New Research shows that improving skin function and health can do much more than previously understood
At evolv Plastic Surgery and Medical Aesthetics we have always believed in and practiced the fundamentals of improving skin health in benefiting overall quality of life for our patients, ourselves and our families. Now a growing body of evidence in clinical and scientific research is providing answers as to why this may be so essential to our overall health and well-being.
A recently published study in Nature Communications found that skin that is inflamed and has poor barrier function (a common factor in most compromised skin as well as in sun damaged or prematurely aged skin) releases inflammatory protein messengers called cytokines that can negatively affect not only the surrounding local skin cells but also other remote tissues in the body as well. Our cells contain a variety of cytokines which are basically ‘signaling’ messengers that tell our cells what to do in a variety of situations.
These cytokine protein messengers are many and have a variety of effects in their influence on cell function. Inflammation, more specifically chronic inflammation at the cellular level, is a common cause of most disease conditions as well as advanced aging and deterioration and can lead to compromised function and disease in our bodies. Common skin conditions or disorders associated with chronic inflammation include acne, rosacea (chronic redness), excessive pigmentation, various forms of dermatitis, sun damage and even premature skin aging and skin cancers. Reducing chronic inflammation through anti-inflammatory nutrition and anti-oxidant supplements, regular exercise and stress reduction as well as general healthy lifestyle choices are the fundamental pillars of improving overall health and reducing the signs and symptoms of advanced or premature aging.
Researchers from the University of California San Francisco (UCSF) recently published their findings in the Journal of the European Academy of Dermatology proving for the first time that improving skin barrier function in otherwise healthy adults may reduce risk of other diseases or conditions associated with chronic inflammation such as Type 2 diabetes, heart disease and even loss of muscle mass associated with aging. Obviously systemic diseases may result from a variety of sources and may have multiple etiologies, however the fact that skin inflammation and compromised function thru inflammatory cytokines can contribute to disease or deterioration elsewhere in the body helps support the importance and wider impact of improving and optimizing skin health.
The research and vast clinical experience of Dr. Zein Obagi, an internationally recognized dermatologist and educator and inventor of the original Obagi Medical Products and now ZO Skin Health, has progressively defined and revealed the fundamentals of achieving optimal skin function. One of the major priorities in all of our evolv patients’ individualized medical skin care programs is restoring and improving skin barrier function and reducing inflammation with proper cleansing, exfoliation, stimulation and protection. The recently published studies from UCSF and Europe researchers help provide why this matters and is so important not only to the skin but also overall systemic health. Another study from the University of Pennsylvania following 10,000 patients over five years revealed that those patients with an inflammatory skin condition (psoriasis) involving more than 10% of body surface area had an 80% higher risk of death from any cause as well as an increased risk of stroke.
An additional finding in some of the recent studies was that long term use of topical steroids like cortisone, which are commonly used for many skin conditions associated with irritation, itching and redness, worsened the skin barrier by reducing cellular turnover and function. Based on the above findings, this implies that chronic or excessive use of topical steroid products may have negative effects on local skin as well as general health and their use should be carefully evaluated as needed. Skin function and cellular turnover, which is optimal in our early years, tends to slow down with aging, stress, in the post reproductive years and especially after menopause. That is why one of the primary goals in regenerative skin care is the stimulation and restoration of healthy cellular turnover which results in optimal skin barrier function and the reduction of harmful inflammation.
The above recently published research is very compelling in implicating a direct connection between chronic inflammatory skin conditions and other potentially serious health problems. The basis of this association appears to be cytokines or inflammatory mediators released by irritated skin cells and other immune based pathways that may affect or be associated with other areas of the body. As further evidence of the ‘mind-body connection’ evolve, we also know that optimally healthy and youthful functioning skin not only has physical health advantages, but also emotional and psychological benefits. Research has validated that patients who have successful aesthetic treatments and outcomes have measurable increases in the ‘feel good’ neurotransmitters in the brain resulting in improved happiness, confidence and quality of life.
We now have ever increasing, research supported evidence that improving our skin health and the use of properly selected aesthetic products, services and treatments can result in an overall improvement in physical and emotional health as well as general well-being. And that is what really gets all of us excited at evolv and why we love what we do!
As many are aware, there has been much recent publicity and discussion in the news about a rare type of lymphoma associated with breast implants and has been termed ‘Breast Implant Associated – Anaplastic Large Cell Lymphoma or BIA-ALCL.’ On July 24, 2019, Allergan Medical Corporation issued a worldwide recall of all of their textured surface breast implants and tissue expanders per request of the Food and Drug Administration (FDA) because of the association of BIA-ALCL with the ‘macro texturing’ or Biocell texturing on some Allergan devices. This recommendation was based on recently submitted Medical Device Reports (MDR’s) reporting an increase in worldwide cases of BIA-ALCL associated with these devices compared to other textured surface and smooth surface devices.
