In our last blog post, we discussed specific skin treatments that individuals in their 20s and 30s can pursue to improve skin quality, texture, tone, and overall appearance, and help reverse visible signs of aging.  This week we will focus on those individuals in their 40s, a decade that deserves special attention in the pursuit of facial rejuvenation.

Forties – Most individuals in their 40s will start to show their age, as genetic and environmental factors lead to deterioration of the key proteins in one’s skin. Collagen production decreases, leading to skin thinning; elastin fibers diminish, leading to tissue descent and sagging; and fat atrophies, causing hollowing of tissues.  Consider environmental factors such as sun exposure and pollution, and it should come as no surprise that our skin can develop unwanted lines and wrinkles that cause us to look tired and prematurely aged.  The 40s are notable for the development of:

• Set-in wrinkles;
• Atrophying tissues in the temples;
• Lowered eyebrows;
• Thinning lower eyelid skin;
• Descended cheek tissue, which creates deeper smile lines, and
• Jowling, and loss of jawline contour.

Because of the multi-dimensional changes to facial skin in this decade, most patients require a well-developed skin care regimen, complemented by minimally invasive procedures such as chemical peels, wrinkle removers, dermal fillers, and lifting agents.  Fillers also tend to play an increasingly large role in one’s 40s, as they support the soft tissues of the face, enhance a patient’s facial anatomy, restore soft tissue volume loss, and help lift tissues that gravity and age have caused to thin and sag.

If patients in their 40s begin to experience wrinkling in the forehead and between the eyes, as well as Crow’s feet, they may benefit from the combination of Botox and fillers – Botox to prevent worsening of the wrinkles, and fillers to correct any established deepening of the skin.   Tissue atrophy along the temples is also a hallmark of the 40s and can be remedied by placement of a long-acting filler like Voluma.

Similarly, Botox can be used to elevate the outer corner of lowered brows, while filler placement will effect an uplifted, younger appearance to the upper eyelid.  Thinner fillers can be placed into the lower eyelid to help smooth the transition to the cheek and improve areas of darkening skin.

Unfortunately, 40-50 year old patients may also experience cheek deflation which leads to a number of characteristic changes that may cause the face to transform from a youthful, heart-shaped or oval shape to a more rounded or square shape. Cheek tissue sagging will worsen the appearance of the lower eyelid region; it can also cause the “apple” of the cheek to drop, which increases downward pressure to the tissues around the smile lines – ultimately causing them to deepen. Many times, patients seeking correction of these specific areas can have fillers placed into their cheeks to help add volume and elevate the cheek tissues into a higher position, indirectly improving all of the affected areas.

Similar to the cheeks, the lower face develops loss of jawline definition and formation of jowling as tissue descends towards the chin and blunts the angles of youth.  To combat this, fillers can be placed into the jawline and near the jowls, which will improve jaw contour and camouflage the jowls.

Because of the increased dependency on fillers and most patients’ lack of interest in surgery, the “Liquid Facelift” was colloquially coined.  The Liquid Facelift combines the use of wrinkle removers and long- and short-acting dermal fillers to address the early signs of facial aging.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo provides in-depth skin care consultations, both for patients seeking aesthetic improvement, and for those in pursuit of high-quality protection from nature’s elements.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

Many patients worry that if they do not properly care for their skin or begin to undergo minimally invasive cosmetic procedures by their 20s, 30s, or 40s, their attempts at facial rejuvenation later in life will be futile.  In actuality, patients can pursue treatment options at any age – treatments that will improve skin quality, texture, tone, and overall appearance, and help reverse visible signs of aging.

Twenties – In one’s 20s, facial tissues are firm, supported and show little signs of aging.  Skin has a radiant glow, cheeks are full, and lips are plump.  The decade between 20 and 30 is the perfect time to practice preventive medicine and adopt a proactive approach to skin and facial health, preserving a youthful appearance for years to come.  First, and perhaps most importantly, women in their 20s should maintain adequate hydration to their tissues.  They should minimize their sun exposure and pursue a good skin care regimen incorporating lightening creams, retinols, and sunblock. Once a professionally approved regimen is in place, chemical peels can help improve skin clarity, texture, coloration, light wrinkles, and skin tightness. Minimally invasive procedures such as Botox can be used to smooth horizontal worry lines of the forehead, vertical frown lines of the glabella, nasal sidewall “bunny” lines, and the dimpling and creases that can occur on the chin.  Fillers such as Juvederm can be used to lend soft tissue support, helping lift, shape, and define areas of the face such as the jawline or cheeks; they can also be used to enhance and augment such prominent features as one’s lips.

