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chapter 6
Enhancing
the
Appearance
of Your
Skin
Wrinkle procedures/Skin resurfacing
chemical peeling
Dermabrasion (Surgical planing)
caring for Your Skin after
peeling and/or Dermabrasion
Non-Surgical approaches to the
aging process
Sun Screens
retin-a
Scar revision and Skin Surgery

131
Advanced Skin Rejuvenation
Wrinkle Enhancement and Skin Resurfacing Procedures

Note: Prior to reading this section, you should
have read Chapters 1 and 2 of this book!

About Non-Surgical Facelifts and texture of the skin, but may be
Some surgeons and aestheticians refer used as adjuncts to the methods here-
to the procedures herein described as a in described. the Mosaic Spa at the
“non-surgical facelift.” creative ways to Mccollough Institute offers a variety
apply peeling solutions do not change of products and services designed to
the fact that the materials cause a enhance the results and promote healing
separation of the upper layer of skin after resurfacing.
which “peels” or “sheds” within a few
days. Superficial layers of skin can be Treatment For Wrinkles
removed by a variety of methods of skin Neither a facelift, eyelid surgery
resurfacing including chemical peeling, (blepharoplasty) nor a brow lift will
dermabrasion and laser resurfacing (see remove the wrinkles of weatherbeaten
p. 138-146). each seems to have some skin, the transverse creases of the fore-
unique qualities and an experienced head, “crow’s feet” around the eyes nor
surgeon can explain which procedures the vertical wrinkles of the upper and
might be the most advantageous in any lower lips. Remember, surgery is
individual case. designed to improve sags and bulges
With any of these methods, outer lay- and resurfacing should improve
ers of the sun damaged, wrinkled, or wrinkles.
scarred skin are removed. however, We feel that in most cases some com-
only with deeper (Level III) procedures bination of resurfacing, dermabrasion
are new collagen and elastic fibers pro- and chemical peeling, offers superior
duced in the deeper layers of skin. as a results in treating wrinkling. (see p. 133)
result some tightening of facial tissues But every skin is different, and we will
occurs, but not to the extent which can recommend which combination of proce-
be accomplished with surgical removal dures might be best for yours.
through conventional facelifting and these procedures can usually cause
eyelid lifting techniques. the skin to have a more youthful full-
“Light” peels generally do not produce ness replacing the old wrinkles, in short,
long-term improvement in the quality a rewarding and frequently dramatic

Wrinkling or deep creases are best treated with a Level III skin resurfacing proce-
dure. Surgery improves sags and bulges; resurfacing improves wrinkles.

132
the following is Dr. Mccollough’s Skin and/or surgically-oriented dermatolo-
Rejuvenation Classification: gists. Level III resurfacing procedures
Level I – these kinds of treatment are the most effective methods of remov-
are often offered by non-surgeons, fre- ing severely, sun damaged, blotchy skin,
quently in a spa setting. patients are and deeper wrinkles. healing time is
able to return home or to work or play longer – generally two weeks – however
immediately. Little or no healing time results are long-lasting and dramatic.
is required. Level I treatments tend to treatments range from $950-$1,225 per
“polish” the skin for a few weeks, but facial region (ie around the mouth and
have essentially no long-term benefits. chin, or around the eyes – upper and
treatments range from $100-$250. lower eyelids). Full facial treatments
Level II – these skin resurfacing pro- range from $3,800-$4,900. In most cases
cedures are generally offered by facial operating room and anthesia are included
plastic surgeons and dermatologists. in the cost of resurfacing procedures.
More layers of damaged and wrinkled and, remember, different parts of the
skin are removed with these deeper same face generally require differing lev-
(dermis-level) treatments. healing time els or depths of treatment. For example
generally requires about a week. Level the thin skin of the eyelids may not toler-
II procedures are generally recommend- ate the same level of treatment that the
ed for patients less than fifty years old thicker skin of the forehead, nose, lips,
and/or those with minimal to moderate and chin may require. an experienced
sun damage and wrinkling. treatments surgeon will know how to vary the depth
range from $750-$900 per facial region of the treatment to meet the specific
($3,000-$3,700 for the entire face). needs of his/her patients. the next sec-
Level III – these procedures should tion deals with surgical procedures that
be performed by facial plastic surgeons enhance the breasts and body.

the patient in these photographs had Level III chemical peeling to correct wrinkles
around the mouth and dermabrasion a Level III for the deep lines.

133
this woman represents what might be considered the “ideal” candidate for skin resurfacing. the
deep creases around the mouth and eyes plus the weather-damaged appearance of the rest of the
facial skin result from years of sun and wind exposure. resurfacing with a Level III chemical
peel can often give the skin a much more youthful and “fresher” appearance. No surgery, other
than resurfacing, was performed. the change in hair styling and use of makeup contributes to
the more dramatic improvements in this case.

While resurfacing is not designed to correct the folds of overlapping skin of the cheek or eye-
lids, the resulting generalized “tightening,” smoother skin texture and better elasticity seem to
improve these conditions.

134
this photograph demonstrates the improvement obtained in this patient’s skin texture following
a Level III resurfacing. Some tightening of the eyelid skin also occurs with this procedure. No
other surgery was performed.

Many of the deeper creases around the mouth and cheeks were corrected in this same patient.

Skin Resurfacing may be the best treatment available to the facial plastic surgeon
to help maintain a fresher, more youthful looking skin for his patients. However,
keep in mind that no “down time” equates to no long term results. Unless it takes
2-3 weeks to heal, one should not expect long lasting results.

135
Skin resurfacing can provide a dramatic “finishing touch” to a total facial rejuvenation. this
woman first had a blepharoplasty (upper and lower lids) and facelift; then, nine months later she
had a Level III full face chemical peel.

the surgery improved the condition of sagging tissues while the peel improved the texture of the
skin itself.

Skin Resurfacing, like painting, is an “art form”; results can vary from one procedure
to the other and from one operator to the other.

136
although this woman presented with drooping and sagging tissues in her eyelids, face and neck,
other medical problems prohibited her having a facelift and blepharoplasty. Because she had
wrinkles in all areas of the face, a Level III full face resurfacing was performed. as a general rule
surgery corrects sags and bulges—skin resurfacing corrects wrinkles. Most patients who have a
chemical face peel do get some tightening of the skin.

although the skin resurfacing procedure did not extend below the jawline, notice the dramatic
improvement in the neck. She had no other surgery or treatment other than the Level III peel.

all photographs in this book are used to demonstrate the
result obtained in that particular case and should not be
used for comparison.

137
Laser Surgery
The Right Therapy for the Right Conditions
all lasers are not the same. they come more desirable result. Laser assisted hair
in a variety of different forms, and are removal is less painful and provides longer
designed to perform different tasks. Some lasting results than the traditional ways
lasers vaporize the outer layers of sun of hair removal (electrolysis). Scarring
damaged or aging skin. Some can also is much less apt to occur with laser hair
pass through the outer layers of the skin removal than with electrolysis.
and destroy deeper birthmarks (portwine the advantages of laser hair removal
stains) or tiny blood vessels (spider veins.) are that it is a safe, cost effective method
as is the case with most technology, there with few side effects. this method is fast
is an art to doing it. In order to obtain the and virtually pain free. also it is the most
maximum benefit, experience is required. effective method of permanent hair reduc-
Lasers, like any technology, must be used tion approved by the FDa. Outcomes vary,
for the right reasons. the right reason is as with any other treatment. having a
that a particular technology is superior to physician perform or direct the treatment
other forms of treatment. For some condi- is of extreme importance in order to achieve
tions, lasers exceed other forms of treat- maximal beneficial outcome and reduce the
ment. possibility of adverse effects or complica-
the skin care specialists at the Mosaic tions.
Spa are available to discuss any concerns Before
and desires you may have and recommend
the most appropriate treatment program…
for you.

