We Know Smoking Causes Cancer, But it is Also Harmful to Your Skin

Dermatologist Dr. Suzanne Friedler with Advanced Dermatology Provides Tips on the Skin Risks Associated with Smoking.

Smoking affects nearly every organ in the body and puts your overall health at risk. It damages your heart, your lungs, your bones, even your fertility. What does it do to the largest organ in the body – your skin?

Smoking is related to the development of several skin disorders and if you already have a skin condition, smoking will make it worse. And while it is true that everyone’s skin eventually shows the effects of age, smoking accelerates the development of wrinkles, sagging skin, puffiness under the eyes, uneven complexion, and thinning lips. Along with sun exposure, smoking is a primary culprit in premature aging of the skin.

Dr. Suzanne J. Friedler

Smoking causes premature aging in two key ways. First, the toxins in cigarette smoke destroy collagen and elastin, the fibrous components of skin that give it strength and elasticity. As these building blocks of the skin become progressively damaged, the skin sags and develops deep wrinkles.

The more you smoke, the sooner you’ll see these effects and the longer you smoke, the more pronounced they’ll be. Even exposure to secondhand smoke will cause this damage.

Dr. Suzanne J. Friedler

The second essential effect of smoking on the skin is to deprive it of oxygen and nutrients. Smoking causes narrowing of the blood vessels that deliver these elements that are essential to healthy skin. Their lack contributes to uneven complexion, poor skin tone and the development of a wide array of skin conditions.

Skin cancer: Smokers are at greater risk of developing squamous cell carcinoma, the second most common form of skin cancer. It is thought that tobacco suppresses the immune response that would prevent squamous cells from proliferating on the outermost layer of skin. Squamous cell carcinoma is easily treated when caught early but can metastasize if undetected and can potentially be life-threatening. Smoking is also the primary cause of several types of oral cancer.

Pigmentation: Smoking increases melanin in the skin leading to dark spots particularly on the face and hands. These spots can be caused by sun exposure but research suggests that smokers are more susceptible to them. Stained fingers and nails are also common in smokers.

Psoriasis: Smoking is a risk factor for this chronic inflammatory condition characterized by itchy, scaly patches, usually on the elbows, knees, scalp, hands, and feet. The culprit may be the nicotine in cigarettes which affects the immune system, inflammation, and skin cell growth, all of which contribute to the development of psoriasis.

Wound healing: Narrowing of the blood vessels caused by smoking constricts circulation making it harder for even minor cuts and scrapes to heal and contributing to scarring. Patients are advised to stop smoking before a surgical procedure to reduce the risk of impaired healing of an incision in the skin.

According to the Centers for Disease Control and Prevention, more than 30 million American adults smoke. But more than 50 million Americans have quit smoking. “There are many reasons to quit smoking,” says Dr. Friedler. “Any skin condition you have that is related to smoking will be more manageable when you quit and further damage will be avoided. While not all the damage to your skin will be reversible, there are topical retinoids and vitamin C and E creams that can help and cosmetic procedures like laser skin resurfacing and chemical peels can improve the appearance of the outer layers of skin where damage is most visible. You can quit smoking. Ask your doctor which cessation strategy would be best for you”.

About Dr. Suzanne J. Friedler

Suzanne J. Friedler, M.D. F.A.A.D., is a board-certified fellow of the American Academy of Dermatology, with expertise in many areas of medical and cosmetic dermatology. She has been with Advanced Dermatology PC since 2002.

Come into the beautiful world of Suzanne Friedler, MD.

Post Mastectomy Breast Reconstruction Basics: Understanding Your Options

Plastic surgeon and breast reconstruction specialist Dr. Constance Chen offers practical tips on breast reconstruction.

Breast reconstruction has come a long way. Although breast cancer was known to the ancient Egyptians as far back as 1600 B.C., it was not until the 18th century that it was understood to be a localized disease whose spread could be contained by isolating and removing the affected cells, and it was not until a hundred years later that pioneering work was done on what we know today as mastectomy.

Early practitioners of surgical breast removal did not believe in reconstruction. They feared that any intrusion at the surgical site could adversely affect the progression of the disease or hide a recurrence. So while the first attempts at reconstruction were made in the 1890s, it was not until the mid-20th century when radical surgery gave way to equally effective but less aggressive treatments that interest in breast reconstruction soared. Today, women have many options for breast reconstruction and every woman can make an educated decision about what is best for her.

Dr. Constance Chen, plastic surgeon

There are two types of breast reconstruction and multiple options for each: implant-based breast reconstruction and natural tissue breast reconstruction, also known as “autologous reconstruction.” Either type can be performed immediately, or months or even years after the mastectomy. For the best results, most breast reconstructions will require more than one procedure. Many factors will influence a woman’s decision on the best option for her. Chief among them are her general medical and genetic history, the size, location, and characteristics of her tumor, her treatment plan, and her aesthetic expectations. “An initial consultation with her surgeon will help a woman sort through her options,” says Dr. Chen, “but it is important for her to start with a general understanding of the basics of breast reconstruction.”

