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Highlands, NC 28741

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What Do You Know About Wrinkles?

What Do You Know About Wrinkles?

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:

facial rejuvenationWrinkles 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.

The Truth about Artificial Sweeteners

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.

Myths about the Sun and Protection from it:

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.

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.