Laser Hair Removal
Unwanted hair on various places of the
body haunts men and women. Fortunately,
at the Mccollough Institute Mosaic Spa
has a laser that will eliminate much of the After
problem.
at this time, laser therapy will remove
existing hairs. those, which have not, yet,
come through the skin may require some
future treatment.
Most treatment protocols usually take 3
to 6 treatments to be effective, spaced every
6-8 weeks. after these treatments most
patients will have no growth of hair for a
removal of unwanted hair.
period of time that may vary from months
to years. Laser hair removal should actu- Dilated Blood Vessels, Rosacea,
ally be considered “hair reduction” because and Pigmented Spots
a small percentage of hair will always after years of unprotected sun exposure,
grow back no matter what form of laser the skin will lose its smooth, uniform,
hair removal is used. those patients that youthful appearance. certain chronic skin
experience re-growth of hair, however, will conditions (like rosacea) can also cause
usually have a finer, less dense popula- damage to the collagen and elastic fibers of
tion of hair in that anatomical area. Spot the dermal layers. Maintenance and reju-
treatments may be done to achieve an even venation of collagen and elastic fibers help

138
maintain a youthful appearance to our skin.
Some types of skin conditions improved by Before
laser therapy are: benign vascular lesions
(telangectasias, rosacea, flushing, heman-
giomas), sunspots, photoaging, different
colorations in the skin, fine wrinkles, large
pores, and loss of tone and elasticity.
You are urged to refer to the rest of
Chapter 6 to learn more about Skin
Resurfacing Surgery for treating deep-
er wrinkles. After
Before

Dilated veins and capillaries.
After Acne
acne is a condition that affects about
80% of the human population. Usually
it is caused from the obstruction, inflam-
mation, and infection of the oil glands of
the skin. this condition normally presents
itself during the adolescent years due to the
hormonal changes in the body’s oil glands
become occluded. however, it can occur in
Sun damage and age spots.
adults as well.
Leg Veins Different modalities of medical treat-
Different types of lasers have been used ments for acne have been tried, unfortu-
during the last 20 years to address various nately, many patients fail to respond to
kinds of vascular lesions. (Dilated veins and them, including topical or systemic antibi-
capillaries) among these lesions are includ- otics, accutane therapy, and hundreds of
ed problematic leg vessels. (Varicose veins) over the counter remedies. Now there is an
these superficial vascular problems include effective way to treat acne with the lasers
small spider veins and larger varicose at the Mccollough Institute...with no side
veins. traditionally sclerotherapy (concen- effects, no pain, no downtime, and no sys-
trated salt solution) and surgical interven- temic drug treatments. Laser treatments
tion with stripping were the main methods for acne may only take 15 minutes. a mini-
of treatment for patients with this problem. mum of 8 treatments in a period of 4 weeks
Today the lasers at the McCollough is the recommended interval of therapy. In
Institute are being used to expand the severe cases it may be necessary to work
treatment of spider and varicose veins with a dermatologist in order to provide the
in the legs, ankles and feet. maximum degree of improvement
advantages of this treatment are lower So if have a skin condition, which con-
rate of side effects, shorter healing time, cerns you and you think you may be a
and absence of compression therapy after candidate for laser therapy, call us at
treatment when compared to traditional 251-967-7640.
therapy.
139
Chemical Peeling
a “chemical peel” involves the careful expressions. the creases around the eyes
application of a scientifically formulated produced by smiling, the forehead creases
solution to the skin which later causes that occur with frowning, and the verti-
the top layer to separate and shed (like a cal lines in the upper lip that occur with
blister) taking with it the sun-damaged and puckering the lips for the most part are due
wrinkled layers. Swelling of the peeled area to the contraction of the muscles of facial
may be pronounced for the first few days expression. None of the surgical procedures
but subsides dramatically after 5-7 days. discussed in this book are able to eliminate
the Level II & III peel procedure is much the preceding conditions. If wrinkles and
like having a sunburn or a blister in that creases are present at rest then resurfacing
the top layer of skin begins to “peel off” over combined with surgery may improve them.
a 4-5 day period revealing the fresh new patients are often misinformed about
deep pink layer underneath. Makeup may the long-term restrictions of activities fol-
be used approximately two or three weeks lowing a peel or dermabrasion. they have
after the application of the peeling solu- heard that once they have had a peel (or
tion; therefore most patients may return to dermabrasion) they can never get in the
work or go out socially at this time. When sun again—this, too, has not been our
instructions and precautions are heeded by experience.
the patient, the redness of the skin slowly While it is very important to avoid sun
subsides over the ensuing six (6) to eight (8) exposure and to use sun screen products
weeks, but can ordinarily be camouflaged for the first six (6) months, ordinary sun
by makeup during this time. exposure after that is allowed. It simply
takes time for the new skin to toughen or
Limitations and Restrictions build up a natural resistance to sun and
avoidance of prolonged exposure to wind. Because of persistent winds,
sunlight (as in sun bathing, fishing, golfing, salt in the air, and both direct and
etc.) for three (3) to six (6) months, is the reflected rays of the sun, patients who
primary restriction after peeling because live or recover along the seashore or
the “new” skin must build up a tolerance lakes must exercise extra precautions
to the elements; otherwise some patients especially during the early stages of
develop pigmentation and skin irritations. healing. those who do, tend to heal more
Since the advent of sun screen products quickly and are able to once again resume
and with the use of large brimmed hats all their interests and activities.
these restrictions can sometimes be loos- In our experience the results have gener-
ened. ask about any activity you question. ally been very good. the degree of improve-
(See page 157, sunscreen products.) ment for a surgical skin peel is not tran-
Neither surgery nor resurfacing can cor- sient, lasting for a period of time measured
rect wrinkles that occur only during facial in years.

Vertical creases frequently seen in the area of upper and lower lip are best treated with a Level
III skin resurfacing procedure.
140
Pertinent Facts You recommend you consider staying in pre-
Should Know arranged accommodations at or near the
1. With Level II & III chemical peeling, Institute during the first week, especially
the solution stings as it is applied, but this if you are having a full face peel.
is short-lived, a matter of seconds. Later 3. the procedure may be performed in
discomfort can be eased with appropri- our clinic but we may recommend you
ate medications. Since twilight and local stay close by for several days, (usually 3-5
anesthesia (page 42) are used for full face days for full face resurfacing).
peels, most patients have amnesia to their 4. When instructions are followed by
operating room experience. patients, scarring following peeling is
2. considerable swelling may occur for a extremely rare.
few days. the patient must be emotionally 5. Should red lumpy areas occur, they
mature enough and be willing to accept are softened with cortisone. Several treat-
this temporary distortion of appearance in ments might be required.
order to achieve the end result desired. It You should read the postoperative
is best to warn family members about this instructions (page 147) prior to your con-
beforehand. For this reason, we usually sultation and surgery.

Chemical Peeling: Stages of Healing

preoperative photograph of One day postoperative.
woman with deep facial wrinkling.

Seven (7) days postoperative. Fifteen (15) days postoperative.
141
Dermabrasion
Note: Prior to reading this section, you should have
read Chapters 1 and 2 of this book!

elevated or irregular scarring can often be improved by Level III dermabrasion as demonstrated
in this case. Occasionally, a second procedure can provide additional improvement.

When the skin has an irregular or and defects of different widths, depths
uneven texture from acne scarring or and configurations. (Study the series of
from previous injuries, a Stage II or drawings on page 144-145.)
III dermabrasion may provide some as the drawings demonstrate, the
improvement. It is also a helpful adjunct more superficial defects might be com-
to laser resurfacing when treating wrin- pletely removed by dermabrasion. those
kles, sun damaged, or deeply pigmented which are moderately deep may be
areas of skin. improved but not removed and some of
the technique of dermabrasion is sim- the deeper or “ice-pick” type scars may
ilar to sanding a scratch from a wooden not be improved at all.
table in that the work is actually done In some cases a second dermabrasion
on the elevated areas in an attempt to within 6-12 months can provide addi-
take them down closer to the level of tional improvement to those moder-
the defect. When successful, this dimin- ately deep scars. In some circumstances,
ishes the high-low junctions which are dermabrasion can be done a third time,
responsible for casting shadows when but there is a limit. prior to surgery
light strikes the face from an angle leav- it is difficult to predict the degree of
ing the skin somewhat smoother and improvement and each patient’s skin
tighter than before. responds to the same treatment by the
When the texture of the facial skin is same surgeon in a different manner.
very irregular from excessive or deep Skin pores are the surface openings
scarring a second treatment may be of the oil glands. Neither dermabrasion,
required 6-12 months after the initial laser, nor a peel, is designed to alter
treatment. them.
the following drawings represent an We will give you an appraisal of your
area of skin that might contain scars particular problem(s) and advise you

142
accordingly during your consultation. ly without the judicious use of sun screen
When dermabrasion is done as a part products. We will discuss this with you
of a revision for surgical or accidental during the consultation and postoperative
scars it can provide the finishing touch period. (refer to discussion of Sunscreen
to help smooth the tissues after the ini- products, page 157.)
tial procedures have been completed. Since the treated area will possess
(See photographs opposite page.) (See “new” skin it is understandable that the
Scar reVISION aND SKIN SUrGerY, skin tones and texture may vary from the
page 161.) untreated areas. proper makeup applica-
In some cases only dermabrasion may tion at the appropriate time should
be required for scars resulting from acci- camouflage this condition.
dents. (See photos page 146.) While we do not contend that derm-
abrasion is a treatment for “common”
After Surgery acne, in many cases, we have seen con-
as is the case with all resurfacing, the siderable improvement in this condition
final result will not be apparent imme- following dermabrasion. It can be helpful,
diately after dermabrasion. During the however, in cases of cystic acne which is
healing period the face demonstrates a refractory to medical therapy. (See photo-
deep pink or red color which should fade graphs below.)
dramatically within a week or two, but the degree of improvement will be
several months may pass before the heal- determined in part by the severity of the
ing is completed. condition treated. Please inform us if
Within about 2-3 weeks, makeup may you have taken Accutane for acne.
be worn to cover any residual discolor-
ation and patients may return to work, The Surgery
school, or resume their normal indoor Stage II & III dermabrasion is usually
social activities. But, do not use makeup performed in our clinic on an outpatient
until directed (by us) to do so. basis. “twilight anesthesia” is used when
Since the skin of the treated area will large areas of the face are treated. (See
be “new” skin it will need to be cared for twilight anesthesia page 42.) the sur-
as one would care for a new baby’s skin gery is relatively painless since the skin
–very delicately. is anesthetized by local anesthetics dur-
Direct sunlight during early stages of ing the procedure. With the technique we
healing, and later, is discouraged especial- use, pain is rarely a problem.

