How We Treat The Hand: Hand Medicine and Surgery

Hand Surgery is an unusual specialty. Among other things, it is a specialty shared by General Surgery, Orthopedic Surgery and Plastic Surgery, each doing the same things. Also, though officially a surgical  specialty, care of the hand actually involves more medical care than surgery. Care can be divided into several categories, trauma care, arthritis and inflammatory processes, congenital problems, and miscellaneous problems.

Trauma Care

This can be mostly surgical initially, involving repair of cut or injured tendons, muscles, nerves or vessels. However, many injuries do not involve transection of a structure and require only observation and retraining. Even initial surgical repairs require more follow up than most injuries elsewhere because of the necessity of retraining the brain. Many initial repairs may require only minor surgery to achieve later function. Retraining is achieved through cooperation of the patient, a specially trained hand therapist and the doctor.

Arthritis & Inflammatory Processes

This is probably the largest group of problems and the one with the least actual surgical procedures. Rheumatoid arthritis and osteoarthritis are well known problems, but other processes like psoriasis, gout, and autoimmune disease can also cause similar symptoms. Part of all the arthritides is inflammation of the synovium, the tissue surrounding the joints. This tissue also surrounds the tendons and other structures in the hand and arm and can become inflamed without joint problems. Common examples of this is tenosynovitis, trigger finger, De Quervain’s, and, even, carpal tunnel and other nerve compression syndromes. Though many of these, including carpal tunnel, are generally considered surgical problems, medical treatment is actually best.

Congenital Problems

Most of these are, indeed, surgical, to correct the congenital problem. Though Dr. Buchanan did a large numbers of these while at Children’s Hospital in Oklahoma City, he believes these problems generally need to be treated by those who do so frequently.

Miscellaneous

These are almost all other problems that can occur in the hand and upper extremity. Many of these, such as Dupuytren’s contracture have gone from usually surgical to frequently medical. In the case of Dupuytren’s, an injection into the contracting band instead of cutting it essentially melts the scar, releasing the contracture.

The Center for Plastic Surgery & Hand Care

In addition to plastic surgery, Dr. Buchanan is board certified in hand surgery and taught it for many years. He still cares for many patients with hand problems. If you have a problem with your hand or upper extremity, call the Center for Plastic Surgery at 828-526-3783 to learn more or for an appointment.

Three groups of physicians see and evaluate patients with skin cancers, family physicians, dermatologists and plastic surgeons. We as plastic surgeons do so because we treat other skin problems related to sun damage and aging, we are good at excising lesions, and many skin cancers occur on the face and hands, areas where we have significant experience and are asked to treat by the other specialities.

Types of Skin Cancers

There are three main types of skin “cancers.” The least common (fortunately) is melanoma, a true, aggressive cancer of the pigment cells. Next is squamous cell carcinoma, also a true cancer that destroys the local tissue and can spread to other parts of the body. The most common is basal cell, a tumor that destroys local tissue but does not spread except by direct extension. There are also multiple other cancers that can occur on the skin, mostly related to skin appendages like glands or metastatic from other areas. These, however, comprise only about 0.5% of skin cancers.  Each requires different evaluation and treatment.

Evaluation of Skin Cancers

The problem with skin cancers is that they can look like each other or other entities. The first thing that must be done is recognizing what may be a skin cancer. That is where dermatologists and plastic surgeons excel. Once the possibility is recognized the exact nature of the lesion needs to be determined. This is usually accomplished with a biopsy, removing a piece for pathological evaluation. Shaving a piece of the lesion is the most common method of biopsy  This takes a week or 2 to heal with several times a day antibiotic care. We prefer a punch biopsy that takes a small full thickness piece of the lesion. This heals quickly and takes no care, important if the lesion is not a cancer. It is also the best way to sample a melanoma, as lesion thickness is important in determining treatment. Once diagnosed, further tests may be required to decide on treatment, especially if the lesion is melanoma.

Treatment of Skin Cancer

The lesion determines the treatment. We treat basal cells multiple different ways including chemotherapy, freezing, and excision depending on its characteristics. Squamous cell is treated similarly, but more aggressively. Melanoma always requires excision and may also need lymph node biopsy or excision.

