The Cosmetic Treatment of Facial Scars

Facial scars are very common from injuries or surgical procedures.  If you call your average cosmetic surgeon and tell them that you have a recent scar, the chances are they will tell you that there is nothing that can be done for a year after the injury.  Unfortunately, this is frequently misinformation.

There is evidence that by treating a scar early, the outcome of the result can be improved.  Some studies have shown that when a scar is treated within 8 weeks of the injury or surgery that it can heal much better than waiting an extended time.  I have adopted this method of treating traumatic and surgical scars of the head and neck and it has worked well.  When a patient presents with a scar of the head or neck that is less than 8 weeks old, I will begin treatment with various modalities including steroid injection, silicone sheeting and pressure.  When the scar reaches its point of primary healing then I will most commonly treat it with the CO2 laser.  The laser performs several functions to improve the scar.  Number one, it allows uneven tissue margins to be blended or smoothed down.  Number two, it causes new collagen to be produced to fill in the irregularities and number three it helps blend the coloration with surrounding tissues.  Lasering the scar is usually done under local anesthesia and takes only a few minutes.  The area will be raw for the first 5-6 days and then be a smooth pink.  This pinkness will fade over the ensuing weeks but may last several months in some cases.

The above scar was treated with CO2 laser resurfacing about 6 weeks after the injury.  This was an exceptional result and not all scars of this type respond to such an extent from a single treatment, but this case shows the power of the CO2 laser for scar treatment. 

The above patient sustained this scar from a surgical procedure at another office.  Dr. Niamtu treated the scar with two sessions of CO2 laser resurfacing.

Sometimes the scar is lasered multiple times as it improves with each treatment.  While simple lasering may work great for simple scars, more complex scars may need surgical intervention first.  Many surgical procedures exist to make scars less noticeable by changing the direction of the scar, making it it more random (straight line scars stand out more) or making the margins even.  Sometimes Dr.  Niamtu will perform a surgical scar revision and then follow up with laser resurfacing to better blend the scar.

Some depressed scars (those that are like craters) respond will to filler injection.  By injecting silicone or other fillers, many depressed scars can be simply “popped out” by filling the base of the depression with filler.  This is useful in acne or pock scars.  Subcision is another useful technique.  Subcision is a process in which a special needle is used to break up scar tissue at the base of a depressed scar.  A depressed scar has spider web like bands called adhesions that, in part, are what keep the depressed scar tethered down.  By inserting this cutting needle under the scar and swiping it back and forth, these adhesions can be separated and allow the base of the depressed scar to rise up and fill in.  Subcision can be performed multiple times to improve a depressed scar.

 

This patient sustained a severe facial scar from a motorcycle accident.  This scar required surgical treatment followed by laser resurfacing and silicone injection.

There are many myths surrounding the treatment of surgical and traumatic scars.  Applying Vitamin E, commercial products like Mederma or Scar Guard or covering the scar with silicone sheeting are probably all useful, even if not scientifically proven.  Keeping a new scar protected from the sun is also important.

For more information on the cosmetic treatment of facial scars or other cosmetic facial surgery see

www.lovethatface.com

 Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Tanning, Sun, Premature Facial Aging and Skin Cancer

 

 

Having a blog requires keeping it up to date and therefore bloggers are continually looking for new, interesting and relevant content.  I have recently read a fantastic journal article in Dermatologic Surgery about Tanning and the associated dangers. 

Ibrahim SF, Brown MD.

Tanning and cutaneous malignancy.

Dermatol Surg. 2008 Apr;34(4):460-74.

This article by Drs. Ibrahim and Brown is entitled “Tanning and Cutaneous Malignancy” is one of the best and most authoritative articles I have ever seen on the subject.  I have summarized the article by a series of self explanatory and sometimes startling facts and also added a few of my own.  After reading these bullet points, one should have a good understanding of the dangers of outdoor and indoor tanning.  All tanning is dangerous.  A tan (and worse, a  burn) represents DNA damage to the skin cells and increased the chances of melanoma and nonmelanoma skin cancers.  There is no such thing as a safe tan.  Although it would be ideal to never get any sun exposure, it is ludicrous to think that younger people will refrain, so I recommend moderation and common sense.  The basis of these facts will be self evident and gives us all something to think about.  Tan now, pay later!

