chandler-plastic-surgery

How to Care for New Scars

laurelkchandler@gmail.com (Laurel Chandler) — Sun, 31 Jan 2021 02:51:54 GMT

What is the Best Thing to do for New Scars?

What should I do right away?

Let's assume you have a laceration that was originally due to some kind of trauma. It's probably a little red around the edges and there may be some additional areas outside the wound where the skin was abraded (superficially injured but not requiring stitches). Usually for the first 2 days after an incision has been repaired, you shouldn't shower or allow soap or tap water to touch your incision. This is because it takes 24-28 hours for initial sealing of the wound edges to occur, making the incision water-tight in most cases. If there is a problem with healing, it can take longer. You should avoid strenuous activity and heavy lifting for a few weeks after repair, because anything that causes your heart rate to go up will also increase your blood pressure and cause blood flow to go up in the area of your healing incision, which could increase swelling and cause poor scarring.

Step 1 - Moisturize!

What color are your stitches? Are they black or blue - if so, you probably have permanent stitches meaning they need to come out. Are they gold, tan or clear or are they underneath the skin - if so, they are likely dissolvable stitches. Permanent stitches are always removed, usually around 5-7 days from the face, but sometimes as long as two or three weeks after repair if the area is a high tension closure or an area such as the leg, abdomen or back. Usually when I place permanent stitches on the face, I have my patients put bacitracin on the suture line 2-3 times daily starting the same day as the injury, because keeping the suture line moist is key to initial healing. Not only is the entire construct of our skin based on moisture, your body needs that moisture to perform basic skin repair functions. You only want to use a basic ointment for this initial period of moisturization like bacitracin, neosporin, aquaphor or vaseline. Ointments are more moisturizing than creams, and creams sometimes have ingredients that could irritate a healing incision. When your incision is fresh, you have to be careful what comes into contact with it. Ideally only sterile ointments should touch your incision. When I use dissolvable stitches, I usually use steri strips to cover the incision, which provides occlusion of the scar and also allows the incision to stay moist under the strips, while not requiring any maintenance by the patient (no need to apply ointment daily but still providing moisture to the healing incision).

Step 2 - Silicone

Silicone the rapy is one of the only evidence-proven treatments for scars. It's not expensive. But it works. Stay away from brand name scar creams. Unless they have silicone in them, they probably don't work a ny better than vaseline, because anything that moisturizes a scar is likely going to improve the scar's appearance.

We don't actually know exactly how silicone therapy works, but we have some theories, and we have shown through evidence that scars improve significantly with this treatment. The theories are as follows:

Silicone occludes scars. It prevents a scar from growing (becoming "hypertrophic"). No one wants a scar that is raised or thick in appearance - silicone presses down on the scar so that over time it resists the tendency to grow or thicken.
Silicone hydrates scars. It acts as an impermeable membrane (essentially a complete occlusive cover) that keeps the skin hydrated. It prevents water from evaporating through the silicone, keeping as much moisture as possible in the area that needs it. Providing moisture to cells like your keratinocytes (the main cell in the top layer of your skin that forms the structure of your skin) increases signals in your skin that control function of cells that are in charge of healing and producing collagen (fibroblasts).

How do you get silicone? Go to CVS or your local pharmacy and pick up something called "silicone tape" or "silicone gel". There should be only one or two ingredients, one of which is silicone dioxide . Scar Away is a reliable brand that makes the gel and tape. The recommendation is to use silicone for 12 hours per day on the scar. You should not start the therapy until the wound is completely healed with no scabby areas or areas that look wet. The scar should be completely dry and perfectly healed (usually about 3 weeks after injury assuming a well-healed scar). Ask your physician before you start silicone. You cannot use silicone on an open incision or an incision that is too recently healed.

Step 3 - Scar Massage

Once the scar is well healed (no open areas, no scabs, completely dry), try and massage your scar for 10 minutes a day, or twice daily for 5 minutes each. Make it part of your morning and nighttime routine, and feel free to perform additional massage during the day if you can find the time. Put some vaseline or aquaphor on your finger and perform massage in circular motions using one finger, while putting some firm pressure on the incision. The ointment helps avoid friction while performing the massage. The idea is that you are physically breaking up scar tissue as it develops, preventing that scar from becoming too raised. You do NOT want to do this if your wound hasn't healed completely, but once it has healed and is completely closed, this type of massage is not going to hurt anything. Usually a week or two after healing is complete it is fine to start scar massage.

