Archive for September, 2011

Actinic keratoses (AKs) are rough, scaly tan brown patches on the skin, caused by excessive exposure to the sun, that can sometimes progress into dangerous skin cancers. More than 10 million Americans live with these skin lesions thinking that they represent “age spots”, and far too many people ignore them. Unfortunately, leaving AK’s untreated can have serious consequences. Doctors estimate that 40 percent of skin cancers [squamous cell carcinomas, the second leading cause of skin cancer deaths in the United States] begin as AKs. For this reason, major medical groups —The American Cancer Society, The Skin Cancer Foundation, and the American Academy of Dermatology — all recommend that people with Aks seek review and treatment options for them immediately.

What does Actinic Keratosis look like?

AKs are very common on sun exposed parts of the face, scalp, ears, chest, back and extremities. They present as rough scaly patches of tan to brown skin. Sometimes these patches can become larger and thicker called “hyperkeratotic.” These enlarged lesions may then progress to changed to frank squamous cell carcinomas. Patients may notice increased redness, tenderness, itching, and burning associated with the thickened rough skin. However, these symptoms can be the same for either Aks or squamous cell carcinomas. This is what makes distinguishing between the two so difficult without a simple skin biopsy. Left untreated, squamous cell carcinomas may become larger, go deeper into the skin, and eventually spread to other parts of the body by the lymph nodes. This results in thousands of skin cancer deaths each year, many of which could be prevented with appropriate surveillance and early intervention.

It is impossible to predict if an AK will evolve into a squamous cell carcinoma, or at which point it will happen. Many doctors believe that AKs and squamous cell carcinomas are really the same condition at different stages of a continuing process. This process begins with minor cell damage and, over time, ultimately results in the cell becoming cancerous. These doctors believe that AKs occur in the early stages of the process; squamous cell carcinomas occur in the final stage. One thing, however, is certain: a significant percentage of AKs develop into squamous cell carcinomas. Estimates range from 10 percent to as high as 20 percent over a 10-year period of patients with known actinic keratosis.

Preventing Actinic Keratosis

Long-term exposure to the sun is the single most significant cause of AKs, so the best defense against them is a comprehensive sun protection program. This includes wearing protective clothing and a wide-brimmed hat, avoiding the sun at midday when ultraviolet rays are strongest, staying in the shade as much as possible, and wearing a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. Unfortunately many of us already have sun damaged skin and a more aggressive approach is needed.

Treating Actinic Keratosis

Surgical excision, freezing and electrodessication have been the main tools to deal with AK’s. Advanced technology is now available with photodynamic therapy. Levulanic Photodynamic Therapy uses photochemical methods to target minimally to moderately thick Grade 1 or 2 AKs (AKs that have not yet become enlarged and thick). This therapy is unique because it uses light activated drug therapy to destroy AK’s in their early stages. The 2-step process consists of treatment to the affected skin with a weak acid solution which is chemically altered by exposure to certain wavelengths of light.

When levulanic acid is applied to Grade 1 or 2 AKs, the solution is absorbed by the AK cells where it is converted to a chemical that makes the cells extremely sensitive to light. Topical Solution is applied to the AK’s with incubation for the recommended time in order to allow the solution to penetrate the target cells. Target AK’s are porous and absorb more of the levulanic acid than does normal skin cells.

After an incubation period, the painted skin is then treated with blue light with wavelengths in the 400-450 nm, which is the second and the final step in the treatment. The levulanic acid is changed to a toxic substance which kills the abnormal cells in which the acid was concentrated during the incubation period with gentle sparing of the normal skin. Over a few days, these abnormal cells die, crust over and slough off with new skin as replacement. The most common side effects include scaling/ crusting, hypo/hyper-pigmentation, itching, stinging, and/or burning, erythema and swelling.

Photodynamic therapy has proven very effective for thin early actinic kerotosis skin lesions. Treatment has proved to reverse the signs of early skin cancers. Medicare and most insurances pay for this therapy.

