Cosmetic surgery to ease bullying?

What would a parent do to ease the teasing and bullying of his or her child? Most parents would go to great lengths to prevent or limit any taunting or mocking that may cause a child distress. One option may include a visit to your facial plastic surgeon to discuss the advantages and disadvantages of seeking a treatment plan. The most common cosmetic operation performed on young children is otoplasty (ear surgery); teenagers have rhinoplasty (nose surgery) and otoplasty, among others.

Consultation

Before coming in for a consultation with a facial plastic surgeon, do your homework. Make sure you fully understand why your child or teen is getting teased and how it is affecting him or her. Children tend to feel excluded from others or uncomfortable from awkward stares and name calling. These devastating feelings can lead to depression and affect not only self confidence, but also academic performance.

At the consultation appointment, your facial plastic surgeon will discuss how the child feels about getting teased. For younger children, this may entail drawing a self-portrait. It is important that the child is old enough to understand why they would be getting the operation and what to expect afterward. For older children and teenagers, your facial plastic surgeon will not recommend an invasive procedure just so he or she may look prettier. Surgeries that produce subtle results with minimal benefits are not recommended either. Motivations and expectations will be fully explored before deciding on a treatment or procedure.

Otoplasty

Otoplasty can reshape, reduce, or make the ears more symmetrical. The surgeon will evaluate the ears based on proportion and harmony with the total facial features, in addition to taking measurements. Timing is important; the ideal age is about six years old, when the ear is 90 percent Cosmetic surgery to ease bullying? of adult size. The cartilage is extremely pliable, thereby permitting greater ease of shaping. The procedure is performed on an out-patient basis, so there is no overnight stay required. Young children usually receive general anesthesia.

Other procedures

Congenital defects, acne scarring, asymmetry, or imbalance can create distress unnecessarily if it can be corrected with treatment or surgery. Rhinoplasty (nose surgery), blepharoplasty (eyelid surgery), and scar revision are procedures that may be appropriate for teenagers. Again, your facial plastic surgeon will be very careful in evaluating if your child is a good candidate physically and emotionally.

Decision

You want your child to feel secure and self-assured, protected from unnecessary teasing or hardship. Be sensitive and ask questions when your child comes to you regarding getting teased. Make an appointment with your facial plastic surgeon to talk about your child’s feelings, your concerns, and the options available.

Consider the art of adding to your appearance, not removing or reshaping

When you think of facial plastic surgery, your first thought may be to remove unwanted wrinkles or sagging skin. Depending on your unique needs, however, your facial plastic surgeon may recommend adding to your facial features instead. Topical treatments, fillers, and implants are viable options that you should explore in an effort to bring out the best, youthful-looking you.

Adding to the eye area

As we age, the delicate skin around our eyes starts to thin. Blood vessels become more apparent (dark circles) and fine lines appear (crow’s feet). Before you jump to eyelid surgery, consider what you can apply to the skin. Dark circles under the eyes can often be improved, depending on the cause. Camouflage dark circles by applying a concealer that is yellow or green-based; this will counteract the blueness. Creams with hydroquinone and retinoid (vitamin A derivatives) will lighten dark areas. Moisturizers with anti-aging ingredients such as vitamins C or B5 can also improve slightly the tone and tightness of the skin when applied regularly over time.

Crow’s feet are tiny wrinkles that radiate from the corner of your eyes. They can be treated through various methods. An injectable filler will plump up the area and soften the wrinkles. Fillers are temporary and will require repeated treatments. Neurotoxins, such as Botox or Dysport, can be injected under the skin to paralyze the muscles in the face that pull the skin and cause wrinkles. The resulting smooth skin lasts from three to six months.

Forehead frown lines

If you have wrinkles across your forehead or the area between your eyes, two options you may consider are neurotoxins and fillers. Botox or Dysport will prevent the muscles from contracting and causing wrinkling. The fillers will add volume to the area to efface deep facial creases. Your physician may prefer one over the other or a combination of both depending on your needs.

Around the face and mouth

Fillers can be used to improve the appearance of moderate to severe facial wrinkles and folds around the mouth and the nose. The most common areas are the smile lines around your nose and mouth, marionette lines at the corners of your mouth, and fine lines above the mouth. The filler is injected with minimal discomfort and wrinkles and folds are plumped up instantly. The results last between a few months to two years, depending on the material used.

