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209 Hospital Dr #202
Highlands, NC 28741

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The Importance of Daily Sunscreen

The Importance of Daily Sunscreen

About this time of year, many start thinking about using sunscreen and many stores add new sunscreen choices. The truth, however, is that we all need to use a good sunscreen every day all year. It needs to protect from both UVB, the rays that cause sunburn and are present mainly in the south, mid-day and in the summer, and UVA, those present morning to night, at all latitudes and all year that cause aging and skin cancers. My preference, because it is exceedingly effective as well as practical, is micronized zinc oxide of from 8-14%. We stock several in the office. We also have many excellent methods of rejuvenating the skin from skin care creams to laser, IPL and peels. A recent publication by Drs. Oz and Roizen has reinforced our thoughts on this subject.

Many “Medical” Spas Lack Proper Oversight.

The Hampton Roads (VA) Virginian-Pilot (8/29, Simpson) reports on the growing trend of spas “tacking the word ‘medical’” onto their business’s name and “pitching invasive services,” often without “proper doctor oversight.” The paper writes that the trend is a result of a few factors, including “aging baby boomers, people looking for a cheaper alternative to plastic surgery and elective enhancements, and doctors looking for a way to replace shrinking insurance reimbursements.” Cases have begun to pop up, the latest of which occurring in Virginia when a Norfolk physician “received a state reprimand and a $5,000 fine” form the Virginia Board Of Medicine “for letting an unlicensed person use his prescription information to obtain medication for erectile dysfunction at a local medical spa.”

Other spas pay a non qualified off site physician to write prescriptions for other prescriptive medications including skin care products and then sell these without physician supervision. The Obagi Nu-Derm system is an excellent example as this system definitely requires oversight. Other spas are using lasers and other semi invasive machines without physician oversight. These too require oversight and the state of North Carolina where we are also requires this oversight. 

The Center for Plastic Surgery and Medi-Spa has been operating with more than the required oversight for over 14 years. All prescriptive skin care, such as Obagi, is personally supervised by Dr. Buchanan who also carefully oversees or personally does all invasive procedures, including lasers, IPL’s and major peels.

“WWII’s Guinea Pig Club helped revolutionize plastic surgery”

This excerpt from the book “Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century” by Kevin Fong illustrates how efforts to treat troops’ horrific wounds during World War II transformed the field of plastic surgery. Reconstructive surgeon Archibald McIndoe was among those treating severe burns and reconstructing facial features using skin flap and other pioneering techniques. Recovering patients formed a social club, dubbed the Guinea Pig Club, which evolved from “drinking and singing around pianos to rehabilitation and support,” Fong writes. Slate (5/12)

Viagra Linked to Increased Rate of Melanoma

NBC News (4/8, Aleccia) reports on its website that a group of researchers has linked Viagra [sildenafil] to melanoma, the most fatal form of skin cancer. The study finds an 84% increase among users of the prescription drug versus controls. Lead author Dr. Abrar Qureshi cautioned patients that the results are preliminary and are not a cause for them to stop the drug regimen, but all patients at an elevated risk for melanoma should address their concerns to a primary care physician or dermatologist. Qureshi theorizes, “Viagra may increase the risk of melanoma because it affects the same genetic pathway that allows the skin cancer to become more invasive.” The study has been published in JAMA Internal Medicine.

Lab-grown Vaginas Implanted in 4 Women.

        Plastic Surgeons have been constructing vaginas for many years in women with congenital  absence, in sexual reassignment and after loss in cancer surgery or injury. This reconstruction, until now has been by use of a skin graft that has the potential of creating a large scar at the place from where the graft was taken. Anything that reduces the risk of scar is a welcome addition to our reconstructive abilities.

        The Wall Street Journal (4/11, Naik, Subscription Publication) reports that researchers have transplanted lab-grown vaginas into four teen girls, according to a paper published in the Lancet.

 FOX News (4/11, Woerner) reports on its website that the girls “suffered from severe forms of” Mayer-Rokitansky-Küster-Hauser syndrome.

        The AP (4/11, Cheng, Ritter) reports that the “researchers took a tissue sample less than half the size of a postage stamp from the patients’ genitals.” The researchers then “multiplied cells from this tissue in the lab, seeded them onto a biodegradable scaffold and molded it into the right size and shape for each patient before implantation.”

        On its website, NBC News (4/11, Aleccia) reports, “Within six months, the biodegradable scaffolding had dissolved and the new organs had taken hold so thoroughly they were indistinguishable from native tissue.” The researchers found that, “after as long as eight years, tissue biopsies, MRI scans and internal exams showed that the new organs were functioning normally.”

        Newsweek (4/11, Bekiempis) reports, “In a questionnaire on female sexual function, the women said they had ‘normal sexual function after the treatment, including desire and pain-free intercourse.’”