As a Board-Certified Plastic Surgeon and member of the American Board of Plastic Surgery (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), we are committed to patient safety, advancing quality of care, and practicing medicine and surgery based upon the best available scientific evidence. If you have received breast implants or tissue expanders and have any concerns or questions about this recent information and the Allergan recall and BIA-ALCL, we encourage you to make an appointment or call us at evolv Plastic Surgery and Medical Aesthetics so we can provide science-based and factual information specifically to you. I have over 30 years clinical experience in the use of various breast implants and tissue expanders in both cosmetic augmentation and breast cancer reconstruction as well as published research studying breast implant biomaterials and their function and safety.
Most Recent Science-based Facts:
- BIA-ALCL is extremely rare. There have been 573 confirmed cases worldwide, and considering the many millions of women with breast implants for both cosmetic enhancement and in breast reconstruction, the incidence is very low although significantly higher in association with deeper or ‘macro’ textured devices like Allergan’s Biocell surface.
- Because of their significant advantages in some patients, I have used textured breast implants and tissue expanders for over 30 years and have never had a confirmed case of BIA-ALCL in any patient.
- BIA-ALCL most always presents with new onset swelling, fluid accumulation around the implant (serum), and discomfort and can be consistently and quickly diagnosed with laboratory studies of the fluid aspirated around the implant. When detected early, removal of the implant and all of the scar tissue capsule around the device cures the problem. In rare cases left untreated, chemotherapy and/or radiation may be necessary.
- BIA-ALCL is not breast cancer but is a cancer of white blood cells (lymphoma) and is usually localized only in the scar tissue capsule around the implant and most often can be definitively treated by removal of the surrounding scar capsule (capsulectomy) and implant.
- Although only recently described and relatively rare, evolving research studies indicate that the development of BIA-ALCL is multifactorial and involves the interaction of 4 factors: textured surfaces, bacterial contamination, genetic susceptibility and time. It appears that deeper or more aggressive texturing increases risk and that there is no association with smooth surfaced implants.
- The FDA has clearly stated that if you are a patient with textured surface implants and are not experiencing any symptoms as described above, they are not recommending removal of the implants. If you have any questions about risk they are suggesting that each patient talk to their health care provider.
For patients in the U.S. who, as a result of the recall announcement on July 24, 2019, choose to replace their Bio cell textured device with a smooth surface device, in consultation with their Plastic Surgeon, Allergan Medical will provide Allergan smooth device replacements of a similar size at no charge to the patient. This Replacement Program will run for 12 months until July 24,2020.
Breast implant surgery, whether for cosmetic enhancement or for breast cancer reconstruction, when done by a Board-Certified Plastic Surgeon on the appropriate patient, can have a profound effect on improving quality of life for women of all ages. The other fundamental goal is long term patient safety and utilizing the best research-proven evidence or breast implants and bio materials. There are several safe choices available to patients when selecting implants. Research on BIA-ALCL is still developing, and it is important to focus on what is proven and scientifically validated.
We are encouraging any patient with implants or any patient considering breast augmentation or implant-based breast reconstruction to discuss these issues with a board-certified plastic surgeon with proven experience in breast surgery.
Links from reputable sources to learning more about these concerns.
If you should have any additional questions or concerns, please feel free to contact our office at 419-720-2008. We highly recommend annual exams to all our patients. We want everyone to put safety first, regardless of insurance coverage or not, therefore we offer annual complimentary breast exams to all our patients.
I thank you for your attention.
Frank Barone, MD
I was first diagnosed with acne when I was in high school. As a female in my early thirties, I still have periodic breakouts, albeit far less frequent or severe. Having acne weighs on you. It affects your confidence and makes you question what you should be doing differently. Any time you see a new blemish, you play detective to ascertain the cause. Did I consume the wrong food? Did I wear an occlusive makeup? Did I not change my pillowcase? For people who don’t suffer from regular acne, they may not understand the struggle, but even leaving the house can feel daunting when you have a face full of blemishes. Wearing makeup daily can became routine and cancelling plans out of embarrassment a commonplace occurrence. For those who don’t feel comfortable wearing makeup, showing their face to the world is perhaps even more intimidating.
To add insult to injury, after suffering from severe cystic acne, I was left with scarring. And not just post-inflammatory hyperpigmentation (those dark marks left behind after a pimple heals), I had uneven texture and indented scarring. Far more difficult to correct, scarring can be even more traumatizing than the acne itself. You want nothing more than to confidently make eye contact with those around you, but you are constantly wondering, “are they looking at my skin?”
So, where am I in my acne journey? After obtaining a job with evolv Plastic Surgery & Medical Aesthetics, I have been privileged to try new skincare products and treatments geared to addressing my acne and the scarring that was left behind. With visible improvements, I feel hope. I see changes when I look in the mirror, and I am excited to share with my fellow acne/acne scarring suffers what has helped me improve my skin.
ACNE BASICS AND WHERE TO START
Let’s go back to the basics. What is acne? That question is easy to answer. Acne is a skin condition that occurs when oil and dead skin cells get trapped within the oil glands and hair follicle resulting in an infection. What causes acne? This question is far more difficult to answer and can cause frustration for acne sufferers everywhere. Things like genetics, diet, lifestyle and hormones can all play a role, but not all cases of acne are created equally. One thing is for certain – acne affects us, not just physically but emotionally. Whether it be moderate or more severe, acne can lead to low self-esteem, anxiety, and even depression.