 

Facts about Sun Exposure and the Associated Dangers

1.       Every civilization has had an unwavering reverence for the sun

2.       Before the industrial revolution a tan was a sign of lower class field workers and “porcelain paleness was the epitome of high society” and after that workers went into factories and those with leisure became tanned.

3.       Fashion icon Coco Chanel  sparked the tanning craze in the western world  proclaiming “a 1929 girl must be tanned….A golden tan is the index of chic”

4.       Bikini’s were introduced in 1946 and the “California Beach Culture” of the 1960’s further exposed the skin and increased sun exposure.

5.       A 1907 study in France noted the grape pickers developed increased numbers of cancers on sun exposed areas.

6.       Over the past 40 years, the association between sun exposure, prematurely aged skin, and cutaneous malignancy has become indisputable.

7.       However the desire to tan is higher than ever before. 

8.       In a survey of 8,000 Americans 94%  were concerned that exposure to UV light could lead to skin cancer, yet 68% felt they looked better with a tan.

9.       The first ad for a sun lamp appeared in Vogue in 1923 and there are up to 50,000 indoor tanning facilities in the USA.

10.   There is little sound evidence for any medical benefit from recreational tanning.

11.   We are currently experiencing a skin cancer epidemic and exposure to UVR (ultraviolet radiation) remains the single most modifiable risk factor for the prevention of skin cancers.

12.   Sunlight is 95% UVA and 5% UVB.  UVB is a complete carcinogen and are largerly responsible for sunburn, tanning and carcinogenesis.

13.   Tanning is a response to DNA damage.

14.   Cancer Stats

a.       The WHO estimated in the year 2000 up to 70,000 deaths worldwide were attributable to excessive UV (ultraviolet) exposure.

b.      In the USA skin cancer represents for more that 50% of all malignancies

c.       Mortality from melanoma in the USA occurs at the rate of approximately one life per hour or more that 8,000 deaths annually.

d.      Although melanoma only represents 3% of total skin cancers, they are responsible for over of 80% of skin cancer deaths.

e.      Skin cancer incidence is rising faster than any other cancer and the lifetime risk of an American to develop melanoma has increased 2,000% in the last 75 years.

f.        Melanoma is currently the second most common cancer (after thyroid) form women in their 20’s.

g.       Residents of New Zealand and Australia have the highest melanoma rates in the world due to largely fair skin and live close to the equator.

h.      Caucasians have 23 times higher incidence of melanoma than blacks.

15.   Red heads, fair skinned people and light eye color are at more risk, as is excessive sun exposure before the age of 18, and sunburn at any age have been repeatedly shown to increase one’s lifetime risk for development of melanoma.

16.   “A single severe in childhood may double the risk of melanoma” (ref 77 in article).

17.   The tanning industry generates $5 billion annually, up from 1 billion in 1992.  1 million people tan daily and 70% are Caucasian females form 16-49.  30% of teens between 13 and 19 are tanning with girls 2-3X over boys.

18.   Indoor Tanners are

a.       More likely to tan outdoors

b.      Less likely to use sun protection

c.       Less knowledgeable about skin cancer risks

d.      More influenced by social factors

e.      More concerned about weight

f.        More likely to smoke

g.       More likely to binge drink

h.      More likely to use recreational drugs

i.         More likely to have parents who tan

19.   20 minutes in a tanning bed is equal to 2-3 hours in the noon day sun.

20.   Evidence shows several positive associations between indoor tanning and melanoma, particular with exposure before age 35.

21.   Patients that use indoor tanning think they are protected and hence spend more time in outdoor sun, which is bad.

22.   Studies show that up to 88% of tanning salons allowed minors to tan without parental permission and 75% provided reassurance of the safety of tanning.

