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209 Hospital Dr #202
Highlands, NC 28741

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Learning from Sleeping Beauty

Learning from Sleeping Beauty

It looks like there’s more to life lessons and happily-ever-afters that fairy tales are trying to teach us when it comes to aging gracefully. Take, Sleeping Beauty, for example. This recent study by physician-scientists at University Hospitals (UH) Case Medical Center was able to conclusively demonstrate that lack of sleep could accelerate aging and decrease the skin’s ability to recover from sun exposure.

They Don’t Call it Beauty Rest for Nothing

While it has been known for a while that chronic lack of sleep could negatively affect your looks, the aforementioned study was the first research to actually support such theory with a solid scientific data. Interestingly, they even figured out that it’s not just about the number of hours you devote to your bed, the quality of sleep also plays a significant role.

The Action Plan

To help you snooze your way to younger looking skin, we recommend the following steps:

1. Create a sleep-friendly atmosphere. A dark, quiet, and cool environment works for most people. Figure out what works for you and work towards creating the right setup. ]

2. Sleep and wake up at the same time. By doing so, your body will be able to adapt to your sleeping pattern.

3. Limit exposure to PC,  gadgets and television. This study found out that giving up on your PC and TV habits before bedtime could help you reduce your sleep debt.

Let us help you figure out the best solution for your aging concerns — from crow’s feet to sagging facial skin. We are located at 209 Hospital Drive, Suite 202, Highlands, NC.  Call us at 828-526-3783 or fill out this contact form to schedule an initial consultation. We look forward to your visit!

Your Exercise Could Be Making You Look Older

Apart from time itself, aging is influenced by a variety of factors — from sun exposure to nutrition to one’s lifestyle. However, did you know that your workout could actually make you look older? Find out why below.

Premature Aging

High-impact exercises such as running could actually make you look older by making your skin thinner, resulting to that prematurely old and gaunt appearance. Increase intake of oxygen also makes those wrinkles appear earlier than usual. Add in prolonged exposure to the sun and fluctuating levels of temperature and your collagen easily degenerates.

Bouncing Breasts

Ill-fitting sports bra and too much exercise may cause your breasts to sag as they are constantly bouncing up and down while doing your workouts.

The Action Plan

You do not have to stop exercising in order to avoid sagging breasts and premature aging. Here at our North Carolina plastic surgery practice, we recommend the following tips and tricks to make your workout more enjoyable and less stressful on your end.

1. Consider trail running over road running. The trails offer less pollution and less impact (which also means less risk of injury).

2. Slather on sunscreen before going out and always follow label instructions as to the amount and timing of application.

3. Wear proper support.

If you’ve been exercising for a while now and you’re noticing obvious signs of aging, let us help you out! We have a variety of anti-aging options suited to your needs and preferences.  We are located at 209 Hospital Drive, Suite 202, Highlands, NC.  Call us at 828-526-3783 or fill out this contact form to schedule an initial consultation. We look forward to your visit!

Don’t Let Crow’s Feet Bring You Down

So you wake up one morning and looking at the mirror, you suddenly discover that you’ve got those unflattering wrinkles around your eyes! Ugh, you’ve got crow’s feet! One of the most effective ways to avoid crow’s feet from happening is to never squint, frown, smile or even laugh! But that would be next to impossible.

Here at our Highlands plastic surgery practice, we have a solid plan to help you bring those crow’s feet down and not the other way around!

1. Slow down on your smoking habits. It’s quite known that smoking accelerates aging so the lesser you smoke, the lesser your chances of aging faster.

2. Keep your moisture levels up, both from the inside and the outside. Increase your fluid intake and do not just wait for that feeling of thirst to drink up. On the other hand, moisturize the area around your eyes before you tuck yourself to bed. Eye creams actually work better in preventing crow’s feet rather than treating existing wrinkles.

3. Consider non-surgical cosmetic procedures if you already have crow’s feet. Botox and dermal fillers are designed to significantly help erase those lines around the eye area.

Let us help you figure out the best solution for your crow’s feet and other aging concerns. We are located at 209 Hospital Drive, Suite 202, Highlands, NC.  Call us at 828-526-3783 or fill out this contact form to schedule an initial consultation. We look forward to your visit!

