2012

Archive for 2012

Web Log - April 2012 - Komen for the Cure Race and HealthSmart Segments

Sunday, April 8th, 2012

Not following directions on Diamond Head

The annual Komen for the Cure 5K race is coming up soon on May 12th. Don’t be left out. Click on the link below and join Team Wigod Plastic Surgery for the Race. We will have runners as well as walkers. Sign up in time and get a highly prized Team Wigod Pink Bandanna.

http://idaho.info-komen.org/site/TR/RacefortheCure/BOI_IdahoAffiliate/55609806?pg=team&fr_id=2544&team_id=202221

Why join the Race? To help raise money for a very effective charity in the fight against breast cancer. 75% of the money raised stays local to fund screening and education, with a particular emphasis on low income and geographically isolated women. Komen Boise just released 2012 grants to 21 recipients totaling $220,000. That is in addition to $80,000 earlier this year. The Boise organization also just united with the Coer d’Alene group to form Komen Idaho. The service area will be expanded from 19 to 28 counties. Fundraising is down this year relative to last year, so please help meet this greater need.

Komen Boise produced some great videos to illustrate the cause. Take a look and pass the link along to a friend.

Race for the Cure Boise: Susan G. Komen Boise and Marie Edwards http://youtu.be/oN2TVkDFNks
This is the inspirational story of a breast cancer patient who decided to share her story. Thanks to Susan G. Komen Boise, Marie Edwards wants everyone to know there are no more excuses for not getting a mammogram. Awareness of breast cancer isn’t enough. We need action. Please donate and participate in the Race for the Cure on Saturday May 12 in Boise, Idaho.

Race for the Cure Boise: Komen Boise, St. Luke’s and Women’s Health Check http://youtu.be/gouv7XSc_yo
The state of Idaho ranks 51st in the nation in mammogram screening rates. Let’s do better. Susan G. Komen Boise is proud to partner with many local organizations like St. Luke’s and Women’s Health Check to provide direct assistance to women and families affected by breast cancer. Please donate and participate in the Race for the Cure on Saturday May 12 in Boise, Idaho.

Race for the Cure Boise: Komen Boise, Saint Alphonsus and Terry Reilly http://youtu.be/osrhT9mrz9M
Susan G. Komen Boise is proud to partner with many local organizations like Saint Alphonsus and Terry Reilly Health Services to provide direct assistance to women and families affected by breast cancer. Last year, Komen Boise and its partners made 1,800 mammograms possible. Please donate and participate in the Race for the Cure on Saturday May 12 in Boise, Idaho.

Race for the Cure Boise: Komen Boise, Saint Alphonsus and American Cancer Society http://youtu.be/_SIkX8PwBnI
Susan G. Komen Boise is proud to partner with many local organizations like Saint Alphonsus and the American Cancer Society to provide direct assistance to women and families affected by breast cancer. Seventy-five percent of the funds that Komen Boise raises locally, stay local. Thank you for making an impact. Please donate and participate in the Race for the Cure on Saturday May 12 in Boise, Idaho.

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Below are the transcripts for the most recent HealthSmart segments on KTVB. Go to our media page to see the videos. http://www.wigod.com/video-media.html

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I am a 23 year young male and I have acne. My father had cystic acne when he was a child that he had to get medically drained. I have been on doxycycline for almost 5 years now and thankfully have never had acne as severe as my father which I think I can thank my doxycycline for. My question is, when will my acne calm down to the point of where I no longer need to take medication? I still get a few pimples here and there even while on doxycycline, but my father is 52 and on no medication what so ever with getting a few pimples a year. So I assume that means that there is a point in time where the acne will calm down.

-Kevin

Dr. Wigod, what can Kevin as well as other viewers with adult acne expect in the future?

Acne is so common that it affects about 2 out of 3 people and about 1 in 5 will suffer from severe acne. Acne usually begins in puberty and is gone by the early 20’s, but may persist into later adulthood. By 45 years old, about 5% of men and women still have acne. So when will acne stop? Well, no one really knows. The good news is that patients with heavier and oilier skin that is more prone to acne tend to age better with fewer wrinkles and ultimately look younger.

