Thursday, February 27, 2014

Five Skin Care Tips for a Healthy Skin

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This is a guest post by Alyssa Furnell Content Writer/Proof Reader at Authority Specialists. Authority Specialists provides top-quality, value-filled content with the goal of building the authority of your website.

For busy individuals wanting to have their skin pampered, going for an intensive skin care is not easy. If you have a healthy lifestyle and practice good hygiene - especially in caring for your skin, then there is no need to go to a dermatology clinic. Unless of course your problem is getting rid of those hideous scars, then you really need the help of a professional, where they have a laser clinic.

Simple Tips for a Healthy Skin
  1. Protect yourself from the UV rays
  2. Being exposed so long under the sun can cause damages to your skin especially hastening the aging process. The sun has UV radiation that is harmful to your skin and can cause skin cancer in the long run.
    • Use sunscreen to protect your skin with an SPF of at least 15. If you are staying outdoors for longer periods of time, apply sunscreen every two hours.
    • Wear clothes to protect your skin and a wide-brimmed hat to shade your face from the rays. Remember that getting exposed under the sun for a long time can hasten the aging process – wrinkles and age spots
  3. No Smoking
    There are a lot of issues connected to smoking and the most obvious is in your skin. Smoking according to some researches, can make the skin look old, dry and promotes wrinkles. The reason being – it narrows the tiny blood vessels that is located in the outer layers of the skin and blood supplied there is limited. This will deplete the oxygen that is needed in the skin plus the nutrients it needs.
    Another effect that smoking contributes is damaging the elasticity of the skin.
  4. Pamper Your Skin Gently
    The daily cleansing, shaving and strong soaps can have its repercussions towards your skin. You need to be gentle with your skin by doing the following:
    • Limit the time you spend in your bath. Taking long showers or baths can remove the natural oil that your body produces, which actually helps your skin.
    • Do not use strong soaps and especially not detergents because this will definitely take the natural oil that your body produces.
    • When you shave, try to be gentle and careful. For proper lubrication, use shaving creams, lotions or gel right before you start shaving. For the shaving direction, make sure you shave along the direction that the hair grows.
    • Do not rub the towel hard on your skin when you are finished with your shower or bath. Pat to dry to keep some of the moisture on your skin – hydrate your skin.
    • Once you are done with taking a shower or bath, apply a moisturizing lotion especially for dry skin.
  5. Have a healthy and balanced diet
    Remember the saying, you are what you eat? Well, this is true. Having a healthy diet can encourage a younger and healthy-looking skin.
  6. Be stress-free
    Being under stress can cause several skin reactions such as acne breakouts or rashes. If you are under stress, take some steps to manage them. Better yet, ask some professional help. There are different levels of managing stress in every individual. Take time to understand and resolve the things that cause you stress.

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Thursday, February 20, 2014

Laser Hair Removal and Hidradenitis Suppuritiva

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Lasers and Laser Hair Removal

As described in my previous blog Hidradenitis of the Armpits Hidradenitis occurs when a plug of dead skin in the duct of a gland emptying into a hair follicle initiates an infectious process as bacteria multiply within the plugged gland. As the gland swells a boil becomes visible. The obstructed gland or boil ruptures into the deep layers of the skin; adjacent glands become involved; and abscesses form. Subsequently, multiple draining sinuses or holes appear on the skin surface and the whole hair bearing area may become inflamed. Such inflammation may result in star shaped skin scars and tunneling, causing ridging of the skin. The association of Hidradenitis with hair follicles has fed the notion that removal of this hair early in the process can cure or ameliorate Hidradenitis. Since the 1990s laser treatment to remove unwanted hair has become increasingly popular therefore such treatments should to some degree treat Hidradenitis.

A laser is basically a container of some medium (such as a liquid dye, gas, etc) into which an electrical charge  or flash of light is introduced. The charge or flash excites electrons in the material at the molecular level and the material gives off a narrow band width of light as the electrons come out of excitation. The exact wavelength of light created depends on the material itself and the characteristics of the charge or flash. Mirrors inside the container bounce the light around to create a chain reaction of molecular excitation and the emitted light is allowed to escape through a pinhole. This single wavelength coherent light is then focused down into a hand piece so it can be applied to tissue. The effect on the tissues depends on which tissue components absorb the specific wavelength of light, the depth into the the tissue that the laser can penetrate, the duration of exposure to the light (pulse width), the power of the light at the point of tissue contact, etc.