Non-Cosmetic Eyelid Problems

Medical problems of the eyelids are exceedingly common.  They are exceptionally problematic because they disturb the proper function of the eyelid, which, in turn, can affect our vision, cause dry eye, or cause headache.  They can be divided into those intrinsic to the eyelid and external problems that just happen to occur on or to the eyelid.

Intrinsic eyelid problems may be due to muscle abnormalities of the eyelid or laxness, scar, or malposition of the eyelid itself.

Perhaps the most common problem of the eyelid is droop or ptosis.  This problem can be either extrinsic or intrinsic.  Intrinsic droop of the upper eyelid is secondary to an abnormality of the muscle holding the eyelid up.  This is complicated by the fact that there are actually three muscles that elevate the upper eyelid.  The most common problem occurs when the levator, the voluntary lid elevator, stretches and becomes lax with time.  We see this very commonly in people seeking cosmetic improvement of the eyelids.  This muscle is easily accessed through a regular blepharoplasty incision and requires only a few stitches to imbricate it and elevate the eyelid to a normal position.  Another common cause of droop seen at the time of cosmetic consultation is that from descent of the brow.  Although it is most commonly due to gravitational pull on the brow, which causes the tissue from above the eyelid itself to descend into the eyelid, pushing the eyelid down, it can also occur from weakness of the frontalis muscle, the muscle that elevates the brow.  Usually this is corrected with some type of brow lift procedure which pulls the tissues back into the brow where they belong and out of the eyelid, thus allowing the lid to assume its normal position. With the popularity of Botox®, we also occasionally see ptosis from weakening of the muscle s holding the eyelid up. Fortunately, this will resolve when the Botox® wears off.

The third muscle that controls eyelid position is Muller’s muscle.  This is a muscle that is not voluntarily controlled but controlled by the sympathetic nervous system.  It normally holds the eyelid in the correct position while you are awake, but it allows the eyelid to close when you become sleepy.  Occasionally it also becomes stretched and fails to hold the eyelid in its normal and open position.  When this occurs, this muscle is approached from the inside of the eyelid and shortened by removing a strip of conjunctiva and muscle from the back side of the lid.

Several problems occur to lower lid from either stretch of the lid itself or tightening of one of the layers of the lid or both.  Of these, ectropion, eversion of the lower lid away from the globe, is most common.  Mild forms can cause dry eye.  More advanced forms cause chronic irritation of the lining of the eye and lid, with redness, swelling and occasionally even weeping.  If left untreated, this can even cause blindness.  This condition therefore needs to be treated early by simply taking out the excess lid length, adding skin to replace scar (usually from removal of a skin lesion), or both.

The opposite of an ectropion is an entropion where the lid turns inward.  Frequently the most symptomatic part of this is what is known as trichiasis, or irritation of the eyeball from the eyelashes scraping against the globe or cornea.  This condition is usually from some type of scarring of the internal layers of the eyelid following some type of surgery.   Correction usually involves a graft of some description to release the scar.

Perhaps the most common problem in the eyelids is the presence of either malignant or nonmalignant lesions on the eyelid itself.  Benign lesions generally require no treatment unless they are causing problems with function of the eyelid or are simply cosmetically undesirable.  The one exception is verrucae, better known as warts.  These lesions occur when a virus enters an otherwise benign lesion and begins growing.  This can cause a very large, irritative lesion that can interfere with function of the lid, bleed, or become otherwise problematic.  These are treated essentially like malignant lesions in order to make certain that all of the cells containing the virus are removed.

Premalignant and malignant lesions, however, such as actinic keratoses, basal cell epithelioma and squamous cell carcinoma, all do require treatment to prevent destruction of the eyelid.  These are more easily treated on the loose upper eyelid skin.  On the lower eyelid simple excision can cause ectropion or other functional abnormalities of the eyelid.  Therefore, frequently a skin graft or flap which moves tissue from a looser area into the tighter lid may be necessary in order to prevent problems in lid function.  This is one of the places where Moh’s surgery is exceptionally useful.  Moh’s removes the lesion with exceptionally small margins and then makes certain, by microscopic examination, and further resection if necessary, that the margins are totally free.  This allows removal of as minimal an amount of lid skin as possible.  This procedure is done by a specially trained dermatologic surgeon.  We generally then do the closure to assure that the eyelid continues to function properly.