The first step is to see a skincare professional who can diagnose your individualized skin type and concerns. Did you know that rosacea, a common skin condition that can cause redness and swollen bumps, can often be mistaken for acne? Schedule a consultation with a Dermatologist or Plastic Surgeon to establish your skin condition and start developing a plan of action.
Once diagnosed, it is important to note that acne does not resolve quickly. You need to give yourself and your skin a chance to heal. It can take 4-8 weeks to notice a marked improvement in your skin once you start an oral or topical medication and/or treatment program. Be patient because these medications can cause reaction like dryness, redness and flaking.
Topical products that contain ingredients like benzoyl peroxide, salicylic acid and tea tree oil have all been known to help clam and clear the skin. You see many of these ingredients in over-the-counter (OTC) products, but it is best to see a professional to ensure that you are receiving medical-grade skincare.
Antibiotics, oral and topical, have been proven to help kill bacteria and reduce inflammation in the skin. If you are female and hormones play a role in your specific type of acne, birth control can be effective. Isotretinoin can be effective in addressing more severe forms of acne, but it can also have some of the worst side effects and should not be treated lightly. A doctor would need to prescribe any of these medications, so if you want to delve into one of these options, you will need to consult with a physician who specializes in medical skin care.
In-office treatments such as manual extractions, chemical peels, and light therapies have also proven beneficial for acne sufferers. If you are dealing with scarring left behind from acne, chemical peels, microneedling options, and laser-based therapies can yield dramatic improvements. Like anything, however, it takes time to see change in the skin, and you must be patient. Trained skincare specialists, referred to as licensed aestheticians, can perform most of these treatments, depending upon the state in which you reside. In Ohio, laser-based therapies need to be performed by physicians. Our trained aestheticians at evolv can recommend a comprehensive skincare regimen and treatment program tailored specifically to you and your unique skincare concerns.
WHAT HAS WORKED FOR ME?
Except for Isotretinoin (Accutane), I have tried almost every possible acne therapy under the sun. You need to figure out what ingredients work well for you, but I respond very well to ZO Skin Health products, a medical-grade skincare line that can actually change the skin on a cellular level. Evolv Medical Aesthetics believes that a personalized skin care plan to restore and improve optimal health is the most effective way to treat and prevent acne. I am lucky to have an aesthetician who can tweak my regimen as needed and make additional recommendations based upon how my skin is behaving.
As for treatments, I feel like my results have been cumulative. Combining at-home skincare with treatments in the office (microneedling, chemical peels and laser therapy), I have seen visible improvements in my skin. I notice smoother skin and a healthy radiance I have never been able to achieve before. I still have redness, because I have also been blessed with rosacea, but my skin clarity and texture are also markedly improved.
My acne and acne scarring journey is not over. I don’t know if it will ever be over. I feel very lucky to be where I am, as a part of the evolv family. I want to continue to share with you what is working for me and my skin. If I am able to help even one person feel more confident in their own skin, I will count it a great success. If you are suffering from acne or acne scarring, you are not alone. You are part of a much bigger family than you realize, and we are here for you. If you want to start discussing options, call the office to learn more!
‘Anti-Aging’……….we have all heard the term and experienced its use associated with creams, potions, diets, supplements, lifestyles, workouts, and on and on and on. This is especially pervasive in our aesthetic or cosmetic profession. But don’t worry, wanting to hold on to or regain your natural youthful characteristics and look younger is not just mere vanity but a basic and hardwired human characteristic ingrained by many thousands of years of evolution. Looking younger and more attractive is essential to preservation of the species and thus a powerful biological drive and an essential part of our humanness.
But the use of the term ‘anti-aging’ would imply that any of these heavily promoted products or options would somehow potentially stop or at least slow down the aging process…..at least that’s what the marketers would like you to believe.
What they don’t want you to know, and what science clearly has proven, is that biological aging is an inevitable process that cannot be stopped……at least not yet. None of the ‘anti-aging’ products, treatments or services currently available have ever been proven to affect or slow the biological process of human aging. On the other hand, the good news is that the signs or manifestations of aging can certainly be reduced or improved as has been credibly proven in many peer reviewed and respected studies. Credible and proven aesthetic products and cosmetic procedures performed by appropriately trained professionals can restore natural and balanced youthful features, resulting in tremendous personal satisfaction and confidence for patients of any age. Just ask any of our evolv patients who have been consistent with their ZO Skin Health programs, and that includes myself!
Since it has been proven consistently that we cannot stop the aging process, what if we changed our attitude toward aging and just embraced it? What if we ignored the ‘hype’ of the ‘anti-aging’ marketing and focused our energies on living well, taking great care of ourselves, looking our best and just accepting the natural aging process?
I was asked to write an article for Emmy Award winning director Keith Famie’s documentary ‘The Embrace of Aging,’ which was a series aired on PBS several years ago. In the programs, Keith examined both the female as well as the male perspective on aging gracefully and well. He also interviewed a number of experts and professionals involved with aging research and in treating the aging population. So what were the ‘secrets’ to happiness and longevity? What might allow us to truly embrace our inevitable aging that is proven by the most knowledgeable and experienced scientists who have studied longevity and aging populations around the world? Actually the answers are not surprising, but here is a summary of their findings and conclusions:
– Pay attention to what you eat…..mostly plant based foods, less meat (especially processed), more seafood, less salt and less sugar and processed carbohydrates. Also try to reduce your portion sizes. In general, the less you eat, the longer you are likely to live.