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cosmetic surgery in Chattanooga, Tennessee

New anti-aging skin creams claim to do as much as medical and surgical procedures, but can they really deliver the same wrinkle-relaxing, age-defying results as some pricey filler injections, Botox or surgery? If you’re skeptical about what you see in print or on the internet, you’re not alone.

Unlike medications , cosmeceuticals are not regulated by the Food and Drug Administration (FDA). Drug companies are required by the FDA to perform extensive trials and testing prior to claims of performance or efficacy of the medication. The cosmetic industry has little or no regulations; making it difficult to find substantial trials and testing of “creams, serums, potions and cosmeceuticals,” having stated the disclaimer for testing. Skin cream technology for the most part is focused on a few areas: collagen production, healing and antioxidants.

Free Radicals and Collagen Loss

One of the major ways our skin ages is through the loss of collagen, a naturally occurring substance that keeps our skin looking plump, lifted and smooth. The collagen is a scaffolding which supports our skin. As time ticks by, we lose some collagen because of natural aging, sun exposure, smoking and pollution. These exposures increase the rate at which our natural cellular process occurs. The cell aging process releases molecules called “free radicals” or oxidants into the skin. The link to aging? Free radicals attack and destroy additional collagen support structures, and without that support, skin sags and forms wrinkles.

Skin Penetration with Fatty Acids

Many creams claim to increase the collagen content of our skin. One problem, penetration of the outer skin. Our skin is a barrier maintained between us and the environment which makes us water tight, limiting water based liquids from entering or exiting the body. So how do creams “penetrate” the skin? Water based moisturizers stay on the surface with little penetration of the outer surface of the skin. Deep penetration into the skin requires more expensive synthetic peptides with fatty acids. The fatty acids allow products to be transported to the deeper layer of skin. Once the product is delivered to the skin, companies claim increased collagen production in 4-12 weeks. Limited studies have shown that collagen is produced with the creams, but not anywhere near what happens during collagen production with wound healing.

Antioxidants: The Fountain of Youth?

On the front lines of anti-aging is a group of antioxidants. Antioxidants attack oxidants, free radicals before they have a chance to destroy our collagen supply. An ingredient derived from the “coffee berry” is now hailed as the strongest antioxidant with the most powerful anti-aging ingredient to date. The same coffee which wakes you up in the morning, may also add a kick to your complexion. Coffee berries contain high levels of antioxidants. But are these and other antioxidant advances enough to guarantee anti-aging results?

Before you reach for hope in a jar, take a critical look at your facial skin. If you have never used anything on your face, you are probably more likely to see results simply because you are doing something for your skin. A Consumer Reports investigation found the current crop of antiaging
creams fall short of delivering on their “promises” — a conclusion shared by some cosmetic doctors.

Cosmeceuticals can do some wonderful things for the skin by diminishing brown spots, improving skin texture and making the skin feel smooth again. Cosmeceuticals have limited effects in filling wrinkles. Until published medical studies are available, it may be up to consumers to decide for themselves if even the cosmetic results have merit from the cosmeceutical.

The best hope in a jar at this point: 1) stay out of the sun; 2)wear sunscreen; 3) keep your skin well moisturized; 4) use estrogen replacement.

Are we closer to the proverbial Fountain of Youth? The answer, it seems, depends on whether you need a trickle or a roaring river from the fountain.

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Scratch the Surface

Skin that is smooth and supple with a warm glow is a sure sign of youth. As we age, our skin is marked with reminders of our past experiences. The canvas of skin tells a tale of our sun exposure, wrinkles, superficial scars caused by acne, surgery or trauma. The etched skin surface is then painted by color (pigment) changes or defects in the skin, such as liver spots or coffee spots and tattoos. Stressed by smoking and environmental chemicals, all combined, our skin shows the signs of aging.