Reconstruction with implants

The introduction of silicone implants in the 1960s signaled the beginning of the modern era of breast reconstruction. Implant insertion used to be delayed until after the mastectomy had healed but now is often done in a single surgery at the time of the mastectomy. Usually, a temporary device called a tissue expander is placed on the chest wall and gradually filled with saline solution until the tissue has expanded enough to hold the permanent implant. Today, breast implants are either filled with saline or silicone, and the outer shell is either smooth or textured. The silicone gel has also become more cohesive over time so that there are now different types of silicone gel implants with different degrees of firmness.

“Implants have continued to improve and many women are happy with them,” says Dr. Chen, “but patients should be aware that implants are not expected to last a lifetime. In the United States, all breast implants have a ten-year warranty but complications such as pain, infection, hardening, and rupture lead many implants to be removed well before that. Some women find that their breasts feel hard and look unnatural, or that they’ve lost all feeling in the breast, or that their breasts are distorted and asymmetrical.” According to the implant manufacturers, at least half of breast implants need another operation within 7 years. Many women who suffer complications or are unhappy with implants ultimately have them removed and opt for reconstruction with their own tissue.

Reconstruction with your own tissue

The gold standard in breast reconstruction today is surgery that creates a breast from a woman’s own tissue, a procedure, known as “autologous reconstruction.” Natural tissue breast reconstruction creates a breast that is soft, warm, and when combined with nipple-sparing mastectomies can be barely distinguishable from a woman’s own breast. Unlike implant-based reconstruction, a restored breast made of her own tissue reacts just like any other part of her body, expanding or contracting with weight gain or loss, for example. When nerve reconstruction is added, the reconstructed breast may be sensitive to touch. Autologous reconstruction produces the best aesthetic result and the highest level of patient satisfaction but it should be noted that it requires more complex surgery and a longer recovery than reconstruction with implants.

Autologous tissue breast reconstruction uses tissue from a donor site in the patient’s own body to create the new breast. This type of reconstruction has been done for decades but new advances have made it unnecessary to sacrifice muscle from the donor site which reduces recovery time and enables a woman to maintain muscle strength. In this new type of reconstruction, known as “perforator flaps,” microsurgical techniques are used to carefully separate muscle from the fat and skin that will form the new breast. “Perforator flap reconstruction can use tissue from several donor sites,” says Dr. Chen. “Most often, tissue is taken from the abdomen, but for thin women or women who have had a previous tummy tuck, it may be more appropriate to use tissue from the upper inner thigh.”

Nipple and areola reconstruction

Changes in mastectomy itself have also facilitated improved restoration results. Surgery that spares skin and the nipple-areola complex enhances the surgeon’s ability to create a breast much like the woman’s own. If there are cancer cells in or near the nipple and it cannot be saved, the nipple-areola complex can be reconstructed later using skin from the breast or from another part of the body. Three-dimensional tattooing is also an effective option that creates a realistic illusion of a nipple.

Nerve restoration

During a mastectomy, the nerves that provide feeling to the breast and nipple are severed, causing loss of sensation in the remaining skin whether the woman undergoes reconstruction or not. With certain types of autologous reconstruction, however, it is now possible to reconnect blood vessels and nerves and have them grow through the transferred tissue to reach the skin and significantly improve the return of sensation. “This is the next frontier in breast restoration,” says Dr. Chen. “By microsurgically reconnecting nerves that are cut and restoring sensation to the breast, we can not only create a soft, warm breast that looks and feels natural to others but one that feels like her own breast to the woman herself.”

“The evolution of restorative techniques over the last several decades has been remarkable,” Dr. Chen concludes. “What makes a woman feel ‘whole’ again after mastectomy is an individual matter but we will continue to pursue solutions that enable her to regain not just her health but her confidence and sense of self”.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance M Chen Offers Tips on Improving Post Mastectomy Breast Reconstruction Results

When secondary breast reconstruction is necessary. Breast reconstruction should be thought of as a process rather than a single procedure. Most mastectomies will not be identical, and it is unusual for the initial breast reconstruction to have perfect symmetry. Usually, breast reconstruction requires multiple stages to obtain the ideal results.

The objective of breast reconstruction after mastectomy is to create a natural breast with the shape, symmetry and softness of the original. In most patients, modifications are needed after the initial surgery to accomplish that goal. Women should know that with a customized plan and advanced surgical techniques, we can often improve shape, size, and symmetry after the initial breast reconstruction to help a woman’s breasts look better and feel more normal.