Lesions near the lid margins are especially problematic because immediately under the skin at the margin is a thick, cartilaginous structure called the tarsus.  Here the skin cannot simply be excised but requires grafting, a flap, or complete transection of the entire lid and tarsus in order to remove the lesion and close the defect.

In summary, there are multiple problems that can occur to the eyelids.  Some of those problems have multiple causes.  Therefore, when evaluating a problem, the underlying cause needs to be determined in order to select the most reasonable method for correcting the problem.

Breast and Face Procedures Soar High in 2012

The American Society for Aesthetic Plastic Surgery (ASAPS) recently released its annual multi-specialty procedural statistics. The figures revealed that there were approximately 10 million cosmetic procedures done by U.S. board-certified plastic surgeons in 2012. Breast augmentation and Botox topped the surgical and non-surgical categories, respectively. In the Highlands-Cashiers area, Dr. Robert Buchanan is a top-notch North Carolina plastic surgeon concerned with not only the results but patient care and recovery at the same time.

Top Surgical Cosmetic Procedures in 2012
With approximately 1.7 million procedures performed, cosmetic surgical procedures rose to 3 percent than that of last year. As lifted from the report, the top cosmetic procedures in 2012 include:

  1. Breast Augmentation: 330,631
  2. Liposuction: 313,011
  3. Abdominoplasty: 156,508
  4. Eyelid surgery: 153,171
  5. Rhinoplasty: 143,801

Leo R. McCafferty, MD, President of the American Society for Aesthetic Plastic Surgery attributed the increase of breast augmentation demand  to the increasing popularity of silicone implants. Recently in February, the Natrelle 410 implant ( a type of silicone implant) by Allergan received FDA approval.

“According to the Society’s statistics in 2006, 383,886 breast augmentation procedures were performed and of those 81% were saline implants and 19% were silicone.  In 2012, 330,631 breast augmentation procedures were performed and of those only 28% were saline implants and 72% were silicone.”

Top Nonsurgical Cosmetic Procedures in 2012
On the other hand, minimally-invasive cosmetic procedures rose to 10 percent than the figures in 2011. Of the 8.5 million nonsurgical procedures performed, the top 5 procedures were:

  1. Botulinum Toxin Type A
  2. Hyaluronic Acid
  3. Laser Hair Removal
  4. Microdermabrasion
  5. Chemical Peel

“For the past 16 years, the interest in and demand for cosmetic plastic surgery has risen exponentially, a 250% increase in surgical and nonsurgical procedures, and our comprehensive statistics continue to show that,” Dr. McCafferty, MD added.

The Center for Plastic Surgery in Highlands, North Carolina
We invite you to explore your cosmetic options with us! We perfectly understand that cosmetic surgery is not just about improving the physical aspect but making you feel better about yourself, too.

Dr. Buchanan has hospital privileges at both Highlands-Cashiers Hospital and at Harris Regional Hospital in Sylva.  The procedures are performed either in his office or at Highlands-Cashiers Hospital.  We are located at 209 Hospital Drive, Suite 202, Highlands, NC.  Call us at 828-526-3783 or fill out this contact form to schedule an initial consultation. We look forward to your visit!

Defeating the Tired, Angry Look

Have you been told you look tired or angry? A furrowed brow may be the problem. While the brow can express curiosity, it can also convey anger and tiredness. When your brow conveys other than your feelings, you may decide something needs to be done.  What is required to correct the problem depends on the cause.

Three things affect the brow.  First, the underlying muscles frequently hypertrophy and cause unintended expressions, even if we are not tired, curious or angry.  Second, gravity causes the brow to descend giving us a tired, sleepy look.  This is frequently made worse by muscle overaction, which tends to also pull the brow down. The third force that affects the brow is the sun, which causes the skin to age and thin.  As the skin thins, the lines created by both descent of the brow and muscle action become indelible and are constantly present, even without the causative force.

Many people say that they seemed to have no problem, and then, suddenly, over a short period, noticed aging around the brow.  This is generally because the frontalis muscle (overlying the brow) retains normal brow position against the forces of aging.  When this muscle finally becomes tired, the brow descends.  This is also why we frequently look better in the morning than we do at night, since the frontalis muscle is fresher in the morning.