Step 4 - Stay Away From The Sun

Your scar will be extremely sensitive to the sun for up to a year after the initial injury. If you were to get a sunburn on that new scar, it could become permanently red or discolored, even if the sunburn happens months after the injury. You should use a sunscreen with an SPF of at least 50 or higher during any prolonged sun exposure, and a slightly lower SPF on a daily basis for any intermittent exposure, even if it is just a few minutes here and there. After one year, you can treat your scar as you would the rest of your skin.

The best type of sunscreen to use is a sunscreen that contains mineral ingredients like zinc oxide and titanium dioxide , which act as a protective barrier on top of your skin but are not absorbed by your skin. Other chemical sunscreens may contain ingredients that are absorbed and even have the potential to cause systemic effects when applied in large quantities. Chemical ingredients include oxybenzone, avobenzone, octinoxate, homosalate, octisalate and octocrylene.

TCA Peels

Mon, 05 Oct 2020 15:26:05 GMT

Areas you can treat, the effects and recovery process

With summer over and fall upon us, now is a great time to consider rejuvenating your skin with a peel. Are you seeing signs of sun damage - or do you have fine lines and wrinkles you’d like to minimize? TCA peels (trichloroacetic acid) can be applied in varying strengths and be spread out over a few weeks. These medium to deep peels can address multiple skin concerns while leaving your skin refreshed.

Stronger than a superficial glycolic peel, TCA peels are an excellent choice if you are looking to diminish brown spots, acne scarring, melasma or large pores. You can treat the whole face, cheeks, a problem area or the lower eyelids - Dr. Chandler’s most common request.

An important factor to keep in mind when scheduling a TCA peel is preparing for the recovery time; you will have redness and sometimes mild peeling for up to 2 weeks. Allow yourself a sufficient amount of time if you plan the TCA peel before a big event. You may have to pause some medications, such as retinol or salicylic acid, prior to your peel as well. Be sure to avoid using any harsh exfoliators on your face a few weeks before your appointment. Wash your face with gentle, gel cleansers instead.

TCA peels can be applied without anaesthetic. A very mild stinging is experienced for only a few minutes before the peel is neutralized. You will then be given detailed instructions regarding aftercare for your skin. During recovery you are also encouraged to go about with light activity and to limit excessive, strenuous exercise.

It’s important to have patience as your skin will be red and you may have some swelling. Within a week, you will see the “new”, brighter skin start to emerge as the chemically treated skin falls off; after the full 2 weeks, your skill will feel revived and have a youthful glow.

It’s imperative to follow Dr. Chandler’s advice and instructions post-peel. Sun exposure should be avoided as much as possible. During recovery, take the right precautions and stay out of the sun, wear sunscreen, and avoid use of facial exfoliants. TCA peels can be administered every few months to have your skin looking and feeling its best. Many patients are extremely satisfied with their results and continue with maintenance TCA peels as a part of their skin care regime.

Click here to read more about chemical peels by Dr. Chandler

What is the best way to improve skin quality?

Wed, 25 Sep 2019 00:24:23 GMT

What nonsurgical treatments improve skin QUALITY?

Surgical procedures like a facelift and neck lift will improve the appearance of the lower face, including the jowls, nasolabial folds and jawline by removing excess skin and tightening the underlying facial architecture. While a well-maintained skin care regimen is helpful in optimizing the appearance of the skin before surgery, the surgical procedures themselves have no effect on improving skin quality. Patients with poor skin quality may have a suboptimal aesthetic result, regardless of the surgical technique.

What is Poor Skin Quality?

Thin skin
Abnormal pigmentation
Large pore size
Scarring
Rough texture

Patients with skin quality concerns may consider other methods in conjunction with surgery to improve skin quality. Many different methods exist, including advanced skin care, chemical peels, dermabrasion, laser therapy, radio frequency skin tightening, autologous fat grafting and microneedling. While all treatments will have some effect on improving skin quality, they have different modalities and indications.

Microneedling vs. Chemical Peel – Which is Right for Me?

Microneedling and chemical peels have different mechanisms of action and act at different levels in the skin. Microneedling was originally used for post-acne scarring. It works by breaking down scar tissue with fine needles to stimulate healing and new collagen production at the level of the dermis (deeper), without disrupting the integrity of the superficial (epidermal) layer of skin. Microneedling is effective against deep and fine wrinkles, post-acne scarring and also has a tightening effect on the skin. It is extremely effective against the vertical lines above the red upper lip.

Learn more about microneedling here!

Chemical peels, on the other hand, act more superficially by chemically exfoliating the skin, removing the top layer of damaged skin cells to rejuvenate the skin. Chemical peels are effective against more superficial skin issues, like fine lines and wrinkles, brown spots and other discoloration from sun damage, and has some effect against acne scarring. It leaves the skin looking healthier and more refreshed.

Learn more about chemical peels here!

