EVOLV Medical Aesthetics


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 Improvementthe 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.

Evolv’s Top 5 Tips for Healthy Summer Skin    

  1. Choose a high-quality sunscreen to protect against new damage to the skin. skin cancer foundationRadiation from the sun passes through the skin, creating DNA damage and free radical exposure which can cause skin cancers and a breakdown of collagen and elastin in the skin; resulting in wrinkles premature aging changes.  Do your research on sunscreens!  Recent independent studies have shown that many of them are not as effective as stated on the package.  Look for a medical grade product, or look for a sunscreen that has The Skin Cancer Foundation’s Seal of Recommendation.  These products have met specific criteria to receive the certification.  All of the ZO and EltaMD sunscreens at evolv – including Jane Iredale makeup with SPF – are backed by the Skin Cancer foundation’s Seal of Recommendation.  Learn more here: http://www.skincancer.org/prevention/seal-of-recommendation.
  2. Use your sunscreen properly. All sunscreens should be reapplied every 2-3 hours, lip drinkespecially during the middle of the day when the sun’s rays are at their peak.  It is a good idea to reapply after swimming, even if your product says that it is “Water Resistant.”  For best protection, apply sunscreen 20-30 minutes before going outside. Don’t forget to apply sunscreen to ears, exposed scalp or hair part, and don’t forget about lips!
    Get a good lip balm with SPF, we like EltaMD’s UV Lip Balm Broad Spectrum SPF 31 and Jane Iredale Lip Drink SPF 15.
  3. Enjoy the summer weather but learn how to manage your exposure.  As mentioned above, a good quality sunscreen with reapplication every 2-3 hours is important but also limiting your time in direct sunlight and wearing sun protective clothing and hats are excellent ways to keep your skin healthy and safe from the sun.
  4. If you have a professionally recommended skin care regimen, don’t stop during the summer. Have you ever heard the saying “one step forward and two steps back”? Stopping your skin care regimen in the summer can reverse some of the damage that you have spent time and money correcting. Remember that sun damage is cumulative and adds hatup over time, so if you have a history of high sun exposure, SPF may not be enough to protect you against skin cancer. Using quality skin care products including antioxidants and retinols (vitamin A derivatives) in addition to sunscreen can keep your skin in top shape throughout the summer months, and all year-round.  Applying an antioxidant product before your sunscreen is particularly effective in reducing fine lines, wrinkles and loss of elasticity.  Regular use of retinol in the evening, along with exfoliation of the top layers of skin with products or professional skin treatments will keep new, fresh and healthy skin visible and will also reduce damaged cells that can over time lead to skin cancer.  Your skin care professional can educate you on how to use your products to optimize safety, results and skin health.
  5. If you want color, choose sunless tanning products or services – don’t tan! When you get a tan from the sun or indoor tanning, the color change you see is the skin trying to protect itself from damage.  Indoor tanning is even worse, concentrating UV light to deliberately produce that “golden tan,” which is really just visible damage to the skin.  Sunless tanning products have come a long way, and can produce very natural results.  Seek out a reputable spray tan professional for excellent results, and if you can’t go for spray tans as much as you’d like, ask them to recommend a home product you can use to keep up your tan without the damaging and premature aging that results from excessive sun exposure.

Why You Need to Peel

The use of chemical peels to reduce the signs of aging and to improve skin quality is a safe and extremely effective technique when performed by experienced medical professionals.  In addition to improving texture and tone, while reducing uneven pigmentation and wrinkling, peels are also very effective in treating acne, rosacea (facial redness), large pores and melasma.

Chemical peels utilize a medical acid or enzyme to allow deeper exfoliation or removal of the outer
layers of the skin and to simultaneously stimulate the growth of new cells for replacement.  Chemical peels are categorized based on the depth of the exfoliation: superficial, medium or deep.

Superficial and medium depth peels are most popular, and are usually performed by a qualified aesthetician in the office.  Although the more superficial peels will not correct deep wrinkles or skin laxity, they can significantly improved texture, pigmentation irregularity and overall skin health and appearance.

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Before ZO Skin Care and series of ZO 3 Step Peels
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Before ZO Skin Care and series of ZO 3 Step Peels










Deeper peels should be done by an experienced physician and can be performed in the office or in surgery in conjunction with other aesthetic procedures.  In addition to improving deeper wrinkles, acne scars and skin laxity, deeper peels can reduce skin cancer risk in patients with a history of excessive sun exposure.

Patient 2 - Before
Before TCA & Eyelid Surgery
Patient 2 - After
After TCA Peel and Eyelid Surgery










So why do you need to peel?  It may be surprising to learn that your skin reaches a relatively inactive phase after age 30, with progressively decreased cellular function, and an increase in the appearance of wrinkles and other signs of aging.

Along with a proven daily skin care regimen, appropriate chemical skin peeling is essential to optimize skin health and youthfulness after our younger years.  This is because as we age, we no longer spontaneously shed the more aged and damaged surface cells and their progressive accumulation results in dull, dry and prematurely aged skin.  Finally, it is important to emphasize that the most effective peels not only loosen and help remove the outer skin layers, but also stimulate the deeper layers (called the dermis) that result in increased collagen, elastin and growth factor production.

At evolv medical aesthetics, we have over 25 years experience with medical skin care and skin peeling.  If you are looking to create real improvements in your skin’s health and appearance, we encourage you to work with our team to develop a personalized skin care program – a great time to do this would be on our Spring Peel Days on April 14th and 15th!