facial plastic surgery - eyelid lift

Upper eyelid blepharoplasty

Facial plastic surgery: Does it make you look younger or more attractive?

A recent study in the Journal of the American Medical Association: Facial Plastic Surgery looked at how much younger people appeared after certain facial plastic surgery procedures.  It involved one rater looking at before pictures and guessing the patient’s age and rating their attractiveness. A different rater did the same with the after photos and the results were compared. On average, the patients looked 3.1 years younger and were slightly more attractive. The problem with the study was that the same person didn’t see the before and after photos together, which is typically where the most difference is noted and what would happen in real life with a patient’s acquaintances.  But it does highlight a question: Does plastic surgery make you look younger or more attractive, and is this actually the goal?

Expectations around facial plastic surgery

When discussing patients’ expectations before eyelid & brow surgery, I try and stress that I’m not trying to shave off years, just trying to improve their peripheral vision with the added benefit that they won’t look as tired or angry.  We all know that there is “good old” and “bad old” when it comes to how people age.  Some patients, although into their 70’s or 80’s, still stand up straight, show good muscle tone and weight, and carry themselves like much younger people. While many patients in their 40’s to 60’s are just the opposite: overweight, sedentary, with poor skin and poor diet.  Plastic surgery isn’t likely to make this second group significantly more attractive or youthful, given all the other factors making them look prematurely older.  A red flag that someone is going to be unhappy after surgery, no matter how good the outcome, is their expectation that changing this one small aspect of their appearance will solve their problem of not feeling young or attractive.  It just doesn’t work like that.

What I hope my patients can understand is that we are all aging chronologically at the same rate, which no one escapes. No one can expect to look younger than the calendar suggests if they aren’t taking the best care of their bodies. We can slow the feeling of inevitable degeneration by first living a healthful life and only addressing those aspects we can’t otherwise change, such as baggy eyelids or a sagging brow, with facial plastic surgery or other procedure.  Patient’s with these realistic expectations are nearly always satisfied with their outcomes and will radiate both youth and attractiveness to the people they know and love.

 

Dr. Call, my former partner, and I returned to Haiti last week for another marathon session of surgery with the locals. My last visit was in March and Dr. Call hadn’t been in the interim, so we had quite a few waiting. This trip was different in that we are now sponsored by LDS Charities. We were not only going to perform surgery, but also to do some fact finding on what support LDSC could give in the form of equipment and construction. The waiting room, for instance, is a crowded, small, dark room, which usually contains about a hundred people when we arrive in the morning. It should realistically hold about 30, so everyone is standing and you can’t open the gate to get through without yelling at everyone to move back.

Haiti medical trip

top: Waiting room at HUEH, LL: Dr. Call examining on broken slit lamp, LR: Resident doctor speaking with patient.

The equipment we use in Haiti is always in a state of disrepair. Once something breaks, it often is very difficult to get it fixed. We really take for granted how easy it is to get a specialty light bulb for our examining scopes back home. The surgical instruments are also a nightmare. Some of this is due to lack of training on how to take care of them. But in many cases, delicate instruments are used for any and all cases and just get worn out faster. During this particular trip, we had almost no instruments that resembled oculoplastic instruments we’d use back home. You have to learn to improvise. In this picture below, I performed a frontalis sling procedure on a young boy with a droopy eyelid. Normally, this surgery involves suspending the eyelid from the brow with a special thin silicone material, which allows the eyelid to open when the child raises their brow. Unfortunately, they had none of the necessary equipment or an implant. We found some silicone normally used for intubating the tear duct and ran it through the skin from the brow to the eyelid margin with a needle and sleeve (angiocath) normally used for placing an IV. This ended up working well and I actually repeated it on another patient the next day.

Pediatric ptosis repair in Haiti

UL: young boy with droopy eyelid, UR: placing the sling material with an angiocath, bottom: handing over the case to a resident to close.

The sheer diversity of pathology we see each time we go is amazing. In the 5 days we saw patients, I saw more varied and advanced badness then I’ll see all year in my clinic back home. It is a real challenge, but very rewarding to recall those zebra diagnoses from my residency days.