        The Huffington Post (4/11, Chan) reports that a separate paper published in the Lancet “details the first reports of nostrils being engineered by scientists for five people who had skin cancer that damaged their noses.” It has “been five years since those reconstructive surgeries, and all of the patients can breathe and are happy with how their noses look.”

        HealthDay (4/11, Thompson) reports that physicians “from the research team said the same technology could be used to engineer cartilage for reconstruction of eyelids, ears and knees.” Also reporting on one or both papers are Reuters (4/11, Steenhuysen), theTIME (4/11, Sifferlin) website, the National Journal (4/11, Resnick, Subscription Publication), and US News & World Report (4/11, Neuhauser).

Studies Again Show Exercise Reduces Breast Cancer

The NPR (3/21, Shute) “Shots” blog reports that research presented at the European Breast Cancer Conference suggests that “exercise reduces women’s risk of breast cancer,” regardless of “what kind of exercise they do, how old they are, how much they weigh, or when they get started.” Investigators looked at data from “studies that involved more than 4 million women around the world who participated in prospective studies from 1987 to 2013.” The data indicated “that the more active a woman is, the better her odds of avoiding breast cancer.”

HealthDay (3/21, Dallas) reports that the data showed that “when compared with the women who got the least amount of physical activity,” the “most active” women “reduced their risk for breast cancer by 12 percent.”

The Disappearing Scar

We all have scars, the result of any injury to our skin. Have you ever wondered what makes one different from another?

Whether a scar is readily seen depends on many factors, mainly color. The scar itself can be a different color than the surrounding skin, most commonly red (all early scars), but also white or pigmented. If the scar is either raised or depressed, or just a different texture than the surrounding skin, light striking the area produces shadows and highlights and these then make even a skin colored scar visible.

Scars result from several causes, an incision (from glass, scalpel, etc.), blunt injury and surface injury (abrasion/burn/freeze). Healing of each generally results in markedly a different scar. An incised wound heals with a very minimal scar since no tissue beyond the edge is injured. Blunt injuries where the tissues split apart at the weakest point have tissues injured away from the wound edge. In them, not only does the point where the tissue came apart heal, but the tissue on either side also heals as a scar. This can result in a wide or raised scar.

Another difference is whether the scar resulted from a planned or unplanned injury. We as surgeons try to put incisions in the most advantageous place for them to heal well. Unplanned (traumatic) injuries may be in any position and may cross normal skin crease lines or be in a place where there is significant tension on the scar. If the latter occurs, the scar may spread resulting in an area with a different texture than the surrounding skin making it visible even if it is not raised, depressed or discolored.

One of the most common discolored scars is that from freezing or doing a shave biopsy for a malignancy, premalignancy or occasionally a benign problem. If the area is frozen or shaved deeply, the majority of the pigment cells are destroyed and the resultant healed area is white. This can generally be prevented by treating only superficially, even if this requires coming back a second time to re-treat the area. Additionally, we can also take into account any known healing problems to try and prevent problems.

We, as surgeons, can also generally control other intentional scars. We try to make incisions along natural lines, folds and creases so that they essentially disappear. We also consider one’s history of how other wounds have healed and try to find a way to prevent any known problems from developing. Though not frequently used by many surgeons, there are also wounds closure tricks that can reduce scar visibility. As scars heal, the wounds are held together initially by tissue glue that has no strength. The body then begins to strengthen the wound. This latter process takes up to six months. If simple skin stitches are used and removed quickly, the scar can stretch if there is any tension present. Therefore, in most wounds, I generally place sutures below the surface that will provide strength to the wound for up to six months before dissolving. This generally assures that the scar is as thin and minimal as possible.

In traumatic wounds, the placement may not be ideal and there is very little that can be done initially other than to remove any significantly injured tissue if the wound was caused by a blunt injury and to try to support the wound. It this is done, any resultant visibility is generally the result of the initial injury itself, since the amount of injury frequently can only be assumed from the history of the type of injury. Additionally, the resultant scar is also the result of how one heals. With accidental injuries it is difficult to take these factors into account.

Injuries that do not heal well can usually be improved. We can treat a discolored scar with an IPL or other laser-like machine. We can remove the scar in a controlled manner and even change the position of the scar. If the scar thickens, we can inject it with steroid to modify its healing.

Over the years there have been many products reported to improve how scars heal. Although there are many on the market, only a few have been actually proven to improve the appearance of scars. One, steroid injection, has already been mentioned. Silicone sheeting with pressure over it is also proven to improve certain scars. This is especially useful in burns with multiple scars. It only works, however, if you use it continuously for a minimum of one year. Any less has been shown to produce no improvement whatsoever. Therefore, all the silicone sheets that people use intermittently or for a short time without pressure do absolutely no good. All the creams that are on the market to rub on scars to improve them have also been shown to be of no help. It is not the cream that causes the improvement in the pictures; it is time. The same improvement would have happened anyway without the cream.

