Spring Sunshine and Your Skin

As I compose this latest newsletter, I can’t help but notice the 10cm of fresh snow that we have just received. Spring certainly seems a long way off. With the eternal optimism that defines Albertans, I am confident that we will soon be enjoying Alberta’s long sunshine-filled days as we pursue our favorite outdoor activities.

Albertans annually receive some of the most hours of sunshine in the entire world, despite our snowy winters. While this is great for honing our cycling or golfing skills, it also puts us at risk of developing skin cancers, such as basal or squamous cell carcinoma as well as malignant melanoma.

While my practice is not focused on skin cancers, every year I detect several early facial skin cancers, including melanomas on patients that come to see me for other problems. Fortunately, most facial skin cancers are slow growing and when detected and treated early, cure rates most favorable.

These skin cancers are caused by solar (sun) radiation and many factors increase our chances of developing skin cancers. These include occupation, genetics, skin type, pigmentation, time of day exposure and believe it or not, elevation. In general, someone such as myself, a Fitzpatrick type I skin – very white with little pigment, always burns - is at a high risk for skin cancer. Between 10:00am and 3:00pm, solar intensity is at its highest, and consequentially, the risk is greatest. There is a 4% increase in sunlight intensity for every 1000 foot rise in altitude above sea level. Generally speaking, our best defense is the liberal use of sunscreen with an SPF above 30 and to always wear a hat. It is also important to remember that prolonged sun exposure causes photoaging in which the skin loses elasticity causing a dry, wrinkled leathery appearance that is cosmetically unappealing and very difficult to correct. In other words, the best treatment is ALWAYS prevention.

With spring on the horizon, we also see a significant increase in interest in cosmetic interventions both surgical and non surgical. I suppose as the days grow longer and the sun starts to shine, our focus often shifts to maximizing how attractive we want to look and feel. In my practice, I see an increase in surgical consultations and procedures between April and September. Some of this is related to vacation time and school schedules. However, some of it due to our brains awakening after the long dark winter.

As always, we advise patients to plan well ahead when contemplating surgery. While we strive to do our best, there are occasions when we cannot accommodate the last minute request.

Have a great spring – remember lots of sunscreen and wear a hat!

Dr. John Keohane

A Touch of Hollywood

As I watched the Academy Awards last week, I noticed that there is certainly no shortage of beautiful men and women in Hollywood. The truly distinguished, however, are the actors and actresses who have managed to maintain successful careers, and a refined appearance and persona over several decades.

These are not the stars that we see in the tabloid magazines. These are the beautiful, iconic faces that typically grace the covers of Vanity Fair, GQ, or Vogue. These are the type of good looks that we try to emulate with cosmetic surgery, fillers or Botox. While we can’t make our patients look like celebrities, we can accentuate positive features such as cheek bones, lips, eyelids, and noses with nonsurgical and surgical interventions. Small amounts of Botox and Juvederm in the right places frequently result in a recognizable improvement in overall aesthetics.

Dr. Theda C. Kontis, M.D. from John Hopkins Medical Institute recently published an excellent scholarly review of injectable facial fillers. In the February 2013 issue of JAMA Facial Plastic Surgery, Dr. Kontis reviews the history and safety record of Hyaluronic acid, the main component of Juvederm, which has now been used for over seven years. Safety data has been recorded from over 400,000 patients with an adverse reaction rate of 0.06%. Most commonly used medications have an adverse reaction rate between 2-10%. In 2011, 1.2 million patients were injected with Hyaluronic acid in the United States. Based on those numbers, we can extrapolate that approximately 100,000 patients received Hyaluronic acid injections in Canada. This confirms what I tell my patients: Hyaluronic acid fillers such as Juvederm are very safe and effective. The best news in all of this is that you do not need to reside in Beverly Hills or make twenty million dollars a movie to enhance your true beauty.

Have a great March. Spring is just around the corner.