Controlled Skin Damage

Skin repair techniques have been around for centuries: chemical peels were very popular in the early part of the 20th century, but with a price: scarring and pigment changes. Now safer high tech laser resurfacing techniques result in consistent skin resurfacing, also with a price: the cost of technology. Each technique, from chemical peels to laser resurfacing, have similar properties. They cause controlled damage to the skin, causing the underlying skin to rapidly reproduce and slough off the old damaged skin, resulting in new, more youthful skin in place of the timeworn and etched skin.

Laser Skin Resurfacing

Laser resurfacing uses heat induced by laser light to destroy and remove (vaporize) the upper layers of the skin. This causes new skin to grow. It is typically used to remove or improve the appearance of wrinkles, shallow scars (from acne, surgery or trauma), tattoos and other skin defects. The laser sends out brief pulses of high-energy light that are absorbed by water and certain substances in the skin called chromophores. The light is changed into heat energy, and the heat then vaporizes thin sections of skin, layer by layer. As the wounded area heals, new skin grows to replace the damaged skin that was removed during the laser treatment.

The CO2 (carbon dioxide) laser is the most common type of laser used for resurfacing. Fractionated lasers are also used frequently and are growing in popularity because they do a similar job, but penetrate less deeply and therefore heal more quickly. Laser resurfacing is usually very precise and causes little damage to the surrounding skin and tissue. It is done most often on the face, but it may be done on skin in other areas of the body. Laser resurfacing is usually done in a doctor’s office. The time needed for healing and recovery after laser resurfacing varies according to the size and depth of the treated area.

Chemical Peels

Chemical peeling is completed by applying a chemical solution to the skin. Mild scarring and certain types of acne may be treated. The procedure enables new, regenerated skin to appear, improving the appearance of the condition. Chemical peels are generally recommended for discoloration caused by acne, not deep pitted scars. Commonly used chemical peels are glycolic and lactic acid, which are also available for home use.


Subcision (undermining), needling with dermabrasion are used for depressed scars, pitted scarring and ice pick type scars. During a subcision session, a small needle is used to break up the scar tissue underneath the depression. Subcision along with needle rolling are highly effective methods in the treatment of depressed scars, but usually require multiple sessions depending on the number and depth of the scars. These sessions are normally spaced four weeks apart, and require five to seven days downtime after the procedure. Skin manipulation techniques have been used by physicians for decades. When used correctly, the techniques fool the skin to insight repair without scarring, pigment changes or significant down time.

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Neck Liposuction

As we age, certain areas of the body can accumulate fat that is hard to lose, in spite of a healthy diet and vigorous exercise. The neck is one such area. Fat deposits in the neck can detract from the appearance of the entire body, making a younger person seem older, or a fit person seem out of shape. Liposuction can give this area a new streamlined contour, enhancing the effect of facial features and improving the facial profile. Patients who have been self-conscious about their bulging necklines often feel more comfortable wearing a range of clothing and jewelry styles after liposuction. Neck liposuction produces consistently good results and has a particularly high satisfaction rate.

During the initial consultation, your surgeon will talk with you about the changes you would like to make in your appearance. He should explain the different options available, the procedure itself, its risks and limitations and costs. You should have a physical examination to evaluate your overall weight, your skin and muscle tone and the pattern of distribution of fat deposits. Be sure to ask all the questions you have about the procedure, and ask to see photos of the doctor’s recent patients, before and after treatment. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

Before your liposuction procedure

Before surgery, the surgeon will mark the precise areas of the body where the fat is to be removed. Before and after photographs should be taken. An intravenous (IV) line will be inserted in a vein in your arm to make sure the fluid level in your body stays within healthy limits throughout the procedure. Neck liposuction is very safe and can be completed in an office setting surgical suite. You may be given sedatives for relaxation in addition to numbing medications for local anesthesia.