If you have a lesion that you are concerned about or know needs treatment, call us at our Highlands, NC office at 828-526-3783.

Whether you have been a tobacco user for your entire life or if it’s just a habit that you just picked up, there’s no denying that tobacco isn’t good for you. With Surgeon General warnings on every cigarette box and with commercials that are enough to severely scare you, the information is out there.  With the holidays in full swing and the new year just around the corner, you may have a few resolutions that you want to make. If you are a tobacco user or smoker, why not quit before the new year even starts? Here at The Center For Plastic Surgery, we encourage all of our patients to quit smoking,  and, in some cases, will not do a surgery if the patient is smoking, because nicotine use slows down your body’s natural ability to heal and, may severely jeopardize the success of some procedures. To help you quit, we have created a brief guide of a few things that you can do.

Change the Habit of Putting Something In Your Mouth

Whether It’s after work, on your lunch break, or after a drink on a Friday night, one of the things that keep people coming back for more cigarettes is their habit of having something to put in their mouth. This is a hard habit to break, so we recommend you just modify it to something other than a cigarette or tobacco, or nicotine containing product. Electronic cigarettes are in the latter category. Instead, consider using something like a toothpick or straw as a substitute for the cigarette.  

Break the Nicotine Habit

The hardest thing of all is breaking your nicotine habit. When trying to quit smoking, try doing something like making a chart of how many cigarettes that you smoke each day and when. Then, make a goal of smoking two fewer cigarettes each day for 10 days, deleting one from the morning and one from the evening. If you can, continue this until you are no longer smoking. If you find it problematic, then just delete one ever day or, even, if you have to, every other day until you are no longer smoking. Make sure that you physically log your cigarette use so that you can see just how well you are doing.

Picture Your Life Without Nicotine

Sometimes, one of the best ways for you to quit smoking is to think of just how much better your life will be without nicotine. For instance, you can:

• Daydream of all the wonderful aromas that you can smell once you quit smoking.
• Think of how GOOD food will smell and tastes when you quit.
• Think of your lungs thanking you for setting them free.
• Think of your body being able to get more oxygen again.
• Think of those facial wrinkles no longer forming at such a rapid rate.
• If all else fails, talk to Dr. Buchanan about other options

Here at The Center for Plastic Surgery, Dr. Buchanan wants all patients to live healthy, cigarette-free life. If you want to learn more about ways that you can quit, contact our Highlands office or call us at (828) 526-3783.

We all think we know about the sun, what it does to us and how to protect ourselves from it. Unfortunately, most of us really do not know what we need to know. A great deal of this is because most of the people who write about this keep repeating information that has been outdated for years. Though you may think that this is implausible, several studies have shown that it takes an average of 13 years before a new discovery is adopted into general usage. Unfortunately, it has already been well over 20 years we learned new information about the sun and how to protect from it, and it has still not been generally accepted.

 

You only need to use Sunscreen when you “go out in the sun.”

 

This is based on what we previously knew about UVB. Since UVB is immediately absorbed rather than being reflected, it is much less strong in the shade or inside. It is also what causes sunburn. Because of that, it was considered really bad. Also, many modern windows block UVB so you would not sunburn inside. None really block UVA, which is present almost equally all day, all year, at all latitudes and even inside and in the shade. UVA is also the “bad guy.” It is what really causes sun damage. We remember the effects by “UVB, Burn, UVA, Aging.” We, therefore, need to protect from UVA all the time every day. This requires the proper sunblock and sun protective clothing.

 

 “You don’t need sun protection in the winter.”

 

This is similar to the above. While UVB is twice as strong in the summer as it is in winter, the strength of UVA is almost the same. This means that you need to protect from UVA aging all year. This is also true indoors and on cloudy days as UVA is unchanged in strength then also.

“SPF is what you need to look for in selecting a Sunscreen.”

 

SPF is a designation designed to tell you how well the sunscreen protects from sunburn. It has no bearing on whether it protects you from sun damage, however. As I said, sunburn is caused by UVB that is absorbed by everything, including your skin. This is the reason it causes a burn (all the energy is concentrated in the outer skin layer) and present twice as much in the summer as the winter, at noon as morning and evening and in Florida as in North Dakota (because of atmospheric absorption). Since it is UVA that is absorbed into all layers of the skin and causes cellular damage resulting in skin cancers and aging, you need a way to tell if what you are using does that. SPF does not do this.

