Q: I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth?
A: It is difficult to completely eradicate fine lines on the face, but there are certainly some non-surgical options that will improve the skin. First and foremost, start protecting your skin against further damage with regular application of a good broad spectrum higher SPF (above 35) sunscreen. This one step in your daily skin care regimen is the most important thing that you can do, both to reduce additional premature aging and to protect your skin against skin cancer, which is epidemic in the South. The next thing you can do is incorporate a few topical creams in your skin care routine that will begin to slow the aging process. A good medically directed skin care program can make a significant improvement in skin quality. The skin care program that I recommend in most cases of sun damaged skin includes a regimen of several key products, including Tretinoin (Retin-A®) which stimulates new collagen that can reduce existing fine lines and slow the onset of new ones. In addition, a mild exfoliant is employed to remove the outer layer of dull, dead skin which can help restore a healthier glow to your complexion. Finally, if you have brown spots on your face, hydroquinone cream, which is a prescription medication, will significantly fade these brown spots. There are, of course, other topical applications that can be added that will improve the skin even more. You should seek an individual evaluation by a licensed medical aesthetician, dermatologist or plastic surgeon in order to design a skin care program that maximizes the chance of improving your skin.
Once you have reached maximum improvement with the topical skin creams, if the wrinkles have not improved to your satisfaction, the next step to consider is either a chemical peel or laser skin resurfacing. Chemical peels range in strength from very mild to very deep. In my practice, we use the medium depth peels for mild skin aging issues and employ the laser for more damaged skin. The laser can be set to deliver different levels of energy to customize the treatment based on one’s skin type (oily, dry, fair complexion, dark complexion, etc.) and the degree of your skin damage. The fractionated CO2 laser is our go-to device for resurfacing facial skin and restoring a healthier, smoother appearance in cases of more advanced aging or more severe sun damage. The laser treatment can be performed under oral sedation and a local anesthetic to the face. The recovery ranges from 1-2 weeks depending on the severity of skin damage. If laser treatment is deemed necessary, the procedure is typically performed by a plastic surgeon or dermatologist.
Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount.
A. First, let me say that it is OK to go into the sun but you must protect yourself with a good sunscreen. It is so common for me to hear how careful patients are protecting their face, but they forget to put sunscreen on their chest. So as a result, some of the worst sun damage I see in my practice is in the décolletage area. (Read More)
Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common?
A. Online sources of information can sometimes be misleading, but in this case the information that you read is correct. Blindness is a potential, albeit rare, risk with any injectable into the face. It is most associated with hyaluronic acid fillers, such as Juvederm® and Restylane®. (Read More)
Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route?
A. I applaud you for having the gene test for breast cancer. You now can take some control over the disease rather than the disease having control of you. As you have probably been informed, there are two genes that are commonly evaluated to see if a patient has an increased risk of breast cancer, BRCA1 and BRCA2. BRCA is an abbreviation for BReast CAncer. (Read More)
Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?
A. There is no absolute science to picking a good doctor in any specialty. Fortunately, in plastic surgery most everything is somewhat elective and you at least have time to investigate your choices and visit several plastic surgeons before making a decision. You did not say what kind of eye surgery you are contemplating, so I am assuming that it is some type of cosmetic surgery of the eyelids. My suggestion is to first ask your primary care doctor to give you a list of 2 or 3 plastic surgeons who he/she would recommend. (Read More)
Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it.
A. It is not unheard of to have some loss of hair in the temple area after a facelift. The hair loss is generally due to tension caused by the pulling of the skin when doing the lifting of the face. If the tension at the incision is significant enough, it can reduce the circulation of blood to the skin around the incision. Hair follicles are very sensitive to reduced blood flow and can result in the hair bulb, where the hair grows, dying. This leads to a bald spot. (Read More)
Q. The hole in my earlobe where my earring sits has gotten progressively larger over the years. My earring now does not sit nicely against the earlobe but hangs down. Can the hole in the earlobe be made small again?
A. Yes, it can. It requires a small surgical procedure to remove the enlarged hole and suture the skin back together again. The repaired earlobe hole is allowed to heal for about three months, then the lobe can be re-pierced. The procedure is performed under local anesthesia and has no down time after the repair. The key in the future after re-piercing is to not wear heavy earrings that pull on the hole causing it to elongate again.