When cystic acne does not respond to medical treatment, a Stage III therapeutic dermabrasion
can often improve both the appearance and medical problems in the affected areas. the pro-
cedure may be repeated if necessary within several months. although we do not contend that
dermabrasion is a treatment for every case of acne, many patients have received some improve-
ment following this procedure. acne is generally a medical condition, not surgical; therefore, its
treatment should be supervised by the patient’s dermatologist.

143
You will be given additional instruc- All patients should read Chapters 1
tions regarding the care of the treated and 2 of this book and the section on
area and appropriate medications when Scar Revision and Skin Surgery.
discharged from the clinic. Postoperative instructions follow
Since dermabrasion is a surgical proce- on the next page.
dure usually performed by a rotating or
spinning brush, the risks of the surgery
should be considered and understood.

Dermabrasion is an invaluable component
of scar revision surgery. the scars depicted
in this patient required two stages. the scar
was first excised and closed with a zig-zag
plasty (geometric broken line). (figure B)

Six months later the elevated edges were
dermabraded, or sanded down with a Stage
III dermabrasion, leaving a much smoother
contour.

Figure “c” represents the final result six
months after the dermabrasion.

the dermabrasion procedure was performed
with a rotating wire brush under local

Following dermabrasion, the new skin may possess different skin
tones and a smoother texture.

A personalized skin care program administered by an experienced medical aesthetician
can help maintain the improved quality and texture of new skin for years to come.

the photographs in this book are used to demonstrate the
result obtained in that particular case and should not be
used for comparison.

144
GOALS OF DERMABRASION
Skin
Surface

this drawing represents a cross-section of skin containing a variety of defects.
the defects may vary in depth, width and configuration. Some are very deep,
penetrating far down into the dermis.

Dermabrasion (at level Z) generally removes the epidermal (top) layer of skin.
Many of the more superficial defects may be completely eliminated, those of
intermediate depth improved, but the deeper ones are only slightly better.

after a Stage III dermabrasion, a new layer of skin forms at a lower level.

145
Z

Often a second dermabrasion (at level Z) can be performed within another 6-12
months.

Following two (2) Stage II or III procedures some defects still exist but one may
see improvement in the overall texture and consistency of the skin.

Dermabrasion is designed to diminish the high-low
junctions of the skin’s surface.

Remember “microdermabrasion” is only a skin polisher and
will not eliminate wrinkles or improve scars.

Filler Grafts
Some skin craters (like chicken pox scars) can be surgically removed or elevated with
filler grafts using the patient’s own collagen. Dermabrasion is generally required 3-6
months later.