Dr. Keohane

Dermal Fillers — Where Bioscience Meets Biochemistry

As a surgeon, my number one goal for my patients is that any procedure I do will be safe, predictable, and based in science and physiology. Many things in life are predictable – sunrise – sunset – freezing weather in Edmonton in January. Unfortunately, many treatments in the field of cosmetic medicine and surgery are not. Fads come and go, sometimes with dire results for the patient. However, if we stick with well-researched and developed products and strategies, and use them in a thoughtful, conservative fashion, we should achieve aesthetically pleasing, long lasting results.

Juvederm Voluma is an example of bioscience meeting biochemistry. Juvederm Voluma is a highly concentrated crossed-linked hyaluronic acid, perfectly suited for volume replacement in deep cheek and nasolabial folds. Its effects are immediate and long lasting – up to a year- and if used properly, very safe. Juvederm has an excellent safety record. FDA approved in 2006, it has been used in thousands of patients, with no significant toxicity. However, if injected too superficially or on areas of very thin skin, i.e. “tear trough” below the eye, it may result in a visible bluish-grey discoloration due to the “Tyndall effect” - the scattering of light through the Juvederm. The lower eyelid is anatomically complex. Very thin skin fuses with a dynamic and well-vascularised muscle. Thus, injecting in this area can be extremely problematic. I am usually reluctant to inject this area and in the rare instance I do, I inject very conservatively – small amounts, slowly. Because of its cross linking, Juvederm Voluma is not suitable for this anatomic area. Lips are another area that can be augmented with Juvederm; however, we need to again be conservative and use the correct product and amount. I have found Juvederm Ultra plus XC to be excellent filler for the lips.

As many women age, the muscle of the lip – the obicularis oris- undergoes atrophy. This leads to a thinning or reduction of vertical height of the lip and a loss of lip definition with an increase in vertical wrinkles or fissures. Proper use of fillers in this area will correct this problem. Usually 0.4cc into the red lip – white lip junction with attention to creating a well-defined “cupids bow” for the upper lip with 0.2 – 0.4 cc’s for the lower lip will create a well-defined lip without the over-filled, pouty appearance many women fear.

In summary, if we choose the right therapeutic solution for the defined cosmetic problem, a solution that is well researched, tested and safe – and use it appropriately, the end result should be an aesthetically pleasing, natural cosmetic appearance.

Spring will be here shortly; stay warm!

Dr. Keohane 

Renewed, Recharged and Refocused...

In early December, I attended a three day course in exciting New York City—“The Cutting Edge 2012". This was an international interdisciplinary rhinoplasty symposium highlighting advances in rhinoplasty and facial cosmetic surgery. This course was co-sponsored by the American Society for Aesthetic Plastic Surgery and the American Academy of Facial Plastic Reconstructive Surgery.  There was great participation from surgeons from all over the world.

The universal theme of this meeting was the integration of rhinoplasty, fillers, Botox and other therapies to achieve a harmonious, natural result that is in balance with the rest of the face. Since rhinoplasty surgery is as much artistic in nature as it is scientific, often nonsurgical modalities, such as radiofrequency therapies like the eMatrix, judicious use of injectable fillers or steroids are used to modify results for those patients who have difficult-to-treat skin types. 

The use of high-volume fillers like Juvederm Voluma accentuate a good rhinoplasty result. Botox placed in the frown lines above the nose will soften the face, highlight the surgical result and provide a pleasing, harmonious result.  It was also reassuring to learn that our standard of care and good quality results are more than comparable with those of international experts from all over the world. 

These international scientific seminars are a wonderful way to recharge and refocus on our practice.  Maintenance of competence and continuing education is something that I take very seriously.  I attend 3 or 4 scientific surgical meetings each year and register and record these events with the Royal College of Physicians and Surgeons of Canada.  I believe this process makes me a better physician and ultimately, the beneficiary is you, my patient.

Whether your 2013 wish list includes younger looking skin or facial rejuvenation through surgical techniques, our team provides safe, effective, natural-looking treatments tailored to your unique needs. On behalf of the Centre, I wish you a beautiful New Year. Hope to see you soon.

Dr. John Keohane