Whether the result of a surgery or a traumatic injury, a poor scar can leave patients with unsatisfactory results and psychological distress. Contrary to popular opinion, plastic surgeons do not perform “scarless” surgery. Each plastic surgery procedure trades the creation of a scar for an improvement in the shape or contour of the face or body. Plastic surgeons are trained, however, to minimize a scar’s appearance using a combination of surgical techniques and adjunct therapies.

Over-The-Counter Therapeutic Strategies:

• Moisturizer – An important piece of any skin care regimen, a moisturizer helps keep skin soft, supple, and hydrated. Once a wound has been cleansed, and there is minimal risk of infection, consistent moisturizer use will speed healing and improve long-term results.  Moisturizers will also prevent wounds from scabbing, which should be avoided for the best cosmetic result.  Over-the-counter ointments, such as Aquaphor and Eucerin, are excellent options, and they can be used for a variety of other skin maladies, including chapped lips, dry skin, and eczema.

• Sunblock/Sunscreen – UV radiation from the sun is one of the most underappreciated risk factors that can lead to poor wound healing and scar appearance. Regardless of an area’s climate, it is important to maintain consistent use of a sunblock on any incision for six months or more.   Look for sunblocks that list titanium dioxide or zinc oxide as their active ingredients, as both act as physical barriers to all spectrums of UV radiation and require only once daily application.  Sunscreens, which physically absorb UV radiation and as a result become degraded from sun exposure, necessitate repeated application during the day.  When choosing a sunscreen, ensure that it has multiple active ingredients, such as avobenzone and octinoxate to cover the full UV spectrum.  A sunscreen or sunblock can replace the moisturizer in your daily scar management routine and can later be used as part of an overall skin care regimen.

• Physical Barriers – If a sunblock or sunscreen is unavailable, then use of physical barriers can aid in scar prevention. To minimize an incision’s UV exposure, as well as the likelihood of scarring, patients should wear dark colored items of clothing and cover the affected area with band-aids or medical tape.

• Silicone Sheeting – We do not know how or why silicone sheets work, some believe it’s a pressure phenomenon, and others think it lowers the oxygen tension across the scar surface. Regardless of its mechanism, what we do know is that silicone sheeting is an inexpensive therapy used to soften and flatten scars.  The sheets can be trimmed to the size of the incision and are reusable.

Physical Scar Manipulation Strategies:

• Scar Massage – Used in conjunction with a moisturizer, scar massage aids in softening and flattening scars that are partially healed, still maturing, and in the process of remodeling. Scar massage also helps in desensitizing scar tissue and the surrounding skin.  Proper instruction by a plastic surgeon must be given to help speed healing, while minimizing the risk of a wound separation.

Physician-Directed Medical Strategies:

• Retinol/Tazorac – The same products used for skin rejuvenation will allow for quicker recovery and more rapid scar maturation and fading. When applied to incisions and wounds, these medications will help turn over your skin cells faster, accelerating the healing process.

• Bleaching Creams – Injured skin often darkens relative to the surrounding skin as a result of direct injury, as well as exposure to UV radiation. Used in conjunction with retinols, bleaching creams can help fade a scar’s appearance.

• Corticosteroid Injections – For those patients prone to hypertrophic scars and keloids, injections of cortisone into the scar can help them soften and flatten, while removing redness and any itchy sensations.

Surgical Scar Improvement Strategies:

• Subcision/Filler – Some scars become tethered to the underlying tissues of the face and body leading to contour irregularities and unattractive shadowing.  Subcision involves the creation of a small puncture near the location of scarring, and a needle is used to release the tethering bands.  Once the scar tissue has been released, small amounts of fillers can be placed to elevate the scar to the level of the surrounding skin.

• Surgical Revision – If a scar does not respond to more conservative treatments, and the skin has fully healed, removal of the old scar can be performed and a re-do attempted to make the new scar thinner and less noticeable.

A scar will flatten, thin, and fade in color for over a year or more from the time of injury.  Though the measures discussed will not prevent the formation of, or “erase,” a scar, diligent care can lessen a scar’s appearance.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo welcomes the opportunity to discuss any skin care or scarring concerns that you may have, and he is happy to individually tailor a treatment regimen that can best address your particular concerns.

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

Choosing a plastic surgeon is a decision that you will live with for years, if not your entire life. It is important to research any surgeon’s credentials, experience, and training, but what are other questions you need to ask to find the right plastic surgeon for your needs?