What causes acne?

Sebaceous glands are found around hair follicles, under the skin at the base of the hair shafts. They make sebum which helps keep our skin smooth and moist so that we do not feel like a crocodile. In puberty, the cells that line the hair follicle shed more rapidly and in those with acne, these cells stick together more. This blocks the sebum. Add normal skin bacteria and you get the inflammation and pus that we call acne.

What can teens and adults do to help minimize their acne?

Diet, sun exposure, and stress do not seem to matter much. Heredity is what really matters. Wash your face twice a day gently with a 2% salicylic acid soap and do not squeeze the blemishes. Topical antimicrobial treatments like Benzoyl Peroxide or Clinidamycin gel and oral antibiotics may help reduce bacteria. Topical Retinoids, particularly Aldapalene, can be helpful in adults to reduce follicular cell blockage. They are related to Retin - A, so they have the nice side effect of helping to minimize wrinkles. Your primary care physician is a good place to start for help, but a Dermatologist should be seen for resistant cases requiring more aggressive treatment

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I have bags and wrinkled skin under my eyes that make me look old. How can surgery help and what are the risks?

There are three factors to consider when evaluating a patient for lower lid rejuvenation - skin quality, skin quantity, and fat distribution. Skin quality improvement is the most straightforward, but most frequently neglected and often least dramatic element of the three. All the things we advise for improved skin quality for other parts of the face - vitamin C products, peels, even laser - can be done for lower lid skin. The big thing to realize is that if skin is thin, discolored, or deeply wrinkled - crepe like we call it - surgery cannot improve its quality.

What about skin quantity, then?

The surgeon has to consider skin quality when deciding what type of operation to offer the patient, but he or she has to ignore it to determine if there is indeed excess skin. I think the easiest thing to do is just pinch gently and have the patient open and close the eyelid. The key factor with skin is to not remove too much. That can lead to disaster and is a whole different topic.

What about the bags under the eyes, then?

Lower eyelid anatomy is very complicated. There is fat around the eye to pad the globe against impact. As we age, the structures holding this fat in place weaken and the fat herniates and we see a bulge. The supporting structure’s connection to the bone, however, does not move much and then we get a groove, or tear trough which emphasizes the bulge. In lower lid surgery - blepharoplasty - this fat is located and manipulated. If there is excess fat, it can be trimmed, but you do not want to trim too much and make the patient look hollow or cadaverous - like someone starving. If the lower supporting attachments are released, the excess fat can be positioned lower instead of being completely removed and help minimize the groove. Fat can also be grafted into the groove, but this is very tricky.

Well, it all sounds very tricky. Next week we will discuss different types of lower lid blepharoplasty and potential complications to be avoided.

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Last week we discussed lower lid aging and how poor skin condition, skin excess, and fat excess all contribute to an aged look. Since creams and lasers can only do so much, what are the risks of surgery on such a delicate area?

Lower lids really are one of the trickiest aesthetic surgeries to perform safely and should only be performed by a plastic surgeon, facial plastic surgeon, or ophthalmic plastic surgeon with formal training. We worry about asymmetry, insufficient aesthetic improvement to satisfy the patient, and damage to the eye itself. Most problems, however, are caused by being too aggressive when trying to get a great result. You can end up with an ectropion.

Explain an ectropion.

When too much skin is removed from below the eyelashes or if the muscle in the area that allows you to squint is damaged, the eyelid is drawn down . The lower lid and eye globe become red and the patient has excessive tearing and a sad look. Not only does it look bad, it is also very uncomfortable. Try pulling your lower lid down for just a few moments. You start feeling dry almost immediately. This dryness can be debilitating and even lead to damage to the cornea eye covering with vision loss.

What can be done to avoid an ectropion?