Dr. Constance M. Chen, plastic surgeon

In most cases, the best aesthetic outcomes are achieved with natural tissue. There is a principle in plastic surgery to ‘replace like with like’. On the operating room table, the actual breast tissue looks and feels like regular fat – breast tissue and fatty tissue look and feel the same. As a result, when it is feasible to use a woman’s own fat to recreate the breast, the reconstructed breast will feel very much like the original – sometimes it is almost identical.

Women should know that even if they had reconstruction with breast implants that the implants can be removed and replaced with natural tissue. While many women with implant-based breast reconstruction are happy with the results, some women who have undergone breast reconstruction with implants feel uncomfortable because breast implants are usually placed underneath the muscle. In these cases the subpectoral breast implants can cause rigidity and trouble with breathing, and a hyper-animation deformity can also result in which the patient’s breasts move up and down when she flexes her pectoralis muscle.

In our experience, many women are surprised when their breast implants are removed and replaced with natural tissue. They commonly report feeling much more comfortable and they are pleased that their new breasts feel and look normal.

Dr. Constance M. Chen, plastic surgeon

Breast reconstruction problems can also arise due to asymmetry. Breasts should look like sisters if not twins, and it’s best when at least they look like they belong to the same family. It is easiest to obtain symmetry with bilateral reconstruction, in which the incisions from the mastectomy and reconstruction method are the same. However, in cases where only one breast has undergone a mastectomy with breast reconstruction it may be necessary to perform additional procedures on the other breast to achieve symmetry. Fortunately, the 1998 Women’s Health and Cancer Rights Act requires all health insurance companies to cover all stages of breast reconstruction and any complications from all stages of mastectomy or breast reconstruction, and symmetry procedures on the opposite breast are also covered. A woman’s right to breast reconstruction at any stage is protected by federal law and many state laws.

Refining and improving breast reconstruction

One common type of secondary breast reconstruction procedure is fat grafting, in which fat is collected from another part of the body through tiny incisions via liposuction. The extracted fat is processed to remove impurities, and then the fat graft is transferred by injections into the breast. This process is used to make the breast larger or to correct contour deformities by sculpting and filling in small areas to improve breast size, shape, and symmetry.

Another common secondary breast reconstruction is called mastopexy or breast lift. Here the goal is to improve the look and/or evenness of the reconstructed breasts. Reconstructed breasts are usually perkier, particularly after implant-based breast reconstruction. If only one breast has undergone mastectomy and breast reconstruction, a mastopexy may be needed on the unaffected breast to match the reconstructed breast. A breast lift will remove excess skin and raise the nipple-areola complex so that the breast sits higher on the chest wall. A breast lift will not significantly alter the size of the breast.

Finally, in some cases the breast size may need to be modified with a breast reduction or a breast augmentation. A breast reduction is similar to a breast lift, except breast tissue is removed along with the breast skin to make the breast smaller. A breast augmentation may be performed with fat grafting or a breast implant.

Any of these procedures can also be implemented on the reconstructed breast(s).

Additional procedures to achieve symmetry are almost always needed for women who have undergone a unilateral (single-sided) mastectomy and breast reconstruction with a breast implant. On the other hand, the best aesthetic outcomes are from bilateral (double-sided) nipple-sparing mastectomies with immediate natural tissue breast reconstruction. When all the breast skin has been preserved and the breast reconstruction is performed with natural tissue at the same time as the mastectomy, it can be nearly impossible to tell that a woman has had a mastectomy.

“Too many women have experienced the devastating upset of a cancer diagnosis and subsequent treatment only to have added disappointment of an unsatisfactory reconstruction outcome,” says Dr. Chen. “Correcting a poor or uncomfortable reconstruction can be the last step in restoring a woman’s physical and emotional health and improving her quality of life.” Even women who have not had the gold standard in mastectomy and breast reconstruction from the beginning can undergo secondary breast reconstruction to improve their initial results.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Persistence needed to tackle stubborn pigmented cells associated with melasma

Dermatology specialist Jennifer Wong, PA-C with Advanced Dermatology PC offers tips on causes, treatment and prevention of patchy skin discoloration.

It’s been dubbed the ‘mask of pregnancy’, but melasma’s patchy brown, tan or blue-gray skin discoloration doesn’t just occur in expectant mothers. Fortunately, a variety of treatments can minimize this often-embarrassing condition, according to Jennifer Wong, PA-C, of Advanced Dermatology P.C.

About 90% of people with melasma are women between the ages of 20 and 50, and this skin spotting – typically appearing on the nose, cheeks or jawline – is more common during the hormone-fueled months of pregnancy, says Wong, a physician assistant with comprehensive experience in medical and cosmetic dermatology for all ages. But sun exposure and genetics are also leading contributors to melasma, which the American Academy of Dermatology estimates affects about 6 million women in the United States.