The right choice for you depends on your skin quality concerns. If you have post-acne scarring, deeper wrinkles, or vertical lines upper lip lines, then microneedling is the right choice. If you have large pores, discoloration from sun damage, uneven skin texture, blackheads or skin congestion, then a chemical peel is probably the more appropriate choice.

Nanofat Grafting

“Nanofat” grafting is a unique technique of harvesting and processing fat in order to create a form of injectable fat that can be injected through fine needles into delicate areas of the face while simultaneously isolating stem cells and growth factors, called the “stromal vascular fraction” of fat. These stem cells and growth factors trigger cell growth and increase collagen and elastin in the skin, leading to thicker, healthier looking skin. The potential effects are long-lasting, with potential continued improvement over many years.

What are the potential visible effects of nanofat grafting?

Softening of wrinkles
Reduction in pore size
Improved skin pigmentation
Improved skin texture, softness and thickness

Learn more about facial fat grafting here!

“Retinoid” vs. Retinol – What is the Difference?

Mon, 29 Jul 2019 23:24:21 GMT

“Retinoid” is an umbrella term used to describe a family of ingredients chemically related to vitamin A. These compounds are well known for their anti-aging and anti-cancerous effects. Specifically, retinoids reduce the appearance of fine and course wrinkles, reduce discoloration that results from photo aging and improve skin texture resulting in smoother, brighter skin. The anti-cancerous properties comprise regression and reducing risk for precancerous lesions. There are both over-the-counter (OTC) retinoids and prescription retinoids available in various strengths and with different side effect profiles. Some are also used to treat acne.

What is the mechanism of action of retinoids?
All retinoids are converted by skin enzymes into retinoic acid, which is the form that our skin is able to process. Retinoic acid works by binding receptors inside cells to cause multiple effects, including:

Increasing collagen production and collagen organization
Reducing collagen breakdown
Improved organization of elastic tissue
Increasing deposition of glycosaminoglycans (a structural component of skin that helps maintain moisture)
Decreasing melanin (reducing discoloration)
Exfoliating the top layer of skin called the stratum corneum

What does all of this translate into? Because collagen is the most important component of skin structure, the beneficial effects on collagen quality and quantity help to smooth the skin and reduce the appearance of fine and course wrinkles. The effect on decreasing melanin helps reduce skin discoloration that results from photo aging. In addition, the anti-cancerous properties help to reduce risk for premalignant lesions and to stimulate regression of existing premalignant lesions.

What are the different types of retinoids?

Retinol – an OTC retinoid that is extremely popular and effective. Like the other retinoids, it works by increasing collagen and helps to reduce the appearance of fine and course wrinkles, smooth the skin and reduce discoloration, and has additional anti-cancerous properties. Retinol is less irritating to the skin and causes less peeling compared to prescription retinoids.
Retinyl palmitate – another OTC retinoid that results in even less skin irritation and peeling than retinol, but comes at the cost of being less effective.
Retinaldehyde – more effective than retinyl palmitate but not as effective as retinol, and has particular anti-acne properties.
Retin-A (tretinoin, also known as retinoic acid) – the most popular prescription topical retinoid. Highly effective against lines and wrinkles, acne and discoloration, but can cause significant irritation and peeling, moreso than retinol.
Accutane (isoretinoin) – comes in oral form and is used to treat acne. Should not be taken by pregnant women. Can cause an increase in cholesterol and triglyceride levels.
Differin (adapalene) – topical retinoid used to treat acne and prevent breakouts. Less irritating than tretinoin and now available over-the-counter.
Tazorac (tazarotene) – topical retinoid also used to treat acne. Similar in strength and level of irritation when compared to isoretinoin.
Beta-carotene – this is a natural source of retinoids that appears in our diet from orange and yellow plant pigments, which is prevalent in foods such as sweet potatoes, squash, carrots, pumpkins, cantaloupes, apricots, peaches and mangoes. However, topically applied beta-carotenes are not as effective and don’t penetrate as well as retinol and tretinoin. However, these foods are still great sources of antioxidants and convert to vitamin A in the body.

What are the side effects of retinoids?
The primary issue with topical retinoids is skin irritation, redness and peeling. These side effects are normal and can be avoided if the regimen is started slowly with a lower potency, and increased in frequency and strength over time. You can also adjust the strength and type of retinoid to match your skin type for an optimal result with minimal side effects. Typically, it takes a few days to see the effect of skin irritation, so it is important to wait at least four days after the first application before reapplying. In addition, your skin is more sensitive to the sun, so applying the retinoid only at night and using a sunscreen of SPF 15 or greater during the day is helpful.