Thirties – For many, the 30s can represent a decade of significant life changes – a transition to greater relational, professional, and familial stability.  The 30s can also bring about changes in one’s appearance as the first signs of aging start to develop: a loss of skin elasticity and suppleness, leaner cheeks, and lowered eyebrows.  The fine lines first observed in one’s 20s can start to deepen and become set, even when the face is relaxed.  Ultimately, this is the time to take action and set a beauty management foundation that will promote positive cosmetic outcomes for the next several decades.  Whether beginning or continuing the treatments of the 20s, Botox can be used to treat the fine lines around the eyes, and fillers can be added to smooth the laugh lines or parentheses around the mouth.  And finally, stronger chemical peels can be employed to improve skin thickness and accelerate skin turnover, uncovering vibrant, glowing skin.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo provides in-depth skin care consultations, both for patients seeking aesthetic improvement, and for those in pursuit of high-quality protection from nature’s elements.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

Hyperhidrosis is a common medical condition whereby a person’s sweat glands become overactive, often producing 4-5 times the amount of sweat than those of unaffected individuals. Patients with hyperhidrosis can experience decreased self-esteem or generalized embarrassment, especially when the sweating occurs in an area of the body that is easily seen or exposed to regular interaction with others – like shaking hands, for example.

The most common “hot spots” for hyperhidrosis include the hands, feet, armpits, face, and scalp; in most patients, more than one of these areas will be affected. Though episodes of sweating can be spontaneous, patients will commonly have a number of possible triggers, including physical activities such as exercise; dietary choices such as coffee, tea, alcohol, and hot/spicy food; hot or cold environmental temperatures; habitual smoking; and emotional stress or anxiety.

So how does one know if he or she has hyperhidrosis – and how is it diagnosed? There are two major types of hyperhidrosis: primary focal and secondary generalized. Primary focal hyperhidrosis accounts for 90% of cases of hyperhidrosis and is differentiated from secondary generalized by sweat not caused by a medication or other medical condition. Patients must have at least a six-month period of focal visible sweating and two of the following symptoms:

● Sweating that occurs on the same area on both sides of the body and with the same           relative amount of sweating
● Sweating that impairs daily activities
● Sweating episodes that occur at least once per week
● Sweating that began before the age of 25
● Sweating that is found in other family members
● Sweating that stops when sleeping

Unfortunately there is no cure for hyperhidrosis, but there are a number of available treatments that can improve symptoms, such as creams, prescription strength antiperspirants, lasers, electromagnetic machines, oral medications, and in refractory cases, sympathectomies. Each of these procedures comes with its own set of risks and benefits, so it is best to see a specialist when entertaining treatment. Alternatively, there is another minimally invasive option that can be used to treat any part of the body suffering from hyperhidrosis: Botox.

In 2004 the FDA approved Botox for axillary hyperhidrosis, and it is now routinely used to treat all forms of excessive sweating.  Contrary to popular perception, Botox does not work directly on muscles, but rather the nerves that cause the muscles to contract.  As a result, Botox treats hyperhidrosis by temporarily blocking the signals that nerves release to control sweat gland function.  Treatment is similar to Botox placed for cosmetic purposes in that a series of injections using low volumes of Botox is administered throughout the areas of greatest sweating.  Nearly painless, the procedure can take between 10-15 minutes, with a significant reduction in sweating appreciated within 1-2 weeks.  On average, results will last for six months, and any missed sweat glands can be treated with a touch-up at 14 days.  The total amount of Botox used will depend on the area of the body treated, but one armpit will normally require 50 units, one hand 50-75 units, and one foot 50-100 units.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo performs all of the injections himself, supplying patients the same level of care that he would give his friends and family.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

One of the most commonly discussed topics in any procedural consultation is the management of bruising – both prevention and treatment. Bruising is distressing to patient and surgeon alike, as it can prevent the post-procedure anonymity and privacy a patient would otherwise enjoy.

To understand how to best avoid bruising, one needs to know how a bruise occurs. Underneath the human skin is a fine network of vessels that supplies blood to the skin and muscles. Any intervention that then disrupts this network can leak blood, temporarily “staining” the surrounding skin and adipose tissue. If the injury is significant enough, a collection can develop that becomes apparent on the skin surface and can be difficult to cover up with make-up.

As each person has a different propensity towards bruising, it is helpful to review options with anecdotal evidence of either preventing or treating bruises.

Supplements – Two of the most commonly discussed over-the-counter supplements thought to reduce swelling and bruising include Arnica Montana and Bromelain.  Arnica is a naturally occurring herb that is found in multiple forms, including topical gels and oral pills; it is thought to dilate local blood vessels, speeding clearance of bruises through increased blood flow.   Bromelain, a protein found in pineapples, is thought to naturally reduce inflammation, limiting swelling and the duration of bruising.