We had a chance to travel to the city of Cap Haitien on the northern coast. A group of doctors, many of whom were trained at the hospital in Port-au-Prince, set up a clinic where they see a mix of “social” and private patients. The social patients are asked to pay a very small fee for their care, or receive it free. They sit in a bare-bones waiting room and are often examined in front of other patients. The private patients pay a higher price and get a nicer waiting room and a private consultation with a doctor. This system works well to give both groups adequate care and keep enough money coming in to cover most of their costs. The remainder of the costs are made up be charity sources, such as Charity Vision and others. Our plans are to try and establish a similar clinic in Port-au-Prince where some of the residents can set up shop, see patients, make a living, and remain in Haiti instead of leaving the country for a better job as many do.

Dark Circles Under Eyes: 5 deep tear trough treatments

We’ve talked before about dark circles under eyes. One of the most common causes is a deep tear trough.  The tear trough is that depression extending from the inner corner of your eye diagonally toward your cheek.  This depression occurs where the facial fat has thinned out and dropped down into the cheeks. The bone of the eye socket is now right below the skin and the two are fairly well attached to each other.  As the skin above and below age and change, this area becomes even more apparent. It can become dark and develop a noticeable shadow, which makes one appear tired and more aged.  There are many options to treat this, and the methods are changing as we better understand facial aging.

dark circles under eyes - Facial filler Juverderm

Juvederm treatment under eyes and around mouth.

1. Make-up:

Many women (and even some men) utilize concealer in this area to lighten the skin and diminish the shadow.  When the problem is subtle, make-up is a great, non-invasive and inexpensive treatment.  As the problem worsens, however, make-up cannot fully hide the changes and may begin to accentuate it.

2. Skin lightening creams:

In certain people and ethnic groups, the skin in this area darkens. This can be due to actual pigment changes in the skin or from very shallow blood vessels just below the thin skin. When it is pigment related, skin lightening creams, such as hydroquinone, can be effective.  When starting this type of treatment, it is helpful to consult a skin specialist or aesthetician highly experienced in its use. Start with a weaker concentration (no higher than 4%) and use it for a short time until you are sure you aren’t especially sensitive.  Slowly increase the use and concentration until the desired effect is achieved. Rarely will these types of creams completely fix the problem, but they can make a noticeable improvement.

dark circles under eyes - Hydroquinone skin cream

Hydroquinone skin cream

3. Phototherapy:

Intense pulsed light, and even some laser treatments, are used to lighten skin pigmentation and tighten skin in the under eye area. Often this is proceeded by use of a topical lightening cream and possibly a short course of Retin-A to maximize effect.  Again, this should be done by someone with a lot of experience in administering the whole treatment.  Different skin types react differently, so be sure your practitioner explains how they are tailoring your treatment to you personally.

4. Facial Filler:

Hyaluronic acid fillers such as Juvederm, Belotero, and Restylane are well suited to treating the tear trough area when the problem is loss of facial fat volume.  Filling this area back up with a substance that is similar to the building blocks of normal collagen can give a new youthful appearance to the mid-face. It is relatively inexpensive, costing around $500 for a treatment. In many cases it lasts 12-18 months.  Filler is injected with a small needle into the space directly above the bone and then massage around until it appears smooth.  In a few weeks, it softens up be hardly be felt.  It is a safe procedure with some occasional bruising taking place. When injected deep, the chances of it getting into a blood vessel and causing problems in uncommon, although this is the greatest risk. See Dr. Harris explain more about facial filler in a short video here.

dark circles under eyes - Belotero facial filler

Belotero facial filler

5. Lower eyelid fat repositioning and blepharoplasty:

When fat in the lower eye socket begins to come forward, it creates a bag in the lower eyelid. A crease forms at the bottom of the bag over the bone of the eye socket. Lower eyelid surgery (blepharoplasty) is performed to move fat from this bag into the upper cheek and tear trough, which fills in the depression and returns the fat to a normal location, where it was before it descended into the cheek.  In some people, a portion of the fat is also removed. In others we also remove a small amount of skin below the eyelashes. All of these techniques serve to smooth out the transition from the eyelid to the cheek, which is a hallmark of a youthful, rested appearance. See our gallery for eyelid before and after photos.

If under eye shadow or bags are a problem for you, give us a call for a free consultation at (801)264-4420, or email Dr. Harris directly at [email protected].

TCA Chemical Peels

TCA chemical facial peels have been used for years to rejuvenate the skin.  They are excellent for skin tightening, softening fine lines, and smoothing out skin color and texture. The TCA (trichloroacetic acid) peel is a medium-depth peel, and is very popular for skin of all colors and imperfections. TCA chemical peels can vary in strength from 10%-50% depending on the skin tone, imperfections, wrinkles, etc. that are in need of improving. TCA chemical peels at higher concentrations produce deeper peeling, as does the number of applications (layers) of TCA applied to a given area.