Diagnosing melasma isn’t difficult, with a health care provider often able to pinpoint its presence just by looking at your skin. A device called a Wood’s lamp is sometimes used to further examine any skin patches whose depth might be concerning. But the vast majority of melasma patches are harmless, though dismaying to live with.

Jennifer Wong, PA-C, of Advanced Dermatology P.C.

Treatment options. It may be encouraging to know that melasma can sometimes fade on its own, given time and patience. But waiting it out might be a good approach, Wong notes, when the condition’s trigger has been identified and will soon end, such as pregnancy, oral contraceptive use or excessive time in the sun.

Aside from that, you may wish to take a more aggressive treatment path, with both at-home and in-office options available, Wong says. Melasma treatments can include:

  •     Hydroquinone: This medication, which is available in cream, lotion, gel or liquid forms, lightens the skin. Over-the-counter versions can be found, but your doctor can prescribe stronger concentrations if needed.
  •     Corticosteroids and tretinoin: When added to hydroquinone, these medications can enhance skin-lightening effects. Some products are called a ‘triple cream’ because they include all three ingredients.
  •     Other topical medications: Skin-lighteners such as azelaic acid or kojic acid work by encouraging cell turnover to rid the skin of unsightly marks and promoting healthy new skin cell development.
  •     In-office procedures: Topical medications are usually the first line of treatment, but if they don’t do the trick, your doctor can try in-office procedures such as a chemical peel, microdermabrasion or dermabrasion. These treatments slough off the top layers of the skin, where melasma occurs.

No matter what treatment you try, results likely won’t be instantaneous, Wong cautions. “It simply takes time for stubborn pigmented cells to turn over,” she says. “And whatever you do, don’t think you can scrub them off at home. This can actually worsen melasma by irritating the skin and leading to more pigment production.”

Prevention is key. Unfortunately, melasma isn’t necessarily gone forever once skin patches lighten. Wong says the condition can easily return, requiring both vigilance and persistence to keep at bay.

Prevention, then, is the watchword for melasma management. Wong recommends these prevention approaches:

  •     Sunscreen use: Yes, everyone should use broad-spectrum sunscreen with an SPF of 30 or higher when out in the sunshine. But this habit is even more important for those with melasma, for whom a main risk factor is sun exposure.
  •     Hats: “A wide-brim hat can do wonders to keep the worst of the sun’s rays off your face,” Wong says.
  •     Gentle skin care: Don’t use facial cleansers that sting, burn or irritate, since they can make melasma worse.

About Jennifer Wong

Jennifer Wong, RPA-C is a certified registered physician’s assistant specializing in dermatology with Advanced Dermatology PC.

Advanced Dermatology P.C.and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. Come into the beautiful world of Advanced Dermatology PC.

Understanding the Benefits of Short-scar Breast Reduction

Breast Reconstruction Specialist Dr. Constance M. Chen Provides Tips for Women Considering Breast Reduction Surgery.

Many women with large and heavy breasts experience significant discomfort including back, neck, and shoulder pain, challenges finding clothes that fit, and a feeling of self-consciousness about their bodies. Some report rashes under their breasts, stares and unwanted attention, and find that large breasts can also make vigorous physical activity difficult. Breast reduction surgery, or reduction mammoplasty, helps deal with these problems and helps many women feel more comfortable in their own bodies.

In a reduction mammoplasty, breast tissue and breast skin is removed and the nipple-areola complex is repositioned higher on the chest wall, creating a smaller and more youthful breast.

Dr. Constance M. Chen, plastic surgeon

A traditional reduction mammoplasty is performed with an incision that results in an “anchor scar,” which involves three discrete scars. One incision is made around the border of the areola, the second extends down vertically from the areola to the inframammary fold, and the third is a long horizontal incision along the bottom of the breast at the inframammary fold. Dr. Chen explains that “the horizontal scar sometimes can extend beyond a bathing suit or bra and be visible. This same scar is also susceptible to complications while healing and can become wider or hypertrophic (raised).” This is where a short-scar or limited-scar reduction can be advantageous. That’s because it eliminates the horizontal scar,” adds Dr. Chen.

Short-scar reduction uses what we call a ‘lollipop incision’ – around the areola and down to the inframammary fold. “In this case, the horizontal scar is eliminated,” says Dr. Chen. The best technique for each woman is determined by the breast surgeon depending on the size and shape of the patients’ breasts and by the amount of reduction desired.

In most cases, patients who undergo a breast reduction will leave the hospital the same day, with overnight stays rare. The recommended recovery at home is typically 10-14 days before returning to work and several additional weeks before returning to a fully active lifestyle.

Dr. Chen says that “a breast reduction can be performed on healthy women after the breasts are fully developed. She reiterates that “short-scar breast reduction minimizes scarring on the breast after surgery. With advances in breast reduction surgeries, women today don’t have to tolerate the discomfort and emotional distress of large breasts that are out of proportion to their bodies so that they can be more comfortable in their own skin.”