– Increase your physical and mental activity, especially as you age. The more you sit, the less long you will live. We have an epidemic of ‘sitting disease’ in our culture! Do something active with your body and your mind every day….walk, jog, dance, lift weights, stretch…..just move…it’s all good! Regular mental activity can also reduce your risk of dementia.
– Please don’t smoke. Smoking has been proven to reduce your average lifespan by more than 10 years as well as cause widespread health problems that reduce quality not life. Smoking will also prematurely age the skin and dramatically reduce skin health.
– Be social and try to cultivate a positive attitude. Happy and optimistic people have been shown to not only live longer but also better! We are social creatures and we need each other…. loneliness is bad for your health. Cultures with a spiritual connection or religion that were studies tended to live longer and happier lives.
-Make an effort to control and reduce your chronic stress. Take the time to learn to meditate…..it works! A number of studies have clearly documented the many physical and mental health benefits of regular mediation. Yoga and regular mindful activities and exercise along with adequate sleep are all beneficial. Ongoing stress will reduce the quantity and quality of your life.
These are the ‘secrets’ of the longest living cultures and populations in the world that are supported by science.
So now that we clearly know what to do……..how do we actually do it?
There is always a predictable spike in new gym memberships and use of exercise apps after New Year’s Day, as resolutions are made with good intent. Unfortunately, reality soon sets in, and very few of us are successful long-term. Real life seems to get in the way of our best intentions and resolutions. The reality is that real change takes work, commitment and organization. Based on a recent study, here are some suggestions that can really improve your chances of sticking with those New Year’s Resolutions to improve your health, quality of life and well-being to embrace your aging!
– Integrate – incorporating the above health fundamentals or your resolutions are not just one more thing to cram into your busy schedule. ‘Integrate’ your new goals into your day, and find a sense of balance. What can you eliminate or reduce to find the time? Try to fit it in to your routine and schedule in a way that is practical and convenient.
– Be Realistic – try to set goals that are simple and realistic. Set lower goals. It is better to succeed at one resolution than to fail at many.
– Embrace the Fail – statistics confirm that you are likely to fail or not attain some of your goals. That is just human nature. Instead of being self-critical or quitting, simply embrace it. Don’t get discouraged, or if you do, embrace that too! The fundamental of mindfulness is to just notice it, acknowledge it, and then let it go! The funny thing is that as soon as you notice the failure, you are no longer failing. Let the failure go, and just move on…..it’s a new day, and it’s all good.
– Forgive – since we are all likely to experience some ‘failure’ in achieving our resolutions at some point, why don’t we just incorporate some forgiveness into our New Year’s Resolutions? Instead of making absolute or rigid goals such as ‘I will lose 10 pounds by February,’ try something more flexible. If you do fail, resolve to forgive yourself too, and move on with your goals. Allowing yourself forgiveness can result in setting yourself up for success and keep you in the game.
Our mission at evolv Plastic Surgery and Medical Aesthetics is not only to safely provide proven and state of the art aesthetic procedures, treatments and products but also to improve the quality of life and overall well-being for our patients, our families and ourselves. That is our promise and our commitment. We believe that aging can be embraced and enjoyed by incorporating the above health fundamentals for anyone at any age. We believe that through education, research and commitment, combined with personalized programs that achieve natural and balanced results for each patient, we all can ’embrace our aging’ and enjoy an improved and optimal quality of life.
As we begin 2019, Dr. Peter Koltz and I, as well as our entire evolv staff, would like to thank all of you, our patients and friends, for your ongoing support. We are especially thankful and appreciate your trust in us and in our patient care. We would like to wish all of you and your families happiness, joy and peace in your lives.
Welcome to the Holiday Season from all of us at evolv!
The Thanksgiving through Christmas Holiday season has always been my favorite time of year for many reasons. Growing up in a large Italian family in the 60’s meant lots of family traditions, celebration, anticipation and best of all…..Rosie’s (my Mom) food!
This is a time of year that just about everyone can appreciate. Who among us wouldn’t benefit from a little more gratitude in their lives? A little less taken for granted; a little more time to stop and smell the roses. Even though this season can be the ‘best of times’ for many, it can also be one of the most stressful and challenging as well.
Evolutionary scientists believe there may be a negativity bias built in to the human brain……it’s easier to survive threats and danger if you are constantly on guard, suspicious or worried. Unfortunately, it just may be a human nature survival instinct to dwell too much on what’s wrong rather than appreciate what’s right. Have you ever noticed that after you’ve had a backache, you are grateful when it goes away? But how many of us woke up this morning and were thankful for not having a backache?
Science has also taught us that chronic stress, anxiety and worry can also make us physically ill and shorten our lives. Conversely, studies also prove that the practice of developing a more positive attitude, and being grateful and appreciative, can also improve our health, well-being and longevity.
