Is there a way to prevent skin cancer?

I think we all understand that skin cancer is caused by sun exposure, and that the best prevention is using sunscreen.  But what if you’ve missed the boat on that option? Every day I see patients in their 40s, 50s and older who have already been subjected to many years of sun damage. Wearing sunscreen moving forward is certainly important, but is there a way to improve some of the damage that’s already been done? Thankfully there is.

Topical retinoids may help reduce chronic sun damage. I’ve covered how to use these products in a previous post, so we’ll skip over that here. Two other options are also effective:

  1. Skin resurfacing. Skin resurfacing includes treatments such as dermabrasion, laser peels and chemical peels. These treatments remove the outer layers of the skin, which is where most of the sun-damaged cells reside.
    Pros:

    1. Skin resurfacing will improve fine lines and pigmentation as well as reduce the risk of skin cancer.
    2. The recovery time is only about a week, and these procedures can be done in the office.
      Cons: Skin resurfacing is usually considered cosmetic, and thus is not covered by insurance.
  2. Topical medication. Efudex (fluorouracil) is actually a chemotherapy drug used to treat cancer, which was formulated into a skin cream. It kills abnormal cells, such as those at risk of turning into skin cancer. The medication is used for a few weeks until most of the abnormal cells have been killed.
    Pros:

    1. Efudex is covered by most insurance plans.
    2. Efudex will remove sun-damaged cells that are not visible to the naked eye.
      Cons: Efudex causes skin irritation, rash, and redness, which may persist for up to two months after you stop the treatment.  No makeup can be worn during the treatment period. The photo below is what a typical patient looks like during treatment.

      Side effects of Efudex. From: http://alaneg1948.blogspot.com/2012_05_01_archive.html

      Side effects of Efudex. From: http://alaneg1948.blogspot.com/2012_05_01_archive.html

 

If you are interested in pursuing Efudex or skin resurfacing, I would recommend seeing a board-certified Plastic Surgeon or Dermatologist in your area who has experience treating skin cancer with both of these treatment options.

 

Questions? Leave them in the comments section and I’ll do my best to get back to you.

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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.

Will tattooing cover up a scar?

I’ve written previous blog posts about what makes a scar good or bad, but I never addressed the topic of tattooing. Tattooing done to camouflage a scar is referred to as medical tattooing. This is in contrast to cosmetic tattooing, which is done to apply permanent makeup, and the tattooing of artistic designs for body modification.

Tattooing does have a role in scar camouflage, but it must be done after the scar has completely matured. Scars may be raised up and appear red or purple during the initial healing period. They then begin to settle over a period of 6-12 months, eventually becoming flat. The final scar may be lighter than the surrounding skin (hypo-pigmented) or darker than the surrounding skin (hyper-pigmented).  Hypo-pigmented scars may benefit from tattooing, which essentially adds pigment to match the surrounding skin. This should be done on un-tanned skin, so the scar is pigmented the correct color. Remember, however, that if the surrounding skin is exposed to sun, the resulting tan will make the scar more noticeable.

hyper-pigmented scar

hyper-pigmented scar

hypo-pigmented scar

hypo-pigmented scar

 

 

 

 

 

 

 

 

In contrast to a hypo-pigmented scar, a hyper-pigmented scar is darker than the surrounding skin. In this case the treatment is to remove pigment rather than adding it. This can be done with laser or broad-band light (BBL) treatments. I would recommend waiting at least a year to allow your scar to mature, and then seeing a Board-Certified Plastic Surgeon to evaluate your scar. He or she can recommend the best course of treatment, and refer you to a tattoo artist with experience in scar camouflage if necessary.

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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.

What is the difference between Botox and fillers?

I perform many minimally-invasive procedures to treat wrinkles in my office, and I’ve noticed that there is often a lot of confusion about exactly what the difference is between a neurotoxin such as BOTOX, and a filler such as Juvederm or Restylane. My blog post today is written with the intent of clearing up that confusion.

Confusion is understandable, as the two treatments do share many similarities. Both neurotoxins and fillers are injected in the office. Both treat wrinkles. And both are temporary, meaning the results wear off over time. But the two products actually work quite differently.

As I mentioned before, Botox is a neurotoxin. This means it is actually toxic to nerves, thereby preventing muscles from contracting in the areas where it is injected. Muscle contraction is responsible for what are called “dynamic wrinkles”, i.e. wrinkles resulting from motion. Dynamic wrinkles are commonly seen between the eyebrows, over the forehead, and around the eyes. Preventing the muscles from moving stops the wrinkle from forming. Because neurotoxins cause localized muscle paralysis, I do not like to use them around the mouth as this may result in drooling or difficulty speaking and eating.

