Monthly Archives: September 2012

Can you do the kind of surgery that doesn’t leave a scar?

As a plastic surgeon, at least once a week I’m asked:

Will it leave a scar?

 

As I explain to my patients, any time a cut is made all the way through the skin, it heals with a scar.  Today I’ll tell you how to make that scar better.

Courtesy of Office.com

Three things control how good a scar is:

1. How the wound was made.  Sharp, clean cuts leave better ones than say, a dog bite, or road rash.

2. How the wound is closed.  Certainly having a doctor who is expert at repairing cuts and lacerations will help.  But I’m also a plastic surgeon, not a magic surgeon – no matter how perfectly I repair a laceration, it will still leave a scar.

3. How the wound heals. Wounds that heal quickly tend to form less noticeable scars.  Some part of this is genetics, and some part is environment.  If you tend to form big, raised scars, then that’s how your body responds to injury.

So what can you do as a patient to get the best scar possible?  Let’s ignore number two- as long as you see a well-trained doctor, that part is pretty much out of your hands.  And many cuts and scrapes don’t even require the care of a doctor, but still leave scars.  Here are the top 4 things you can do to improve the appearance of a scar:

1. Clean the wound or cut.  Once.  Immediately after the injury, using mild soap and warm water.  That’s all you need.  Avoid peroxide, alcohol, and betadine.  Although these solutions do kill germs, they kill healthy cells as well, and repeatedly dousing a cut in peroxide or betadine will make it heal more slowly.  What do you get when a wound heals slowly?  A worse scar.

2. Keep it moist.  When I was a kid, my mom used to take my band-aids off every day to “let things air out.”  You don’t need to do this, and wounds that are uncovered are exposed to germs.  Keep things covered, and keep them moist using antibiotic ointment or even plain Vaseline.  Granted, you don’t want the surrounding skin looking like a prune, but the cut itself should be covered with Vaseline or antibiotic ointment at all times.

3. Use a scar product.  There are some great scar products out there.  I’ll fully admit that we don’t know exactly why they work, but the fact is, they do work.  Mederma will fade the redness of a scar more quickly.  The product I personally recommend to all my patients is Kelo-cote.  It’s a silicone-based produce, and silicone has been shown multiple times to fade redness and help scars flatten out.  It’s available online, and you don’t need a prescription.

4. Be patient!  Scars take 6-12 months to mature.  Yep- a full year before you know how that scar will really look.  Now if that scar is getting raised, red, or keeps getting bigger go see your doctor.  We have some other tricks up our sleeves such as steroid injections.  But if it’s just not fading as quickly as you want, remember that it takes several months to flatten out and for the redness to fade.

 

Thanks to Dr. Bernstein and Dr. Lin for letting me steal some of your favorite lines!

Do you have any questions about scarring or scar products?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

When I was your age…

I walked uphill, in the snow, both ways…

 

Things have changed dramatically in medicine over the past decade, and effects of this change are just now starting to trickle down to where the general public is aware of them.

Courtesy of office.com

For those of you not in the business, resident physicians had work hours cut to 80 per week back in 2003.  Prior to that, these trainee physicians sometimes worked 100, or even 120 hours per week.  Of course, with the normal lag time such new restrictions have,  the law was not really enforced with any strictness until around 2007-2008.  So it’s only in the past 4-5 years that doctors have been training less than in previous years.

Does this have an effect on the quality of doctor you’ll see as a patient?  I trained right as the hour change was being enforced, and I wholeheartedly say “Yes!”

I understand that working 120 hours a week is absurd.  It is.  I’ve worked some 100 hour weeks (the 80 hour standard is average over a month, so you can still have some busy weeks in there), and you really don’t do anything but eat, sleep, and work.

80 hours, however, gives you plenty of time to clean the house, study, and even take on a hobby or two.  I ran a half marathon in residency, so clearly I did have some free time.  I’m super-slow, by the way, so those were some looong training runs!

But now there is talk of cutting the work week even more.  This is a terrible idea- let me explain. When the initial cuts took place, people thought of going into tougher (i.e. longer hours) specialties such as surgery that never would have thought of it before.  And with the new rule in place, you literally get kicked out of the hospital if you’re over hours.  Meaning someone else picks up the slack on the work you didn’t get done.  So there’s no motivation to become more efficient.  And there’s also no longer the mentality of “This is my patient, and I will take care of him/her until the job is done.”

Instead we have a new paradigm of shift work.  The night team comes on, and the day team leaves.  New doctors (and I’m speaking generally here.  There are, of course, exceptions) no longer have the same sense of ownership and responsibility.  And if they do, they get sent home regardless of their dedication.

So I ask you: do you want a doctor who’s learned to be efficient, so that he can get the work done and get you both home in a timely manner, and one that will stay to see the problem through?  Or one who works until his shift is over?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Why might your child need a plastic surgeon…?

…. and more importantly, how to avoid needing one!