Laser penetration is a factor of light wavelength with usually greater penetration for lasers with higher wavelengths of light. The wavelength also governs which tissue component will absorb a specific wavelength.
 Light is absorbed by dark objects. Color as we perceive is really reflection of light at wavelength that corresponds to the color we see. If there's enough light, something dark can get pretty hot (like the hood of a black car in the summer sun). In a similar way, laser energy is absorbed by specific tissue components creating heat at the target point. This dark target matter, or chromophore, can be naturally-occurring such as natural hair color or artificially introduced such as a tattoo. The 1064nm laser is optimal for reaching the hair follicle depth and absorption by darker pigment. This is complicated by the fact that hairs in any given treatment area can be widely variable in diameter, color, and depth. Some follicles can be as deep as 7mm below the skin surface. The other problem is that red, blonde, grey and white hairs do not absorb this wavelength. In such cases carbon, can be introduced into the follicle by rubbing a carbon-based lotion into the skin following waxing thereby creating something right near the follicle that can absorb the laser light.

To thermally destroy the hair follicle without harming the surrounding skin tissue, the laser has to target the melanin pigment in the hair follicle with a specific wavelength in the 600-1100nm range and the target hair has to cool before it is hit with a second laser pulse in order to minimize collateral skin damage. The hair has to be heated to 65 degrees C in order to be removed while the skin is damaged at heats above 44 degrees C.

From these 2 figures it is clear that the YAG laser is best for reaching the follicle and heating it up to the appropriate temperature. The problem again is that 1064nm is reflected (not absorbed) by lighter colored hair. The other problem is that the pigment if darker colored skin will also absorb the light as it passes through and once that skin heats up above 44 degrees C it is damaged i.e. burned. In such cases cooling of the skin surface at the same time is important. Another technical safety point is setting the time between laser pulses to allow for skin cooling but not hair follicle cooling as the skin cools more quickly than the follicle.

Most doctors space laser treatments 4 to 6 weeks apart, but theoretically, there is a point of diminishing return where additional treatments will not cause additional hair loss.

Laser Hair Removal to Treat Hidradenitis

CO2 lasers have been used treat Hidradenitis as early as 1987 but these are ablative leaving wounds that take time to heal. For small areas these heal with small recurrence rates but for large areas the healing process could take months and result in bad scarring that could be symptomatic or hamper range of motion. The use of fractional CO2 lasers in Hidradenitis has not been studied.

800 nm and 1450 nm Diode Lasers have effectively been used for laser hair removal but I have only been able to find a couple of anecdotal single case reports of their use in treating Hidradenitis.

Broad band or intense pulsed light (IPL) is a strobe light of multiple wavelengths that generates skin surface heat when it hits the skin surface. It also kills bacteria. Filters can be placed between the light source and the target so that the target only sees a specific wavelength. This is basically the poor man's laser but has been effective in hair removal, skin rejuvenation, reducing sun damage to the skin, evening out skin pigmentation and acne treatment depending on the settings.  In a 2011 study 18  Hurley stage II and III patients received a total of eight 420nm IPL treatments, twice weekly for 4 weeks, to one side of their body. The treated sides were then compared to the non-treated sides.They found that the Hidradenitis Suppurativa Examination Scoring System improved by 56% at 3 months after treatment, 44% at 6 months after treatment and 33% at 12 months. This is clearly not a permanent solution for mid and advanced stage Hidradenitis and improvement in a scoring system is not equal to a cure.

Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) laser  as I have shown above is quite effective for hair removal. The most quoted report of its use in Hidradenitis is the 2010 study by Xu LY et al. Two laser treatments were performed in 22 patients with Hurley stage II Hidradenitis in a randomized right left fashion. Double pulse stacking was used at the first treatment, and triple pulse stacking at the second on inflamed areas. These patients were examined 24 hours,1 week, 1 month, and 2 months after treatment. Lesion Area and Severity Index scores modified for HS, patients improved 32% in treated areas 2 months after the second treatment. Biopsies proved the hair follicles and shafts were affected and the areas were scarred by the laser. This was not a cure although there was some improvement and the follow up was only 2 months so it unclear how long the result lasted.. The presence of darker thicker hairs in the armpit than in the breast crease may be the reason for this.

Another study by Tierney et al involved 22 patients (skin types II-VI) with Hurley stage II / III hidradenitis suppurativa on both sides of the body. One side was treated with only topical antibiotics and the other with 4 monthly Nd:YAG laser treatments. 2 months after the last treatment laser treatment improved the modified HISERG scale by the greatest amount for groin HS (68% vs. 2%) but also improved HISERG scale scores of lesions in the armpit (63%  vs. −11%) and in the breast creases (30% vs. −71%). The -% means the non-lasered side became worse. This probably due to the presence of darker thicker hairs in the armpit than in the breast crease.