Of all the forces that happen to the brow, the easiest to overcome are those of muscle function.  This is why Botox® has become so popular.  Botox® was, in fact, first used cosmetically to treat the lines between the eyebrows.  These lines are caused by two different muscles which pull the brows together as well as down, causing both vertical lines between the eyebrows as well as horizontal lines in the upper part of the nose. By injecting these muscles with Botox®, before they have formed permanent creases within the skin, the lines can be eliminated.  Likewise, the lines around the lateral eyes (the “crows’ feet”) can be eliminated or markedly reduced by injection with Botox®, if there are no permanent lines there. Since this muscle also pulls the brow down, blocking it can cause brow elevation.  Transverse forehead lines can also be reduced or eliminated with Botox®; however, one must be exceptionally careful since frequently the reason that the lines are present is that the underlying muscle causing them is holding up the eyebrows.  Therefore, if the muscle is relaxed, the eyebrows drop significantly.  Sometimes this can be balanced by also treating the muscles that are pulling the eyebrow down. These two injections tend to negate each other as far as brow position, but eliminate the wrinkles.

When the lines are permanent and the use of Botox® will not eliminate them, then a filler such as Juvéderm® or Radiesse®, can plump up the line and eliminate it. Although it is possible to eliminate the line somewhat with just the filler, it is usually best to eliminate the cause, which is the muscle, as well as to fill the resultant crease or fold.

Once the process has evolved to where the lines cannot be eliminated without dropping the brow, then the only option is a brow lift.  Fortunately, this procedure has changed dramatically over the last number of years.  Initially, the muscle lifting the brow was paralyzed and the brow pulled up with an incision across the entire forehead, just behind the hairline.  This gave a very unnatural appearance.  It also caused numbness in a great deal of the scalp.

Presently the procedure is done using an endoscope (a small lighted tube connected to a video screen) through small incisions in the hairline between the nerves. This simply repositions the brow as well as removes the excess muscles that are causing a lot of the lines in the area between the eyebrows.  This method also allows us to pull the tissues up more laterally, recreating the normal eyebrow arch, pulling the brow skin out of the upper eyelid and eliminating a lot of the crow’s feet. Thus, the procedure generally eliminates the need for Botox®.

Many of the people who see me seeking upper blepharoplasty to remove the excess skin in their upper eyelids need only a brow lift to elevate the skin of the brow back to where it belongs, pulling it out of the upper lid.  This restores the normal curve laterally and removes a great deal of the skin within the lid.  Even if there is extra skin, the amount that needs to be removed is minimal.

This has prevented one of the major stigmata of upper blepharoplasty, the hollow eye.  When a needed brow lift was not done, the tendency in the past has been to simply resect lots of fat to try to recreate a normal looking lid.  This was never totally successful and created an upper lid that looked quite gaunt.  By pulling the tissues upward and laterally and flattening the crows’ feet, we can improve the lateral orbits significantly better than with just a blepharoplasty alone.

The brow thus has the potential of making us look quite old, tired, or angry, or it can make us look young and rejuvenated.  The approach to achieving this varies by the underlying cause and can be as simple as minimal skin care or injection or as complex as brow lift combined with an upper blepharoplasty.

Dr. Buchanan is experienced with both injectables, including Botox®, Juvéderm®, and Radiesse®, as well as skin care, brow lift and blepharoplasty.  All of his brow lifts are done endoscopically through very small incisions, with very rapid recovery and almost no bruising.

Study shows longevity of Facelift

More than 75% of patients who had a face-lift looked younger than they did before surgery more than five years later, according to a study in Plastic and Reconstructive Surgery. Though the patients did show signs of aging, their jowl area, chin-neck angle, nasolabial folds and overall appearance looked better. Standardized images of 50 patients were assessed for the study. The study was reported generally by United Press International.

Sun Protection

Almost all of us will agree with the concept of sun protection. After all, we know that the sun causes sunburn, aging and cancers of the skin. The problem is that most of what we are told and have used will not accomplish the protection we need. A portion of the Sun’s emitted electromagnetic spectrum, namely radio waves, some infrared, visible light and some UV waves, penetrates the atmosphere to strike us. All but UVA and UVB are considered harmless.