In some cases, an implant may produce optimal results to reduce marionette lines. Small implants can be placed along each side of the jaw, just in front of the jowl.

The Nose

Rhinoplasty (nose surgery) improves the function or shape of the nose; a surgeon may recommend increasing parts of your nose using a variety of materials, usually synthetic.

Cheeks

One of the strongest characteristics of youth is fullness of the cheeks, indicating an abundance of healthy soft tissues and fat that is present under the skin. As we age, we lose this fullness and the skin sags, appears flattened or sunken, and may cause folds and wrinkles around the mouth. The midface implant can hold up the collapsed tissue and restore the youthful appearance of adequately padded skin at healthy levels of distention and elasticity. This improves the contour, creates balance, and bolsters selfesteem.

Chin

In a recent study by the University of Rochester Medical Center, researchers found that significant changes in facial bones—particularly the jaw bone—occur as people age. As the jaw bone loses mass, it contributes to sagging skin, decreased chin projection, and loss of jaw line definition. Genetically, many people have a chin that is too small for their face, as well. Chin augmentation can help restore balance to the lower face and jaw line.

Make a consultation appointment with your facial plastic surgeon to determine whether or not adding to your appearance could provide an optimal, revitalized look for you. In some cases, adding could be combined with removing or even reshaping parts of your face. Only your facial plastic surgeon would know.

Advances in hair restoration

There has been much advancement in the quest for hair restoration. Medications, laser therapy, medical devices, and cloning are offering many men and women hope that progress is being made. With all the different treatments, make sure you talk to your facial plastic surgeon about what option(s) might be right for you.

Medication

In 2008, the U.S. Food and Drug Administration (FDA) approved Latisse, with the active ingredient bimatoprost, for eyelash growth. This created new buzz about how it could affect growth on the scalp. Some physicians have been prescribing the generic form of bimatoprost to combat hair loss since 2007. Patients that have had success state that where the hair was thinner and less pigmented, the hair grew in thicker, stronger, and healthier. It appears to work much the same way as Rogaine (minoxidil applied topically twice a day) or Propecia (finasteride taken orally once a day); all three strengthen hair that grows from a dying follicle, but none create new growth. The manufacturer of Latisse, Allergan, is currently conducting a clinical study to determine whether bimatoprost can be used as a treatment for hair loss. Stay tuned to see if it receives FDA approval.

Laser therapy

Low Level Laser Therapy (LLLT) was approved by the FDA in 2002 as a safe and effective treatment for hair loss. In 2007, the FDA approved the first home-use LLLT product, called the HairMax Laser Comb. Since then, several more hand-held devices have emerged—all less intense and more compact than what a patient would receive in the physician’s office. LLLT requires multiple treatments at regular intervals in order to produce results. The light wavelength emitted is non-thermal, or without heat; this means it is noninvasive and the patient remains comfortable during the treatment. LLLT is still under scrutiny; it doesn’t work for everyone and there are few published, long-term studies. Technology advancements and clinical findings are sure to shape this treatment option in the near future.

Medical Devices

High-tech medical devices that facilitate improved harvesting of follicles during a follicular-unit extraction (FUE) type hair transplant have been recently approved by the FDA. The NeoGraft was approved in 2009 and works as an extension of the surgeon’s hand, allowing for faster and more accurate harvesting of hair follicles. In April 2011, the ARTAS System received clearance from the FDA for harvesting hair follicles from the scalp in men diagnosed with androgenetic alopecia (male pattern hair loss) with black or brown straight hair.

The manufacturer, Restoration Robotics, states that “ARTAS is a physician-controlled, state-of-the-art, interactive, computer-assisted system that enables harvesting of hair follicles during hair restoration procedures. It combines several features including an image-guided robotic arm, special imaging technologies, small dermal punches, and a computer interface.” These devices make the process of hair transplantation less invasive, quicker, and less costly.

Cloning

Researchers have been working on ways to clone hair—the act of producing entirely new hair from the DNA of an existing one. There was some progress and renewed interest when a wound-healing powder was combined with plucked hair and claimed to grow new hair. There is some skepticism by clinicians and further study is being done.