Properly preparing your skin beforehand along with proper aftercare are all important to getting the most out of the treatment. Here are the 5 most important things to know and do before and after a peel.

Chemical peel

1. Prepare your skin:

Patients undergoing TCA chemical peeling should pre-treat the skin with an alpha hydroxy acid (AHA) product for 3-4 weeks prior to the peel. Products containing AHA encourage exfoliation and faster skin cell turnover. This will result in a more even peel and reduce the risk of hyperpigmentation after the peel. Patients that have any potential for hyperpigmentation (i.e. darker skin tone, history of dark scars) are asked to use a product containing 2% hydroquinone, a “fading cream”, in addition to the AHA product for 3-4 weeks. This will further reduce the risk of hyperpigmentation after the peel. You can get AHA online or at certain pharmacies.  We really like the product from Acne.org. Palmers Skin Success Fade Cream (2% hydroquinone) can be purchased online or at most Walmart, CVS, Rite Aid, Walgreens stores.

Alpha hydroxy acid cream

Alpha hydroxy acid cream

Palmer's Skin Success Fade Cream

Palmer’s Skin Success Fade Cream

2. Prevent complications:

TCA chemical peels may cause an individual to develop a cold sore if they are prone to getting them. Prescription anti-viral medication will be prescribed for a couple days before and after the peel to prevent a cold sore outbreak for all patients with a history of cold sores. Please tell your physician if you have a history of cold sores.

3. Let the skin heal:

In the days immediately following the TCA chemical peel, your skin may take on a dry, brown appearance after the initial redness has faded (usually around days 3-5). This is normal. This is the stage right before the skin begins to shed. Do not force the peeling process by attempting to peel any skin that has lifted.  It is very important that the skin stays intact until it’s ready to slough off on its own, as it is acting as protection to the fresh new skin underneath. Twenty-four hours after your peel, use a very mild cleanser (such as Cetaphil) to wash your face gently with your fingertips. Gently pat your face dry and reapply the antibiotic ointment put on right after the peel. You can also use Aquaphor, Eucerin, or similar thick moisturizer. Do not use abrasive scrubs, cleansers, or cloths on your skin for at least 14 days.

 4. Protect your skin:

After the peel, it is absolutely essential to protect yourself from the sun. The TCA chemical peel makes you very vulnerable to sunburn, which can also cause discoloration of the skin. You must commit to wearing a zinc-based sunblock of 30 SPF or higher everyday in the weeks prior to the peel, and for at least two months after the peel is done. This step is absolutely crucial in terms of your outcome after the peel. Failure to wear sunblock after the peel will result in scarring and hyperpigmentation (dark patches).Make sure the sunblock you purchase contains zinc as one of the active ingredients, as zinc provides a “barrier” protection against sun damage, and is also nourishing to the skin. A few brands that contain zinc: Blue Lizard, Clinique “City Block SPF 40”, ECO Logical Skin Care “Green Screen”.

5. Repeat the treatment:

TCA chemical peels can show good results with only one treatment, but often a few treatments spaced 6-12 weeks apart are necessary to stimulate long-lasting change in the skin.  Many offices, including ours, offer deals when several peels are purchased together.  Once the skin texture has improved and you are happy withe the result, doing a peel once or twice a year may be all you need to maintain the appearance.

If you have questions about TCA chemical peels, call our office for a free consultation at (801)264-4420.  Thanks to Katrina Poulsen, RN for contributing to this article and helping to establish our office protocols for TCA chemical peels.

 

 

In our office, we see people everyday who are dissatisfied with the appearance of their lower eyelids and are seeking lower eyelid blepharoplasty. Whether it be due to bags that have formed or deep tear trough lines, the lower eyelids can make give us a tired or even ill appearance. We’ve written before about lower eyelid bags and shadows and it is important to figure out if your problem can be easily remedied, or if surgery is in order. When, with the help of an oculoplastic surgeon, you determine that you will need some surgical intervention, it helps to know your options and the best techniques to achieve a good result.

 

lower eyelid bags

Lower eyelid bags

What lower eyelid blepharoplasty (eyelid lift) complications can occur?