 

All sunscreens protect from damaging rays equally,

 

Since December of 2013, any product labeled as a sunscreen or sunblock have to protect from both UVA and UVB. Any product that simply puts an SPF on the label but does not claim to be a sunscreen or sunblock does not necessarily have any UVA protection and any that it does have is usually short lived. Even those that are approved as sunscreens are not all equal in the protection provided. There is a long list of chemical sunscreens and the manufacturer can use a mixture of them. Some are better than others. The one thing they all share is that they only last about an hour if you are outside or 2 hours if you are inside. The physical sunblocks are zinc and titanium oxide. Both protect from both UVA and UVB and last until washed or rubbed off. However, zinc is by far the best, protecting maximally over a larger spectrum.

 

Something other than an applied sunscreen or sun protective clothing will protect you,

 

There have been many claims over the years. Most recently, several companies have marketed either a pill or something to drink that is supposed to protect you from sun damage. None of these products work, and the FDA has recently warned these companies to stop making such claims.

 

For proper sun protection, we suggest:

 

Since zinc oxide provides the widest spectrum of maximum protection and lasts as long as it remains in place, this is, not only the best, but the most practical. Probably the main reason it has not been adopted better is another myth, “it is that white stuff the lifeguards used to wear on their noses.” A recent health writer even bemoaned that we did not have a reasonable sunblock or “something other than that white stuff.” The fact is that it has not been “white” for well over 20 years and rubs in clear but provides superb protection. Instead of looking for SPF, we recommend that you simply look at the ingredients and buy one with at least 8% zinc oxide. This will give you all the UVA and UVB protection you need. We also suggest that your clothing is sun protective, either bought that way or washed with Rit SunGuard that washes in sun protection for 20 washes. We sell both in the office. Call, come in or visit our web site to find out more.

After a long day of work or activities, all you want to do is crawl into bed. But, before you lay down and really get comfy, make sure that you wash your face. With dirt, makeup, oil, and environmental chemicals on your skin, your skin is a lot dirtier than you may be aware. Plus, dirty skin can leave you with a wealth of problems. Let’s take a closer look at what clean skin can do for your confidence and why you shouldn’t avoid washing your face before bed every night.

Acne or its Adult Equivalent

Acne is an interesting problem. It is very common in teenagers and young adults. However, it is also quite common in older adults also. At an older age, it is frequently confused with other problems and labeled “Rosacea.” The initial inflammation causes redness and then stimulates the pigment cells causing dark spots. It can, therefore, be one of the hardest things on a person’s self-esteem, especially if you have a lot of it. Acne at both times is caused by clogged pores. The number one reason why we at The Center For Plastic Surgery encourage our patients to wash their face with a cleansing device like the Clarisonic is to get rid of the things clogging the pores. Oil can build up and clog the pores whether from overproduction at a younger age or small pores caused by years of sun damage. When you wash your face with a Clarisonic and an exfoliating cleanser you unclog the pores and prevent the inflammation. The Clarisonic has been shown to unclog the pores many times better than washing otherwise.

Rough, Dry Skin

The dryness of the air inside during this time of year can make your skin feel exceptionally dry. This is made much worse if you have not been keeping the outer dead cell layer thinned. Washing your face with a gentle exfoliating facial scrub will help you get rid of the dry dead cell layer, exposing the hydrated layer below. This is our preferred care instead of using moisturizers.

Fine Lines

Washing your face with an exfoliating cleanser also helps to prevent fine lines and wrinkles. If the dead cells build up, they tend to weight down the skin making it more likely to crinkle as the underlying support layer thins. This is also the reason we strongly recommend against the use of moisturizers as they also add weight to the skin.

Washing your face every night before bed is one of the best (and easiest) things that you can do for your skin and your self-esteem. If you want to learn more about how to take better care of your skin, contact our Highland’s office today. Call us at (828) 526-3783.

Liposuction is one of the most popular cosmetic surgeries for a variety of different reasons. It reduces localized fatty areas and even some less localized fat to smooth and even your contours. It is, in the right hands, quite safe. It is relatively easy on you and has a moderately fast recovery. Although we can perform the surgery to give you the results you desire, there are some things that you can do to make sure you get great results.