146
Postoperative Instructions for
Patients Undergoing Facial Skin Resurfacing
Chemical Peel and Dermabrasion

application of Dermal-AIDtM – a post resurfacing healing gel
the following instructions are based peak by the second or third day and
on experience with thousands of patients should begin to subside by the fifth
who underwent skin resurfacing proce- or sixth day. You can help decrease
dures and are designed to answer practi- the amount of swelling by keeping your
cally every question regarding the “Do’s” head elevated about 30 to 40 degrees
and “Don’ts” following these procedures. when reclining and, by staying up (sit-
You and your family should read these ting, standing, walking around) as much
instructions several times and become as possible. Sometimes the medications
thoroughly familiar with them. Faithful which are prescribed may help reduce
adherence to these instructions the swelling, but gravity and time are
tends to result in the smoothest post- more reliable.
operative course and most favorable
healing. Whenever a question arises, Discomfort (for peels only)
refer back to this section; more than Following the application of the peel
likely you will find the answer. If you solution, there is a stinging pain which
still are unsure, by all means, telephone lasts for a few seconds. the stinging
the clinic. quickly disappears but returns within
Failure to follow these instructions several minutes. When it returns it per-
faithfully can lead to certain com- sists for six (6) to eight (8) hours, occa-
plications which potentially could sionally longer. this type of discomfort
jeopardize the desired result. can usually be relieved by taking the
prescribed pain tablets.
Swelling after the first night, discomfort should
as you were informed before surgery, be negligible and can usually be relieved
you can expect moderate to severe swell- by regular or buffered aspirin. In fact,
ing in the areas treated, especially around aspirin is the medication of choice for
the eyes and lips. remember this is only the pain associated with this type of
temporary. Swelling reaches its procedure. (If you have had a facelift,
147
eyelid surgery [blepharoplasty], at the applied sparingly but gently rubbed in,
same time use only non-aspirin medica- as one would use any other moisturizing
tions.) You should use one of the non- cream. Do this only if instructed to do
aspirin pain relievers if you are unsure so—and use only products we recom-
(tylenol®, anacin-3®, percogesic®). mend.
try to keep the fingers, facial tissues,
Skin Appearance cotton balls or Q-tips away from the
(for all procedures) face. Fingertips contain bacteria and oils
Within twenty-four (24) to thirty-six and have been in contact with soaps,
(36) hours the treated areas resemble a nail care products and other materials
deep sunburn, blister, or abrasion, and which might irritate the delicate new
you may notice fluid oozing from the skin. Facial tissues and cotton can leave
skin. this is expected, because the super- behind irritating fibers. For other sub-
ficial layers of skin have been removed stances known to irritate new sensitive
from the deeper layer. skin see “Quick check” later in this sec-
Specific instructions will be provided tion. (p. 150)
for you to follow for the first several days Within about 2-3 weeks many patients
after your procedure. can use makeup over the resurfaced
Never pick at crusts or pieces of areas. Do not institute this yourself. In
skin that do not loosen easily. Apply some cases, healing may take longer. We
the topical dressing and try to leave will discuss makeup during your follow-
it in place until instructed other- up clinic visits. although they do not
wise. Sometimes we may prescribe usually cover as well, water base make-
an ointment or cream to help loosen ups are more easily removed and are
crusts, but do not use them unless therefore recommended for the first few
directed (by us) to do so. Crusting days. Makeup should never be applied
sheds naturally with time and treat- to unhealed areas.
ment. (avoid getting softening agents in We recommend a consultation with one
your eyes.) of our trained aestheticians. Hypo-aller-
at this time in your healing process, genic products are advisable as long as
new delicate skin is being formed. the skin is pink.
premature removal of the crusts may the intense pink color usually fades
damage this tender new skin and delay rapidly after the second week but some
healing. pink color will remain for six (6) to eight
DO NOT TOUCH: KEEP (8) weeks, continually decreasing in
HANDS AWAY FROM intensity.
TREATED AREAS. For a while, the skin usually appears
Do not wear a shower cap, wig or somewhat tense and slightly scaly. the
hair piece that comes in contact with finer wrinkles and the deep grooves,
any area which has been resurfaced. however, should also be less evident.
this might result in delayed healing and Occasionally small “white cysts” may
jeopardize an otherwise good result. appear in the treated areas. they are
During the first seven (7) days, the stopped-up oil glands and usually disap-
delicate new skin is undergoing a “tough- pear in two (2) to three (3) weeks without
ening up” process. By about the tenth specific treatment. If they persist, con-
(10th) to fourteenth (14th) day most of tact us; we can demonstrate a technique
the crusting should have disappeared to help eliminate them.
and the new skin will appear intensely early in the healing process, exposure
pink. the lower lid region is usually the to heat, cold wind or emotional upset
last area in which crusting disappears. (fear, anger, crying, etc.) will cause the
In some cases softening agents can be skin to temporarily become intensely
148
pink. this is due to increased blood flow you have a history of “fever blisters” or
or “blushing.” after about three (3) to four “cold sores,” other medications may be
(4) months, this phenomenon should dis- prescribed for you as mentioned on the
appear. Each time we have witnessed previous page in the section on “Fever
prolonged redness or irritation of Blisters.”
resurfaced skin, we have found that
something in the patient’s environ- Depression
ment and/or self-administered skin Because a person is so “keyed-up”
care treatments contribute to the before the operation, there is usually a
problem. mental and physical let-down afterward.
It is not unusual for the patient to feel
“Fever Blisters” depressed and tired following surgery. If
patients who have had difficulty with this happens do not be concerned.
recurrent “fever blisters” or “cold sores” No matter how much they wanted the
may develop an exacerbation of these operation beforehand and how much they
lesions four (4) or five (5) days postopera- were informed about what to expect post-
tively. If you have ever had this problem operatively, most are still surprised when
you should take enisyl®, one tablet four they see their face swollen and discolored.
(4) times a day for the first two (2) weeks One usually looks worse for a few days
postoperatively. this can be purchased following skin resurfacing. realize that
over-the-counter at the drugstore in every other patient experiences the same
bottles of 100 (no prescription is nec- feelings. the best “treatment” is to busy
essary). In many cases, we prescribe one’s self with postoperative care and to
Zovirax® or Valtrex™ pre and postopera- divert one’s attention to other activities
tively. Should lesions definitely appear, (t.V., books, etc.).
call the clinic so that we may prescribe
additional medication to be applied to the Resuming Activities
affected areas four (4) times a day. We 1. Wearing Eyeglasses—if the area
feel this helps prevent spreading of the around the nose has been resurfaced (as
“fever blisters” and often relieves some in a full face peel or dermabrasion), you
of the discomfort. although alarming, we should wait three (3) weeks before wear-
have rarely seen any permanent effects ing eyeglasses for prolonged periods. the
from them. pressure of glasses resting on the skin of
the nose, except for very brief periods of
Medications time, is to be avoided.
When discharged from the clinic you 2. Sun Exposure—try to avoid either
should continue with the medicine you direct or reflected rays of the sun for at
were taking prior to surgery. take these least eight (8) weeks, since pigmentation
as directed until the supply is exhausted; of the resurfaced areas may result when
these prescriptions need not be refilled. the new delicate skin is exposed too early.
continue taking the prescribed vitamins this means that sunning oneself (golfing,
for three (3) weeks postoperatively. You fishing, tennis, or similar activities) dur-
may also be given several new prescrip- ing the sunny part of the day should be
tions at the time of discharge. One of avoided during the initial eight (8) week
them is for the relief of pain. Sleeping pills period. the peeled or dermabraded areas
may also be prescribed but should not be should be protected for six (6) months
filled unless you feel that you need them. by large brimmed hats and a sun screen
Sometimes an antibiotic will be given. If product (ask our aesthetician to recom-
prescribed they should be started imme- mend the appropriate one for your skin
diately after surgery. antibiotics should type). these products must be worn if
be taken until the supply is finished. If you are to be exposed for prolonged peri-
149
ods. (See page 157 for details.) procedure(s) and at several intervals for
3. Skin Care—We recommend the first few weeks. the exact timing of
you consult with one of our trained these visits will vary from individual to
aestheticians and follow a personalized individual depending upon the healing
or customized program best suited for process, the extent of the areas resurfaced
your own skin type and life-style. and your place of residence. please make
4. Returning to Work and every attempt to keep these appoint-
Resuming Social Activities—When ments, since it is vitally important that
these should commence depends upon we closely monitor your healing. If you
the amount of public contact, the amount live in another city we prefer that you
of sun exposure your job involves, and the stay in town for the first week after sur-
degree of redness and swelling you devel- gery. Obviously, if small areas are peeled
op. the average patient returns to work or “touched-up” you may be allowed to go
or goes out socially about three (3) weeks directly home.
after the laser, peel or dermabrasion,
although, depending upon individual cir-
cumstances, social exposure can begin as
soon as makeup can be worn.
5. Athletics—Strenuous athletic
endeavors should be avoided for the first
month. exposure to extremes of heat,
cold or wind as in snow skiing, sitting
or walking by (or on) the beach or a boat
during the early stages of healing must
be avoided. Such exposure certainly
causes the skin to become pink because
of increased blood flow. however, this
condition should subside in a short while
if it occurs. remember you should care
for your new skin as carefully as that of a
newborn baby. Like a baby’s skin it may
have a more delicate texture and possi-
bly a different color. Your delicate new
skin (like that of a newborn baby) must Quick Check Postoperative
toughen with time. household clean- Care for Patients Having Skin
ers, fabric softeners, lotions and creams Resurfacing
with fragrances and preservatives, please follow these instructions care-
newsprint, dyes, makeups, nail polish fully. You should also review the mate-
products, astringents, detergents, hair rials in the consultation book relative
sprays, facial tissues, or cotton balls and to your surgery. Your final result will
Q-tips, etc., could produce some irritation depend upon how well you care for the
(contact dermatitis) during the first few treated areas and protect them from irri-
weeks. (See additional items next page tating materials or products.
bottom of first column) Your skin will remember…Keep haNDS aND
gradually toughen and tolerate most of WIpeS aWaY FrOM treateD areaS
your pre-surgical activities. aS MUch aS pOSSIBLe.
Keep haNDS aWaY FrOM
Postoperative Clinic Visits reSUrFaceD areaS
and Accommodations Remember your new skin is as
You will usually be seen in the clinic sensitive and delicate as a newborn
the day following your resurfacing baby’s…so…use good judgment. Don’t
150
take chances… and please do not ask covered with Dermal-AIDtM GeL at all
permission to vary from the instruc- times. this is done to prevent drying of
tions that you are given. Patients who resurfaced areas, so that they may heal
follow them tend to heal more quickly more quickly.
and end up with better results. * re-apply Dermal-AIDtM GeL every
As healing progresses, your skin one to two hours or as needed to create
will become more resilient, but this a protective covering over the treated
may take 2-3 months. Most people areas.
agree that the final results are worth * DO NOt USe aNY creaMS Or
the inconvenience. OINtMeNtS other than Dermal-AIDtM
After your operation, you become GeL at this time, unless instructed to do
the most important person in pre- so by your doctor or nurse.
venting problems. So, please follow * the doctor or nurse will instruct you
instructions! when to use cetaphil bar soap; do not use
If your new skin comes in contact the “anti-bacterial” or liquid cetaphil
(directly or indirectly) with irritat- soap.
ing substances, you might develop * try to avoid water on face; small
amount is not a problem; dry with blow
a rash (contact dermatitis). Should
dryer on the cool setting.
this occur, we can initiate another
* Do not touch resurfaced areas with
treatment program. But as is the case
anything other than Dermal-AIDtM GeL
with any allergy or irritant, avoid-
until instructed to do so.
ance is the first…and most effective
* You will be able to shampoo hair the
remedy. first day after surgery…however…USe
Tell us if you have a history of ONLY recOMMeNDeD ShaMpOO –
sensitive skin or other conditions. NO cONDItIONer.
(Dandruff, Seborrheic Dermatitis, * IF YOU are StaYING ON Or
Rosacea, Lupus or other Collagen Near the Beach, StaY INSIDe,
disorders.) WINDOWS cLOSeD, OUt OF the
SaLt MISt—it can irritate healing
For The First Week Post-Operative skin.
Following your procedure, we will DO NOt: Use aNY skin care or mois-
instruct you to use a product that has turizing products anywhere on your body,
been shown to provide more comfort and except those specifically recommended by
to promote more rapid recovery. It is us...and only when told it is okay to do
called called Dermal-AIDTM GEL. It is so.
the only product that we want you to use DO NOt: touch or rub your new skin
until you are healed. with fingers between treatments.
The objective during the first week is to DO NOt: rub or wipe skin with
prevent dry crusts or “scabs” from form- Kleenex®, skin cleansers, fabrics that
ing. Dermal-AIDTM is the best product shed, or facial tissues at any time.
we have found to help achieve this goal. DO NOt: Use cotton balls or Q tips®
(Beginning the day after surgery) on or around the treated areas.
* apply a thick coating of Dermal- DO NOt: pick at crusts.
AIDtM GeL to cover resurfaced areas. DO NOt: touch your skin until after
(For peels, we may recommend that you you have washed your hands thorough-
wait until the top layer of skin begins ly with cetaphil bar soap. Newsprint,
to shed before applying Dermal-AIDtM computer paper, household cleaners, pet
products & powders, detergents, cold
GeL.) creams, body creams, baby oil, bubble
* Keep all resurfaced areas completely bath products, soaps that contain cold
151
cream or fragrances, tartar control tooth- * When make-up has been approved by
paste and toothpastes which bleach or your doctor or nurse, please do not ask
whiten teeth should be avoided as long as permission to use anything other than
any pink color remains to the new skin. all mineral make-up. We recommend you
or any of these materials can cause rashes. check with the skin care specialists at the
Keep hair spray, colognes, perfumes, or Mosaic Spa at the Mccollough Institute
any substance with a fragrance away from for the make-up Dr. Mccollough has
the treated areas at all times. as a rule, approved.
if it smells “good” or “bad” its fumes may * remove make-up in shower with
irritate your new skin at this point. Follow water and cetaphil bar soap only.
the rules, protect your new skin and you * Use only Dermal-AIDtM Gel as a
can speed up the healing process. hand lotion or skin moisturizer, but only
DO NOt: Use bleach or fabric softeners if you feel you absolutely must use one.
in laundry. Keep haNDS OFF treateD * If you experience dry lips—use a
areaS eXcept aS INStrUcteD. small amount of healing ointment as
instructed by your doctor or nurse.
WEEK 2 (after seven days)
* reFraIN FrOM appLYING
continue Dermal-AIDtM GeL in week
Dermal-AID tM GeL ON aNY
two if crusts are still present and if you
reSUrFaceD area UNLeSS
are directed to do so. The objective for
INStrUcteD tO DO SO BY DOctOr
continuing with Dermal-AIDtM GEL is to
Or NUrSe.
soften any residual crusts crusts. Do not
* Keep haNDS aND WIpeS aWaY
use Dermal-aID GeL on skin which has
FrOM treateD areaS aS MUch aS
no crusts.
pOSSIBLe.
DO NOt USe MaKe-Up DUrING
DO NOt tOUch YOUr SKIN: Until
WeeK tWO (see week three instruc-
after you have washed your hands thor-
tions).
oughly with cetaphil bar soap. refrain
DO NOt tOUch YOUr SKIN: Until
from: newsprint, computer paper, house-
after you have washed your hands thor-
hold cleaners, detergents, cold creams,
oughly with cetaphil bar soap. refrain
body creams, baby oil, bubble bath
from: newsprint, computer paper, house-
products, soaps that contain creams or
hold cleaners, detergents, cold creams,
fragrances, and toothpaste with bleach
body creams, baby oil, bubble bath prod-
or whitening agents. Keep hair spray,
ucts, soaps or products that contain creams
colognes, perfumes, or any other sub-
or fragrances, and toothpaste with bleach
stance with a fragrance as far away as
or whitening agents. Keep hair spray,
possible and away from the treated areas
colognes, perfumes, or any other substance
at all times.
with a fragrance away from the treated
WEEK 4
areas at all times.
* continue using cetaphil bar soap as
WEEK 3 your body wash and face wash as your
* Use only mineral make-up with no
doctor or nurse has instructed.
sunscreen if skin is smooth and free of
crusts…but only if we have instructed you * rinse thoroughly to remove soap
to do so. film. Do not use soaps with fragrance or
cold cream. (Dove®, camay®, etc.)