Over the past 30-40 years, lower eyelid blepharoplasty has changed tremendously. As surgeons have gained a better understanding of facial anatomy, facial aging and how the tissues respond to surgery, their techniques have evolved. The standard practice for lower eyelid blepharoplasty used to be creating an incision below the eyelashes, dissecting through the muscles and soft tissue layers, exposing and removing fat, then removing excess skin and closing up.  This technique worked for some, but very often caused scarring in the lower eyelids, which pulled them down and/or out away from the eye.  Patients would end up with dry, irritated eyes, eyelid redness, and possible inability to close the eyes.  Others may not have scarring, but the removal of fat alone would cause a hollow appearance, especially in thinner patients.

How is lower eyelid blepharoplasty performed today?

Techniques evolved and most surgeons have updated how they perform the surgery.  We now commonly make our incisions through the inside of the eyelid to access the excess fat.  This avoids dissecting through tissues that commonly cause detrimental scarring.  The three fat pockets of the lower lid can be partially removed, or the fat can be moved into areas, such as the tear troughs, where it is missing causing a sunken appearance. Once the fat is repositioned or removed, a small amount of extra skin can be removed through an incision below the eyelashes, without any dissection that can cause scarring.  We also will often tighten the lower eyelid from the outside corner to ensure it stays in a youthful position and doesn’t pull down or away.

What is the recovery for lower eyelid blepharoplasty?

Eyelid surgery almost always causes bruising and swelling, though this may vary in intensity.  Bruising resolves in 1-2 weeks and swelling can take 1-4 weeks, but longer in some individuals.  Pain is minimal, but some have itching as they heal.

What will I look like after lower eyelid blepharoplasty?

Check out our before and after photos by clicking here.  Here are a few examples:

upper and lower blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

If you have questions, email Dr. Harris at [email protected], or call our office at (801)264-4420. To read what other surgeons have written on the subject, start by clicking here.

I’m on my way back from another week in Haiti.  I had many profound, disturbing, humbling and enlightening experiences. I thought I’d share a few here and try and put in words what you would experience if you made a similar trip.

Eye clinic

Eye clinic in Port-au-Prince.

First, I wanted to address the title of this post.  The “Third World” is actually an outdated and useless term, which came about after World War II to describe countries that neither belonged to NATO or the communist bloc.  This third group of countries were very often also poor and the two labels become synonymous. What the term does however, is lower these countries to a status unbefitting of the people living there.  There is no doubt that Haiti is poor, but to cast it and its people aside as being in a different world is unfair and detrimental to understanding their plight.  It takes around an hour to fly from Miami to Port-au-Prince, hardly a world away (remember when Haitians were crossing to Florida in rafts). In truth, they live in exactly the same world as the rest of us, that world just hasn’t given them as much to work with.  As a kid, I never wondered if my next meal was coming, or if I’d have access to clean water. The power was on 99.9% of the time, along with either the A/C or heat.  And if, God forbid, I or someone I knew got sick, I knew every possible treatment was available to them.  These all seemed to be my right as a human.  So when you see people who have little to no hope of achieving many of these basic rights, you can’t help but wonder what is going on in this world.

The good news is, I also saw hordes of people, mostly from the US and France, visiting on mission trips.  Most were with church groups building schools and churches, establishing water sources and doing ministering.  Everyone was jazzed about the difference they made and many talked about what they were planning for their next trip.  You can’t help but think with all this help coming, more than 3 years after the earthquake, it is only a matter time before momentum brings real change to Haiti. Just sending money to their government won’t help, just ask Somalia, Ethiopia, Sudan….

Just a couple of stories of patients I met.  I saw quite a few children with facial deformities due to tumors or hemangiomas, but also due to trauma.  Trauma was the theme of the visit.  This great young kid had been hit in the face by someone a few weeks earlier and had a persistently swollen right eye. I was worried about a foreign body.  During surgery, I encountered a hard mass against his eye and tenting the conjunctiva out where it appears red and swollen in the photo.  It turned out to be a chunk of bone that had been dislodged from inside his eye socket. No one had examined him thoroughly and this had been missed.

orbital fracture

Young man with medial orbital wall fracture

The same day, we saw two men in the ER who had been assaulted. One stabbed in the eye, the other shot through the cheek, with the eye being the exit wound.  Nearly every face we saw seemed to have some sort of scar.

facial trauma

Several cases of facial trauma

The young man with the stab wounds above had 4 1-0 sutures closing all his lacerations.  1-0 suture is usually used to close very thick tissues, such as the abdominal wall, not delicate structures like eyelids.  I removed them and replaced them with about forty 6-0 and 7-0 sutures.  The young woman above had numerous scars dating back to the earthquake, which split her eyelid in two and left it retracted.

post ops

Several post op patients

Her repair involved borrowing skin from her right upper eyelid to lengthen her left upper eyelid, as well as a full thickness resection of her scar and realignment of her eyelid margin.