1. Is your physician board certified by the American Society of Plastic Surgeons (ASPS)? The ASPS is the chief governing body for plastic surgeons, and certification ensures that an accredited, broad-based training program in plastic and reconstructive surgery was completed. Do not be confused by other official sounding boards or certifications. There is no recognized board with “cosmetic,” “aesthetic,” or “facial cosmetic” in its name. These surgeons do not meet the standards of training and expertise required of board certified plastic surgeons. Check your surgeon’s current standing with the ASPS at www.plasticsurgery.org.
2. Does your surgeon have hospital admitting privileges? Even if your operation is to be performed at an outpatient surgery center, hospital privileges ensure that, should any complications arise, you can be admitted for continued care. Additionally, hospitals perform an exhaustive background check on physicians, adding an extra layer of security and protection for you.
3. Were you comfortable with your doctor during the initial consultation? A successful patient-doctor relationship is a team effort, one grounded in the ability to maintain the lines of communication open. You should feel comfortable disclosing your full medical history and asking your surgeon any question. Your surgeon should be willing to take the time to listen and answer them.
4. Was the surgeon’s office staff professional and courteous, and did they return your calls promptly? Office staffs play a significant role in your experience, helping to answer questions, scheduling your surgery and appointments, and discussing fees and payments. They will be as intimately involved in your care and recovery as your surgeon.
5. How many times has your surgeon performed the procedure you are interested in? Familiarity and experience with a particular surgery leads to safer, more predictable outcomes for patients. They also improve the chances of attaining your desired outcome.
6. Is your surgeon, or their office staff, available to you 24 hours a day to answer your questions, and address any issues that arise? You should never have to wonder if you would be able to find someone to help you when needed.
7. Does your surgeon provide you with the ability to look at before and after pictures, or talk to previous patients? There is little substitute for talking to a patient who has undergone a procedure similar to the one you are interested in.It provides further reassurance, and enhances your overall experience.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo has full admitting privileges at Northside, Piedmont, and North Fulton Hospitals. At the Nelson Center for Plastic and Reconstructive Surgery, we are committed to recognizing the unique needs of each patient to ensure they are treated with compassion and respect, in a comfortable environment. We allow patients the time to express their goals and ideas through open discussions grounded in trust and respect, while empowering patients with the knowledge to make fully informed medical decisions. Schedule an appointment to meet with us to discuss your next plastic surgery treatment.

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

Consider the following question…”Would you rather have wrinkles on your face, or would you rather have sagging skin?”

Unanimously we would agree that wrinkles would be preferred. Why then, when trying to combat the signs of facial aging, do we preferentially treat wrinkling, and address any facial skin thinning, or sagging, secondarily?

As commonly as Botox and other wrinkle relaxers are used, fillers should play an equally large role in facial rejuvenation. Most individuals unfamiliar with fillers are unaware that both treatments are administered identically, have similar recovery times, and are used to treat different signs of aging. When wrinkle relaxers and fillers are used in combination, dramatic and long-lasting results can be obtained.

So, how exactly do fillers work?

The most commonly used fillers today are comprised of hyaluronic acid, or HA, a naturally occurring substance found in the connective, skin, nervous, and extracellular matrix (ECM) tissues of the body. It is HA’s role in the ECM that provides most of its cosmetic benefits. The ECM is a gel-like fluid found in the spaces between our cells, providing tissue support, increasing tissue volume, and preventing tissue compression. Fillers place HA into the ECM, restoring and augmenting its properties.

In an earlier post we discussed how fillers improve the appearance of “static” wrinkles. These are wrinkles present in our skin even when we are not moving the underlying muscle, but fillers help address a number of the signs of aging:

Nasolabial Folds – These are the “laugh lines” or “parentheses” around our mouths that can deepen into noticeable lines. Fillers add volume and smooth the transition from the lips to the cheeks.

Upper and Lower Lips – Fillers plump thin lips, improve lip asymmetries, and enhance full lips. Fillers also help lift the corners of the mouth.

Marionette / Chin Lines – These are facial creases that run from the corners of the mouth towards the chin. Fillers add volume to the creases, minimizing their depth.

Jowling / Jawline – Fillers mask the shallow contour of jowling, while recreating the straight jawline of youth. Fillers can also be used in males to augment the back of the jaw, creating a more masculine, squared-off profile.

Cheeks – As we age our cheeks thin, flatten, and droop. Fillers reposition our cheeks into a higher, more youthful position, creating a more heart-shaped appearance to the face.

Lower Eyelids – The lower eyelids develop hollowing and darkening due to tissue atrophy and skin thinning. Fillers restore this volume and thicken the tissues.

Temples – Thinning of our temples is a hallmark sign of reaching our forties. Fillers replace this volume, improving an under-appreciated facial contour.

Others – Fillers are used to correct chin dimpling and clefting, subtle nasal asymmetries, low eyebrows, and recessed scars.

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Castillo leverages his training and experience to achieve natural, but noticeable facial rejuvenation results. Dr. Castillo performs all 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

In an earlier post we touched base on “dynamic” wrinkles, those present only when we are expressive (i.e. smiling, frowning, and laughing). These are best treated with wrinkle relaxers to prevent the underlying muscles, which cause these wrinkles, from contracting.

Given enough time, dynamic wrinkles give way to “static” wrinkles, those present even when our facial muscles are not moving. These wrinkles demonstrate continued breakdown of collagen and elastin, preventing our skin from creating a smooth, even appearance after muscle contractions have ceased.

For young patients, and those not yet ready to have surgery, dermal fillers can be used to improve the appearance of these wrinkles. By untethering the skin from its underlying muscle, and restoring lost volume, fillers help smooth these static wrinkles away.