In summary, scars are the natural result of any injury to the skin. When this happens accidentally, the resultant scar is more related to the injury than the repair. When done intentionally, the resultant scar is determined by where the scar was placed, how it was made, and how it was repaired. It is, thus, important to know who is controlling that scar.

Breast Reconstruction Underutilized

Pink ribbons remind most of us that October is National Breast Cancer Awareness Month. But many women know little about one part of the breast cancer experience, breast reconstruction after a mastectomy or partial mastectomy. To combat this, a national campaign has started to educate women about the options available. The kick off for this is October 17th, BRA Day (Breast Reconstruction Awareness Day).
Recent studies have shown that 7 out of 10 women undergoing some type of mastectomy are not made aware of breast reconstructive options. Thus, there are thousands and thousands of women walking around without one or both breasts, because they don’t know the options available to them. In fact, only 1 in 5 women with a mastectomy undergo reconstruction. Although some of those that do not have reconstruction do so by choice, the majority do not do so due to ignorance of their choices.

One of the most common reasons for women’s ignorance is that their doctors neglect to inform them. Some mistakenly think that reconstruction at the same time as the mastectomy can reduce the chance of cure. Others believe wrongly that recurrences of breast cancer can’t be diagnosed if reconstruction is done. Some may be practicing where there are no plastic surgeons at their hospital and, thus, assume that the cancer treatment and reconstruction cannot be coordinated. Some just may not realize that reconstruction is an option.

All of this is in spite of national legislation, the Women’s Health and Cancer Rights Act of 1998. This was intended to increase the options available to women with Breast Cancer and encourage Breast Reconstruction. It required any insurance company that pays for a mastectomy, to also cover breast reconstruction surgery. This included Medicare and Medicaid. The law further stated that the company’s clients must be told about the coverage. By doing so it defined breast reconstruction as not simply cosmetic surgery, but a medical necessity for the physical and emotional well-being of breast cancer patients. In the fourteen years since this law was enacted there has been almost no increase in breast reconstruction after mastectomy.
Why is breast Reconstruction deemed to be so important? Very simply, loss of the breast causes both mental and physical problems. From around the age of 10 the breast is synonymous with femininity and part of what defines womanhood. I am frequently told they “no longer feel attractive,” or that they were “outgoing and now have become an introvert.” Additionally, the asymmetry of weight can lead to shoulder, neck and/or back pain and difficulty sleeping. Although Dr. Buchanan has worked for years to make breast reconstruction available to women, some regional hospitals are now also recognizing this.

To correct this, there are a number of options. These can be divided into two major choices, timing and method. Timing is either immediate or delayed. With immediate reconstruction, the initial reconstructive surgery is done at the time of the mastectomy. This restores a mound (though sometimes not to the final volume) and reduces the number of surgeries and the time to complete restoration of the breast. It also prevents the skin from contracting and making any reconstruction harder. Data has shown that it does not interfere with cure of the cancer or reduce the acceptance of the new breast into the woman’s psyche. Delayed reconstruction can be anywhere from 24 hours to many years.

There are basically two reconstructive methods, use of an implant or use of one’s own tissue. Each has variations and the two can be combined. Occasionally, especially with large breasts, an implant can be placed under the tissues after the mastectomy and the reconstruction of the mound is complete. The nipple/areola is reconstructed a later time. If the remaining tissues are too tight to allow the final volume to be inserted initially, an expander (an implant containing a valve) containing a smaller volume is placed and then expanded, thus stretching the overlying skin safely to the final size. It is then exchanged for the proper sized implant.

Because the scar around the implant can contract and make the implant feel firm and some women’s desire not to have anything foreign, one’s own tissue can be used. Most commonly this is taken from the abdomen or back. Occasionally, at some specialized centers, tissue from the buttocks is used, reattaching the tissue microsurgically. When taken from the back the tissue is simply transferred from the back to the chest based on a long artery and vein. Frequently an implant is also used to reduce the scar to the back. Using the tissue from the abdomen is probably the most common and the most aesthetic, since one gets a tummy tuck at the same time as the reconstruction. This can be done by leaving the flap attached by its vasculature and just rotating it, or it can be done microsurgically. Both methods have pros and cons.

Since a true reconstruction requires the two breasts to match, and some breasts just cannot be matched by reconstruction, remodeling of the other breast to match the reconstructed one is also mandated by the 1998 law. This is very frequently required with implant reconstruction and commonly needed with tissue reconstruction.