23.   Sun is not necessary for Vit. D which is in many foods, 5 minutes at noon in the June Boston sun is adequate for maximal cutaneous production.  2 glasses of milk or orange juice cover it, as does incidental exposure of face and back of hands.

24.   Tanning can produce endorphins and contribute to “tanner’s high”

25.   The link between natural and artificial sun and skin cancer is becoming much like cigarettes and lung disease or alcohol abuse and liver damage.

To find out more about skin aging and facial rejuvenation see

www.lovethatface.com

Joe Niamtu, III DMD

Richmond, Virginia

Can Cosmetic Surgery Get You a Job Promotion?

 

 

There is no more unreliable media than the cosmetic surgery media.  It is fueled by promises of miracle treatments that provide something for nothing.  As good as it sounds, it is a rare innovation that allows dramatic results with little or minimal treatment.  The only thing that I can even think of that comes close to that in the last 30 years is Botox.  It satisfies the definition of innovation.  Never before were patients able to get of wrinkles (albeit temporary) in a non surgical manner.

It is impossible to pick up a paper or magazine of to turn on the news and not hear about some new “miraculous” cosmetic treatment.  Unfortunately, most provide empty promises.  I ( as well as many other surgeons) have seen many come and go.  Thermage, which was all the rage several years ago has proved disappointing to the point where many docs are trying to unload their machines.  The Contour Thread Lift was another dud and the company is no longer in business.  Although there are many new minimally invasive lasers and light devices, I predict most of them will also fall by the wayside because they just don’t deliver dramatic enough results to warrant the cost of treatment.  I will admit that all of these technologies do provide some result, but not enough to satisfy the demanding patients in most surgical practices.  If a non surgical specialist can tighten the neck skin 5%, for $6,000 and some of their patients see tiny a result, they may be happy, but 100% of patients in my practice would want a refund for these minimal results.  My patients, like many other surgeons want to see a dramatic difference.  They realize they won’t get that without surgery and recovery; they are realists!

Back to the cosmetic media.  There has been a lot of news buzz lately about patients having cosmetic surgery to fare better in the work place.  A reporter called me the other day and was surprised to hear me say that I think that is a silly pretense.  Don’t get me wrong, I am obviously an advocate of cosmetic surgery and I will agree that all patients want to look younger.  I will also agree that younger, thinner, less bald and taller patients get more promotions.  That is just a fact of life.  There is nothing wrong with wanting to look younger.  If you have a big “turkey wattle” neck and you work with a bunch of 35 year olds, it makes sense to want to look younger.  However, to think that tightening ones neck or lopping off some eyelid skin will enable promotion or retention is rather ludicrous in my opinion.  Although cosmetic surgery can make a patient look younger, the best surgeon in the world cannot make a 68 year old patient look like a 45 year old.  Cosmetic surgery can make you look younger, but will it really make you look that much younger?

First of all, patients need to have the right motivation to have happiness after cosmetic surgery.  If they go through the recovery and expense of cosmetic surgery and do not move forward in their job, it will only serve to compound their unhappiness.  Sometimes we need to look at our inner beauty!  We are all going to get old, count on that.  Progress in the workplace is much more about attitude, team work, accountability and reliability.  If you really want to do advance in the workplace, a conscious effort to work harder that any other employee will go a lot further than geting your eyelids tucked.

I love performing cosmetic facial surgery, it is my passion and there is not better feeling for me than making patients look and feel better.  Sometimes my work may lead to a new relationship or a job promotion, but usually it simply leads to a patient with better confidence and self esteem.  I relate it to the way one feels when their car is dirty and how good you feel when you drive out of the car wash.  Cosmetic surgery patients feel like that for years.  Cosmetic surgery makes you look better, but can also make you feel better.

It is imperative to consider many aspects of ones life prior to making the decision to have cosmetic surgery.  Health, recovery and budget are important points, but the true underlying motivation is the most important factor and has much to do with the patent’s perception of success of the procedure.  Do it because you want to look better, be more confident and elevate your self esteem.  The relationships, jobs and modeling contracts may or may not follow.