The cases we did were all difficult, but the cases we couldn’t do were the hardest to deal with. We saw several patients with large growths emanating from various parts of their faces. They had saved money and paid for a CT scan (around $300, average monthly income is $60).  The scans showed invasive tumors filling their eye sockets and often extending into their brains.  Surgery was not an option.  When I’d recommend an oncology consult, the residents would shrug.  They knew that even with a consult, the treatment necessary would not be available in most cases. As one resident said when I asked her to explain to a patient what we were seeing, “tumors don’t go over well here, everyone knows they are going to die.”

orbital masses

Orbital masses

Anyone interested in helping us out, can either donate to CharityVision or contact our office. Every trip we identify a slew of instruments and supplies we need to offer better care.  Any help with attaining these supplies is greatly appreciated.  My retired partner, Dr. Call, and I have committed to having one of us visit every 3 months. The needs are seemingly endless.

Eyebrow trends change with time, but droopy brows are never in style. When the brow starts to descend, it can cause a hooded look pushing down the eyelids and leaving you looking tired. While you can’t avoid getting older and losing skin elasticity, there are several ways to approach beautification of the brows.

Eyebrow proportions

Eyebrow proportions from britneybeauty.com

1. First, figure out the best eyebrow shape and color for you, and actively maintain it. Choose a shape you like, but keep it natural. An overly-thin brow makes you look older while very thick or dark brows can dominate your face and take attention from your eyes. Understanding the proportions of a beautiful brow is important. The head of the brow should start in line with the inner corner of the eye and ideally with the outer corner of the nostril (see #1 on Angelina Jolie above).  The peak of the arch should line up with a line drawn from the outer corner of the iris to the corner of the nostril (see #2 above). The end of the brow should fall on a line from the outer corner of the eye to the corner of the nose (see #3 above).

2. Consider reshaping drooping brows with Botox injections. When injected above the brow, it will help to lift the brow into a more youthful-looking position by immobilizing the muscles.

3. Fillers, such as Juvéderm and Radiesse, can be injected and instantly lift the end of a brow that’s begun to sink over time.

4. If you need a dramatic lift, browlift surgery is a permanent fix that can be done endoscopically, which makes it a minimally invasive procedure. During a browlift, the muscles are repositioned to lift the brow into a more natural position. Plus, any sagging excess eyelid skin can be removed as well.

For a few tips on shaping and tweezing the brows properly, click here and here for some excellent articles on Elle.com and here for a video demonstration.  Taking a little time to properly learn to shape your brows can give a whole new look to your eyes.

We recently celebrated our first year in practice in Salt Lake City.  I’ve been privileged to perform hundreds of eyelid surgeries and other procedures in that time and I’ve come to learn that every patient is unique in how they get through surgery.  I strive to make my techniques consistent so that my patients can expect consistently good outcomes, but despite my best efforts, some patients have a more difficult time of it.  Whether it be significant differences in swelling and bruising or unexpected bleeding, road blocks to quick recovery can occur.  It is important that all patients know the limitations of modern medicine and understand that recovery from surgery can involve setbacks and unexpected twists and turns.  With that in mind, I wanted to compile a short guide on what a patient can expect from surgery, both before and after, to help them better anticipate what their course may be like.

Upper and lower eyelid blepharoplasty

Pre-op: Prepare for surgery

Patients can make their surgery much smoother by following a few simple rules before surgery.  Beginning 2 weeks before the procedure, they should identify and avoid any medications, supplements or foods that may cause them to bleed more easily.  The list is extensive, but includes aspirin, ibuprofen, naproxen (Aleve), fish oil and vitamin E.  They should consult with their prescribing doctor if they have a history of heart arrhythmia or blood clots to ensure it is safe to stop taking the medication. Patients on coumadin will need around 5 days off the medication to allow safe surgery. They are often “bridged” during this time with an injectable blood thinner, such as Lovenox.  To reduce stress on the day of the procedure, ensure transportation is arranged and ask your doctor if you can fill any post-op medication prescriptions ahead of time. Have a normal meal the night before surgery and remember to not eat after midnight.  You should take your normal medications the day of surgery, with the exception of any diabetic medications while fasting.  These should be taken with a very small amount of water.  Shower and wash your hair the morning of surgery.  This will cut down on skin bacteria lessening the chance of infection. You may not be able to shower for a few days after the procedure and will be glad you did just before surgery.