Make Sure You’re a Good Candidate for Liposuction

One of the best ways to really get the most out of your liposuction results is to ensure that you are a good candidate to begin with. One common misconception about liposuction is that it’s for people who are obese and have a lot of weight to lose. Although liposuction is considered to be a body contouring procedure, it is only for patients who are close to their ideal body weight but simply have localized areas of fat that spoil an otherwise nice contour, in other words, those who have already tried a combination of diet and exercise but are still unable to get rid of stubborn, excess, localized fat.

Make Sure That You’re Mentally Prepared

One thing to know about any sort of cosmetic procedure is that it can oftentimes be a lot more mental than it is physical. Although we can control the physical aspect of liposuction, it’s up to you to mentally prepare yourself for the surgery and recovery. What results do you want? Can you tolerate the procedure when done under local anesthesia? Are you ready to wear the post- op elastic garment? All of these things will help you head into surgery and recovery feeling like a champ.

Make Sure You Take Recovery Seriously

Yes, you may think that recovery is optional and that you can ignore your doctor’s recommendations, but recovery is definitely mandatory. By taking several days off any vigorous activity to rest and relax, you can help to speed your recovery time and allow your body to heal before you fully get back into your normal routine.

Make Sure You Maintain Good Habits

Getting liposuction doesn’t all of a sudden mean that you have a free pass to eat and drink whatever you want while you sit on the couch and watch TV all day. In fact, one of the things that you have to do after you get liposuction is to maintain a healthy diet and exercise plan. The leaner you eat and the more you exercise, the better results you will have.

Are you ready to take the next steps toward getting liposuction? Schedule your constellation at our Highlands office today by calling us at (828) 526-3783.

If you are a man or woman “of a certain age,” the aging of your body and skin manifests itself in countless ways, facial wrinkles being one of the most visible and obvious.

Why wrinkles?

What’s the main causes of wrinkly skin? The sun’s UV and UVB rays resulting in an unbalance between the skin and the underlying muscles that, in the face, are attached to the skin.

How does this happen? The sun’s UVA rays cause a loss of your skin’s connective tissues including collagen and elastic tissue making your skin thinner, less elastic and much more vulnerable to wrinkles which are the result. More importantly, repeated, unprotected sun exposure can cause skin cancer. Additionally, the effects of the sun’s damaging rays are cumulative over your lifetime.

Most wrinkles appear around the eyes, eyebrows and mouth. This is because of repeated facial expressions, such as frowning and smiling. Smiling is a good thing, but worrying is not. Those frown lines don’t need extra help to deepen!

What helps? Here are 7 things to consider:

Wrinkles are a natural result of aging, that’s true, but there are some things you can do to prevent or reduce them:

1.  Sunscreen is critically important but it doesn’t do any good in a drawer. Be sure to choose a product that contains at least 8% zinc oxide and re-apply it whenever you rub or wash it off (other products are OK, but need to be reapplied hourly outside and every 2 hours indoors). Don’t forget your hands and neck.

2. Stay away from tanning beds. They use UVA, the damaging part of sun rays.

3. Be gentle. Don’t scrub your skin with a rough cloth; don’t rub and pull at your skin; use an easy touch when applying makeup, especially around the eye area.

4.Use a retinol cream applied daily, especially after 30 years of age to reduce loss of collagen. If you are in your 50’s or older and haven’t been using a retinol, you probably need tretinoin (Retin-A).

5. Consider adding Obagi ELASTIderm® that converts some of the collagen to elastic tissue. This is especially true the older you are.

6. If you smoke, quit. Smoking greatly accelerates the aging process and causes wrinkles to appear prematurely.

7. Consider injectables, like Juvederm and Botox, if your wrinkles are deep and pronounced.

Today is the beginning…the rest of your life awaits you! Give Dr. Buchanan a call and request your complementary consultation 828.526.3783.

For decades dieters and diabetics have used artificial sweeteners to reduce sugar intake in an attempt to lose weight or control their diabetes. Multiple studies have shown that this does not work. One study split a number of people with metabolic syndrome (prediabetes) who drank sodas into 3 groups. One stayed on the regular sodas, one switched to diet sodas (with artificial sweetener), and the third switched to Perrier or other drinks without sugar or artificial sweetener. By switching to diet soda, the prediabetes did not change. However, stopping all sodas did markedly reduce the problem.