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Tragedy Following Illegal Surgery Underlines the Importance of Insisting on Board Certified Plastic Surgeons for Procedures, says Dr. J Plastic Surgery

The Beverly Hills-based double board-certified plastic surgeon comments on a recent article that plastic surgery has never been safer or more effective. On the other hand, using cut-rate providers with questionable credentials – or none at all – is a recipe for disaster.

A September 21 article on the Daily News details the arrest on murder charges of a mother-and-daughter team who illegally performed an illegal buttock augmentation procedure on a woman, with predictably tragic results. Police allege that neither woman had any medical training. Leading Beverly Hills plastic surgeon, Payam Jarrah-Nejad, M.D., F.I.C.S., F.A.C.S., known to colleagues and patients simply as Dr. J, says that this is a very extreme example of a serious misjudgment far too many prospective patients make.

Dr. J says that caution is a must when deciding to get plastic surgery. First and foremost, patients should only consider board-certified plastic surgeons. He adds that, while it is critical to stay very far away from shady providers who may not even be doctors, patients also need to know that simply having an MD may not make a physician fully qualified to perform plastic surgery. He adds that, on top of a regular medical degree and residency, young doctors must also obtain an additional two years of training to call themselves plastic surgeons. After that, they need to demonstrate their abilities by taking part in the rigorous board-certification process that establishes their skills in one of the most demanding of all medical specialties. Dr. J adds that patients should be aware that doctors who are not plastic surgeons are legally allowed to perform plastic surgeries. However, he adds, only board-certified plastic surgeons have the credentials to prove that they are capable of procedures that are consistently successful and as safe as possible.

The Beverly Hills-based plastic surgeon notes that looking for a plastic surgeon is no time to shop based on price. He says that patients need to consider the fact that, whether they are considering a breast augmentation or rhinoplasty, they will likely be living with the outcome of their procedure for the rest of their lives. He adds that, even if an operation is performed safely but is disappointing or worse on the aesthetic level, saving a few dollars on a less qualified physician is a very poor bet. While botched or even just disappointing procedures can often be remediated through revision procedures, says Dr. J, the ultimate costs in terms of money, time, and heartache are vastly more than if the patient had just gone with an outstanding board-certified plastic surgeon in the first place.

About Dr. Payam Jarrah-Nejad, Dr. J

Payam Jarrah-Nejad, MD, FICS, FACS is a double board certified Beverly Hills Plastic Surgeon. Nicknamed Dr. J by his patients and staff, he holds certifications from both the American Board of Plastic Surgery and the American Board of Surgery. Dr. J is also an active member of the American Society of Plastic Surgeons and a Fellow of The American College of Surgeons.

Dr. J first started his medical career during an internship he held in NYU. It was during this time that he also began working with hospitals around the New York area. It was in New Jersey that he completed his training and served as Chief Resident at Morristown Memorial Hospital.

Certified by the American Board of Surgery and the American Board of Plastic Surgery, Dr. Jarrah-Nejad received a fellowship at Beth Israel Medical Center in New York City to specialize in hand surgery. The fellowship was under the guidance of Dr. Charles P. Melone which was a big influence on the young doctor. It was during his training at Wayne State University, Detroit Medical Center in Michigan that Dr. J found his true calling working with many well-known plastic surgeons.

Years later, practicing as a board-certified plastic surgeon, Dr. J still uses the same techniques he learned in his training in his frequent operation on the face and body. He is greatly admired by his staff and patients who happily contribute positive testimonials to his website.

Dr. J is known throughout the Los Angeles Area medical community as well as beyond it, for his record of outstanding outcomes and his engaging, patient-friendly personality. He has published a wide range of papers in many prestigious scientific and medical journals and has presented his research to local, regional and national symposia.

Finally, Dr. J has performed pro-bono surgery in several countries as part of humanitarian efforts helping children with congenital anomalies. He works side by side with charitable organizations devoted to providing needy children around the world with free plastic surgeries to repair such issues as cleft lips and palates.

Come into the beautiful world of Dr. J.

Dermatologist Dr. Suzanne Friedler with Advanced Dermatology PC with tips on wide array of options for treating a double chin

You don’t have to live with a confidence-zapping double chin. A strong jawline can inspire confidence at any age, but double chins are a sad fact of aging and genetics for many. Fortunately, an expanding number of treatments can target this dreaded profile-buster, says Suzanne Friedler, MD, of Advanced Dermatology P.C.

Patients with double or saggy chins now have multiple effective options that empower them to strengthen their jawline and regain their confidence.