152
Non-Surgical Approaches
to the Aging Process
For centuries mankind has searched respected scientists are researching
for the mythical “fountain of youth.” ways to reverse or at least slow down the
explorers have traveled to distant aging process. there is little doubt that
lands, ingested untold numbers of exotic better medical services, pharmaceuticals,
potions, and practiced ancient rituals technonogy, and heightened awareness of
for the sake of extending the length and
risk factors have extended the average life
quality of life.
Modern science is now engaged in the span throughout the world, especiall in
quest. more developed countries.

MAX-A-LIFE™ Diagnostic
An Advanced Health Screening and Supplement Program
“Wellness...a state in which all body systems are in biologic and
emotional balance.” E. Gaylon McCollough, M.D.

through the combined efforts of the program, developed by Dr. e. Gaylon
professionals located in the Mccollough Mccollough. the program has been more
Institute for appearance and health, we than twenty (20) years in the making...
are now able to offer advanced health and now is available only through the
screening and anti-aging programs. Mccollough Institute (and clinics).
Our MaX-a-LIFe™ program is avail- MaX-a-LIFe™ is based upon the fun-
able for anyone interested in knowing damental principle that early detection
more about his/her body...and the bio- of any imbalance in the body’s systems,
logic parameters, which indicate health... is the key to establishing a physical basis
or illness. for good health and long term well-being.
helping people from all walks of life If irregularities or troublesome trends
look—and feel—their best is one of the are detected, counseling and supple-
Mccollough Institute’s objectives. and, ments can be prescribed.
through the efforts of professionals repre- another distinctive feature of the
senting various wellness and fitness disci- MaX-a-LIFe™ program and testing is
plines, we are in a good position to achieve that, once identified, missing nutrients
that objective. are prescribed on an individual basis...
“Wellness” may best be defined as a state and only those nutrients which are found
in which all body systems are in biologic to be deficient are added to the diet. the
and emotional balance. however, experts “dose” and combination of supplements
agree that there are degrees of wellness— are determined by laboratory measure-
or illness. ments of the current levels of essential
Many times how one “feels” is subjec- nutrients within one’s system. this, we
tive... and based upon a variety of factors, believe, is the most scientific method of
some of which cannot be measured by helping an individual achieve a state of
laboratory testing. the good news is that biologic balance, which seems to be a fun-
some can be measured and corrected. that damental element of longevity.
they can is the basis of the MaX-a-LIFe™

153
In our surgery patients, our objec- advanced Intracellular analysis also
tive is to help determine your own allows us to offer different levels of test-
state of “balance”—or, perhaps, the lack ing that can also include virtually all of
thereof—prior to surgery. the tests we the essential biologic nutrients, including
recommend for our surgery patients are most hormones, and the building blocks
essentially the same as those we have of protein, fat, and carbohydrate metabo-
used for many years. the difference is, lism. Some testing levels also include
that the lab values can now be analyzed many of the catalysts needed to convert
by a computer program. the results the things we ingest into energy...and
of the tests, along with the screening promote health.
analysis, can assist us in prescribing and after the results of any of these tests
administering medications or anesthet- are analyzed, you are provided with a
ics, and in evaluating certain risk factors written report of the results, including a
inherent with any surgery, and the heal- statistical analysis of your current state
ing process, which follows. of health. When considered in context
at the Mccollough Institute (and clin- with one’s lifestyle, these tests offer
ics) our objective is not to treat “disease”. valuable information regarding many of
Our programs are intended to help well the factors believed to effect one’s qual-
people feel better...and, hopefully, live ity—and length—of life. We emphasize
longer. We stress that no program, by that the results of MaX-a-LIFe™ test-
and unto itself, can achieve this lofty ing and any suspected problems should
goal. It requires the full cooperation of be shared with your personal physician
the client/patient. Supplementation is for further investigation.
only a part of a healthy lifestyle. We do not believe that, when rea-
the right amount of exercise, avoid- son is exercised, Nutritional and
ance of known health risks, and proper Supplementary Science is in conflict with
diet, work hand-in-hand with one’s mind- traditional medical practices. to the con-
set regarding health. and, a positive trary, the evidence shows that this field
mind-set is necessary to achieve a state of study is “adjunctive” in nature.
of “well-being.” the body is an outstanding creation,
and, for those interested in a more in- capable of adapting to undesirable cir-
depth analysis, we offer more advanced cumstances. that it can do a better job
testing. of doing so when given the appropriate
At the McCollough Institute, building blocks, is undeniable.
we also offer advanced Intracellular On the “preventative maintenance”
analysis, which, in addition to checking side of the health care equation, most
traditional blood and urine chemistries, everyone agrees that when the indi-
and immune system building blocks, vidual joins in the quest for good health
examines for individual vitamin and (by doing the things he/she can to live a
mineral levels. healthier lifestyle) it is easier for his/her
With these added tests, some informa- physician to care for conditions, which
tion about more than eighty (80) nutri- require traditional therapies.
ents is obtained, allowing us to formulate and, when your body’s current levels of
a supplement and nutritional program essential nutrients are known through
for each person. appropriate testing, medical science can
this type of advanced medical test- assist you in getting them into better
ing is important, not only for trained balance (if indicated) through an indi-
athletes and performers, but for anyone vidualized supplement program, such as
who wants to do what he/she can to help MaX-a-LIFe™.
maintain biologic and emotional balance, as in the case with any maintenance
increase performance and endurance, program, your body’s systems should be
and live a happier, healthier, and hope- monitored by a nutritional consultant
fully, a longer life. who examines your laboratory results on
154
a periodic basis...and we can assist you Now, we can better help achieve that
with that, as well. goal through our MaX-a-LIFe™ pro-
It has been said that we are what we gram.
eat. however, because of certain genetic please refer to part III of this book for
factors, no two individual’s requirements more information on the MaX-a-LIFe™
are identical. a number of factors, includ- programs as well as other “extraordinary
ing exercise, stress, eating habits, gender, Medical testing” services offered at the
age, hormone imbalance, etc., also cause Mccollough Institute.
each of us to have different dietary and For additional information, call the
supplementary needs in order to achieve Mccollough Institute (251-967-7600).
the “balance” necessary to be “well”.