Fillers do what their name implies: they fill volume. Volume loss in the soft tissues contributes to an aging appearance. This is partially responsible for the formation of the “smile lines” which run from the nose to the corner of the mouth, and the marionette lines which run from the corner of the mouth to the chin. Ptosis or droopiness of the overlying tissue secondary to gravity is the other main contributing factor, and this can be corrected surgically. But adding volume directly under a wrinkle can significantly soften the appearance. Unlike neurotoxins, which require several days to take effect, the results from fillers are immediate.

If you’d like to learn more, check out my previous posts on Botox and other neurotoxins as well as fillers.

Any questions? Leave a comment and I’ll do my best to get back to you.

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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.

Are medical-grade skin care products really better?

Yes! There is absolutely a difference between the skin care products offered over the counter and skin care products sold by physicians.glowing skin

  • The products sold in doctor’s offices contain higher concentrations of active ingredients, meaning they are generally more effective. Treatments for brown spots are a great example. The skin lightening creams available at your local pharmacy contain 2% hydroquinone, the active ingredient which blocks your cells from making pigment. But skin lightening creams available through your Plastic Surgeon have 4% hydroquinone.
  • When you see a Plastic Surgeon or a Dermatologist for skin care products you get the benefit of a skin care plan tailored to your needs. A skin care product may be incredibly effective, but it won’t help you if you’re using it for the wrong reason. Along those same lines, a physician can diagnose what is really going on with your skin, and treat the underlying cause, not just the symptoms.
  • Sometimes your skin takes time to adjust to new products. A doctor can tell you if what you are experiencing is a normal side effect, or if you should stop the product or try a different product instead. Tretinoin (aka Retin A) cream is a great example of this. Tretinoin is very irritating to the skin, so many people stop using it before they see results. But Tretinoin can give some amazing results in terms of smoothing fine lines and evening out pigmentation, if you are able to get through that adjustment period. A doctor experienced with skin care can help you adjust your use to minimize skin irritation, or even prescribe other products to calm down the initial redness and flaking.
  • Plastic Surgeons can also recommend where best to spend your money if you have a limited budget.  Skin care products are a way to help augment the results I achieve from laser procedures, Botox, and fillers. Which means I care about your results, not making a commission. I can tell you which skin care products to purchase at your local pharmacy to save you money, and which ones you really need to buy at my office to see results.

Do you have a question about skin care products? I would love to answer them in the comments section!

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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.

How can I make a scar less noticeable?

Making a scar less noticeable is one of the primary goals of plastic surgery. But to accomplish this goal, we first need to understand what makes a scar more visible in the first place. Let’s break it down:

  • Color: scars optimally fade to slightly lighter than skin tone. But some scars may remain pink or red, or even darker than the surrounding skin (hyperpigmented). It can take 6-12 months for a scar to finish fading, so redness or pinkness is normal during this stage. If the pink color persists beyond this time, or if you’re just a bit impatient, laser treatments can help the pinkness fade. Hyperpigmentation in scars occurs when they are exposed to the sun. To prevent this, I recommend applying sunscreen to the scar daily over the first year. If hyperpigmentation is already present, skin lightening creams can help even out the pigmentation, as can laser treatments.
  • Contour: an ideal scar is narrow and flat. But some scars may become thick and raised during the healing process, as I’ve discussed in a previous post on hypertrophic scars. This commonly occurs in scars on the chest, and some people are also just more prone to forming raised up scars. Silicone scar cream, massaging the scar, and steroid injections can all help flatten out a raised scar.
  • Width: instead of becoming thicker, scars may instead widen during the healing process. This is very common on the arms, legs, and back where the skin is under more tension. I have noticed that scar widening also seems to occur more often in teenagers. Keeping a steri-strip or piece of medical tape on the incision for the first several months can help decrease tension on the incision and lower the risk of the scar widening. But widening cannot always be completely prevented.

    photo credit: emedicine.com

    photo credit: emedicine.com

  • Blending into natural anatomic boundaries: you may have noticed that all of the above factors depend on the healing environment, i.e. how the wound is taken care of, and intrinsic healing factors that vary from person to person. But how the wound is closed also impacts how a scar develops. Wounds under significant tension are more likely to widen or raise up, so minimizing this tension through different closure techniques is an important part of plastic surgery. In addition, a good scar will blend into natural anatomic boundaries. This isn’t always an option in a scar resulting from trauma, e.g. after a dog bite. But if I am taking a skin cancer off the nose, for example, I can design the incision in a way that makes it less noticeable. Facelift incisions are another great example. Even though the incision is right on the face, placing on the natural boundary between the ear and the cheek makes a good facelift scar nearly invisible.

Do you have any questions about scars? I would love to hear them in the comments section.

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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.