 A 2012 study reported a 2 step process first using Nd:YAG to destroy the hair follicles and then applying a CO2 laser to remove surface skin in 4 patients. At 3 year follow up there was no recurrence. It is unclear how advanced their HS was to begin with or whether the CO2 really added anything to the treatment results.

A 2013 review of laser treatments performed at the Birmingham England Regional Skin Laser Centre between 2003 and 2011 concluded that laser hair removal "appeared" effective in treating HS particularly at an early stage.

My Conclusion

Nd:YAG is your best option for laser hair removal treatment of HS, it works best in areas with thicker darker hair (it's not worth the effort for breast and chest HS), it is more likely to reduce severity or prevent progression of severity than it is to cure HS, you may need future maintenance laser treatments after the initial treatments, one laser treatment is never enough and it will not do much for advanced stage III HS where the problem is well beyond the hair follicle.

If you find this blog post helpful please share it with others who have HS.

Bandages and Dressings for Hidradenitis Suppuritiva

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Thursday, January 16, 2014

Do It Yourself Plastic Surgery Devices and Gadgets

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As mentioned in my previous blog Plastic Surgery in South Korea South Koreans get more plastic surgery per capita than citizens of any other country in the world. In that country it is seen as a prerequisite for success in work and relationships. The patients are also getting younger so patients in their first or second year of high school are becoming common. With this high demand a number of citizens especially teens cannot afford to have the surgery so they are turning to cheaper devices and gadgets to mold their features into a desired shape or appearance. Most of these devices are designed to supposedly change facial appearance and are sold online. The sellers of these devices make claims that have no scientific basis and there are no studies proving the efficacy of any of these devices. In fact looking at some of these devices would make one think their application is more suited to a form of torture. The use or overuse of these devices could very well result in infections, permanent scars or other irreversible deformities especially in young people who are still growing.

Here is a list of available devices.

Double Fold Eyelid Glasses
Eyelid surgery to create a double fold eyelid is very popular in South Korea.These glasses available for $5.45 force the eyes to stay open without blinking and promise to replace that surgery when worn for 5 minutes a day. The frame pushes the upper portion of the upper eyelid away from the lower portion. As you blink the device is supposed to train your eyelid to keep its new configuration. Thousands of units were sold in its first month on sale so its sales were increased to 200 stores.

Two 17 year old South Koreans who used the product were interviewed and described its use in 12 and 13 year olds and elementary school children. They "know that these methods aren't approved of" and are associated with dangers but don't think they will be affected adversely.

South Korean surgeons are reporting that teenagers are showing up at their clinics complaining of infections and damage to their eyes. Fortunately, most of these are minor and can be repaired.

Jaw Squeezing Roller Device

This jaw squeezing device promises to create a V-shaped jaw and only costs $6. Teens spend hours rolling the product on their jaws in an attempt to change the shape of their jaw line. This is supposed to take the place of jaw surgery which involves cutting the bone and reshaping the jaw. The only way this could work is if it broke the jaw bone while it is rolling.

Nose Pliers
This device sells for $2.84 and is supposed to raise the bridge of the nose when worn for a few hours each day. This isn't likely to raise your bridge any more than wearing glasses would.

Face slimmer
You wear this $63 clown like silicone mouthpiece 3 minutes a day and loudly repeat vowel sounds in a methodical fashion thereby making mouth movements that rejuvenate your face.  The working theory is that the device makes the muscles work harder and that exercising these muscles makes you look younger. It is supposed to treat wrinkles around the eyes and shape the overall look of your face while in front of the mirror or in the bathtub or shower. A motorized version of this called "Facial Lift At Once" is available that vibrates in position in order to exercise facial muscles. The working theory is faulty because muscle movement is actually responsible for aging which is why Botox, a muscle paralyzing agent, is so popular.

Karakuri Ribbon Scalp Stretcher 
This $33 rubber band has combs at either end that hook into your scalp and pull your face upwards simulating a surgical facelift, only the result is instantaneous. It makes signs of aging like wrinkles around the cheeks and eyes, jowls, laugh lines and to some degree excess neck skin disappear. It is hidden under your hair as shown in the above photo. This is the only device in this series that makes any sense and has any efficacy. The main problem with it though is that overtime this traction on the scalp can pull out hair by the roots.

Beauty Lift High Nose - Nose Lift

This torturous looking $68 vibrating device is inserted into your nostrils and has plastic legs that press into the bottom, sides, and bridge of your nose.Wearing it for 3 minutes a day is supposed to raise the tip and bridge and straighten the bridge of your nose.