What if this year we could truly take stock of the good and get some balance to correct the bias of negativity that is hardwired into our ‘survival human brains?’ What if we could find an ‘attitude of gratitude?’ Here are three suggestions on how to do it:
1) ‘Accounting of the Soul’
In his ‘Nightly Gratitude Meditation,’ Jeff Warren recommends that every evening we just think of a single thing or event from the day that was good or positive in our life. It’s not complicated or difficult…..just a single thing that matters and is positive. You could appreciate someone in your family, a friend, your work, your health, anything…..there’s a lot of good out there if only you could just stop for a moment and listen.
2) Share your Feelings
This season provides a great opportunity to open up and share your feelings. Feelings and emotions are a very powerful force in our lives, and sharing them with family or friends can reduce stress and be a very healthy mental exercise. Just letting those you work or live with know how much you appreciate them can bring happiness and peace of mind not only to others, but also to ourselves.
3) Consider the Present Moment and Then Let Go
The realization and acceptance that nearly all worry and anxiety and tension are rooted in thoughts of the past or future is the basis of meditation practice. Perhaps that is why meditation philosophy focuses on releasing all of the constant ‘chatter’ in our heads, to let go of worries of the future or thoughts of the past, and just sit back and observe the moment, just hang out.
The spiritual teacher Eckhart Tolle said ‘turn your entire attention to the now, and tell me what your problem is.’ This may sound naive, impractical or unrealistic because the ‘present moment’ is not the whole story and we do indeed have problems in this world. But although it may take a little effort and consistency, it is possible to stop for a moment, to practice mindfulness, and learn how to let go of thoughts of the past or future, just for a moment, to rest.
I can personally support the benefits of this practice. I lost my mother of 98 years after a wonderful, lifelong relationship, earlier this year. Rosie was a selfless and special woman who touched so many lives. As I sat at her bedside overwhelmed with thoughts of sadness and worry and struggle, I found a moment when I just let it all go. And then I noticed the snow softly falling on the trees, there was a beauty in her face, there was love all around, there was continuity….and that is when I found peace, with all of it.
Thanksgiving and the Holiday Season are a once a year opportunity for ‘gratitude practice.’ And it is that ‘attitude of gratitude’ that can provide a wonderful possibility to be ‘calm in your heart’ and to find peace….right there in the midst of all the anxiety, noise and trouble of a crazy and beautiful life!
All of us at evolv are thankful and appreciate you and the belief and trust that you have placed in us for you care.
Happy Holidays and Blessings to all of you and your families!
All of us at evolv Plastic Surgery and Medical Aesthetics would like to welcome you to the Holiday Season!
November is National Healthy Skin Month, and achieving and maintaining optimal skin health is something we strongly believe in and practice every day at evolv. Our skin health is often neglected or taken for granted with our hectic schedules particularly during the holidays. In honor of National Healthy Skin Month, here are a few interesting facts to consider:
– The skin is the largest organ in the body, and the average adult has approximately 16-22 square feet of skin weighing around 9-11 pounds.
– The skin surface completely renews itself about every 28 days by constantly shedding dead skin cells (a large part of the dust in your home actually came from your skin surface)!
– Your skin surface is home to millions of bacteria (over 1,000 species) and fungi!
– Healthy skin functions as a very selective barrier to keep out harmful toxins and pathogens while protecting, retaining moisture and regulating temperature.
– The skin is the source of more cancers in humans than all other organs combined…..one in five Americans will be diagnosed with skin cancer in their lifetime, and one person dies of melanoma in the U.S. every hour.
– There are over 60 million Americans living with actinic keratosis, the most common type of pre-cancer of the skin.
– Multiple studies confirm that skin health and youthfulness has a significant impact on self-confidence, overall well-being and quality of life.
At evolv, we have witnessed how improving skin health can positively and powerfully impact the lives of our patients at any age and in many ways. We have also experienced how healthy skin can improve results and patient satisfaction in any cosmetic surgical procedure, as well as any non-surgical aesthetic treatment. Optimal skin health plays an essential role in the comprehensive aesthetic care that we provide for all of our evolv patients.
Personalized medical skin care programs with ZO Skin Health can reduce or prevent many of the signs of aging and restore youthful and ageless skin quality, as well as prevent or reduce the risk of cancer, acne and other inflammatory conditions, treat hyperpigmentation and rosacea.
During the cooler months, dry and dehydrated skin is very common and frustrating but can be effectively controlled or prevented and treated with an individualized skin care plan provided by Dr. Barone, Dr. Koltz or one of our evolv aestheticians.
This Holiday Season we would like to encourage everyone to consider the importance of their skin health and the effect it can have on reducing the risk of cancer, as well as improving quality of life. The reality is that healthy skin takes work, especially as we get older. We encourage you to come in and learn about the many exciting new and affordable options in aesthetic skin services, products and treatments that can achieve results in skin health and youthfulness far beyond most patients’ expectations. We believe in comprehensive, natural appearing outcomes and long term programs and would like to share these concepts with our patients and their families! So CHEERS from all of us at evolv to your new skin health and younger look!
Even though it was over 30 years ago, I will never forget her face.