When I go to meetings and see talks on lower lid surgery, it is usually not about how to get a better result, but about how to avoid problems like ectropion. One way is to do a canthoplasty. If you think of the lower lid as a wash line, the more clothes - or tension from removing skin - the lower it will be drawn down. If you tighten the wash line - or tighten the lower lid at the lateral canthus - you can fight those downward forces. Another way which I like is to approach the lid with incisions from the inside and remove as little skin as needed - called transconjunctival approach. I try to select my patients very carefully, counsel them about reasonable improvement, and make sure they know all the risks.

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Case of the Month - April 2012 - Fat Grafting in Breast Reconstruction

Sunday, April 8th, 2012

The patient is a woman who had lumpectomy and radiation on the left for breast cancer treatment. She did not desire an implant, muscle flap surgery, or completion mastectomy. After discussion with the patient’s oncology team, the patient elected to undergo serial fat grafting of the left breast with right breast matching mastopexy. After 3 fat grafting sessions, the breast was soft enough to allow nipple relocation. While this reconstruction was not traditional, fat grafting only in a radiated breast is considered well accepted practice and the patient is happy with her result.

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Monthly Special - April 2012 - Retinol Treatment

Sunday, April 8th, 2012

Spring is a time for renewal, and Retinol is the perfect way to refresh and rejuvenate this season! During the month of April, purchase a medical microdermabrasion or peel of your choice and receive a complimentary retinol treatment. Remember, Mother’s Day is right around the corner and this is something every woman could use…

Retinol: Pure vs. Complexes

When using a retinol based product, it is important to keep in mind the differences between pure retinol and retinol complexes, as each will have different effects on your skin. Retinol is one of the most versatile ingredients used in skin care today. The unique benefit of delivery and stabilization technology combined with skin-specific formulations has led to the most comprehensive line of retinol products.

A retinol complex is a blend of retinol and retinoid esters or other support ingredients designed to increase the retinol’s efficacy and stability. When percentages are listed for retinol complexes, the amount reflects the total amount of all ingredients of the complex, not only the retinol. On the other hand, a product that contains pure retinol truly provides the entire percentage of retinol stated. Both retinol complexes and pure retinol have a place in the industry, and having options to treat patients individually is absolutely necessary.

PCA has just launched two new products, Intensive Age Refining Treatment and Intensive Clarity Treatment. Both contain 0.5% pure retinol. These products are rare in an industry where complexes are far more common, and making these products even more unique are their customized formulations suited specifically for acne and hyperpigmentation or visible aging.

Products containing retinol complexes, such as A&C Synergy Serum and Retinol Renewal with Restorative Complex offer the benefits of retinol with a reduced risk of topical irritation. While visible results will be achieved using a complex, it might take longer to see than when using a pure retinol. Those struggling with skin conditions such as visible aging, hyperpigmentation, or acne will often benefit more from a potent pure retinol product. Retinol complexes are more appropriate for patients looking to maintain a youthful appearance, reduce oil production, as well as anyone who cannot tolerate pure retinol. Always follow treatment protocols and/or instructions given by a skin care professional while using these products.

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Web Log - March 2012 - NWSPS Meeting and HealthSmart Segments

Sunday, March 11th, 2012

Diamond Head Crater Summit View

I recently attended the Northwest Society of Plastic Surgeons meeting and picked up lots of good ideas. Some were small points such as drain placement position and local anesthetic injection technique while others were larger concepts such as breast reduction and reconstruction approaches. These all come under the setting of building a better mousetrap and are very satisfying to most plastic surgeons in our attempt to perform the perfect operation. Really big ideas are usually seen at the major meetings like the American Society of Aesthetic of Plastic Surgeons in May. I will tell you what I find out in the June blog.

Below are the questions and answers for the last few HealthSmart segments. See the segments live every Tuesday Morning at 0735 on KTVB ch 28 or later on our Video and Media Web Page.

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Brow Lifts

“What types of fixation are available for endoscopic brow lifts and what are the advantages and disadvantages of those fixation methods?”