Kogao! Double Face Mask - Anti-Aging Mask
This $40 mask straps around the eyes and head applying pressure across the face to maintain a smooth, wrinkle-free appearance. Kogao is the Japanese term for what is considered a small wrinkle free beautiful face. The mask is supposed to achieve this goal, firming the facial muscles, by squeezing your face and head. It can be worn while eating, sleeping, working or sitting in the bathtub. In the past decade, sales of products claiming to slim and mold the face into smaller proportions have been booming in the country. The "double" refers to the two belt-like straps. If this worked superheroes and super criminals should look younger than their actual age. If the nose pliers and nose lift devices actually worked this device would obviously counteract the effects of those devices.

 Happy Smile Trainer

This clear silicone retainer presses your lips into a smile while you bite into it for 5 minutes a day. By strengthening your mouth and jaw muscles it is supposed to create the perfect smile, improve facial balance and strengthen your gums and teeth. Since smiling elevates the soft tissue of the face they are attempting to exercise the smile muscles to keep that tissue up all the time.

A few crazed addicts have already indulged too far in their love of cosmetic enhancements, inflicting grotesque and irreversible damage to their bodies. Former Korean model Hang Mioku became addicted to plastic surgery and obsessed with having smooth and softer skin via silicone injections to her face. When doctors refused to inject more silicone she began injecting black market silicone into her face. After injecting that whole bottle she began injecting cooking oil. Unfortunately, that left her face severely swollen and scarred.

Korean Model Before and After Self Injections

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Friday, December 27, 2013

Bandages and Dressings for #HidradenitisSuppuritiva

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As described in my previous blog post Hidradenitis of the Armpits - Boils Under the Armpits a plug of dead skin in the duct of a gland emptying into a hair follicle in areas of opposing skin surfaces like the armpits, under the breasts and in the groin initiates an infectious process as bacteria multiply within the plugged gland creating a skin boil. The obstructed gland or boil ruptures into the deep layers of the skin; adjacent glands become involved; and abscesses form. Subsequently, multiple draining sinuses or holes appear on the skin surface and the whole hair bearing area may become inflamed. We call this process #HidradenitisSuppuritiva (HS).

As I described my first choice of treatment for this process is surgical removal of the involved skin and closure of the resulting wound with a flap of adjacent normal skin. However, this aggressive surgery is not always the best near term option because of insurance, financial, work or personal reasons. For early stages of the disease temporizing the situation with topical treatments is appropriate and can provide significant relief.

Tuesday, November 12, 2013

10 Things to Consider Before Having Plastic Surgery

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1. What is my surgeons training background?

Traditionally, doctors from just four medical specialties — plastic surgery, dermatology, otolaryngology (ear, nose and throat), and ophthalmology — have handled the bulk of cosmetic offerings, including everything from minimally invasive aesthetic treatments like botulinum toxin (sold under the brand name Botox) to more involved procedures like face-lifts. And those specialists spend years honing their chops in residency training programs that teach skills unique to each specialty in addition to basic surgical skills. Now doctors in these and other specialties may take a weekend course as the only preparation for doing your surgery. “Unfortunately, this is an industry where the most creative, assertive, sexiest marketing often drives the business, but it may not be someone with the best experience,” said David B. Sarwer, a professor of psychology at the Perelman School of Medicine at the University of Pennsylvania.

Monday, November 4, 2013

Smoking Adversely Affects Facial Aging

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The link between smoking and premature facial aging was first made in 1971. Surveys of twins attending the annual Twin Days Festival, held in Twinsburg, Ohio between 2007 and 2010 conducted by Case Western Reserve University department of Plastic Surgery have corroborated this. In each pair of twins, either one twin smoked and the other did not, or one twin smoked at least five years longer. Pairs in which neither smoked or the difference in smoking was less than 5 years were excluded.Fifty-seven of the included 79 twin pairs studied were women, and the average age was 48. The twins completed questionnaires regarding their medical and lifestyle histories specifically sunscreen use, alcohol intake, work stress and smoking history. A professional photographer took standardized, close-up photographs of each twin's face. Without knowledge of the twins' smoking history, plastic surgeons then analyzed the twins' facial features in the photos, including grading of wrinkles and age-related facial features to identify "specific components of facial aging" that were affected by smoking.

Smoking Adversely Affects Facial Aging
The sister on the left smoked 17 years longer than the one on the right which accounts for larger jowls, lip wrinkles and lower eyelid bags not present in the sister on the right as well as the deeper frown and laugh lines in the sister on the left.

