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

Not following directions on Diamond Head
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.

https://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 https://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 https://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 https://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 https://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.

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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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