We can test for—and replace—imbalances in the vitamins, minerals and nutri-
tional substances necessary for optimal healing and bodily functions.

Vitamins, Minerals, and Herbs
Until now, there has been no scien- and require the presence of food in order
tific way to measure or monitor the blood to be effective as supplements.
levels of vitamins and supplements. the Minerals are another category of supple-
vast majority of vitamins/supplements are ments. In order for vitamins to be effec-
not stored by the body. the portions not tive, the body must also contain the essen-
needed are excreted by the kidneys. the tial make-up and amounts of the essential
fact that they are not retained provides an minerals. the body produces no minerals.
element of safety. “Overdosing” on these they must be supplied through the foods
“water soluble” products is unlikely. and products we ingest. Like vitamins,
Some vitamins (a, c, e, and K), how- minerals contain no calories, are not foods,
ever, are “fat soluble” and are stored and supply no energy. although minerals
throughout any part of the body where are necessary ingredients of the metabolic
fat exists. as more and more of the “fat process, food is still required. Many “pro-
soluble” product is taken in, more builds cessed” foods are depleted of some of the
up. a number of documented problems minerals they once contained. In a society
are associated with high body levels such as ours, there may be a need for sup-
of some of these vitamins, leading to plements. What is in question, however, is
medical conditions which are potentially what needs to be by how much?
dangerous. the same is true with many as mentioned in the previous section
“natural” products. of this chapter, the MaX-a-LIFe™ pro-
Vitamins and minerals are substances gram offered through the Mccollough
often classified as “micro-nutrients.” Institute can answer this question. We
they combine with the body’s enzymes have the ability to measure the body
to assist in the metabolism and utiliza- levels of both vitamins and minerals,
tion of foods, or macro-nutrients. Foods so that we can help determine what the
fall into one of three major categories: needs are for each individual who enters
carbohydrates, proteins and fats. each the program.
can be converted into energy. Herbs are also classified as part of the
the important thing to remember is nutritional supplement family. a number
that vitamins and minerals are not a of herbs contain the same ingredients as
substitute for food. they help to metabo- the “manufactured” pharmaceuticals
lize the foods we ingest. In general, vita- prescribed by the so called “mainstream”
mins have no calories, supply no energy, medical community for the treatment of

155
various diseases and ailments. the fact Digitalis is a naturally occurring leaf
that some herbs contain some of these derived from a plant. In the appropriate
same ingredients is both good and bad. doses, and when taken in the right cir-
One problem is that herbs and other cumstances it can prove extremely ben-
supplements are available to anyone who eficial for certain heart conditions. It is
wishes to purchase them, in whatever also lethal in the wrong doses and when
quantity one wishes to take them, and as taken for the wrong conditions.
often as one wishes to try them...without Marijuana and nicotine are also “natu-
a scientific monitoring system to deter- ral” drugs, which come from the leaf of
mine their safety in that particular a plant. cocaine and many other narcot-
individual. ics are derived from the poppy plant.
the manner in which any single per- Numerous other examples of “natural”
son responds to a drug or treatment is products could be presented, however,
different. Some people experience severe the point is probably made.
allergic reactions to foods, products, and Our objective is to attempt to bring
drugs that have no detrimental effect attention to some of the misinformation
on others. While all this seems rather flooding the health markets, and to dis-
obvious, these principles have not gen- pel some of the many myths, which exist
erally been applied to the practice of in the vitamin and health food industry.
recommending...or taking nutritional While we strongly support the intent
supplements and vitamins. to make people aware of eating more
Virtually any drug, vitamin, or nutri- healthy foods, replacing missing ele-
ent has some beneficial effects when ments from faulty diets, and providing
taken for the right reasons...and in the the body with every advantage it needs
proper doses. conversely, most every to combat disease and aging, we feel
drug, whether “natural” or manufac- an obligation to put things in perspec-
tured, whether recommended as part of tive. We recommend that people who
“mainstream” medical protocol or as part supplement their diets look carefully at
of an “alternative” medicine regimen, has labels, not only for contents and dosage,
some undesirable side effects and carries but also for purity and standardization.
some risks...in some individuals. these two indicators mean the manu-
the point to remember is that just facturer has tested and measured the
because it is a “natural” product does active ingredients. It’s your body—your
not make it safe. Some herbals have health—your life—that’s what’s at risk.
anticoagulant properties; that is, they Be bold...be smart. ask a pharmacist or
adversely alter the clotting system in the certified nutritionist about the reputa-
blood. taken with other blood thinners, tions of companies whose products you
(including aspirin, ibuprofen, Vitamin e, are considering purchasing.
etc.) they could cause internal bleeding or take the time. Do your homework.
increase the chance of complications dur- check with a medical library or reputa-
ing and after surgery. ble reference source and obtain as much
Vitamin e and Selenium, when taken information as you can about products
together, and in higher doses, cause you are contemplating adding to your
inflammation around some of the joints diet. What works for one person may
in the legs and ankles in both humans not work for you. Know what are a given
and animals. product’s side effects...and how to detect
although, the next series of examples them early. For additional information,
may be considered extreme, they affirm see chapter 15 in part III of this book,
our previous cautions about safety and or call the Medi-stat pharmacy at the
adverse interactions of the things we Mccollough Institute (800-737-2550).
ingest...or recommend.

156
Sensible Sun Protection:
What you should know about sunscreens
plastic surgeons and dermatologists What is Ultraviolet Radiation
are often asked, “what can I do to pre- (UV)?
vent wrinkles and slow down the aging Ultraviolet radiation (UV) is simply
process?” the answer is to avoid tanning one form of energy coming from the sun.
beds and shield one’s skin from the dam- UV rays are the sun’s invisible “burning”
aging rays of the sun, by reducing expo- rays—the ones that cause sunburn, and
sure. When one plans to be outdoors how- in some cases, skin cancer. there are
ever, hats/visors, protective clothing, sun- three types of ultraviolet rays.
glasses and sunscreens can help. there is
strong and conclusive evidence that the UV-A
premature—and most severe—signs of these rays maintain maximum con-
aging exhibited by the appearance of stant intensity throughout the year and
one’s skin are brought on by cumulative penetrate more deeply into the skin’s
exposure to the sun and wind. So, if one layers than UV-B rays. these rays con-
wishes to delay or prevent the premature tribute to premature aging, wrinkling,
appearance of wrinkles, blemishes and sagging, and a leathery appearance.
skin cancers, one should minimize expo-
sure…and begin to do so early in life. UV-B
these rays, which are stronger than
What is a sunscreen? UV-a, are more intense in summer
Sunscreens work by absorbing, reflect- months, at higher altitudes and closer
ing or scattering ultraviolet light, there- to the equator. UV-B is associated with
by reducing the amount that reaches the sunburn, premature aging of the skin,
skin. the absorbers are chemical agents and the development of skin cancer.
and the reflectors are physical agents. as
long as a sunscreen ingredient is in con- UV-C
tact with UV rays, it will operate in one these rays, although the strongest and
of these ways. Sunscreens reduce the most dangerous, are normally filtered by
amount of UV rays that come in contact the ozone layer and do not reach the
with your body—they don’t block all of earth. the amount of UV you are exposed
the UV completely. to changes with the time of day, seasons,
altitude, weather conditions, where you
What are the basic types of live, medications, reflective surfaces, and
sunscreen ingredients? length of time spent in the sun.
Sunscreen’s protective abilities vary
according to the sunscreen ingredi- What is the UV Index?
ent. Some sunscreens such as octyl a national UV Index was launched by
methoxycinnamate, octyl salicylate and the environmental protection agency, the
homosalate, absorb the most dangerous National Weather Service and the center
portions of UVB light. Others, like oxy- for Disease control and prevention. the
benzone, and titanium dioxide, absorb UV Index is issued daily to advise you
dangerous UVB and the more energetic on the strength of the sun’s UV rays in
part of UVa, while zinc oxide and avo- your region. the UV Index was recently
benzone absorb into the highest portions updated. It is a number that goes from <2
of the UVa spectrum. to 11+. the number indicates the amount
of UV radiation reaching the earth’s sur-