With minimal downtime, and results that can last for three to four months, one can see why fillers have become the second most commonly performed, minimally invasive procedure in plastic surgery.

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Castillo leverages his training and experience to precisely target areas in the face to achieve natural, but noticeable results. Dr. Castillo performs all 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

In prior posts we have discussed the importance of skin care and adjunct procedures to prevent premature aging, a hallmark sign of which is wrinkling.

But, how do wrinkles form?

In the simplest explanation, wrinkles develop due to a loss of real estate. Consider your forehead. The only muscle found in the forehead is the frontalis. Responsible for raising your eyebrows, when the frontalis muscle contracts, its fibers shorten, and the eyebrows are pulled upward. What happens to your forehead skin? With the now shortened frontalis underneath, the skin of the forehead compensates and accordions into horizontal wrinkles. A similar phenomenon occurs to create crow’s feet and the “11’s” between a person’s eyes.

So, how do wrinkle relaxers work?

There are three main wrinkle relaxers on the market today: Botox, Dysport, and Xeomin. All three use the same compound, BTX-A, whose cosmetic effects on wrinkles was first recognized in 1989. Botox was the first approved wrinkle relaxer, and is the most commonly used today.

In order for a muscle to contract, a nerve must first release small packets of chemicals, termed neurotransmitters, into the space between the nerve and the muscle. Receptors on the muscle then grab on to these neurotransmitters leading to muscle contraction. Contrary to popular belief, Botox does not directly cause muscle paralysis. Botox is instead absorbed by the nerve, and prevents release of the neurotransmitters, thereby preventing muscle contraction. After 3-4 months, Botox levels within the nerve have dropped low enough that neurotransmitters are again released, resuming muscle contraction.

With the knowledge needed to create natural, but noticeable results, let Dr. Castillo tailor a specific wrinkle relaxer treatment plan to rejuvenate your forehead and eyes. Dr. Castillo performs all injections himself, supplying patients with 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

After incorporating the skin care regimen covered in Part I, what other options to accentuate your skin care results exist?

One of the most common signs of premature skin aging is wrinkling. With damage to the elastin and collagen in our skin, fine lines between our eyes, and in our forehead and crows’ feet begin to develop. At first, these lines are present only when we are expressive (i.e. smiling, frowning, laughing) and disappear when our facial muscles are relaxed. These are “dynamic” wrinkles, and are well treated with wrinkle relaxers such as Botox, Xeomin, or Dysport.

Placed into specific muscles of the face and neck, wrinkle relaxers temporarily prevent muscle contractions, affording skin a smoother, more youthful appearance. With minimal downtime, and results that can last for three to four months, one can see why they have become the most commonly performed minimally invasive procedure in plastic surgery.

Most commonly used by women in their late 30’s and 40’s, wrinkle relaxer use has grown exponentially for patients in their 20’s, as well as in male demographics. Patients in their 20’s view consistent wrinkle relaxer use as preventive medicine to avoid premature aging, while men have seen the benefit that an improved appearance can have in the ever-competitive business arena.

Curious to see what benefits wrinkle relaxers can have on your appearance?

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Castillo leverages his training and experience to precisely target areas in the forehead and eyes to achieve natural, but noticeable results. Dr. Castillo performs all 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

Atlantans can all appreciate the warm-weather, sunny climate that living in the South provides. Feeling the warmth of the sun on our skin can be revitalizing and, for sun-worshippers, therapeutic. The drawback to all this sunshine gathered on the weekends, and our long commutes, is premature skin aging.

UV radiation damages two of the most important components of skin’s architecture: Elastin and Collagen. Elastin is an elastic protein found in the body’s connective tissue that is responsible for restoring skin to its original shape after it is stretched, poked, or pinched. It keeps skin flexible and tight. Collagen is the main protein in connective tissue, making up 25-35% of all protein in our bodies, and 75% of the protein in our skin. It is responsible for giving skin its firmness and structure.

Damage to these proteins causes skin to look haggard, rough, and develop signs of premature aging: uneven pigmentation, age spots, thin skin, and wrinkles. Prevention is the best method to avoid sun-damaged skin, and a basic skin care regimen can have profound results.

There are many skin care products available on the market but there are three categories that should be incorporated into a daily regimen:

1. Retinoids (Retin-A, Tazorac, Differin) – These products rejuvenate the skin by increasing collagen and elastin production and help repair sun-damaged skin. These only work with consistent use.
2. Lightening Creams (Hydroquinone, Kojic Acid) – These products aid in evening skin tone and color, while helping improve the appearance of age spots.
3. Sunblocks – These help protect our skin from the sun’s radiation, and aid in retaining the positive effects gained with retinoids and lightening creams. Daily sunblock use is a must.

As an Emory, Harvard, and University of Pittsburgh-trained, board-certified plastic surgeon, Dr. Nelson Castillo can help you come up with a skin care program that can be the first step towards maximizing your youthfulness, and which will pay dividends for the rest of your life.