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The skin and its contents
SCIENTIFIC
FORUM
Editorial
The Skin and its Contents uring my residency program someone jokingly made the statement that plastic surgeons "take care of the skin and its contents," obviously alluding to the fact that on any given day we might use muscle, bone, tendon, nerves, fascia, bowel, or skin in our reconstructive procedures. At that time I was aware of the importance of the skin and, to a very small degree, of skin care treatments. Although sunscreens were not available, we dutifully instructed patients to avoid exposure to actinic rays if they had any degree of sun damage or precancerous changes. We also discussed with them the merits of using Noxema | or Oil of Olay | to protect and tone the skin.
D
When the revolution in skin care technology occurred, we began thinking about the skin in a way to which we were unaccustomed. With the advent of sunscreens, we learned the difference between the effects of ultraviolet A rays and ultraviolet B rays, which sunscreens were the most~ft:ective, and how to use them to enhance and preserve aging skin. During that time we were using phenol peels and dermabrasion to smooth wrinkles and relying on skin rejuvenation products such as moisturizers, which were minimally effective. Then along came alpha-hydroxy acid products and with them, an emphasis on daily skin care with compounds that could smooth finer wrinkles and enhance the absorption of moisturizer into the skin to produce a "plumping" effect. Before all of us had time to learn the actual effects of these products, the lighter alpha-hydroxy acid peels, which produced little change in the skin structurally, were superseded by various types of trichloroacetic acid (TCA) peels, which could actually alter the skin's surface structurally in much the same way as phenol peels and dermabrasion. However, these substances did not produce the harsh depigmentation effects of the stronger peels. Before we had time to grasp all of the nuances of TCA peels and treatment combinations, the much talked about and anticipated laser for skin resurfacing became a reality. Today we have not only laser technology but also a wide spectrum of new skin care products associated with the use of lasers. Even as I write this editorial, newer types of lasers for resurfacing, hair removal, and scar minimization are being introduced. As one reviews the evolution of skin care technology, it seems amazing that the high public demand for these services existed well before any scientific trials were conducted or legitimate peer-reviewed articles on them were written. Yet plastic surgeons had to become familiar with these new skin care technologies, sometimes wondering whether they were truly the most beneficial for patients, but fearful of missing the new information bandwagon. Many of the touted benefits of alpha-hydroxy acid treatments were not realized and simply did not live up to the media's ~ '' of them. The short life span of TCA peel technology could be attributed to the lack of satisfactory results and the frequency of complications such as hyperpigmentation and hypertrophic scarring. What does all of this tell us? First, we must seek information on new skin care technolo-
316
AESTHETIC
SURGERY
JOURNAL
~
SEPTEMBER/OCTOBER
1997
SCIENTIFIC
FORUM
gy from those individuals with the most experience in using particular techniques. Second, when a technology is almost too good to be true, it probably isn't! We must be cautious in the use of new methods, because they bring with them new complications and problems. Use of products and devices that do not live up to their reputation (usually from the media) can damage the credibility of plastic surgeons. Our patients trust us to be a reliable resource for new information and to use new technologies in the safest manner to help them achieve their aesthetic goals.
James H. Carraway, MD
N THE MOVE? ress at least six w e e k s ahea( D o n ' t miss a single issue of the journal! To e n s u r e p r o m p t service w h e n y o u c h a n g e y o u r address, please p h o t o c o p y a n d c o m p l e t e the f o r m below.
Please send your change of address notification at least six weeks before your move to ensure continued service. We regret we cannot guarantee replacement of issues missed due to late notification. J O U R N A L TITLE: Fill in the title of the journal here.
OLD ADDRESS:
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COPY A N D MAIL T H I S F O R M TO: Journal Subscription Services Mosby-Year Book, Inc. 11830 Westline Industrial Dr. St. Louis, MO 63146-3318
Taking Care of the Skin and its Contents
OR PHONE: 1-800-453-4351 Outside theU.S.,call 314-453-4351
OR FAX TO: 314-432-1158
Mosby
AESTHETIC
SURGERY
JOURNAL
~
SEPTEMBER/OCTOBER
1997
3t7
FORUM
Editorial
The Skin and its Contents uring my residency program someone jokingly made the statement that plastic surgeons "take care of the skin and its contents," obviously alluding to the fact that on any given day we might use muscle, bone, tendon, nerves, fascia, bowel, or skin in our reconstructive procedures. At that time I was aware of the importance of the skin and, to a very small degree, of skin care treatments. Although sunscreens were not available, we dutifully instructed patients to avoid exposure to actinic rays if they had any degree of sun damage or precancerous changes. We also discussed with them the merits of using Noxema | or Oil of Olay | to protect and tone the skin.