157
face during the noon hour. the higher the rarely burns,
UV Index level, the greater the strength of tans profusely 2 to under 4
the sun’s UV rays and the faster you may
burn. the National Weather Service fore- *Sun protection Factor
casts the UV index daily in 58 U.S. cities.
check the local newspaper, t.V., radio, When purchasing a sunscreen, check
or the Internet to learn the UV Index in the label to make sure your sunscreen
your area. protects against UVa and UVB rays (i.e.,
“broad-spectrum”). Be alert for sunscreen
allergies, or stinging especially in the eye
What is the Sun Protection or cheekbone area, which may show up
Factor? as redness and itching. Generally, sun-
the “Sun protection Factor” (SpF) tells blocks with microfine titanium dioxide
you how long the product is expected to or zinc oxide are less likely to cause an
protect your skin from burning. the SpF allergic reaction. certain medications,
on the label only reflects UVB protection. including diuretics, many antibiotics such
For example, an SpF 5 sunscreen should as sulfas and tetracyclines, antidepres-
protect your skin from developing red- sants, and some birth control pills can
ness five times longer than no sunscreen make the skin more sensitive to sunlight.
at all, while an SpF 15 product should therefore, exposure to UV rays may lead
protect you 15 times longer than no sun- to an increase in the frequency of adverse
screen. however, the degree of protection reactions to these drugs.
offered by a sunscreen depends not only high-risk individuals such as those
on its concentration but also on the thick- who have sun-damaged skin, autoim-
ness of application. therefore, one should mune disease, and those who have brown
apply sunscreen generously, uniformly, spots or a history of skin cancer, should
and frequently when the occasion calls wear a sunscreen that has the best UVa
for it. and UVB protection if they are going to
be exposed to intense sun.
How do I choose a sunscreen?
the choice of a sunscreen should be When and how should I use a
based on four factors: your skin type, the sunscreen?
length of time you spend in the sun, the apply a sunscreen about 30 minutes
intensity of the sun’s rays in your geo- before every exposure to the sun and reap-
graphic area, and the type of formulation ply frequently and liberally (using about
you prefer. an ounce to cover your entire body), at
the U.S. Food and Drug administration least every two hours, as long as you stay
designates five degrees of protection in the sun. the sunscreen should always
according to the SpF of the product: be reapplied after swimming, sweating,
or rubbing, since products differ in their
Sunburn and Recommended degrees of water resistance.
Tanning History SPF* Don’t forget to apply on all exposed
always burns easily, skin, including lips, nose, ears, neck,
rarely tans 20 to 30
scalp, hands, feet, and other areas that
always burns easily,
tans minimally 12 to under 20 are especially prone to sunburn. Once
Burns moderately, skin starts to burn, get out of the sun.
tans gradually 8 to under 12 Don’t reapply the sunscreen in hopes it
Burns minimally, will keep skin from burning—it won’t.
always tans well 4 to under 8 and remember 70% to 80% of the sun’s

158
damaging rays can penetrate through our advice: no one should stay in the sun
cloudy haze and water, so you need to for long periods, especially between the
use a sunscreen under these conditions, hours of 10 in the morning and 4 in the
as well. afternoon.
Now, proceed to read about the specific
What do doctors recommend? operations which are designed to reverse
the daily use of an effective sunscreen, the undesirable signs of aging. Since
or sunblock may help reduce the chances much overlap exists, we recommend you
of premature aging and wrinkling and the read about all the procedures covered in
incidence of skin cancer. But we repeat this section of the book.

The daily use of a broad-spectrum sunscreen may reduce the chances
of premature aging and wrinkling.

Because the long-term effects of tanning beds and ultraviolet light can
be at least as bad as prolonged sun exposure, we do not recommend them to
our patients.

Retin-A and Alpha-Hydroxys:
Skin Polishers

Whenever something is developed retin-a is a potent substance and will
that will improve the appearance of our cause severe reactions in sensitive skins
patients, we call it to their attention. unless it is diluted. We dilute the medi-
Such is the case with retin-a, a deriva- cine and prescribe it in lotion form and
tive of Vitamin a, and alpha-hydroxys gradually increase its strength over a
that produce similar results. Both period of time to avoid unfavorable reac-
improve early facial wrinkling and skin tions. Several strengths are available
changes caused by the aging process in through a prescription.
many people. retin-a is a prescription item and its
as you know, the skin is constantly use must be supervised by a physician. If
renewing itself. New cells that are not used properly according to directions
formed in its deeper layer, gradually it will be ineffective and represent a waste
move towards the surface and die. these of time and money. alpha-hydroxys are
cells become scaly and are quickly shed available through our clinic aesthetician.
by young people. When we age, however, It should be clearly understood that nei-
the scales accumulate and cause the skin ther Retin-A nor Alpha Hydroxys are
to develop a dull, lifeless appearance. a a substitute for cosmetic surgery, but
number of other changes also occur as a they are a helpful adjunct for the individ-
result of aging: the protective oil glands ual who desires additional improvement
become sluggish, blood circulation imme- beyond what surgery can provide. Many
diately beneath the skin lessens thereby patients become disenchanted with skin
impairing nutrition and the skin loses its polishers because of improper usage. One
elasticity because of the deterioration of of the most common problems is intense
its collagen elastin network. retin-a and redness and peeling. this condition gen-
alpha-hydroxys when used properly and erally occurs when full-strength retin-a
for a long enough period of time, tend to is used from a tube. Because of these
reverse these changes. common, but avoidable, sequela, we pre-

159
fer to start our patients on a product although some patients may see
other than retin-a. Our aesthetician can improvement in the texture and vitality
recommend one she feels is best suited of their skin early in the course of treat-
for your particular skin type. ment, the best results are not usually
after the skin develops some “resis- apparent until skin polishers have has
tance,” the strength of the preparation been used daily for 9-12 months. Unlike
can be increased with each subsequent a chemical peel which is a more perma-
prescription. We usually prefer our nent measure to improve the conditions
patients to stay with each prescription found in aging skin, it is necessary to
for three months before increasing the continue treatment with skin polishers
concentration. We do not charge our indefinitely. We find that highly moti-
patients for follow-up visits, so, please vated individuals are willing to continue
do not ask us to change prescriptions treatments and enjoy the benefits of bet-
through the mail or by phone. ter looking and healthier skin for many
years to come.

It should be remembered that products applied by—or recommended by—an
Aesthetician, purchased without a prescription from a physician, or which produce
only superficial irritations should be classified as “skin polishers.” They may enhance
the appearance of the skin, but only deeper (surgical) peels, dermabrasions, or laser
resurfacing performed by a licensed physician improves wrinkles and deeper
blemishes. For best results both approaches may be required.

160
Scar Revision and Skin Surgery
Note: Prior to reading this section you should have read
Chapters 1 and 2 of this book!

Some scars can be improved with carefully planned multi staged surgery over a period of 1-2
years (see photos page 166 for details about this case).

Unsightly, disfiguring scars, or defects Scars are usually unsightly because
can be disconcerting and often devastat- they may:
ing to one’s self-image. In addition to 1. be wide
scars, other blemishes or defects that 2. be longer than one inch
may be removed or improved with care- 3. cross natural creases or facial con-
fully planned plastic surgical techniques tour lines
include: 4. be elevated above the adjacent skin
• moles 5. be depressed below the adjacent
• skin tumors (cancers) skin
• birthmarks 6. be a different color than adjacent
• cysts tissues
these lesions may be partially or com- If any or all of these characteristics are
pletely excised with surgery. however, a present, improvement in any one of them
defect will result which must be repaired should make the scar(s) less conspicuous.
by either advancing the edges together correction of two or three of these factors
(primary closure), skin grafts, or flaps can often result in dramatic improvement
from adjacent skin. remember, any of the appearance (and sometimes func-
time an incision or injury penetrates tion) of the scar(s). “Surgical treatment”
all layers of the skin some scarring for deep scars and skin defects implies
will result. In most situations, addi- that incisions may be made to remove
tional revisional surgery within six (6) the existing scar or blemish.
to twelve (12) months can help provide a each incision made into the skin,
more satisfactory result. regardless of where it is placed, who
the appearance of most scars or blem- makes it, for what purpose it is made,
ishes may be improved by well planned or whether it is deliberate or accidental,
and carefully executed surgery, but heals in the same manner as any other
there are some important facts patients cut; that is, it produces scar tissue—
contemplating such procedures should nature’s method of healing. this simple
know. fact is frequently forgotten or ignored