The conclusion of the study was that the effects of smoking on facial aging are most apparent in the lower two-thirds of the face specifically lower eyelid bags, malar bags, upper eyelid skin excess, the lips, laugh lines and jowls.  The forehead wrinkles, frown lines and crow's feet wrinkles were not statistically different.  Smokers had more sagging of the upper eyelids, as well as more bags of the lower eyelids and under the eyes. Twins who smoked also had higher scores for facial wrinkles, including more pronounced nasolabial folds, wrinkling of the upper and lower lips and sagging jowls. I had once had a patient who smoked only holding the cigarette on the right side of her mouth. She had aging wrinkles of the right upper lip but not of the left upper lip. In her case one side of her face aged more than the other.

The take home message is do not smoke to lessen the need for cosmetic surgery and do not smoke afterward to maintain the results of cosmetic surgery for a longer period of time.

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Sunday, October 20, 2013

Heart - Coronary Artery Stents and Cosmetic Surgery

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Heart (coronary) artery blockage is a local blocking or narrowing in the arteries on the outer surface of the heart by accumulated deposits of plaque, which is mostly bad cholesterol. Every artery in the body is a blood pipeline. These pipelines get blocked with accumulation of bad cholesterol. When a cardiologist suspects blockage or narrowing of any of these heart arteries he/she will perform an angiography (threading a catheter up a thigh artery to the heart to inject a dye that is visible on X-ray) to view the inside of the arteries. When an area of artery narrowing or blockage is identified a catheter with a balloon is inserted along the same path and inflated at the problem area to open it up. This is called angioplasty. Increasingly stents are placed at these angioplasty sites to keep them open in the long term. In some cases multiple stents are sequentially placed in the same artery. If the area cannot be treated in such a fashion open heart surgery is required which involves opening the rib cage and bypassing the blocked area with a vein graft or connecting an artery from inside the rib cage to the downstream side of the blockage. These procedures have helped prolong the life of countless heart disease victims. This blog only addresses patients who have had stents placed. It does not address those who have had open heart surgery.


Tuesday, October 1, 2013

Blood Clots, Venous Thromboembolism, Pulmonary Embolus and Cosmetic Surgery

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In a previous blog I discussed Bleeding Disorders and Cosmetic Surgery focusing on bleeding tendencies and abnormally low blood clotting. This blog deals with the other side of the coin abnormally high blood clotting. These clots usually form in large veins of the leg or pelvis or in the chambers of diseased hearts.

Sunday, September 15, 2013

Fat Injections to Reconstruct Breasts or Increase Breast Size

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As described in my previous blog Free Fat Grafting grafts of small pieces of fat removed from one area of the body and placed in another area was first attempted in the late 1800s and early 1900s. In 1893, German physician Franz Neuber grafted a piece of upper arm fat to a patient’s cheek. Two years later, in 1895, another German physician, Dr. Karl Czerny, performed the first documented breast augmentation when he grafted a fatty tumor from a patient’s lower back to repair a breast defect. With the introduction of liposuction in the 1980s the available donor source for fat injections rapidly increased. Although a minority of plastic surgeons currently inject fat into the breast to enlarge them for cosmetic reasons the tide is changing. In 1987 the American Society of Plastic Surgeons advised against fat injections into the breast due to concerns that it affected breast cancer detection and the survival rate of injected fat was unreliable. That opinion was reversed in 2008 in the face of increasing evidence that cancer detection and cancer rates themselves were not affected by the procedure. Now the flood gates have opened and everyone even non-plastic surgeons want to inject fat into the breasts.

Tuesday, September 10, 2013

Varicose Veins

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Varicose veins are visible dilated tortuous veins. The term is usually only applied to those present superficially on the legs but they can occur anywhere including the testicles (varicoceles) and the face. The legs have a deep and superficial system of veins connected by another set of intermediary or perforating veins. The deep and superficial systems run longitudinally and the perforating system runs transversely to connect them. Veins have a lower pressure of blood flow than arteries so forward movement of blood requires massage by the movement of adjacent muscles and valves inside the veins to prevent back flow. The superficial veins become varicose when the perforating or deep veins are damaged allowing back flow or clot closed and/or the valves no longer function normally.
Chronic or large varicose veins can cause discoloration and thickening of the skin, swelling of the ankles and feet, actual skin breakdown with the formation of ulcers, blow out of the dilated veins with sudden high pressure bleeding, pain and aching muscles especially with prolonged standing and easily damaged skin. My father spent long periods of time standing without movement at his job and developed large varicose veins in his lower legs that ached and precluded him from working that way when he was older. This type of stationary standing work or prolonged sitting work (airplane pilots) are risk factors for developing varicose veins.

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