Medications – There are a number of medications that can increase the fragility of blood vessels, predisposing patients to bruises: Aspirin, Ibuprofen, and blood thinners such as Coumadin and Lovenox.  These medications should be stopped at least a week or more before treatments, with timing of cessation and resumption dictated by your surgeon.

Diet – There are certain foods that can predispose patients to bruising, due to certain chemical compounds found within them: garlic, ginger, green tea, cayenne pepper, and red wine.   Other foods can help prevent bleeding and include leafy green vegetables – kale, spinach, and cabbage – while the papain found within papaya can help break up and clear bruises.

Herbals – Given the recent increased interest in Eastern medicine, there are a number of herbal remedies that must be avoided prior to any injection or procedure.  The more common ones include Echinacea, Ginkgo Biloba, Ginseng, and St. John’s Wort.

Despite all good intentions, if a bruise begins to materialize, what are the best maneuvers to mitigate its severity?

Apply Pressure – Pressure on the area of concern will slow blood flow through the surrounding tissues, limiting the amount of blood that leaks through the source of injury before your body’s natural responses plug the injury with a small clot.

Icing/Heat Therapy – For the first 1-2 days after treatment, ice and cool compresses will help limit swelling in the skin — and the amount of skin staining that can result from any injury.  Once the bruise has developed and stabilized in size, use warm compresses to increase blood flow and help clear the bruise.

Supplements – In addition to the aforementioned products, taking a multivitamin daily can assist bruise clearance by supplying your body with the Vitamin A, C, zinc, selenium, and B complex medications that help promote tissue repair.  Witch Hazel compresses can also help reduce skin’s irritation post-injury and is also thought to help clear bruises.

Makeup – It is okay to apply makeup to a bruise in order to minimize its appearance.  Try using a yellow-tinted concealer on darker bruises (purple in color) for better camouflage.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo aims for each patient to receive the outcomes they deserve, and although bruising is a possibility with any intervention, he prioritizes limiting patient distress — both visible and internal.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

After this past weekend, it appears that winter is here to stay in Atlanta for the next few months.  We have previously discussed the importance of a good skin care regimen, but we’d like to remind you of the following tips to winter-proof your skin from dropping temperatures and blustery wind conditions.

Hydrate – Taking in sufficient water is important year-round, but especially so in winter.  Cold winds cause faster evaporation of water from the skin’s surface while preferentially shunting blood to the body’s core: a winter woe that results in dry, sensitive skin that can be itchy and can tear more easily.  To prevent irritation, start each day by drinking a glass of water. Doing so will not only jump-start your metabolism, but also help you to replace the water lost during sleep.  In addition to routine hydration, be sure to follow your consumption of naturally dehydrating liquids — like alcohol, tea, and coffee — with a full glass of water.

Limit Hot Showers – High temperature showers may feel good on our skin in the cooler mornings of winter, but combined with soap, they will strip the skin of its natural, protective oils.  Excessively hot showers can produce dry, scaly patches of skin, especially in individuals prone to eczema.  Instead, take lukewarm showers limited to ten minutes, use moisturizing soaps, avoid loofahs and other exfoliants, pat yourself dry, and immediately apply moisturizer to all of your skin to lock in moisture.

Use Thicker Skin Care Products – Just as we use heavier clothing in winter to keep us warm, use thicker lotions and emollients on your face and body to combat water evaporation, dry skin, and wind burn.  Shea butter-containing products are particularly good at keeping skin soft and supple because of shea butter’s fatty acid content. Thicker skin care products will also protect you from the dry heat used to heat our homes and offices.

Moisturize – Our feet and hands bear the brunt of our activities during the day and require special attention.  With repeated hand washing and hand sanitizer use, one’s hands can dry considerably.  During the winter, use gentle soaps and limit alcohol-containing products while constantly applying hand lotion.  At night, apply a thick moisturizer to your hands and place them in cotton gloves for additional benefit.  Your feet deserve similar moisturizer care but also greatly benefit from routine pedicures, which minimize callus skin development and help prevent painful cracking of the skin.

Stop Licking Your Lips – Licking your lips only worsens chapping, as it evaporates saliva from the lip’s surface.  Instead, exfoliate lips with a soft toothbrush daily, and then apply a lip balm made with petrolatum or beeswax consistently during the day.  At night, try applying a thick layer of Vaseline or Aquaphor to your lips to help further soften and soothe them.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo provides in-depth consultations on skin care for not only aesthetics, but also for protection from nature’s elements.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

After Modern Family star Ariel Winter’s acknowledgement of having undergone breast reduction surgery, there has been a marked increase in the number of women – including teenagers – who are addressing personal health issues related to having large breasts. Due to such factors as increasing age, the effects of gravity, and the weight of breast tissue, women with larger breasts tend to develop stretch marks and sagging faster than women with smaller breasts. These same women will have functional problems with neck and back pain, shoulder grooving from bra straps, and breast infections. Fortunately, breast reduction surgery addresses both aesthetic and functional concerns of women, and it routinely leads to a better quality of post-operative life for most patients who elect to have it done.