About Fillers

Fillers are derived from collagen, hyaluronic acid, or synthetic material. Collagen (bovine or human derived) typically lasts between three to six months.

Hyaluronic acid (e.g., Restylane, Juvederm, Perlane) is very popular; it is approved by the Food and Drug Administration for correction of moderate to severe facial wrinkles and folds. This gel compound serves many purposes including filling the space between collagen and elastin fibers providing cushioning; transporting nutrients from the blood to the skin; and retaining water within the cell promoting volume and protection. Hyaluronic acid is biodegradable with results lasting six to 12 months.

A synthetic material such as Radiesse is made from synthetic calcium composite and lasts two to five years. Sculptra is made of synthetic polylactic acid that is contained in microspheres; it can last up to two years.

A permanent filler like ArteFill contains non-resorbable particles and is used to improve the smile lines (nasolabial folds). The results are permanent; however, touch up injections may be necessary within the first couple of weeks to achieve the desired results. Besides the permanent filler, all other filler treatments must be repeated to sustain the desired results.

Which filler is right for you? There is no one filler that is ideal for all sections of the face. Different fillers work better in certain areas and have various durations. Your physician will recommend the filler based on what will best meet your needs.


ASK THE SURGEON

I would like to improve the skin tone of my face, what are my options?

Your facial plastic surgeon may recommend rejuvenating the tone and texture of your skin through topical creams with antioxidants, retinoid (vitamin A derivative), or vitamins C or B5, which can offer slight improvement with regular use. Additionally, there are minimally invasive treatments such as microdermabrasion, fractional laser resurfacing, or intense pulsed light (IPL) therapy. These methods are particularly effective for fine lines, sun damage, rosacea, spider veins, and age spots.

Microdermabrasion offers advanced exfoliation by a gentle rotary tool or by blowing crystals over the surface of the skin to remove the upper epidermal tissue and stimulate cell turnover. The treatment evens the tone and texture of the skin, smoothing fine lines and improving clarity and radiance. Fractional laser skin resurfacing uses a precision laser to target only a fraction of the skin at a time. Small wounds are created deep in the dermis, which prompt your body’s natural response system to heal those wounds by rebuilding collagen and elastin. This results in tighter, more youthful-looking skin. IPL therapy, also referred to as photofacial, emits a broad spectrum of light with each pulse, adjusted for your skin color and type. The top layer of skin remains intact, as the heat energy penetrates the tissue and is absorbed by either the blood when treating vascular lesions or the melanin when treating pigmented lesions, thus damaging them. The body’s natural processes then remove the injured tissue giving the skin a more even and youthful appearance. IPL works well to improve conditions such as hyperpigmentation, enlarged pores, and acne scarring.

HEALTH TIP

Despite warnings about melanoma risk, young women and teens still prefer to tan. According to a survey by the American Academy of Dermatology, among almost 4,000 girls ages 14 to 22, the vast majority (81 percent) said they sunbathe outdoors either frequently or occasionally.

Recent recommendations from the International Agency for Research on Cancer, a subsidiary of the World Health Organization, state, “Policymakers should consider enacting measures, such as prohibiting minors and discouraging young adults from using indoor tanning facilities, to protect the general population from possible additional risk for melanoma.”

Currently, at least 32 states regulate the use of tanning facilities by minors. Some counties also regulate the use of tanning devices, including Howard County, Md., which is the first jurisdiction to ban indoor tanning for all minors under age 18.

Tanning is not safe. Sunscreen or sunblock should be applied at least 30 minutes before going outside with reapplication every two hours during peak times, 10 a.m. – 2 p.m. Avoid tanning beds entirely.

WHAT’S NEW?

The Food and Drug Administration (FDA) has approved Sylatron (peginterferon alfa-2b), an injectable drug for adjuvant treatment of melanoma, manufacturer Merck has announced. A Merck statement said Sylatron is indicated “for the adjuvant treatment of melanoma with microscopic or gross nodal involvement within 84 days of definitive surgical resection including complete lymphadenectomy.” This means that it is typically used to treat patients with advanced disease and is administered after surgical resection.