For the last 30 or 40 years, we have worried about UVB rays because we could see their effects. They are absorbed easily by the atmosphere and anything else they hit. They are, therefore, strongest when they come straight through the atmosphere, down south, midday in the summer. If they strike us, they are absorbed quickly within the outermost part of the skin where they make our skin feel hot, and, if we get enough, cause sunburn. The first sunscreens were developed to block UVB and prevent sunburn. They did a good job at this, some better than others. To inform us how good each was, the FDA created a system that rated their performance. This is known as SPF or Sun Protection Factor.

For years, we thought that the heating and burning of the skin was what caused all the damage and eventually led to skin aging and cancer. This caused us to hypothesize that, since most sunburns occurred when we were young, all the damage was done then. We now know better. UVA penetrates the atmosphere almost as well as light. It is, therefore, present dawn to dusk, summer and winter and from North Dakota to South Florida. It also makes up 97-98% of the UV Rays that hit the earth and us. It is not absorbed well by anything, and penetrates clouds, glass and clothing to reach us. When it hits the skin it penetrates and is absorbed slowly. Though it does not cause sunburn or heat the skin, it does cause direct cell damage.
It is, thus, UVA that causes most of the damage to our skin. It is almost all of the UV radiation that actually hits our skin. It is present all the time. Though we no longer lay in the sun, we are still getting UVA radiation, even in the house, in cars and through our clothes. If we do get a sunburn from UVB, much of the damaged cells are shed. We have also shown that damage is cumulative over a lifetime. What we get now is additive to what we have already gotten to further skin aging or stimulate skin cancer production.

So, how do we protect ourselves? Since SPF only indicates our protection from UVB and sunburn, it is worthless in determining whether we are protected from UVA. The FDA has tried four times over about 14-15 years to create a standard to indicate UVA protection similar to Australia and Europe. Their latest attempt was to go into effect in July of this year. Implementation has now been pushed back to December. So, how do you know how to protect yourself? In spite of the lack of present standards, there is an easy way.

Of the sun protection products presently available, there are only two that block the full spectrum of UVA. One of these, avobenzone (including Helioplex by Neutrogena), as far as we now have data, only lasts about an hour or two and takes 30 minutes to start working. Since we need to reapply it hourly, it is impractical. The other is Zinc Oxide. It, too, was impractical, since it made you appear white. However, new formulations of Zinc Oxide now go on clear and still protect from both VUB and UVA. We, therefore, recommend you look for a product containing at least 5-11% Zinc Oxide. (This amount protects but still goes on easily. Just turn the container over and look under the ingredients. If it does not have a percentage, it does not contain enough.) This has been somewhat hard to find. With the looming new requirements, it is now much easier. Even so, we stock five different brands in our office. We recommend, since UVA is constantly present, that you apply it daily year round to any exposed areas, reapplying if you wipe it off. In the US, because Vitamin D is in so many foods and multivitamins, we, do not have to worry about Vitamin D deficiency.

What about non-exposed areas? Since UVA goes through regular clothing, there is now sun protective clothing available at the Highland Hiker and other retailers. You can also wash your present clothing in Sun-Guard by Rit, available, for your convenience, at our office as well as elsewhere. This is used in the washer and imparts sun protection to the washed garments for 20 washes (about 6 months).

For more information call the Center for Plastic Surgery at 828-526-3783, or toll free 877-526-3784, or go to “Contact Us” elsewhere in this site.

The 10th Anniversary of FDA approval of Botox® as a Wrinkle Reducer

This year marks the tenth anniversary of the approval of Botox® to relax wrinkles. Botox® has been around for about 50 years as a treatment for eye muscle spasm. It was originally used in children treating strabismus, but later broadened to adults with eye muscle problems. In 1987, Dr. Jean Carruthers of Vancouver, BC, Canada, an ophthalmic surgeon, had a patient she was treating for facial muscle spasms tell her that the treatment gave her “a beautiful, untroubled expression.” This led to several clinical trials that resulted in the FDA approving Botox® as a cosmetic treatment of wrinkles in 2002.

Botox®, a potent toxin when used in large doses has proven exceptionally safe over this time. In the last year more than 5.6 million people were injected, making it the most popular cosmetic procedure in the world. Though it is officially approved only for treating the muscles between the eyes to get rid of the “11’s” there, it can be used anywhere there is a hyperactive muscle causing a problem.

To celebrate, Allergan, the maker of Botox®, is offering a discount for the next several treatments if they are prepaid before the end of April, 2012.

Cosmetic problems of the eyelids

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.