Influenced by a variety of factors that also include weight, anatomy and even the position of your airway, double chins usually show up as excess fat in that area – a condition known medically as submental fullness. And it’s very common: 68% of adults have a double chin they’re unhappy about, according to the American Society for Dermatologic Surgery.

“Even if people aren’t overweight, they can still develop a double chin,” explains Dr. Friedler. “For many, it’s the first area of their body and face that shows deterioration, distorting their self-image. But a wide variety of treatments – both minimally invasive and surgical – can minimize these effects or completely eliminate double chins.”

Minimally invasive options. The number of non-surgical treatments targeting double chins has rapidly grown in recent years, Dr. Friedler points out. These include:

CoolSculpting Mini

How it works: A device that freezes fat cells, CoolSculpting Mini causes ice crystals to form that kill these cells, which are then broken down and reabsorbed into the body.
What to expect: The device is held under your chin by a strap for about 45 minutes, with some patients requiring more than one session for full results. The cold temperature may seem uncomfortable at first, but that feeling generally passes. Only fat cells are frozen and no other cells are harmed.
Results: Within 8 to 12 weeks after a treatment session, your body has broken down and reabsorbed excess chin fat, better defining your jawline.

Ultherapy

How it works: Ultrasound waves administered with a hand-held device lift and tighten the skin under the chin and neck. The heat energy causes the skin to contract while also stimulating the growth of collagen. It’s an especially good option for those whose sagging skin – vs. accumulated fat – has led to a double chin, Dr. Friedler notes.
What to expect: Ultherapy takes about one hour and results are very long lasting. The new collagen and elastin that the procedure produces are yours to keep.
Results: Clinical studies revealed that 90% of patients undergoing Ultherapy experienced significant changes in their appearance, reporting a tightened jawline.

Pixel CO2 Laser

How it works: Pixelated beams of light are focused on the face, jawline and neck resulting in tightening, wrinkle reduction and improved skin texture. Skin appears renewed and the treatment stimulates jaw-firming collagen production.
What to expect: Less aggressive than traditional CO2 lasers, Pixel results in much less patient downtime, Dr. Friedler says. It also carries a lower risk of discoloring the skin or producing prolonged redness.
Results: One Pixel CO2 laser session can visibly improve the angle of the jaw, lessening jowls and double chins.

Kybella

How it works: A chemical called deoxycholic acid, which the gallbladder uses to dissolve dietary fat, is injected into the skin beneath the chin, melting fat in the area that the body then reabsorbs.
What to expect: Between 2 and 6 treatments are needed over several weeks, depending on the amount of excess fat in the chin. The injections can be painful, and you may have a swollen neck for several days after each session.
Results: Many patients see about a 50% improvement in their double chin after 2 treatment sessions and 70% reduction in chin fat after 4 sessions. After 6 sessions, excess chin fat is eliminated, chiseling their jawline.

SmartLipo

How it works: This laser-assisted liposuction procedure removes fat in the chin by breaking down fat cells. The destroyed fat cells turn into liquid, which is suctioned out.
What to expect: A tiny tube called a cannula will be inserted through a small incision in the chin after it’s been numbed with a local anesthetic. SmartLipo is less invasive than traditional liposuction, with a quicker recovery time.
Results: For those who don’t gain weight after the procedure, chin-chiseling results should be long-lasting after just one treatment, Dr. Friedler says.

Surgical treatments

In addition to less-invasive techniques, plastic surgeons can also utilize surgery to eliminate a double chin. According to Dr. Friedler, these procedures include:

  • Neck lift: Surgery known as cervicoplasty can remove extra skin in the neck, while platysmaplasty surgery can tighten neck muscles. One or both combined can improve the contour of the jaw, she says.
  • Face lift: This more traditional surgery doesn’t just focus on the jaw, but – as the name suggests – the entire face. It does, however, remove fat and saggy skin around the chin and neck, eliminating a double chin. As with neck lift surgery, recovery involves swelling and bruising that will resolve over weeks.

Whether you choose minimally invasive or surgical treatment, Dr. Friedler says, the decision to tighten your jawline is firmly in your hands.

“Patients with double or saggy chins now have multiple effective options that empower them to strengthen their jawline and regain their confidence,” says Dr. Friedler.

About Dr. Suzanne J. Friedler

Suzanne J. Friedler, M.D. F.A.A.D., is a board-certified fellow of the American Academy of Dermatology, with expertise in many areas of medical and cosmetic dermatology. She has been with Advanced Dermatology PC since 2002.

Come into the beautiful world of Suzanne Friedler, MD.

Pros and Cons of immediate versus delayed post-mastectomy breast reconstruction

A new breast cancer diagnosis is emotionally challenging, and it becomes even more difficult when women must also make decisions about treatment during a stressful time. In the case of a woman who will have a mastectomy, the difficulty can be even more overwhelming due to the variety of options available and the choices she must make about if, when and how to have breast reconstruction.

