IMPROVING YOUR SKIN

Our skin is the protective coating that separates us from the environment.  It is composed of two layers.  The epidermis is the outer layer and the dermis is the inner layer.  The outer layer of the epidermis is composed of dead cells that are continuously shed and replaced.  Hair and nails are specialized structures within the skin.  

As we age, the elastic tissue in our skin begins to break down. While some degree of aging is genetically predetermined, excessive sun and environmental exposure accelerate this process, known as elastosis.  This leads to wrinkling of the skin.  The best way to prevent early wrinkling is to limit sun exposure.  

In addition, all three of the most common types of skin cancer are related to sun exposure.  There are six basic skin types in relation to sun sensitivity.

Estimates are that 70 to 80 percent of total sun exposure is accumulated before age 20.  Several studies show correlation between severe sunburn at an early age and malignant melanoma. Malignant Melanoma is currently considered to be of epidemic proportion.

Therefore, it is important to teach children the importance of sunscreen use at an early age.  No particular brand of sunscreen is recommended, but an SPF of 15 or great is necessary for daily protection, and 45 or greater for outdoor activity during summer.  A sunscreen with moisturizers and water resistant properties is also desirable.  

SPF means Sun Protection Factor; a SPF of 10 means that a person that normally burns at one hour would take 10 hours to burn with the product applied.

Tanning salons have become very popular, but multiple scientific studies have shown that they are associated with significant increased risk of skin cancer. Self tanning products and “spray on” tans have improved over the years and are considered to be safe.


SKIN CANCER

Skin cancer is currently considered to be an epidemic in our country.  All three of the most common types of skin cancer are related to sun exposure.  Some persons, especially light skinned individuals who do not tan easily, are more susceptible than others.  The greater the sun exposure the greater the risk.  Most of our lifetime sun exposure occurs before age 20.

Basal cell cancer is the most common type and usually occurs on the exposed parts of the head and neck.  Although there are several types, it is most commonly a waxy, raised area that crusts or bleeds.  It grows slowly and does not usually metastasize (spread) to distant parts of the body. It is usually treated by surgical removal.

Squamous cell cancer is the next most common, and is typically seen as a non-healing ulcer.  This is a slightly more dangerous type because it can spread to other parts of the body.  It also is usually treated by surgical removal.

The third and less common type is malignant melanoma. Many studies reveal a dramatic growth in the occurrence of  melanoma among caucasians. This type may present as a flat, darkly colored spot with irregular edges, or as a raised lesion similar to a mole.   This form can occur anywhere on the body and is more serious because it is prone to spread through the body. Early diagnosis and complete removal offer the best chance for a cure. Again, early use of sunscreen is most important, as multiple studies have shown an association with blistering sunburn during childhood.

Many skin cancers on the face are easily removed and the defect repaired in the office.  Some more advanced or recurrent lesions, especially if close to important structures such as the eye, may best be treated by a sophisticated form of surgery known as the Moh's technique.

Remember, the best chance to cure all types of skin cancer is early diagnosis and treatment.  Any suspicious lesions should be examined by a physician.


Blemishes and Scars

Most of us have imperfections on our skin such as warts and moles.  Often these are inconspicuous and go unnoticed. When numerous and prominent they may be distracting or unsightly to the observer.   These and other blemishes such as prominent capillaries, cysts and birthmarks can often be corrected with relatively simple treatments in the office.

Unsightly and disfiguring scars and other defects can be very detrimental to one's self image.  These defects may be improved by carefully planned and executed reconstructive surgery.  It must be understood that no scar can ever be completely eliminated, only improved.

Any incision or injury that penetrates the dermis will leave a scar.  All wounds undergo a healing process that takes nine to twelve months.  Initially, the scar is raised and red but as it matures, it flattens, softens and becomes white. Some scars, however, do not flatten and may even widen. These are known as hypertrophic scars and keloids. Formation of this type of scar is an individual tendency and can be difficult to predict and treat.  Scars that may benefit from corrective surgery are those that are lumpy or wide, pigmented, elevated or cross natural skin creases.  In addition, those that alter natural landmarks such as the eyebrow or border of the lip can also be improved.

Before considering attempted improvement of a scar, several factors must be clear:

1.    Scars cannot be completely removed, only rearranged or improved.

2.    The healing process is 9-12 months and the new scar may look worse during  

      the initial healing.

3.    The final result may be enhanced with dermabrasion or further scar revision.


Dermabrasion

When the skin is rough and irregular from acne, scarring or other injury, dermabrasion may help. Dermabrasion is a technique used to smooth and blend irregularities of the skin's surface.  Although somewhat more sophisticated, it can be compared to sanding a scratched wooden surface.

Microdermabrasion is a very mild form of dermabrasion that is commonly used in an office setting for mild improvement in skin quality. It should not be confused with true dermabrasion, which is much more aggressive. There are limitations to the amount of  improvement that can be achieved.  Large scars or deep pits cannot be corrected by dermabrasion alone.

Dermabrasion works best for multiple small scars and for blending the edges of a scar into the surrounding skin.  The deeper pits of severe acne scarring are usually filled in with small grafts of normal skin and then dermabraded. Small superficial scars can often be eliminated; but deeper scars can only be improved.  

A second dermabrasion 6-12 months later may give additional improvement.