To find out more about cosmetic facial surgery or Dr. Niamtu in Richmond, Virginia, see

www.lovethatface.com

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

Cosmetic Eyelid Surgery/Blepharoplasty

If the eyes are the seat of the soul, they are the foundation of beauty.  The eyes are a beautiful, intricate and unique structures and are the first thing that humans notice about the face of other humans.  The youthful eyelid is tight, well defined, sculpted and is one of the basic clues about ones age.  As we get older, the upper face ages more rapidly than the lower face and it is not uncommon for me to perform eyelid surgery on patients in their late third decade and through their eight decade.  A healthy person is never too old to look younger!

Most us that are over 35 can testify to the subtle changes that begin in the mid 30’s.  Usually we fires notice the “crow’s feet” wrinkles that develop on the side of the eyes and are accentuated when we squint and smile.  The next change that becomes apparent is the excess skin that forms on the upper and lower eyelids.  The upper lids get droopy and the excess skin can lie on the eyelashes or lower.  This can actually obstruct a patient’s vision and if this is the case is often covered by health insurance.  For a cosmetic procedure to be covered, the patient must first visit their eye doctor and undergo a test to see if the skin excess qualifies for insurance.

Women will notice that they can no longer wear eye shadow because the eyelid shelf (the area above the lashes) is covered with skin.  Men will usually notice that their eyes look smaller.

The other big change is the development of fat bags around the upper and lower lids.  The eye is surrounded by a protective cushion of fat and as we age, the tissues that keep the fat in place weaken and the fat pockets protrude under the skin.  This (along with skin changes) gives patients a puffy and tired appearance.  It is not usual for patients to present to the office and say “Dr. Joe, I work out, watch my diet and take care of my self but I always look tired. My friends ask me if I am stressed or not sleeping!”  What these patients are actually saying is that they have aging changes in the eyelids.

 

The above picture illustrates aging changes in the eyelids.

Many patients that think they need eyelid surgery actually need brow and forehead lift surgery.  See this topic on my previous blog topics.  Brow and forehead lift is sometimes performed alone or with the combination of brow and eyelid surgery.  The photo below shows a patient with a tired appearance that was refreshed with brow lift and eyelid surgery.

The above patient complained of looking tired and was treated with brow and forehead lift and blepharoplasty (cosmetic eyelid surgery).

Upper eyelid cosmetic surgery is a relatively standard procedure in that an incision is made on the upper lid and excess skin, muscle and fat are removed or recoutoured.  The procedure takes about 20 minutes per upper lid and stitches are placed the dissolve or are removed at about 5 days.  The recover for upper eyelid blepharoplasty is usually about a week although most patients could don sunglasses and go about their business (excluding heavy lifting) in several days.  Many surgeons use scalpel or scissors for eyelid surgery.  Dr. Niamtu performs all his cosmetic eyelid surgery with high technology modalities such as lasers and radiowave surgery.  By using these advance devices, there is virtually no bleeding.  This means less pain, swelling and bruising and a faster recovery.

Lower eyelid surgery is more diverse in the number of surgical approaches the doctor uses.  Basically there are external approaches which leave a scar on the lower lid and internal approaches which are performed from the inside of the lower eyelid (transconjunctival approach) that leave no scar.  Dr. Niamtu generally uses the internal approach due to the fact that there will be no scar and also there are less complications with lower eyelid position with this approach.  Using the external approach can cause a pulled down lower eyelid which is not a problem with the internal approach.  When using either approach, the excess fat is reduced or repositioned to improve the bags under the lower eyelids.  This represents the first part of the operation and the second part is tightening the excess lower eyelid skin.  This thin, crinkly skin is addressed by numerous methods including cutting, lasering and chemical peeling.  Dr. Niamtu prefers treating the skin with the laser as there are no incisions.  The upside of the laser is that it makes new skin.  The aged skin is removed as well as pigment that contributes to dark circles under the eyes.  The downside is that the recovery is longer as the patient cannot wear makeup for about 10 days and will have some residual pinkness that can be covered with make up which can last up to several months.  The best results are available with the laser if the patient can tolerate the recovery.  Dr. Niamtu prefers chemical peel as the second option for lower eyelid skin tightening.  Although not quite as effective as the laser, the chemical peel also tightens the skin and removes unwanted skin damage and has a much shorter recovery which is usually a week and the patient is back in makeup.  A third method of tightening lower eyelid skin is to remove a small amount of skin.  Dr. Niamtu usually reserves skin removal for selected patients that are not candidates for laser or chemical peel.