I’m on call for the Emergency Room this week, which means I sometimes get called into the hospital in the middle of the night to take care of people with broken hands, broken faces, and bad cuts.  And many of those people are children.  Today I’m going to tell you, in a completely non-scientifically verified way, the top reasons I get called in to treat kids — and maybe give you some ideas for preventing them.

Courtesy of Office.com

1) Smashed Fingers

This one is common in children of all ages.  Kids love sticking their fingers in things, and I’ve seen injuries from  slammed doors, bicycles chains and everything in between.  What parents don’t realize is that in serious cases, kids can actually have their fingers cut or torn off in these types of injuries.  Even the less serious injuries often involve removing the fingernail to fix a torn nailbed, which means weeks out of sports activities or the pool.  I don’t know that there is a great way to prevent this type of injury, except for adult supervision (although I see this plenty in adults, too!)

2) Dog Bites

Kids’ faces are right at mouth height for many breeds of dogs.  And nearly all of the dog bites I’ve treated happened (a) with a dog the child knows and (b) were not an intentional attack on the dog’s part.  Usually the dog is going for a treat or a toy, and the child happens to be in the wrong place at the wrong time.  A friendly labrador accidentally catching a tooth on a child’s lip can mean dozens of stitches.  Supervision is key whenever children and pets are playing together.

3) Injuries from ATVs (fill in snowmobiles, motorcycles, or your motorized vehicle of choice here)

My mom was an ER nurse when I was growing up, and never let me ride a 4-wheeler, ATV or snowmobile.  I thought she was too strict at the time, but after seeing the number of kids that come in to the ER with severe facial fractures and head injuries after taking a spill off an ATV, I doubt I’ll ever let my own children on one.  If your family does participate in these types of activities, please use appropriate safety equipment, and never, ever, let your child ride on a vehicle with an adult who has been drinking.  This happens much more commonly than you would think.

4) Injuries from Lawnmowers

Nearly every summer I see at least one child who was accidentally run over by a push lawnmower, or fell off a riding lawnmower while riding on a parent’s lap.  And spending a summer in the hospital, having multiple operations to try to save your foot, is not something anyone should ever have to go through.  When you are operating any type of machinery, be it lawnmower or hedge clipper, make sure you know where your children are at all times.  And please don’t allow them to ride on your lap!

Do you have any questions about when to take kids to the ER? Or any great stories to share?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Lower Your Skin Cancer Risk in 5 minutes a Day…

From Women’s Health to Self, skin cancer has been in the news a lot this summer.  And it’s no wonder- skin cancer is the most common form of cancer in the Unites States, affecting 1 in 5 people (skincancer.org).  Today I’m going to tell you how to reduce your risk of skin cancer- and the best part is that it takes only 5 minutes a day… with an extra 1 hour time commitment once a year.

Courtesy of Office.com

The 5 Minutes

I do give people credit for wearing sunscreen if they’re out in the sun for awhile.  But the actual recommendation (and what I tell every one of my patients) is to wear SPF 30 every day.  Every. Single. Day.  The easiest thing to do is get a moisturizer with SPF 30 and cover your face and arms first thing in the morning.  This will protect you from the intermittent sun you’re exposed to while running errands during the day.  And yes, you should reapply at lunch, although I’ll admit even I’m not that good most days.  Total time for two applications of sunscreen- 5 minutes!

 

The 1 Hour

Once a year, go to your plastic surgeon or dermatologist and have him or her check you for skin cancer.  Just like going to the dentist or getting your oil changed, this is a regular maintenance thing.  Is it fun?  No.  Is it important?  Absolutely!  Getting a yearly skin exam means your doctor can spot many skin cancers while they’re small and easy to treat.  And wouldn’t you rather have a small scar, or even avoid developing skin cancer altogether?

So who should you see?  Many people don’t realize that both plastic surgeons and dermatologists treat skin cancer.  We both see a lot of skin.  If you have many, many moles or age spots, or a history of melanoma, then a dermatologist may be a better option.  Dermatologists are often able to look at suspicious areas using dermatoscopy, which allows them to better diagnose melanoma without a biopsy.  But both types of doctors can remove precancerous areas and biopsy suspicious areas.  The most thing is that you find a doctor you are comfortable with, and see him or her every year for a skin exam.  If you have a history of tanning or sunburns as a child, you should start this in your 20s.

And that’s it- sunscreen every day, and a skin exam every year can keep a small problem from turning into a big one.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Women Who Wine

PJ, Dr. Blanchard and Jude

Here are some photos from Wednesday’s Women Who Wine, at the Winery at Spring Hill. We had a great time hanging out with Paula Taylor from 102.5.  Below you can see some pics of the crew at my office.

me, getting my crazy groove on

PJ, Dr. Blanchard and me

our aesthetician PJ, patient care coordinator Tracy, Dr. Blanchard, and Jude our laser technician

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

4 Simple Steps to Better Skin

Healthy skin doesn’t seem like a big deal… unless you don’t have it.  And if you don’t, it’s so hard to hide.  After all, we all want to take a break from makeup once in awhile, right?  And if you’re a guy, you don’t even have the makeup option to hide behind.