She was a young mother and school teacher with 2 small children and I was a first year plastic surgery resident. She had a mastectomy for breast cancer and was left with a large and painful tight scar. The implant that had been placed by my instructor under the scar was hard, unnatural and uncomfortable…..at that time in the mid 1980’s there just were not many options or choices. She looked at me and I did not know what to say to comfort her. That was the day I decided to seek post graduate training in breast reconstruction and that young mother, with the eyes I cannot forget, changed my life forever.
This year an estimated 230,000 women in the U.S. will be diagnosed with breast cancer but less than 25% of those women will be aware of their reconstructive options before treatment. The breast cancer experience touches not only those women but also their spouses, their children, their families and their lives for years. The breast cancer experience involves much more than just removing a tumor or having a mastectomy, it is a journey that can involve medical and other post-operative treatments as well as impact a women’s personal life and self-confidence and relationships at every level. In short it will someday effect all of us and someone we love.
The really exciting news is that the breast cancer experience is changing significantly for the better for a variety of reasons:
– Education and Patient Awareness – public awareness and educational efforts by a number of professional organizations have resulted in women being more informed and aware of their options. The American Cancer Society, the American Society of Plastic Surgery, the Susan G. Komen Foundation, The Victory Center and many others are doing an incredible job of communicating useful information to patients and their families. The best informed patients make the best choices!
– Identifying Risks and Cancer Prevention – the most effective way to fight cancer is prevention. New research on nutrition and life style as well as genetic testing to quantify risk factors have actually made a substantial difference in breast cancer incidence. Advances in genetic mapping have made great progress and resulted in improved options and treatment outcomes for patients at risk. Prophylactic mastectomy or removing the breast tissue to prevent cancer in high risk individuals, as popularized by actress Angelina Jolie, can reduce cancer risk by 90-95% in appropriate patients and result in excellent aesthetic outcomes. We encourage everyone to learn more about these exciting advances in order to protect themselves and their families.
– Early Detection – After prevention, the next most effective way to impact breast cancer is early diagnosis. Improved patient education and self-exam, consistent doctor’s visits, advances in imaging techniques such as mammography, ultrasound, MRI and other scans have resulted in earlier detection of breast cancer and breast ‘pre-cancers’ which will improve the overall patient experience and outcomes as well as reduce breast cancer morbidity.
– Improved Surgical and Reconstructive Techniques – Significant advances in biomaterials for breast implants and implantable materials (acellular dermal matrix) to help shape breast reconstruction procedures, have resulted in much more natural breast shapes as well as improved safety and less recovery. Earlier detection and research on tumor biology have resulted in less invasive resection procedures (lumpectomy and mastectomy) and options such as sparing the breast skin and nipple in appropriate patients. Placement of implants above the chest wall muscle (pre-pectoral reconstruction) and advances in tissue flap surgery reduce recovery time and have improved results for patients dramatically. Our very own Dr. Peter Koltz, an associate with Dr. Barone at evolv Plastic Surgery, completed advanced training in tissue flap surgery for breast reconstruction last year and has been offering these options for patients in the Toledo area.
– Post Treatment Quality of Life Improvement – the consequences of breast cancer treatment do not stop after the procedures have ended. Many patients taking estrogen blocking medication or other targeted chemotherapy or radiation deal with side effects such as bone and heart health, hair loss, premature skin aging, tissue dryness and laxity, post-menopausal vaginal dryness and urinary incontinence. This often results in femininity and intimacy challenges, sexual difficulties and overall loss of self-confidence and intimacy. New advances in clinically proven topicals, non-estrogen growth factors and other therapies can reduce symptoms and help restore confidence and vitality. Regenerative treatments with platelet rich plasma (PRP) and other stem cell growth factors as well as collagen stimulating noninvasive technologies have given many patients much improvement in these issues and a better quality of life.
October is Breast Cancer Awareness month and October 17th is Breast Cancer Awareness Day (or ‘BRA Day’). Please support these worthwhile programs and help bring more awareness, education and encouragement for the many women, men and their families that are dealing with this life changing issue. We invite you to join myself, Dr. Peter Koltz and the evolv staff at Rosie’s on Wednesday, October 17th to support BRA DAY and spread the word on the improving awareness and quality of life for breast cancer patients and families.
Yes the breast cancer experience is changing for the better and helping improve the quality of life for many. Advances in clinical research, cancer biology, genetic testing, surgical and reconstructive option have transformed the breast cancer experience in such positive way. The quality and safety of new reconstruction choices and postoperative treatment options can restore a patient’s self-confidence and lifestyle. As plastic surgeons we now may often hear a post reconstructive patient say, “Doctor, I sometimes forget I had a mastectomy!”
And I am forever grateful to that young mother and cancer survivor that inspired me with her courage so many years ago.
The latest statistics are quite remarkable: last year in 2017, there were over 20 million non-surgical cosmetic procedures performed in the U.S. and nearly 16 million of that number were injectables of Botox type neuromodulators and soft tissue volume replacement (fillers). So what could possibly explain this explosive growth?
At evolv Plastic Surgery and Medical Aesthetics, we have a long term commitment and interest in ongoing education for our staff as well as our patients. So let’s take a look at some of the reasons driving the increased demand and popularity of injectable soft tissue fillers and Botox type neuromodulators.