This and other studies only showed that switching to artificial sweeteners did not change anyone’s diabetes, prediabetes or weight. One study 4 years ago did show that artificial sweeteners have an effect in causing diabetes. Another study a year ago showed that drinks with artificial sweeteners could increase a person’s risk of dementia or stroke. A new studyfrom the Medical College of Wisconsin and Marquette University links artificial sweeteners to obesity and diabetes, claiming sweeteners change how the body processes fat and uses energy.

We at the Center for Plastic Surgery have preached for years that the way to control weight and diabetes is reduction of sugar through dietary management, not substitution for it. All these studies continue to add evidence of the significant harm that artificial sweeteners do and the necessity of proper dietary management rather than substituting something for sugar or fat.

We all think we know about the sun, what it does to us and how to protect ourselves from it. Unfortunately, most of us really do not know what we need to know. A great deal of this is because most of the people who write about this and even many Dermatologists and Plastic Surgeons keep repeating information that has been outdated for years. Though you may think that this is implausible, several studies have shown that it takes an average of 13 years before a new discovery is adopted into general usage. Unfortunately, it has already taken well over 20 years to adopt new knowledge about the sun and how to protect from it, and it has still not been generally accepted. The following are some widely held myths:

SPF is what you need to look for in selecting a Sunscreen.

SPF is a designation designed to tell you how well the sunscreen protects from sunburn. It has no bearing on whether it protects you from sun damage that causes skin cancer and aging, however. Sunburn is caused by UVB that is absorbed by everything, including your skin. This is the reason it causes a burn (all the energy is concentrated in the outer skin layer) and is present twice as much in the summer as the winter, at noon as morning and evening and in Florida as in North Dakota (because of atmospheric absorption). Since it is UVA that is absorbed into all layers of the skin and causes cellular damage resulting in skin cancers and aging, you need a way to tell if what you are using does that. SPF does not do this.

All sunscreens protect from damaging rays equally.

Since December of 2013, any product labeled as a sunscreen or sunblock have to protect from both UVA and UVB. Any product that simply puts an SPF on the label but does not claim to be a sunscreen or sunblock does not necessarily have any UVA protection and any that it does have is usually short lived. Even those that are approved as sunscreens are not all equal in the protection provided. There is a long list of chemical sunscreens and the manufacturer can use a mixture of them. Some are better than others. The one thing they all share is that they only last about an hour if you are outside or 2 hours if you are inside since the sun actually deactivates them. The physical sunblocks are zinc, titanium and iron oxide. They all protect from both UVA and UVB and last until washed or rubbed off. However, zinc is by far the best, protecting maximally over a larger spectrum and is the easiest to apply.

You only need to use it when you “go out in the sun.”

This, again, is based on what we previously knew about UVB. Since UVB is immediately absorbed rather than being reflected, it is much less strong in the shade or inside. Besides, many modern windows block UVB. None really block UVA, which is present almost equally all day, all year, at all latitudes and even inside and in the shade. We, therefore, need to protect from it all the time every day. This requires the proper sunblock and sun protective clothing.

Something other than an applied sunscreen or sun protective clothing will protect you,

There have been many claims over the years. Most recently, several companies have marketed either a pill or something to drink that is supposed to protect you from sun damage. None of these products work, and the FDA has recently warned these companies to stop making such claims.

For proper sun protection, we suggest:

Since zinc oxide provides the widest spectrum of maximum protection and lasts as long as it remains in place, this is, not only the best, but the most practical. Probably the main reason it has not been adopted better is another myth, “it is that white stuff the lifeguards used to wear on their noses.” A recent health writer even bemoaned that we did not have a reasonable sunblock or “something other than that white stuff.” The fact is that it has not been “white” for well over 20 years and rubs in clear but provides superb protection. Instead of looking for SPF, we recommend that you simply look at the ingredients and buy one with at least 8% zinc oxide. This will give you all the UVA and UVB protection you need. We also suggest that your clothing be sun protective, either bought that way or washed with Rit SunGuard that washes in sun protection for 20 washes. We sell both in the office.

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.