Saturday, November 21, 2009
Key Points to Skin Care
Should be done at least daily, but even better -
morning and night.
1. A gentle but through cleaning of the skin
2. A toner to prepare the skin for exfoliation
3. An Exfoliation Agent (such as a Retinoid or Glycolic Acid) to remove the
outer layers of the skin and promote healthy regeneration
4. Plenty of moisture into the skin
5. A moisturizer to hold the moisture in
We can certainly help you with your skin care needs, using professional products that address your specific skin condition.
Many wounds will heal with time if given proper wound care. The important principles of wound care include removing all unhealthy and/or devitalized tissues, removing any foreign bodies in the depth of the wound (such as wires and screws), controlling infection, off-loading any pressure on the wound, and providing the proper balance of hydration to the tissues. In the past, it was thought that we needed to let wounds dry out and scab in order to achieve healing. We now know that a wound will heal better in a moist envirnoment. There are many wound-care dressings that are used to ensure the proper balance of moisture in a wound.
Topical growth factors have received much attention in the last several years as a way of speeding up the healing process. Hyperbaric Oxygen Therapy (H.B.O.) has been shown to improve healing in many patients by "super-saturating" the tissues with 100% oxygen. This increased oxygen level stimulates new blood vessel formation. It also allows more white blood cells and antibiotics to reach the wound which help fight infection. Electrical stimulation to a wound can be beneficial in some situations. Negative pressure wound therapy (N.P.W.T.) has been a gigantic leap in the treatment of chronic wounds. A sponge dressing is placed on the wound which incorporates negative pressure applied 24/7. This negative pressure "sucks out" unhealthy fluids, stimulates granulation tissue (one of the first steps in healing) and shrinks the wound in all dimensions. One of the more popular units is called the V.A.C. (Vaccum Assisted Closure). A new ultrasound treatment called Mist Therapy (Celleration of Eden Prairie, MN) has been developed to promote healing. Ultrasonic energy has been used in the past with varying degrees of success. This new device that looks like a plant mister sprays saline droplets on the wound that carry ultrasonic energy. The ultrasonic energy dilates blood vessels and stimulates new vessel formation which increases blood flow and oxygen into the tissues.
Plastic Surgeons are an integral part of the wound care team. They provide conservative care with some of the above mentioned tecniques, but also perform surgery to close wounds. Many of these surgical procedures involve muscle flaps to bring in a new blood supply to the wound or micro-vascular transfer of tissue to promote healing. Chronic wounds are a challenging problem and require much skill and expertise. Patients need to realize that this can be a long and slow process.
Sunday, November 15, 2009
CBO says Senate healthcare bill costs $849 billion.
(ABC World News (11/18, story 2, 00:30, Gibson) reported, "On Capitol Hill, after weeks of delay, Senate Democrats" released "a cost estimate on their healthcare reform bill. The total cost is pegged at $849 billion over ten years." )
Ideally, it would certainly be nice, but the hassles and waste associated with any government run entity may not be the answer. The Senate bill is over 2000 pages, and probably not read nor understood by most of the Senators. The latest "political genius" from Washington is a 5% tax on cosmetic surgery procedures as part of the Senate's so-called health care reform. This is a tax that disproportionately targets women in every socioeconomic level. This type of law was enacted in New Jersey a few years ago. After unmet expectations, it was considered a failure and the original author of the bill introduced and shepherded a repeal of the tax which was unanimously approved by the Legislature but vetoed by Governor John Corzine. These taxes are arbitrary and difficult to administer because many times cosmetic and reconstructive procedures blend together.
Doctors have always, and will continue, to take care of people regardless of their ability to pay. If patients without insurance present to the emergency room for any condition, hospitals and physicians are required by law to take care of them. This is a financial burden, but never-the-less, it is our responsibility to take care of those in need with the very best care possible. Patients certainly need to take responsibility for their health and destiny. If they can afford to have insurance, they should choose to be covered. Addressing self imposed destructive behaviors (smoking, obesity, alcohol & drug abuse, etc.) will also lessen the burden on the system. End of life decisions and the large amount of health care dollars that are spent in certain terminal conditions need to be looked at closely, maintaining compassion and dignity in any decision. In conclusion, health care system reform needs the wisdom from physicians and their patients to guide the politicians in formulating the correct policies.
Wednesday, November 11, 2009
In order to get excellent and long lasting results with facial rejuvenation, more extensive surgery is needed. The Neck Lift is a common procedure that addresses the laxity in the lower face and neck. One of the more distressing aspects of aging that can be noticed even in the 30 and 40 year old age group, is laxity in the lower face, jowls, loss of definition of the jaw line and sagging in the neck. Pertinent points related to the neck lift involve the following:
(a) Excess fat in the neck is removed
(b) The muscle laxity in the neck and the deeper loose tissues in the face are tightened. This deeper tightening of tissues is critical in getting a natural and long-lasting result.