According to Constance M. Chen a board-certified plastic surgeon and breast reconstruction specialist, “there are two types of breast reconstruction, breast implants and natural tissue breast reconstruction that uses the body’s own tissue, also known as autologous tissue breast reconstruction.” And with each scenario, there are multiple options. One time-sensitive consideration is whether to have the reconstruction performed immediately in the same surgery as the mastectomy, or delayed by months or even years after the mastectomy. Dr. Chen details the considerations of immediate versus delayed post-mastectomy reconstruction.

Immediate Reconstruction

One of the primary advantages of immediate reconstruction is blunting the emotional suffering from losing one or both breasts. “For many women, waking up from a mastectomy and seeing that she still has breasts is very positive”. Immediate reconstruction that conserves the nipple, areola, and skin is the highest standard in breast reconstruction. Nipple-sparing mastectomy preserves the entire skin envelope, which makes it possible to preserve the breast shape. Thus, regardless of the type of reconstruction, whether implants or natural tissue, the resulting breast shape will always be best after nipple-sparing mastectomy. When performed with natural tissue, the reconstructed breast has the added benefit of being soft, warm and alive, and it is also possible to reconnect nerves to restore feeling.

One drawback of immediate reconstruction is that the hospitalization and recovery time may be longer than with a mastectomy alone with breast reconstruction. Moreover, for women with advanced disease who need immediate chemotherapy, immediate reconstruction may delay treatment until after healing is complete.

Delayed Reconstruction

Delaying reconstruction sometimes shortens the recovery time after a mastectomy. If a patient has a high-grade tumor or advanced disease, she may elect to delay reconstruction so that she can start her chemotherapy or radiation therapy sooner. With both implants or with the woman’s own tissue – breast reconstruction can be performed after healing from the mastectomy is complete and after chemotherapy and radiation therapies, if those are required.

The biggest drawback to delaying reconstruction is the need for another surgery at a later date, and the potential for an inferior aesthetic result. This is particularly true if the patient has not undergone nipple-sparing mastectomy, and/or if the patient needed radiation therapy. Without nipple-sparing mastectomy, a significant amount of breast skin may have been removed, which permanently deforms the breast by changing the shape and flattening it. Radiation therapy also alters the remaining breast skin and tissue so that it does not stretch and heal normally. Without nipple-sparing mastectomy, the skin will need to be stretched with a tissue expander if using breast implants. With natural tissue breast reconstruction, skin from the patient’s donor site can make up for the lost skin, but it may appear as a patch. In these cases, there will likely be a need for additional follow-up procedures to improve the overall cosmetic result.

One of the biggest considerations driving the timing of reconstruction is whether the woman will need radiation therapy after her mastectomy. “Radiation therapy always automatically unfavorably affects the aesthetics of any breast reconstruction,” says Dr. Chen. “But if a woman wants autologous tissue reconstruction, she may be advised to postpone placing the natural tissue until her radiation is completed.” In these cases, the patient can undergo a delayed immediate reconstruction, in which a tissue expander is placed at the time of mastectomy to save the breast skin, and then the natural tissue reconstruction is performed after the radiation is completed.

The Takeaway

According to Dr. Chen, “women have the best aesthetic result and the most sustained level of satisfaction with nipple-sparing mastectomy and natural tissue breast reconstruction. Autologous tissue reconstruction produces a soft, natural breast that looks and feels like the breast lost to mastectomy. Most breast surgeons are reluctant to perform nipple-sparing mastectomy without immediate breast reconstruction, because of the deflated appearance of the breast skin. Whether immediate or delayed, however, preservation of the nipple-areola complex and all of the breast skin sets the foundation for the best possible breast reconstruction”.

“There are pros and cons to immediate and delayed reconstruction, and each woman must consider personal and medical reasons for choosing the best course of action for them. Breast reconstruction is an integral piece of managing breast cancer,” says Dr. Chen. “We’ve made amazing developments in our ability to reconstruct a breast that closely resembles the breast lost to mastectomy. Today more than ever we can offer women a wide range of options to fit their medical needs and personal preferences, including the choice of when to have reconstruction. Each breast cancer patient has unique needs and we can help her get the best care that is ideal for her”.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

The National Eczema Association has awarded its Seal of Acceptance to Eczema Honey

Eczema Honey, the leader in safe, non-toxic soothing cosmetic and over-the-counter products, has recently been awarded with The Seal of Acceptance™ from the National Eczema Association! NEA awards the Seal to products that are deemed suitable for people with eczema or sensitive skin, based on sensitivity, safety, toxicity and ingredient testing data.

Products are reviewed by an expert panel based on a rigorous criterion of ingredients, content and formulation, as well as testing data on sensitivity, safety and toxicity. Many consumers already have some awareness of the importance of avoiding certain ingredients, contents and formulations when they are purchasing personal care products, household products, fabrics, and sunscreens.