The most common reason for a breast reduction is the desire to improve neck and upper back pain. Some patients try losing weight, undergoing physical therapy and visiting chiropractors to help, but unfortunately see little improvement in their symptoms. Having exhausted all other medical options, these patients benefit most from surgically removing a portion of their breast tissue to decrease the tension that large breasts place on their shoulders, neck, and back. The amount of tissue removed depends on a combination of factors – including a patient’s desired size and any insurance requirements – but patients can count on experienced plastic surgeons to leave them with a proportional body silhouette post-surgery.

Similar to the effects of a breast lift, a breast reduction also rejuvenates the remaining breast tissue and nipple, placing both in a more youthful, elevated position on the chest; this lifting takes further strain off of the neck and back. A reduction also tightens the remaining breast skin, removes stretch marks, and leaves the breast with a firmer appearance.

Breast reduction surgery can be covered by insurance, with insurance companies often requiring 3-6 months worth of documentation from a primary care provider of breast-related symptoms (rashes, neck/back pain, and shoulder grooving), and treatment failures (weight loss, physical therapy), that have led a patient to pursue surgery. Knowledgeable plastic surgeons can often assist in this process of insurance approval, as they are able to supply the necessary pre-certification paperwork. If a patient is denied by her insurance company, surgery can still be accomplished through a self-pay model, or financed into monthly payments.

Safely performed in an outpatient setting, a breast reduction does require a few weeks off from any heavy activity or exercises, but many women can return to work within a week or two, depending on their job requirements. There are many training-specific surgical techniques that can and should be used during a breast reduction, so it is important to choose a plastic surgeon that can help you maximize your results.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo provides in-depth consultations addressing the concerns of women seeking to reduce their breast size. If you are a patient who is experiencing neck and back pain, and think your breasts may be the reason, please schedule an appointment with us soon. Results can be so positive and immediately relieving that you will wonder why you didn’t elect to have the surgery much sooner!

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com

In a prior post we discussed the premature skin changes that the sun’s radiation can cause, and the need for establishing a skin care regimen incorporating the use of sunblocks. What, however, are the best ways to protect one’s skin from the sun?

In order to answer this, it’s best to understand how sunlight can harm us. The sun emits radiation towards the earth in the form of ultraviolet (UV) rays. It emits three main types:

1. UV-A – The longest wavelength, UV-A radiation is responsible for Aging us, with wrinkle development. It accounts for 95% of the UV radiation reaching Earth, and is found in consistent amounts throughout the year. It can penetrate windows, windowshields, and shallow water, and is the radiation type used in tanning beds.
2. UV-B – A shorter wavelength, UV-B radiation is responsible for Burning our skin. UV-B radiation is more seasonal, with higher levels in the Spring and Summer, between the hours of 10am-4pm. UV-B rays do not significantly penetrate glass.
3. UV-C – The shortest wavelength, most of this radiation is absorbed by the ozone layer and never reaches the earth.

What can we do to protect ourselves then?

1. Avoidance – Though 100% is impossible, and discouraged, avoiding direct sunlight during times of intense sun exposure is advisable. If outside, seek shelter in shaded areas.
2. Clothing – There is now special clothing that can repel UV radiation, but for most clothing, it is advisable to have loose fitting, full coverage, tightly woven articles in bright colored, or dark colored colors, as these reflect more UV radiation. Don’t forget hats to protect your scalp, and UV-blocking sunglasses for your eyes.
3. Glass Films – With the long commutes in Atlanta, UV-protective films can be applied to car windows (as well as house/business windows) to limit UV exposure, while still letting in sufficient light.
4. Sunscreens/Sunblocks – These compounds can serve as either a physical barrier to UV radiation, reflecting it from the skin, or can absorb the radiation before it has an opportunity to penetrate the skin.

What about our need for Vitamin D?

Vitamin D is the only vitamin produced by the body, with its building blocks stored in our fat, and its active form produced when our skin is exposed to the sun’s UV-B radiation. Its active form then helps us absorb and use calcium for strong bones, muscle development, and many other important body activities.

There is large debate as to the amount of sun exposure needed to meet our Vitamin D requirement, but the National Institutes of Health recommends 5-30 minutes of unprotected sun exposure between the hours of 10am and 3pm, 2-3 days a week. The rest of the time we should be protecting ourselves from the sun’s rays.

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Nelson Castillo can help you protect yourself from the rays of the sun, so that you can enjoy its positive invigorating effects, while minimizing many of its consequences.

If there is a topic that you would like discussed on our blog, leave us a comment, or write us at info@nelson-center.com