More natural long lasting results
Gone are the days of simply injecting Botox to the scowl lines of the forehead (glabella) or adding filler to the nasolabial folds to rejuvenate the aging face. The commitment to comprehensive aesthetics at evolv is a holistic appreciation of all of the parameters of the aging face and body. Along with the fundamentals of a personalized skin health program, a number of different FDA approved injectable neuromodulators (Botox/Xeomin/Dysport) may be used for different applications and results balancing facial expressions and movement to obtain a more youthful outcome as well as to reduce migraine headache triggers. Patients may be surprised to learn that there are over 100 medically approved therapeutic indications for current Botox type treatments! A new Botox type injectable (DaxibotulinumtoxinA or RT002) is scheduled for release soon and has the advantage of lasting 50% longer or up to 6 months. Combining neuromodulators and soft tissue fillers properly can result in a natural and balanced youthful appearance that can be quite cost effective and lasting. New ‘flexible’ fillers (Galderma’s Refyne and Defyne) which create volume replacement while maintaining harmonious movement in the face resulting in a more natural result along with less swelling.
Less chance for bruising, swelling and discomfort with treatments
For many patients, the risk of bruising and prolonged swelling with traditional injection is a major concern. This risk can be minimized by the use of cannulas for soft tissue filler placement in some areas instead of needles. In addition, advances in bioengineering and technology have resulted in new fillers that last longer and induce significantly less swelling (Allergan’s Voluma, Vollure and Volbella and Bellotero form Merz). evolv recently introduced the ProNox system for patients which allows them to self-administer nitrous oxide gas to reduce the perception of any discomfort during treatment. Finally, new formulations in topical numbing or anesthetic creams are more effective in reducing any discomfort during injection and other procedures in the office. All of the above have significantly improved the patient experience during injectable treatments at evolv.
Expanding patient base and options
Because of the improvement in products and the potential for more natural and affordable outcomes, more patients, male and female, and of all ages, are seeking treatments. Indications as well as ‘off label’ uses of FDA fillers and neuromodulators are providing more comprehensive and natural appearing results. A few examples are the use of Botox for migraine prevention, and the use of injectable soft tissue fillers for rejuvenation of the aging hands as well as for correcting depressions and cellulite improvement on the body and buttocks. A new category of fillers that induce soft tissue growth from the patient’s own cells are called ‘biostimulators’ and they include Sculptra and the new exciting product Renuva which is called an ‘adipose matrix’ and triggers natural fat and tissue growth in areas of scars or depression.
The importance of safety and training
As in all areas of aesthetics, the key to achieving high patient satisfaction and safety is comprehensive and ongoing training for all providers and staff. At evolv, education and patient safety are our passion and we believe it is everyone’s responsibility to keep patients safe and happy with their overall experience. We take this commitment seriously because, as everyone is aware, complications and unfavorable results are all too common in cosmetic treatments. The high demand for aesthetic treatments has outpaced the number of properly trained and credentialed service providers so it is especially important for anyone interested in these treatments to carefully research and understand the experience and training credentials of any provider offering services in aesthetic care. Complications can be very difficult and expensive to treat and correct so we encourage any interested patient to be well informed before making a decision to undergo cosmetic treatment.
The advances in biomaterials, technology and research proven new products and techniques have resulted in significant improvement and new options in non-surgical facial and body rejuvenation with injectable soft tissue filler augmentation and Botox type neuromodulators. Safety and longevity of results, when performed by a board certified/eligible plastic surgeon or properly trained registered nurse injector, have also resulted in a tremendous increase in the popularity of these procedures. At evolv Plastic Surgery and Medical Aesthetics, we believe in and emphasize comprehensive aesthetic programs combining these options along with a personalized skin care plan as the most effective way to achieve long lasting and natural appearing outcomes for each patient. And finally, evolv has recently introduced the ensoClub which is a private membership program with the benefits of reduced cost, preferred bookings and more affordable customized treatment plans. If you are interested in more information on the ensoClub program be sure to ask any of the evolv professional staff.
Whether you just received a breast cancer diagnosis or have been living cancer free from your diagnosis for years, every survivor remembers their first consult. Not only the many doctor’s consults but also with family and friends. Everyone tries to piece together all the information they are being told. Much has changed in breast reconstruction, especially in Toledo over the past year that we want all of our patients and friends to be aware of. We like to think we take a very “organic” approach to breast reconstruction and customize the approach to every patient’s goals and personal situation. Our focus is to give you as natural of a breast as possible while causing as little disruption to your body and your life as possible.
There are 5 new advances in breast reconstruction that we want to bring to your attention. We would welcome a discussion with anyone who may have questions about these points, which we will only touch on in this newsletter.