D
When the revolution in skin care technology occurred, we began thinking about the skin in a way to which we were unaccustomed. With the advent of sunscreens, we learned the difference between the effects of ultraviolet A rays and ultraviolet B rays, which sunscreens were the most~ft:ective, and how to use them to enhance and preserve aging skin. During that time we were using phenol peels and dermabrasion to smooth wrinkles and relying on skin rejuvenation products such as moisturizers, which were minimally effective. Then along came alpha-hydroxy acid products and with them, an emphasis on daily skin care with compounds that could smooth finer wrinkles and enhance the absorption of moisturizer into the skin to produce a "plumping" effect. Before all of us had time to learn the actual effects of these products, the lighter alpha-hydroxy acid peels, which produced little change in the skin structurally, were superseded by various types of trichloroacetic acid (TCA) peels, which could actually alter the skin's surface structurally in much the same way as phenol peels and dermabrasion. However, these substances did not produce the harsh depigmentation effects of the stronger peels. Before we had time to grasp all of the nuances of TCA peels and treatment combinations, the much talked about and anticipated laser for skin resurfacing became a reality. Today we have not only laser technology but also a wide spectrum of new skin care products associated with the use of lasers. Even as I write this editorial, newer types of lasers for resurfacing, hair removal, and scar minimization are being introduced. As one reviews the evolution of skin care technology, it seems amazing that the high public demand for these services existed well before any scientific trials were conducted or legitimate peer-reviewed articles on them were written. Yet plastic surgeons had to become familiar with these new skin care technologies, sometimes wondering whether they were truly the most beneficial for patients, but fearful of missing the new information bandwagon. Many of the touted benefits of alpha-hydroxy acid treatments were not realized and simply did not live up to the media's ~ '' of them. The short life span of TCA peel technology could be attributed to the lack of satisfactory results and the frequency of complications such as hyperpigmentation and hypertrophic scarring. What does all of this tell us? First, we must seek information on new skin care technolo-
316
AESTHETIC
SURGERY
JOURNAL
~
SEPTEMBER/OCTOBER
1997
SCIENTIFIC
FORUM
gy from those individuals with the most experience in using particular techniques. Second, when a technology is almost too good to be true, it probably isn't! We must be cautious in the use of new methods, because they bring with them new complications and problems. Use of products and devices that do not live up to their reputation (usually from the media) can damage the credibility of plastic surgeons. Our patients trust us to be a reliable resource for new information and to use new technologies in the safest manner to help them achieve their aesthetic goals.
James H. Carraway, MD
N THE MOVE? ress at least six w e e k s ahea( D o n ' t miss a single issue of the journal! To e n s u r e p r o m p t service w h e n y o u c h a n g e y o u r address, please p h o t o c o p y a n d c o m p l e t e the f o r m below.
Please send your change of address notification at least six weeks before your move to ensure continued service. We regret we cannot guarantee replacement of issues missed due to late notification. J O U R N A L TITLE: Fill in the title of the journal here.
OLD ADDRESS:
NEW ADDRESS:
Affix the address label from a recent issue of the journal here.
Clearly print your n e w address here.
Name Address City/State/ZIP
COPY A N D MAIL T H I S F O R M TO: Journal Subscription Services Mosby-Year Book, Inc. 11830 Westline Industrial Dr. St. Louis, MO 63146-3318
Taking Care of the Skin and its Contents
OR PHONE: 1-800-453-4351 Outside theU.S.,call 314-453-4351
OR FAX TO: 314-432-1158
Mosby
AESTHETIC
SURGERY
JOURNAL
~
SEPTEMBER/OCTOBER
1997
3t7