During Surgery: Relax and let your surgical team work

You’ve searched out and chosen a doctor and surgery center you trust. Let them do their job on the day of surgery. Some patients see a need to second guess a lot of what is going on around them, usually out of anxiety.  Although you should call attention to anything you see as an error, you should also be helpful in getting the team the information they need to perform your surgery well. Relaxing will lower your blood pressure and make administering anesthesia easier and safer.  Don’t hesitate to let them know if you are in pain however, as they will want you as comfortable as possible.

Post-op: Follow directions for a quicker recovery

Your surgery has gone well and your are off to your home to recuperate. Your doctor has given you a list of instructions to follow. This list has been born out of years of experiences with thousands of patients.  Although each patient is different, on average they can expect a similar course and these instructions are aimed at making that course as smooth as possible.  Begin by ensuring you have your post-op ointment and pain pills filled.  Once home, begin immediately applying ice to the eyelids for 20 minutes on and off.  Sit with your head elevated above your heart to reduce dependent swelling.  Avoid any bending over or strenuous activity, no matter how good you feel.  Most broken sutures and open wounds result from people getting back to there normal activities too soon. Apply the ointment at least 4 times daily.  At night, sleep with the head elevated. Day two will greet you with a scary picture in the mirror. Your eyelids will likely be much more swollen and purple than the day prior.  You may even have trouble opening your eyes.  The ointment will be melting and getting in your eyes, making seeing difficult. This is when you are glad you took several days off work and re-upped that Netflix subscription.  Time spent resting and recuperating now will pay off later with fewer complications and a more rapid recovery. Keep up the ice every 20 minutes and avoid rubbing the eyelids.  After 2-3 days, you’ll start noticing gradual reduction of the swelling and a slow color change of the bruising as it fades. This is when the itching will begin to get annoying.  As the stitches are dissolving and breaking down and the skin is healing, severe itching can occur. Resist the urge to scratch and instead treat it with cold compresses.

Upper eyelid blepharoplasty

Follow-up: Let your surgeon monitor your progress

Be sure and follow up with your surgeon within one to two weeks of surgery to ensure healing is on track.  By then you should be noticing great improvements day to day.  Follow up sooner if you experience a complication, such as uncontrollable bleeding, worsening pain or swelling, significant discharge from the wound or any separation of the incisions.

Knowing what to do before surgery and having realistic expectations after surgery will make your experience much more pleasant. Surgery isn’t for the faint of heart, but anyone can have a good outcome with proper preparation.

I have seen many articles lately about children and plastic surgery.  Many have discussed whether it is acceptable in certain situations, like when children are bullied or teased because of their looks.  Another article mentioned parents giving plastic surgery to their kids prior to the prom to “look their best.”  It may be disturbing to think that people so young are permanently altering their appearance, often to please others or build their fragile self confidence, but is there a time when you would find it acceptable?  I had a friend in elementary and junior high with a prominent nose.  She endured some teasing, and was somewhat withdrawn because of it.  I lost track of her for a few years, then saw her again in high school. She had clearly had a rhinoplasty in the interim and was strikingly beautiful.  The most dramatic change was in her attitude.  She was no longer shy and withdrawn, but outgoing and confident (in fact she was now out of my league and wouldn’t talk to me :)).  I had another experience with a friend and prominent ears. He underwent surgery while in elementary school and seemed more outgoing afterward.