1. Autologous Breast Reconstruction
2. New and Improved Implants
3. Breast Sensation Following Reconstruction
4. Save the Pecs!
5. Yellow Gold!
1. Autologous Breast Reconstruction
The prefix “Auto” means “self”. Therefore, reconstruction of your breast with “self”. We think this approach personifies the “organic” breast reconstruction. While traditionally (as well as today) many breast reconstructions are performed with tissue expanders and implants, there are several operative procedures that allow the surgeon to use your own tissues (wherever you have excess, but most commonly the abdomen) to reconstruct your breast. This can take place at the time of your breast removal or even years later, even after you may have already had implants. Through the use of microvascular reconstructive surgery, tissue can be removed from one part of your body and transplanted to your breast with a quicker recovery and with less disruption of where your tissue was removed than autologous operations (TRAM) of the past.
2. New and Improved Implants
If you elect to undergo an implant-based approach to your breast reconstruction, today’s implants have drastically improved. The “organic” approach to implant-based reconstruction is based around the concept that you want your implant to be more “natural breast like” in feel and shape than the implants of the past. Additionally, today’s implants are safer than they have ever been. When the correct implant is chosen for your body there is no doubt that today’s implant breast reconstructions can come closer than ever to your “organic” breast.
3. Breast Sensation Following Reconstruction
So, you have had your breast removed…it frequently is not discussed that you will not feel your reconstructed breast again. This is important to discuss and realize going into your reconstruction. While currently it is not possible to restore sensation if you opt for an implant-based reconstruction, there have been some exciting developments with autologous (auto=self) reconstruction. At the time of transfer of your tissue from one part of your body to your breast, the nerves to your breast can be connected to your tissue that supplies sensation or feel to your abdomen to allow you to regain some sensation to your breast again. We feel like this is an exciting development worth talking about as the “organic” breast is sensate, or able to be felt!
4. Save the Pecs!
Of Course, we all want to preserve as much of the total breast as possible but cancer removal may not allow. However, it may be possible to save your “Pec” muscle or pectoralis major muscle at the time of your breast reconstruction. Traditionally in implant-based breast reconstruction, the chest muscle, the pectoralis major, is lifted from the chest wall and the implant is placed beneath. This is not “organic” but was previously thought to give the safest, most reliable reconstruction. However, with advances in implants and other biologic material now at our disposal, we have been able to produce implant reconstruction above the muscle, where the breast “organically” resides. This allows for less pain, a more natural look, and quicker recovery to your normal activities.
4. Yellow Gold!
Yellow Gold! While jewelry was previously a girl’s best friend, we are here to report that the new yellow gold is your own “organic” supply- FAT! With the advent of new liposuction techniques, developments in processing the fat, and injection techniques, it is now possible to deliver a much more natural looking and feeling breast reconstruction. No matter if you choose implant or autologous reconstruction, most people benefit from a touch of liposuction from one part of your body with transfer to the breast. This can happen at any point in your reconstructive journey in order to produce the most “organic” breast reconstruction.
We sincerely hope everyone is enjoying this beautiful (and HOT!) time of year and look forward to welcoming you all to the office in the near future. We greatly value our relationship with each and every one of you.
Why your diet is NOT working…and probably NEVER will.
January is National Dieting Month, and just about everyone has made some sort of post-holiday resolution to lose weight by cutting calories. Every year brings a new diet and a new hope that this just might be ‘the one’ to restore our health and youthful contours. But no matter how many celebrity-sponsored diets and enticing marketing claims are made, the results are almost always short-lived and disappointing.
Let’s look at what science has proven so that we find some realistic options that can truly benefit our overall health and well-being.
- Diets don’t work! They never will because calorie restriction is difficult to maintain long-term, and our bodies ‘learn’ to adjust and often rebound with later weight again.
- Weight loss alone doesn’t necessarily make you healthier. Although you may lose weight temporarily by restricting calories and starving yourself, your overall health requires regular exercise, reduced stress, adequate sleep and emotional well-being for you to be truly healthy.
- Focusing on dieting will distract your focus from the more important fundamentals of a sustainable, healthy and balanced lifestyle. As always, it’s the big picture that matters!
- Severe Calorie Restriction can lead to mood disorders and binge eating. More importantly, significant calorie reduction can rarely be maintained.
So what can we overweight and frustrated adults do?
Clinical research and nutritional research studies reveal that the real secret to healthy and long-term weight loss lies is in making a sustainable and comprehensive lifestyle change, not in the passing fads of calorie counting.
There are no effective, magic potions, celebrity ‘secrets’ or newly discovered gimmicks that will provide safe and healthy weight loss. What really CAN work is making a personal commitment to a balanced and healthy lifestyle, emphasize a nutritious more plant-based diet, control portion sizes, learn to manage your stress, prioritize adequate sleep and do more of what makes you happy!
At evolv Plastic Surgery and Medical Aesthetics, we believe in long-term and comprehensive aesthetic programs that improve quality of life and happiness. We care about all of our patients’ overall health. We hope to inspire everyone to make healthier choices and improve their lifestyle and well-being through education, research and by providing safe and proven products, services and treatment.
So we invite and encourage everyone to focus on wellness, not weight. Remember ‘weight’ is just a number, like ‘age,’ and not really as important as overall wellness and emotional well-being. By learning and embracing better habits and lifestyle, respecting yourself and cultivating an attitude of thankfulness and gratitude, life can be a lot more fun as well as healthy. After all, life is just too short to drink bad wine!
Dr. Frank Barone M.D., FACS