What type of retinoid should I use if my skin is too sensitive to retinol?
If your skin is extremely sensitive to retinol and you are not able to tolerate the level of peeling and irritation, you can still benefit from using retinoids. You may be switched off of retinol onto one of the less irritating retinoids, like adapalene.

What is the best way to apply retinoids?

Always apply retinoids AT NIGHT because your skin will be more sensitive to the sun after application and there is a potential for deactivation of the product by sunlight. Retinoids should always be stored in airtight containers and you should avoid exposure of the product to sunlight and air.
Wash your skin with a skin cleanser, apply moisturizer, and then make sure your skin is completely dry before applying the retinoid.
Apply a dime-sized amount of retinoid product to clean, dry skin as the LAST step of your skin care routine at night.
Use a sunscreen of SPF 15 or greater during the day.
Wait four days before your second application to make sure your skin doesn’t react with too much irritation. It takes about four days before you may see the side effects of skin irritation, peeling and redness.
Perform the second application in the same manner as the first.
Continue the regimen at night every three nights for the next two weeks.
If your skin is tolerating the routine, increase the frequency to every other night for two weeks.
Increase frequency to applications every night.
Depending on the level of irritation with your current regimen, you can consider increasing the strength of the retinoid product.
After 6-9 months of topical retinoid therapy, you can begin reducing the application to three times a week without compromising on efficacy.

Important things to know while you are using retinoids:

Stop using retinoids one week prior to any facial waxing because your skin is more sensitive while using retinoids.
Avoid chemical peels and facial scrubs while using retinoids.
Retinoids can make rosacea worse, so discuss this with your physician prior to using retinoids.
Protect your skin from the sun during the day by using sunscreen of SPF 15 or greater

When will I start to notice the benefits of retinoid therapy?
After one month, you will start to see an improvement in skin smoothness. After 2-4 months, you will see some lightening of brown spots and reduced hyperpigmentation. After four months, you will notice improvement in fine lines and a more significant improvement in skin texture. Course wrinkles take the longest to improve.

Four Essential Skin Care Products

Thu, 25 Jul 2019 12:56:59 GMT

A skin care regimen doesn’t have to be complex, and you don’t need ten products to keep your skin looking healthy. You should have a regimen that works for you and that is simple enough so that you maintain it consistently. Thee four essential skin products that everyone should have in their regimen include a facial cleanser, a moisturizer, a retinoid product and a sunscreen.

1. Cleanser – Use once in the morning and once at night. This helps remove dirt, microorganisms, makeup, oil and dead skin cells, and also allows the skin to better absorb topical treatments like moisturizer. Use oil or cream-based cleansers for dry skin, and gel or foam-based cleansers for oily skin.

Key ingredients in cleansers:

Ceramides – lipids naturally present in the top layer of skin that maintain your skin’s barrier function and help maintain skin hydration

Humectants – helps skin absorb and retain moisture

Surfactants – allows water to rinse oil and dirt away from your skin. Some surfactants are much more drying to your skin than others. For example, sodium lauryl sulfate tends to be more irritating than other surfactants. Gentle surfactants tend to be the least irritating and drying. Ingredients that are hydrating like glycerin and oils help minimize irritation.

Salicylic acid, glycolic acid or benzoyl peroxide – good for treating acne, because these ingredients penetrate pores.

2. Moisturizer – Moisturizers are important in maintaining the health and balance of your skin. If your skin becomes too dry, it is more prone to acne and milia. Use a thicker, stronger moisturizer in the winter when skin tends to be most dry and a lighter one in the summer. Use your moisturizer one to two times a day. If your skin is oily, use a lotion instead of a cream and exfoliate once or twice a week.

3. Retinoids – This is the best skin care product you can use for reducing effects of photo aging (including treatment of fine and course wrinkles, discoloration and rough texture) and has additional benefits in regression and prevention of precancerous lesions. For the most effective results with the fewest side effects, consult with a physician and build up the potency and frequency of use over time.

4. Sunscreen – Use a sunscreen strength of at least SPF 15-30 every day for intermittent sun exposure, and use a stronger sunscreen for any prolonged exposure (greater than SPF 30). Always use a very strong sunscreen on any scars that are under one year old, because scars are very sensitive to UV exposure and can become permanently discolored from too much exposure.

Mineral vs. Chemical Sunscreens:

The best type of sunscreen to use is a sunscreen that contains mineral ingredients like zinc oxide and titanium dioxide, which act as a protective barrier on top of your skin but are not absorbed by your skin. Other chemical sunscreens may contain ingredients that are absorbed and even have the potential to cause systemic effects when applied in large quantities. Chemical ingredients include oxybenzone, avobenzone, octinoxate, homosalate, octisalate and octocrylene.