This is a pretty advanced question. First, we should discuss a few basics first. When we age, the brow droops and makes us look tired and angry. Our forehead muscle, or frontalis, elevates our brow to help keep our eyelids out of our eyes and caused forehead wrinkles. People see aging in the upper third of their face and think eyelids are the problem, but often, a droopy brow makes up 50% or more of the cause.

The question suggests that there is more than one way to lift a brow.

Yes, there are three main ways. Common to all of them is cutting the corrugator muscles, the ones we paralyze with Botox. Next, the brow is detatched from the superior orbital rim so that it is mobile and can be repositioned. There are 3 incisions: coronal, anterior hairline, and endoscopic. The coronal incision is the long one across the top and is used when there is significant brow droop, when the brow is asymmetric, and when there is a low hairline. It can cause numbness behind the incision line. The anterior hairline incision is used for the same reasons, except when the hairline is higher. I find in Boise, Idaho that this is the most common incision that I use. It is reliable, shortens the senile forehead, and the incision hides really very well.

And that brings us to the endoscopic lift and our question.

In an endoscopic lift, small incisions are and the operation is done via a video scope. It’s nice that there is less scar and numbness, but it is not as powerful of a lift. It is best used in younger or minimal lift patients, but is very popular in some markets. In the open lifts, a strip of scalp is removed and the lift is maintained by the tension of the closure. In the endoscopic, no skin it removed, so the lift is maintained by fixation. Fixation may be with a suture tied to a bone tunnel, a suture tied to a temporarily placed titanium screw that sticks out of your head for a few weeks, or with an endotine device. This is an absorbable plastic like device with is popped into a shallow hole drilled into the skull and holds the scalp up with multiple tines. I like it because it is relatively quick and easy, but it is expensive.

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Upper Lid Blephaproplasty

We previously discussed that a portion of upper face aging is due to brow droop. Let’s talk about how the other part, drooping upper lids.

Depending on the patient, upper lids may make up a large or small part of looking old. In most faces, upper lids are the feature which would benefit from surgery - or blepharoplasty - first. Extra skin that you can pinch is removed, as well as extra fat and muscle. In some patients, the operation can even be done under local anesthetic only and recovery is usually minimal. The scar hides nicely in the sulcus and usually is very hard to see.

It sounds simple, but we know by now, no operation ever is. What sorts of things are there to worry about.

Upper lid blepharoplasty is one of the most straight forward operation on the face, but there is a lot to be careful about. The upper lid is functional - it acts like a roll top desk to protect the eye. If you remove too much skin, the eye can become uncomfortably dry and even threaten vision. The levator muscle which acts like a window shade pulling up the lid can be damaged and potentially cause lid droop. Over resection of extra fat around the eye can make the orbit look hollow. Finally, bleeding caused behind the eye, while extremely rare, can cause vision loss.

So blepharoplasty while it seems simple, can be dangerous. What specialties have formal training for this procedure?

Plastic surgeons, ENT’s who have had facial plastic surgery training, and ophthalmologists - in particular those with ophthalmic plastic surgery training most frequently perform blepharoplasty. Even the most straight forward seeming operation can have problems. Some populations, such as asians and the elderly, can be especially challenging.

Does insurance ever cover upper lid blepharoplasty?

Overwhelmingly, most patient have aesthetic problems only, so it is a self pay procedure. In a small number, however, there is so much extra lid skin that patients actually cannot see well and have what we call a visual field deficit. If after exam by a surgeon, this is felt to be a possibility, the patient should be seen by an optometrist for visual field deficit testing. If it is indeed positive, the case can be submitted for insurance review.

Wigod Plastic Surgery - Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region

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Case of the Month - March 2012 - Brow Lift and Platysmaplasty

Sunday, March 11th, 2012

The patient is a woman who is dissatisfied with her brow position and the laxity in her neck. She has minimal jowls and has tight skin overlying her face. She is best served with an anterior hairline brow lift to ease her central tense look and a platysmaplasty via an incision hidden beneath her chin to redrape her neck skin and musculature. With later aging, she plans a facelift to address her jowl and eventual greater skin laxity.