickening of the skin that reduces wrinkles.
Since our skin is designed as a barrier, the challenge has been to get these products to the cells where they can act. No product by itself can do this. However, when combined into a system, so that they penetrate to the cells deep within the skin, we increase their effectiveness significantly. To totally rejuvenate the skin, we at the Center for Plastic Surgery, therefore, use only total skin care systems where all products are designed to work together and have FDA approval as being effective in skin rejuvenation.
Tags: IPL, Medi-Spa, Microdermabrasion, Moisterizers, Obagi, Peels, Prevage, Retin-A, Rosacea, Skin aging, Skin Care, Skin rejuvenation, Sun Damage, Vitamin C
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