Neck Liposuction:The Procedure

During the procedure, the surgeon makes tiny incisions (1-2mm in diameter) in the skin, typically in the crease just under the chin or behind the ear lobes and low in the neck. A thin tube called a cannula is inserted into the fatty area. The cannula is used to break up the fat deposits and sculpt the area to the desired proportions. The newest liposuction techniques involve the placement of a laser fiber or an ultrasound probe through an open ended cannula. Laser energy or high frequency ultrasound energy is delivered directly to the fatty tissues. This focused high level energy causes the fat to be emulsified making suction removal easier. The unwanted fat is removed with a high suction vacuum, leaving the skin, muscles, nerves and blood vessels intact. The high level energy delivered by the laser fiber or by ultrasound can also be used to heat the undersurface of the skin — thus leading to skin retraction and skin tightening.

The face and neck are usually the first features we notice when we meet someone new, so improvements in this area can create a dramatic change. A firm, trim neck gives the face a more youthful look. Sometimes just having this neck liposuction done provides an incentive to make healthier lifestyle choices and maintain fitness in the rest of the body.

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Scar Technology

As a natural part of the healing process, a scar forms as a result of injury and new collagen fibers which reconnect damaged skin and create a “seam” or scar. The most common causes for scars include surgical incisions, traumatic injuries and inflammatory scars. Your options for getting rid of that scar may depend on the type of scar that you have. Hairline scars are thin, flat and easy to fade or hide. Good surgeons strive to place surgical scars in less conspicuous locations following tension lines of the body. Careful attention to detail allows for better final cosmetic results. Unfortunately, we have no control over traumatic scars — which seem to occur in areas of skin exposed without fabric protective covers.

The Various Types of Scars

Atrophic or depressed scars have a sunken or pitted appearance. Acne is a frequent culprit. Hypertrophy scars are firm, raised accumulations of tissue that develop from an overabundance of collagen production and sometimes grow larger that the original wound or traumatic injury site. These scars are unsightly and can also be painful. Keloid scars are the largest hypertrophic scars, often time looking more like tumors than scars. African-American and patients of Mediterranean heritage are very susceptible to keloid scarring.

Scar Prevention

The key to minimal scarring is prevention. For acne patients, a qualified physician can put together an effective skincare regimen with specific products that will help to prevent acne scarring. Blue light therapy or photodynamic therapy is one of the current cutting edge technologic procedures for acne. If you are prone to poor healing with hyper tropic or keloid scars, protective dressings, suture techniques, compression therapy and steroid injections may reduce the risks. Advanced keloid scars may respond to radiation therapy in early stages of wound healing.

Of key importance, ask your surgeon about his or her suturing techniques and inform the surgeon of any personal or family history of poor wound healing problems. Avoid surgeons who close wounds with wide suture techniques which often leave the “Frankenstein railroad scars.” Look for surgeons who use layer closure techniques with fast absorbing sutures supported by skin bridges or butterfly bandages.

Multiple techniques can decrease scarring after the initial skin injury. During the healing phase, simple topical treatments (ScarGuard, KeloCote, Mederma) and steroid injections can help to minimize the unsightliness of a scar. Scarabrasion, which is performed by using a soft bristle baby’s toothbrush, along with fractionated laser treatments to the healing incision is helpful in the first six to eight weeks after an incision has been made. More invasive laser treatments can improve and flatten the appearance of deeply ingrained scars.

IPL for Coloration Changes

Coloration changes with red to purple pigment changes at incision sites are best treated with intense pulse light (IPL) photodynamic therapy. IPL affects color changes in the skin; causing dark skin pigments to fade to a more normal coloration. White scars are devoid of pigment cells and usually will not respond to therapy. Surgical tattoos can be helpful to camouflage the white scars in cosmetically sensitive areas.

If all else fails, consider makeup concealers for problem scars. Some patients are using temporary tattoos to cover scar imperfections while on vacation with skin areas exposed at the beach.

We offer several treatment options for scars at our Chattanooga office. To learn more, go to our site www.advsurgical.com or call us at 423-648-4011.

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