As I said earlier, October 17th is BRA Day. For more information, go to BRADayUSA.org. The spokesperson for this effort is the singer Jewel. To further education of women about breast reconstruction, she released the single “Flower” on August 12th, and part of the proceeds goes to this effort. This song can be downloaded from iTunes.

Dr. Buchanan has extensive experience in breast reconstruction and is presently on the Breast Reconstruction Work Group of the American Society of Plastic Surgeons writing clinical practice guidelines for physicians around the country. He works year round in Highlands at the Center for Plastic Surgery.

Plastic surgeon Robert Buchanan gives lecture on ‘Turning Back the Clock’

Below is the text of an article appearing in the Highlands Newspaper and the Highlander the week before Labor Day.

Everyone wants to stop aging or at least, prevent the visible signs of aging. Although there are no miracle creams or magic drugs that will stop the body’s internal aging process, living a healthy “optimal” lifestyle can limit or slow the inevitable,” said Highlands-Cashiers Hospital’s Board Certified Plastic Surgeon, Dr. Robert Buchanan.

Earlier this month, Dr. Buchanan presented “Turning Back the Clock – Anti-Aging Secrets” to nearly 50 community residents, providing education and tools to live a healthy and long life.

“Proper medical care and body modification are proven strategies that can improve and extend our life, improve our looks or both,” said Dr. Buchanan. “Most importantly, diet, regular exercise, stress control and the avoidance of negative influences can reduce and sometimes eliminate the development of chronic diseases such as diabetes, heart disease, stroke, and some cancers. Eating a moderate calorie balanced diet of no more than 40% carbohydrates and the rest lean protein with good fat and minimal salt can maintain healthy blood pressure and prevent insulin spikes, allowing the body to burn already stored fat, reducing the waistline.”

Dr. Buchanan stressed that healthy eating plays a large role in anti-aging as does the commitment to live a healthy life style. “We all have to change our “taste,” change our mindset, train our brain and body to crave natural healthy foods and avoid sugar, salts, and bad fats. Sugar substitutes can do as much damage as the real thing and also prolong the body’s dependence on sweets and sugary foods. Modifying your lifestyle should be a gradual process in which diet and negative lifestyle habits are slowly changed over the course of weeks or several months. Your body and brain will accept the new routine and the willingness to continue will grow. Dieting with sudden change in habits is the cause of “yo-yo” weight loss and regain.” Dr. Buchanan offered helpful eating tips listing “things to have in your frig” which included: 1% or 2% milk, fresh fruit, fresh herbs for flavor instead of sugar or salt, organic eggs with yolk, greens, and water. A list of “things to have in your pantry” included: nuts, dark chocolate, legumes, seeds such as flax, steel cut oatmeal/barley, dried herbs and peanut butter. And a list of “things to have in your medi- cine cabinet” included: baby aspirin (recommended 2 per day), omega 3, vitamin D, multivitamins, and calcium. He noted to avoid vitamin E, which can cause increased bleeding, and most over the counter supplements.

Dr. Buchanan also advised the audience on the importance of exercise and how daily/weekly schedules of both aerobic and anaerobic activities can promote health, disease prevention and longevity. “Exercise is crucial; studies show that walking just one mile per day can help you lose 10 lbs. per year and walking 2 miles per day can reduce your chance of death from all diseases by an incredible 50%. Three hours a week can reduce a woman’s chance of developing breast cancer by 30%, and just one additional hour can reduce her chances of breast cancer by 60%.”
“Along with a healthy diet and exercise, sun screen with UVA and UVB protection should be applied each and every day to reduce skin damage. Limiting one’s alcohol intake to one glass per day or less, avoiding smoking and others who smoke will boost one’s optimal health.”

Dr. Buchanan ended the lecture by explaining how cosmetic procedures performed these days have age defying, long lasting results. Minimally invasive treatment such as a rejuvenative skin care routine prompts new skin cell growth and reduces the appearance of wrinkles. IPL (Intense Pulsed Light), an in office procedure, can remove brown age spots as well as red discolorations/blotches on the skin’s surface. The Zerona® laser can melt fat without pain, incision or downtime.

“We are using better injectables such as Botox, which reduces muscle function and, thus, wrinkles and others that fill in soft tissue including Juvéderm®, Radiesse® that offer immediate results, reducing lines, wrinkles or contour deformities,” said Dr. Buchanan. “And these are now administered with less discomfort.”

As for surgical procedures, Dr. Buchanan explained how various “lifts” can markedly reverse the outward effects of aging. “Today’s Facelift”, the facelift technique performed by Dr. Buchanan, maintains facial fat and achieves a more natural result. The technique, unlike older facelifts, prevents the pulled or “windswept” look leaving the neck and face looking refreshed, rested, and healthy.

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.