(c) A natural and conservative re-draping and removal of neck and facial skin.
(d) Incisions under the chin, in front of and behind the ears, and extending into the posterior hairline
(e) Be prepared for at least 2 weeks of bruising and swelling before you are back to work and social activities
(f) Numbness in the face and neck and tightness in the neck will resolve but may take several months.
(g) Heavy and prominent nasal labial folds (the folds running from the corner of the nose to the corner of the lip) are difficult, if not impossible, to correct. Although short-term improvement may be noted, it is difficult to achieve long lasting improvement no matter what technique is used.
The facelift is an extension of the above procedure into the mid face and temporal region.
Forehead lifting addresses the upper third of the face and can be done in several variations. The traditional forehead lift achieves four goals: elevation of sagging eyebrows, improving heavy creases between the eyebrows (glabella wrinkles), improves transverse forehead wrinkles, and some tightening of the excess upper eyelid skin. Be prepared for 2 weeks of "down-time" and prolonged numbness (maybe even permanent) in the forehead and extending into the scalp.
Eyelid Surgery addresses excess skin, excess fat and muscle laxity in the upper eyelids (Upper Blepharoplasty) and excess fat (puffiness) in the lower eyelids (Lower Blepharoplasty). We are limited as to how much we can improve wrinkles in the lower eyelids with this technique. If we try to pull the skin too tight and remove too much skin to try to achieve eradication of all wrinkling, this will produce too much tension on the lower eyelids and cause a pulling down (ectropion). A better technique for excessive lower eyelid wrinkling is laser resurfacing. Be prepared for 2 weeks of "down-time" and even longer to achieve the optimal result in terms of swelling around the eyes. I recommend a pre-operative visit to an opthalmologist prior to eyelid surgery to rule out any underlying eye disease.
Facial Resurfacing falls into four categories:
(1) Dermabrasion (Sanding): A diamond burr is used to "sand" away the outer layers of the skin
(2) Chemical Peeling: A chemical acid is applied to the skin to burn away the outer layers. Depending on the type of acid used will depend on the depth of the peel. Common acids include Glycolic Acid ("light peels"), Trichloracetic Acid -T.C.A. (medium depth peel) and Phenol Acid(Deep peel).
(3) Laser Resurfacing: Uses laser energy to remove the outer layers of skin. There are a variety of lasers available for facial resurfacing. Depending on the skin type and degree of sun damage and wrinkling dictates the laser of choice.
(4) Radiofrequency (R.F.): Uses radiofrequency energy to treat the skin surface. This may be helpful in certain cases of red and pigmentary skin problems.
In summary, facial rejuvenation continues to be popular in many age groups to address the affects of genetics, sun damage and aging tissues. My philosophy is to address the most problematic areas and the areas that concern the patient. A "shot-gun" approach addressing the entire face is usually not necessary in the typical patient.
In a column in the Washington Post (11/10), Carolyn Butler writes on "cyberchondria, loosely defined as the baseless fueling of fears and anxiety about common health symptoms due to Internet research, or, as I like to think of it, Googling oneself into a state of absolute, clinical hysteria over every last pain, itch and strange freckle on your body. Apparently, I'm not alone." Researchers at Microsoft found recently that "about two percent of all the Windows Live searches were health-related." Of those "users who engaged in at least one such query during the study, roughly one-third 'escalated' their subsequent web surfing to focus on far more serious...conditions." Problems can "arise when people turn to a broad web search to diagnose their ills," and Butler notes that "the Medical Library Association has some great tips for evaluating health research online."
Saturday, November 7, 2009
Thursday, November 5, 2009
Tuesday, November 3, 2009
Monday, November 2, 2009
In the U.S., seasonal influenza kills more than 36,000 people & hospitalizes 200,000 yearly.
This information comes from the Journal of the American Medical Association and the Centers for Disease Control (www.cdc.gov/flu/flu_vaccine_updates.htm)
Board certification is an important but somewhat confusing issue for the public to understand. To become a board certified plastic surgeon (we are not talking about a so-called "cosmetic surgeon"), one must complete 4 years of medical school, 5 years of a surgical residency and at least 2 years of a plastic surgery fellowship. Once these basic requirements are met, you have to accumulate multiple cases and experience, and then pass vigorous written and oral examinations which include case reviews. Only then is a plastic surgeon granted board certification or "diplomat" status by the American Board of Plastic Surgery, the only board recognized by the American Board of Medical Specialities to certify board certification. It is up to you to research the credentials of doctors or dentists claiming to be plastic surgeons or "cosmetic surgeons". Some of these doctors even claim "board certification". The bottom line, do your "home-work" and make sure your plastic surgeon is board certified by the American Board of Plastic Surgery. We are fortunate to have some very excellent and well trained board certified plastic surgeons in Tulsa.