Teen before and after nose job

Image from RealSelf.com, article by Melissa Rudy

Of course there is a flip side: youth who want to look a certain way for a variety of complicated reasons turning to surgery to make it happen.  The psychology of this can’t be generalized, but in many cases, children want to please those around them and view their looks as something they can control and manipulate (spoiler alert: this doesn’t change when we reach adulthood).  Unfortunately, the decision to have surgery has permanent lasting effects and possible complications.  Counseling a patient is hard enough when they are an educated adult.  A teen may not fully understand the risks of surgery.  Parents would need to give their consent, but they also may be blinded by a desire to have their child fit in, or make them happy.  A recent poll of readers on RealSelf.com showed that up to a quarter of parents felt it was okay for children to have nose or ear surgery if they were being bullied.  Around than 10% felt it was okay to have breast reduction or double eyelid surgery (conversion of Asian eyelid to a Western appearing eyelid).  Only about 3% felt breast implants would be appropriate for a child.

I don’t claim to have the answer as to when or if elective cosmetic surgery is appropriate for children.  I do feel it is important to weigh all the possible angles before allowing your child to make such a permanent change to their appearance.

This past week I took a basal cell skin cancer off the eyelid of a man younger than I, and I’m in my mid-thirties.  Remember when skin cancer was something your grandma and grandpa dealt with?  Well those days are past and we are ushering in a generation of young people who will be dealing with skin excisions, biopsies, deforming surgeries and possibly early death due to their love of the sun, tan skin, and refusal to believe they are causing themselves harm.  On a recent trip to a sunny locale, I was applying sunscreen before going out on a  morning of boating.  A friend repeatedly scoffed at my use of sunscreen, insisting I needed more color and couldn’t understand what I was worried about.  Everyone in this person’s circle of friends was tan, young and feeling great, but what will the next few years hold for them.  Here are a few tanning myths that you need to get by right away to avoid being a shriveled up raisin of skin cancer in your golden years.

Myth #1: “I have to get a base tan so I won’t burn on my vacation. Many believe they need to achieve a “base tan” early in the spring, usually at a tanning booth, so they won’t get sunburned later.  Some even think this is protective against sunburns and thus skin damage.  Don’t buy into this farce. Any sun or tanning bed exposure that causes a tan is damaging your skin, end of story.  UV rays are still blasting away at your DNA and collagen no matter the color of your skin. Spray tans are no help either. Some believe that these will somehow protect you from a burn or damage.  Not true.

Myth #2: “I only need sunscreen if I’m going to the beach.”  Most people don’t think to put on sunscreen, unless they are expecting to be outside for an extended period of time.  A recent New England Journal of Medicine article showed a man who drove a delivery truck for 28 years. He developed dramatic changes to the left side of his face, which was bombarded by UVA rays, while the right side of his face was protected from the shade.  Check out the difference between the sides in the picture below.

Facial aging from sun exposure

Myth #3: “I’ve got dark skin so I don’t get sunburned.”  Many people born with naturally darker toned skin think they don’t need to protect their skin as they don’t burn as easily.  Whether or not you get a sunburn, the UVA and UVB rays are still bombarding you, causing mutations in your DNA and ruining your skin’s elasticity.  Olive skinned people don’t look any better in their old age than fair skinned people. Very dark skinned people are also at risk for sun damage.  Acral lentiginous melanoma accounts for 50% of melanomas in dark skinned individuals and is often missed as it develops on the palms and soles of the feet. Bob Marley died of this form of melanoma.

Myth #4: “It’s cloudy, so I’ll skip the sunscreen. ”  UV rays are still present on cloudy days. If you are going to be outside, apply sunscreen.

Myth #5:  “I wear sunscreen, so I’ll never have skin problems.”  I wish sunscreen was that good. The mistake most of us make is not reapplying it often enough and not realizing that it doesn’t block all UV radiation.  When possible, wearing hats, sunglasses and longer clothing will block out more UV radiation and further reduce your potential skin damage. Sunglasses are especially important to reduce early cataracts and surface damage to the eyes, including unsightly yellow spots on the eyes called pinguecula (see photo).

pinguecula

Pinguecula

 

 

 

 

 

 

 

 

 

 

 

 

 

Myth #6: “Tanning beds are a safer way to tan.”  And O.J. Simpson is innocent.  The tanning bed industry is constantly working to convince people that tanning beds are safe or even healthful.  Some claim their bulbs emit lower UVB and other say tanning is a great way to get your vitamin D. Both of these claims are misleading.  All tanning beds cause accelerated skin damage.  Multiple studies have shown that people who use tanning beds have a higher rate of melanoma.  And regarding vitamin D, you need about 2-10  minutes a day of sun exposure a day to produce plenty. If you drink milk regularly or take vitamin D supplements you don’t need any extra sun exposure.