But there are so many skin care products out there!  How do you know which ones to use?

Here I break great skin down into four easy steps.  And while I would love to take credit for this knowledge, this is a summary of some great advice I got from Dr. Dee Anna Glaser at Saint Louis University Hospitals.  She’s an excellent Dermatologist, and you may have seen her on the  Latisse® commercials.

Step 1: Keep your skin clean

Between makeup, pollen, and everyday dust and dirt, your face is exposed to a ton of grime, visible and invisible.  Give your skin a break and clean that layer off in the morning and at night.  Even I’ll admit to sometimes just rinsing my face with water in the morning, but I always take my makeup off at night.

Step 2: Even out skin tone

Freckles (the polite term) and age spots (the less-polite term) develop as a result of sun damage.  Instead of producing even color, the little cells that make our pigment start clumping together.  This results in brown spots.  Hydroquinone causes these cells to stop making melanin, and over time the brown spots fade and skin tone becomes more even.  Hydroquinone is available over the counter as a weak formulation in many bleaching creams, but these often have irritating fragrances and additives.  I recommend obtaining prescription strength hydroquinone from a physician.

Step 3: Increase Collagen Production

Retinoids such as tretinoin (a.k.a RetinA) thin the rough outer layer of our skin, resulting in a brighter look.  They also increase collagen production, which improves the appearance of fine lines.  They can be very irritating, so they are usually started at a low dose, every other night.  As your skin becomes used to the tretinoin, you use it every night.  Again, various retinoids are added to many over the counter skin care products, but the best result will be from a prescription-strength product.

Step 4: Prevent Future Damage

 This step is most important- SPF 30 sunscreen, every morning.  Bonus points if you reapply at lunchtime, but even I’m not that good.  Another optional product is an antioxidant such as Vitamin C, which will help prevent DNA damage from the sun.

Some skin care lines, such as Obagi’s Nu-Derm® line, have all of these elements, plus a few other products to boot.  They are touted to work together to improve the end result.  And while I Iove (and use!) Obagi, it can get complicated and expensive.  If you find a cleanser and sunscreen you love at Walgreens or CVS, and get hydroquinone and tretinoin from your doctor, you will still see results.  But skin care is like a gym regimen- results don’t happen overnight.  Expect to see changes after 6 weeks of regular use.

 

Below you can see my results after using a couple Obagi products and tretinoin with over-the-counter Cetaphil cleanser and Oil-of-Olay moisturizer with SPF 30.  I won’t lie- I have pretty good skin to start will.  But after 12 weeks of regular use it was softer, smoother, brighter and more even.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

I do windows, too!

We’re all DIY junkies, right?  Between Pinterest, HGTV, and Food network, I feel like I should be able to outdo Martha Stewart any day.

 So what’s the problem?  I like to fancy myself a Renaissance woman (and just ask me how that went when I found myself elbow-deep in mortar, attempting to tuckpoint*).  And I’m always willing to pitch in a hand and help out, regardless of the pained looks my office staff give me when they find me changing out switch plates, or offering to help take out the trash.

But I’m starting to realize, just because I can do something, doesn’t mean I should.  And this is a hard lesson for me to learn- I am absolutely terrible at delegating.  You’re looking at a girl who spent four weeks raking the lawn to remove the thatch, then aerated it by hand.  By hand.  (Okay, partly to prove to my husband that I could, but I definitely something I would have done if left to my own devices).

I started to think there might be a problem when I was up on a step-ladder, changing out our sun-bleached shutters.

The first sign was the wasps.

Did you know they like to make nests behind old shutters?  Because I didn’t.  We didn’t have shutters in the house I grew up in.  And I thought it would be an easy enough afternoon project to take down the old set and hang some new vinyl shutters.  I’m pretty good with a drill, after all.

But then the wasps showed up.  Apparently they didn’t like me removing their home with a screwdriver.  And being stung in the hand while precariously balancing over a thorny shrub three feet above the ground is maybe not the best idea.  Especially if you rely on your hands for a living.  If you’re, say, a surgeon.

Oh, and say you’re mildly allergic.

Now that I’ve terrified you with mental images of paramedics plucking my thorn-speckled body out of the shrubbery, let me reassure you.  One can of Raid® later, the wasps were dead, the shutters were hung, and I had a swollen, itchy red hand.

Only twenty or thirty people asked me why I didn’t hire someone to hang the shutters.  Which is when I started to wonder if maybe I shouldn’t delegate more things.  So here is my new plan.  I’ll ask myself the following questions:

  1. Am I the best person for this job?
  2. Is this the best use of my time?

 

If the answer to either question is “no”, I’ll do my best to delegate.

(And by the way- I actually do hire someone to wash the windows.)

Question: Do you try to do everything yourself?  If so, why?

 

*Tuckpoint – (verb) a hellish experience in which mortar between bricks is painstakingly removed and then replaced.  Tediously.  In the hot sun.  In no way resembling the rest of the wall you are trying to match.

 

September 12, 2012

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.