Utilizing clean, safe and gentle ingredients, Eczema Honey has been recognized as the best line of skincare for those with skin sensitivities as well as those looking for calming products for themselves and their families.

They put emphasis on high-quality and food-grade ingredients known for their revitalizing and skin-loving properties. Every ingredient in their products has been selected because of the high quality and serves a specific therapeutic purpose. They do not use fillers of any kind. They only use the finest, whole, and cosmetic-grade ingredients that they have developed for themselves and their children.

Eczema Honey’s mission is to deliver soothing products that are safe, nourishing and feel good. We provide natural relief products for people with eczema and sensitive skin. We don’t treat the condition, we treat the person and make them feel happy with soothing and cooling lifestyle products.

Minesh Pate, Founder and CEO

Three Eczema Honey Products will be listed with all Seal products on the Seal Product Directory at NationalEczema.org. Eczema Honey Original Skin Soothing Cream, Eczema Honey Nut-Free Skin Soothing Cream and Eczema Honey Oatmeal Body Lotion.

Eczema Honey Original Skin Soothing Cream

Eczema Honey Original Skin Soothing Cream offers a blend of high quality ingredients to support people living with eczema with a cooling, soothing cream that temporarily protects and helps relieve minor skin irritation and itching due to rashes and eczema. This nutrient rich cream is Dermatologist Tested and complies with the FDA’s Over-The-Counter drug monograph for skin protectant products. Eczema Honey uses a blend of natural ingredients like beeswax and pure honey for their moisturizing and hydrating properties. A blend of almond oil and sunflower oil act as emollients and deliver additional antioxidants into the skin. The Nut-Free version is also recognized by the NEA and caters to those with additional skin and allergy needs. Both creams also offer other benefits and uses such as providing deep hydration and moisture to skin. One may also use the cream to take off makeup with cotton pad or ball or as lip balm.

Eczema Honey Oatmeal Body Lotion

Eczema Honey Oatmeal Body Lotion is also Dermatologist tested and was crafted to achieve the right balance of hydration and feel. The lotion goes on light, isn’t sticky, and provides moisture for the entire body. It was formulated with only ingredients that serve the skin. No fragrances, no phthalates, no harmful chemicals, no unnecessary fragrances. It will not only provide soothing comfort that you would expect from lotion, but also full coverage over a long lasting period. Dermatologist tested and crafted to achieve the right balance of hydration and feel, Eczema Honey Body Lotion goes on light, isn’t sticky, and provides moisture for the entire body. Leaping Bunny certified cruelty free, the lotion complies with the FDA’s Over-The-Counter drug monograph for skin protectant products.

Eczema Honey believes in the power of nature to bring clean and gentle cosmetic products. You can find Eczema Honey online, at CVS Pharmacy® stores nationwide and online at CVS.com, select Target stores nationwide and Target.com and Ulta. For more information, come into the beautiful world of Eczema Honey.

ACS Silver Gel by Results RNA now available in new sizing

Biopharmaceutical company Results RNA has added a 4 oz bottle option to their best-selling ACS 200 Silver Gel lineup. This addition provides a very user-friendly size with excellent pricing and exceptional results. ACS 200 Silver Gel is the only 200 parts per million topical silver gel available, as most silver gels are less than 20 ppm.

Biopharmaceutical company Results RNA has added a 4 oz bottle option to their best-selling ACS 200 Silver Gel lineup. Previously only available in 2 oz and 8 oz sizes, ACS 200 Silver Gel topical formula provides active ingredients Advanced Cellular Silver and Advanced Cellular Glutathione.

This soothing and skin rejuvenating clear topical silver gel supports overall skin health and can be applied to both face and body daily and comes in a sleek tube that is easy to carry with you, and simple to use.

Apply ACS 200 Silver Gel immediately following skin-abrasive applications such as tanning, facials, waxing, tattoos, chemical peels, microneedling, microdermabrasion, microblading, dermablading, dermaplaning, sclerotherapy, pigmentation procedures, or laser skin care procedures to rapidly soothe and rejuvenate.

Additionally, ACS 200 Silver Gel can be used for post-sun exposure, blemishes, underneath masks, maskne, skin redness, dry skin, sensitive skin, burns, cuts, scrapes, irritation, and more.

Post-application, skin is smoother, healthier, and brighter with reduced redness, itchiness, swelling, irritation, and dryness.

Other topical creams and ointments can damage the skin, but ACS 200 Silver Gel provides soothing rejuvenation without harmful chemicals. ACS 200 Silver Gel is odorless, hypo-allergenic, and non-comedogenic.

Results RNA ACS Silver Gel is available at selected stores and online. For more information, come into the beautiful world of Results RNA.