161
in young children. Initially, a freshly
repaired incision of scar usually looks
pretty good. then it becomes reddened,
possibly somewhat raised above the sur-
rounding skin and frequently is hard
or lumpy. Gradually, (unless the scar
is frequently stressed by stretching the
surrounding skin) the firmness and red
color lessen and should disappear, leav-
ing a softer scar which is usually more
level with and somewhat lighter in color
than the adjacent skin.
patients seeking scar revision should
be emotionally prepared to accept sev-
eral facts:
First, removal will result in another
though, hopefully, improved scar;
Secondly, the final appearance will
When removing an existing scar or blemish by exci- not be evident for 6 to 18 months, and
sion, the surgeon makes every effort to place the Thirdly, more than one procedure may
line of incision as nearly as possible in or parallel
to one of the normal crease lines of the face or body. be required.
Sometimes it may be necessary to change the direc- this brings us to another very impor-
tion of a scar so that it will follow these lines. tant matter. Understandably, most
people with recent scarring want repair
by individuals who think that a “plastic immediately; however, scar revision,
surgeon” can make an incision and leave except in selected cases, should not be
no visible scar and that he can, in fact, undertaken too soon. the passage of
eliminate existing scars. time is the best, the kindest, and, in the
In reality, the surgeon’s goal is to long run, the simplest treatment to give
replace an unsightly or disfiguring to any scar of recent origin since most
scar with a better scar, one which is will undergo spontaneous improvement
more narrow, more level, blends with if given enough time to do so, often 6 to
the surrounding skin surface, and which 18 months.
causes no contracture or pull on the Only after the scar has become soft and
surrounding structures; in short, one white is it “mature.” a decision regarding
which is as inconspicuous as possible. a second stage revision may be delayed
the final appearance however is depen- until this time has elapsed. however,
dent on many factors, one of which is the scars which cause distortion of normal
patient’s own healing capability. (See structures (eyebrows, lips, eyelids, nos-
page 31 risks) trils, etc.) those which spread widely or
possibly conditioned by what they see produce deformity by contraction, and
on television and in the movies, many “U” or “J” shaped scars may be repaired
people expect this final result imme- earlier because little or no improvement
diately and become disappointed and in the basic problem can be anticipated
troubled because they have to wait for with the passage of time.
“maturation” of their scars. Maturation is When removing an existing scar or
the continuing change in appearance all blemish by excision, the surgeon makes
scars go through until they reach a state every effort to place the line of incision
where no further change will occur. as nearly as possible in or parallel to one
Maturation of scars may take from 6 to of the normal crease lines of the face or
18 months; sometimes longer, especially body.
162
NATURE’S HAND IN HEALING

a B

Following an injury most patients wish to have surgical correction of scars immediately. Waiting
can sometimes be the best treatment. In this case Figure a shows scarring of the forehead shortly
after an accident. three months later without any treatment Figure B shows some improve-
ment.

Six months later the lumps have flattened approximately two years later the area has
and deep pink or red color is diminished. healed nicely with minimal scarring. No sur-
gery was performed.

Sometimes it may be necessary to cedures to obtain the best achievable
change the direction of a scar so that it result. Usually 6-12 months separate
will follow these lines. each stage. Some scars “mature” more
excision of large unsightly scars, birth- quickly therefore, subsequent stages may
marks or blemishes may require multiple be performed sooner. One of the para-
operations over a period of time (so called doxes of healing is that scars on younger
serial excisions). Occasionally, it is nec- children may take 18-24 months, some-
essary to shift surrounding tissue to fill times longer, to mature, while the same
a defect, or rarely, even resort to skin scar on a patient in their 60’s may be
grafting. flat, thin and soft within 3 months. this
is one of the unpredictable factors that
Stages of Reconstruction accounts for the variability in the final
Scar revision often requires at least result that occurs with scar revision and
two and frequently three surgical pro- wound healing.

163
In Conclusion therefore, if a scar possesses any of
reMeMBer: the above characteristics, improvement
Scars are unsightly because they may: in any one of them should make it less
1. be wide conspicuous.
2. be longer than one inch Since Dermabrasion is usually a
3. cross natural creases or contour lines vital part of most scar revisions, you
4. be elevated should read the Section on Derm-
5. be depressed abrasion (page 142) carefully.
6. be a different color than adjacent
skin

Six months later the elevated edges were
dermabraded, or sanded down, leaving a
much smoother contour.

Figure “c” represents the final result six
months after the dermabrasion.

the dermabrasion procedure was performed
with a rotating wire brush under local anes-
thesia.

the photograph on the left shows a depressed scar on the forehead in this young woman. a zig-
zag plasty (geometric broken line) was performed on the forehead scar and several months later a
dermabrasion was performed. the photograph on the right shows the final result several months
after both the excisional surgery and dermabrasion.

164
Scar Revision And Skin Surgery
Postoperative Instructions
When incisions have been made into in areas where tapes would not stick to
the skin to remove existing scars or the skin (on the lip margin or around
blemishes, the new skin edges are care- the eyelid), tape is not applied over the
fully approximated with fine delicate sutures, so close adherence to the follow-
sutures (clips in the hair bearing scalp). ing instructions is essential.
It takes several days for the wound edges When no tape has been placed over the
to mend so the immediate postoperative suture line, we recommend you follow
period is crucial in your getting the best this routine. Six times daily you should:
possible result. Be careful not to injure — Saturate a Q-tip with full strength
the surgical area. Some swelling and hydrogen peroxide (from the drug
discoloration can be expected with any store).
surgical procedure. It can be minimized — Gently bathe the suture line with
by applying ice over the operated area the peroxide moistened Q-tip for 3
during the first 48 hours. minutes at least 6 times daily.
Some degree of swelling follows any — Always stroke along (parallel to)
surgical procedure. the swelling is due the suture line—never across
to the new tissue fluids brought into the (perpendicular) to it.
area by the body to promote healing. the — Following each peroxide treatment
increased blood supply to the region is apply a thin layer of the recom-
responsible for the pink color of the skin mended ointment to the suture line.
and some of the “discoloration” associ- remember, this ritual should be
ated with surgery. When these healing repeated at least six (6) times daily until
fluids are no longer required, the tis- the sutures have been removed or until
sues release them and they are absorbed we instruct you to discontinue it. We will
through the bloodstream. usually recommend you continue this
You must be willing to accept tempo- treatment program for as long as there is
rary swelling and discoloration which any crusting along the suture line.
occurs following such operations. though If you have had a tape dressing applied
usually visually disconcerting, most peo- to the surgical area, in the clinic, we
ple feel it is a negligible inconvenience will treat the incisions when the tape
to pay for the physical and psychological is removed and the suture material is
improvement they generally experience. cleaned away from the wound. We usu-
In many situations, a tape dressing is ally re-tape the area for another week
placed over the suture line to help protect or so to further support the new healing
it. Do not disturb the tapes and try not to scar. If this is done we ordinarily instruct
get them wet. they will be removed dur- you to remove the tape at home at the
ing your “one week” post-operative visit. end of the second week. If any crusting
Often the incision sites may be re-taped is present at that time follow the routine
for an additional week. outlined above until it disappears.
We generally use a dissolvable suture In most patients, makeup may be
to close surgical incisions. When the tape applied to the surgical area for camou-
dressing is placed over them, the surface flaging within 2-3 days after the tapes or
suture material ordinarily comes off sutures are removed. apply and remove
when the tape is removed. If not, it can it carefully.
be gently removed with delicate instru- We feel it is beneficial for you to tape
ments. the incision site at night or whenever you
When the incisions have been placed can for at least six (6) months. pulling or
165
exerting any tension on any scar seems to obtain the best possible result. the first
promote the formation of new unwanted two procedures generally require exci-
scar tissue. properly applied cross-taping sional surgery with suture repair. Later
will relieve some of the tendency for addi- stages usually require dermabrasion so
tional scar formation, so we recommend read Section on Dermabrasion carefully
you do it as much as possible. (page 142). In some cases laser treat-
anytime tapes are removed they should ments may be helpful. We will advise
be gently pulled along (parallel to) the you as to when your next stage should be
lines of the incisions, not across them. performed.
remember, it takes time (6-12 months) Notify us if you suspect any problem
for the scar to mature. It will get red and (infection, undue swelling or redness, if
lumpy before it begins to flatten and the sutures come out prematurely), or
become lighter in color. Not until it is if you are unsure about the instructions
white and flat is it mature, so be patient. you are to follow.
Sometimes cortisone can reduce exces- Failure to follow these instructions
sive lumpiness should it occur. faithfully can lead to certain complica-
In most scar revision cases, more than tions which potentially could jeopardize
one operation will be necessary in order to the desired result.

Most scar revisions require at least two or three stages in order to achieve the
maximum results.

Facial scarring resulting from fat injections...improved by excising
scars and defects.

166
Wrinkles And Blemishes
...In Perspective

It is important to remember that, in treating wrinkles, injectable fillers are tem-
porarily effective. Surgical skin resurfacing procedures discussed in chapter 6 (p.
131) are the most effective methods of improving wrinkles for many, many, years.

......................................

the most effective, permanent, and cost-effective way to treat wrinkles is with
a Level III chemical peel or dermabrasion. and the most effective permanent –
and cost effective way to enlarge lips and fill in the folds next to the nose or deep
wrinkles between the brows is by using a patient’s own collagen or a graft inserted
into a surgical tunnel.

......................................

Filler is a generic term applied to a mixed group of biomaterials that can be
injected in skin and soft tissues to achieve temporary volume restoration and in
the treatment of wrinkles. Some of these materials are very compatible with the
human body, while others are tolerated for a short period of time.

167