The patient plays an important part in the success of any operation and especially eyelid surgery.  Serious complications are rare with eyelid surgery.  Bleeding behind the eye can be catastrophic and although very rare can be caused by bending, lifting, over activity, high blood pressure and medications as simple as aspirin that can affect the clotting system.  It is vitally important to adhere to the pre and post operative instructions provided by our office.

The following pictures show before and after cases of cosmetic eyelid surgery. 

 

   

Dr. Niamtu and his staff invite you to visit our office for a free consult for eyelid rejuvenation as well as visit our website www.lovethatface.com for more information about Dr. Niamtu and cosmetic eyelid surgery in Richmond, Virginia.

Repair of Torn Earlobes

Although it seems like a minor problem, thousands of people with pierced ears have torn earlobes and with the popularity of body piercing the number will surely grow dramatically.  The torn earlobes can result from the continual wearing of heavy earrings, trauma, getting earrings snagged on phone cords, pull over sweaters, bath towls, hairbrushes or children pulling them.  The actual tear may be a partial tear or a full thickness tear that completely splits the earlobe.  Torn earlobes bother patients from a cosmetic standpoint as they are unattractive and also because the patient either cannot wear earrings or the earrings tip or move out of place due to the large hole.

 

The above image shows a partial earlobe tear.

The repair of torn earlobes is a very simple process that takes about 15 minutes.  Local anesthetic is injected in the earlobe to make it numb and depending upon the severity of the tear, there are several means of fixing it.  Partial tears are treated by cutting out the pulled apart area and resuturing the hole.  Total tears require a bit more surgery and are treated by excising the borders of the completely torn earlobe and placing dissolvable sutures on the front and back of the ear.

Dr. Niamtu has publilshed several articles on this procedure in the maxillofacial and dermatologic literature and was the first to publish a method on simultaneous piercing.  SInce most patients don’t want to go without wearing earrings, Dr. Niamtu can repair the tear and at the same time place a special sterile earring stud through the stitches so the patient can heal with the new earring in place.

Although the technique is simple it requires finess to properly line up the earlobe to have a natural curve and shape.  Dr. Niamtu also performs laser or radiowave surgery on earlobes that heal wiht a notch which sometimes happens in the best of hands.

The recovery is also simple.  Generally dissolvable stitches are used and the patient can resume normal activities that do not place tension on the ear.  The stitches dissolve in about a week and a fine linear scar is visible for several weeks and generally fades to an acceptable result.  For the suture scar that does not heal gracefully, Dr. Niamtu will resurface it with the CO2 laser which dramatically improves it.  If the ear is not pierced at the time of the surgery, the patient generally waits about a month to repierce the ear.

Dr. Niamtu also performs earlobe reconstruction on “piercings gone bad” where people intentionally stretch the earlobes or susain disfiguring tears of the ears or lobes from body piercng.  He also treats keloids of the earlobes.  Finally, many patients are born with very large earlobes and Dr. Niamtu frequently performs earlobe reduction in these patients to reduce the size of their earlobes.

 

The above pictures show several cases of earlobe repairby Dr. Joe Niamtu in Richmond, Virginia. 

For more information about earlobe repair, earlobe reduction or earlobe keloids  or other cosmetic facial surgery procedures see www.lovethatface.com.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com