Facing Plastic Surgery -- Michael Powell, MD -- 9/24/2003

By Michael Powell
WebMD Live Events Transcript

Cosmetic surgery is more popular than ever, with men, women, and even children choosing procedures from eyelid lifts to major reconstruction. If you see a need for change in your mirror, check out our discussion with facial plastic surgeon Michael Powell, MD.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Powell. Is elective cosmetic surgery still growing by leaps and bounds in the U.S.?

Powell: Certainly it is. The latest reports show that more than 6.5 million people had cosmetic surgery in 2002.

Moderator: So is it safe to say plastic surgery is no longer a secretive thing for most people?

Powell: I think so. With the exposure through the media and Hollywood, most people today are very comfortable with considering and talking about cosmetic surgery.

Moderator: Do you think it's a good thing that so many people now consider cosmetic surgery an option? It certainly aids in boosting self-esteem for many, but is there danger of it being taken too lightly?

Powell: Yes, there's always that danger. I think it's a good thing when a person can consider self-improvement in a rational way, but on the other hand it can be taken to excess or considered lightly.

Moderator: Do you recommend people considering cosmetic procedures undergo some form of psychological counseling first to make sure they have a proper frame of mind, expectations, etc., before proceeding?

Powell: Most cosmetic surgeons do a fairly good job at screening appropriate patients. You should certainly be in good health and you should certainly consider the risks in cosmetic surgery, but it's necessary only to make an appointment with the surgeon you're considering, and he or she will be able to help you to determine if you're an appropriate candidate and if you're emotionally ready for this type of surgery.

Member question: I have had dark circles/bags under both eyes my whole life. I am now in my 40s and would like to look into having them removed. Is there such a procedure and if so what are its complications?

Powell: Yes, there is a procedure for this problem. Many people think that eyelid surgery corrects this problem. It does not. Instead, you may possibly be a candidate for a chemical peel or a skin resurfacing procedure around the eyes. This would certainly depend on the type and color of your skin, as well as other factors, which you would need to discuss with your surgeon.

Moderator: Could you explain skin resurfacing?

Powell: Skin resurfacing is a procedure whereby the top layers of skin are removed. This can be done with various chemicals, with dermabrasion, or with a laser resurfacing procedure.

Once these layers of skin are removed the underlying or deeper layer of skin regenerates a new and improved surface, thus improving wrinkles, age spots, and certain pigmentation problems.

Moderator: How permanent is skin resurfacing?

Powell: It depends, to a great degree, on the type of procedure that you have. Most patients are aware that there are different levels of peels or skin resurfacing procedures:

  • The milder peels -- an example would be the alpha hydroxy acids -- are simply a refreshing type of treatment, and are usually not very long lasting.
  • Then there are medium peels, which can last from six months, possibly to two years.
  • Finally, the deeper peels -- and you would put laser skin resurfacing in this category as well, as the stronger chemicals -- and these can last five years, possibly even much longer, depending on the skin, the age, and the desired result.

Member question: Is facial cosmetic surgery more difficult for people of color as far as scarring is concerned?

Powell: Yes. Scarring, as well as pigment problems. Certain people with darker skin produce hypertrophic scarring, such as keloids, and also darker-skinned people can be problematic because of unpredictable and/or abnormal changes to the skin color after the procedure. This can be in the form of hypopigmentation (abnormal lightening of the skin) or hyperpigmentation (abnormal darkening of the skin).

Member question: What's the youngest age a person can have elective plastic surgery, such as a nose job?

Powell: Well, one procedure that is typically done at a very young age is otoplasty. This is a procedure that corrects a lop ear deformity (pinning back of the ears).

However, if you are specifically interested in the nose, it depends on multiple factors. One is sex. Females typically mature earlier and can sometimes have rhinoplasty surgery in the early teens. The main concern is to make sure that full adult maturation has occurred.

In males, other factors should be considered. Not only do they take longer to reach full maturation or growth to the nose, but we also tend to wait until they are finished with contact sports, so as to not re-break a nose, complicating additional surgery.

Member question: My sister just had a nice-looking nose surgery. She feels a lot better about herself. But my question is what happens in 20 or 30 years as she ages (she's 30 now)? Will she have this perky little nose surrounded by and old lady's face? Will she have to keep getting her nose redone over the years?

Powell: No; that should not be the case. As we mentioned in the previous response, this surgery should not be done until full growth and maturation has been achieved. Therefore, one would suspect that even though she is getting older and maturing, the growth of the facial bone structure, including the nose, should be almost complete. The nose then should be a permanent change to her face and should fit proportionately as she becomes older.

Member question: I was in a bar fight where this guy hit me with a beer bottle. Now I have a scar across the bridge of my nose. Sometimes it appears bigger than other times. What can I do to get rid of it?

Powell: First, you need to see a facial cosmetic surgeon. He or she would advise you to protect this scar from sun exposure, and may prescribe certain treatments to help this scar to heal more favorably. Most surgeons would not consider revising or operating on this scar for approximately one year after the injury, but I would advise that you go ahead and make an appointment to be seen right away, because early intervention can sometimes prevent the need for later surgery.

I can certainly understand your concern, since this is in a very obvious part of your face. This is something that is covered by health insurance, but either way you should consider having this corrected.

Member question: Could you compare and explain glycolic peels, Retin-A, and microdermabrasion? I want to smooth out my skin, reduce the oiliness, and even out my skin tone. I have some fine lines, have some "pock marks" from a bout with cystic acne last year, not sure if anything will help those.

Powell: All of these will help to some degree. Certainly you may need to see a dermatologist to make sure that the cystic acne process has arrested. However, after that, a facial cosmetic surgeon would be able to examine your skin (type and color) and decide which method of treatment would be best for you.

Retin-A is a milder treatment, but if one is diligent and committed to using it many, many months, it can be a very helpful treatment. Glycolic acids would probably be the next step up from Retin-A, and can be performed in a doctor's office with minimal recovery time. However, their effects are sometimes short-lived and you will need to have these treatments repeated.

Depending on the level of scarring that you have you may need a more intense treatment regimen. This would possibly consist of injectable fillers for discreet acne scars, or even a deeper dermabrasion procedure, which is usually more beneficial in severe cases than microdermabrasion.

Member question: Is microdermabrasion the same as laser skin resurfacing?

Powell: No. Microdermabrasion is a milder abrading of the skin, usually done in the physician's office, sometimes by trained nurses, but is not the same level of treatment as laser skin resurfacing, which is, of course, performed by the surgeon in the operating room for a much deeper and more effective peel.

Member question: I am considering the Cool Glide laser for affordable and noninvasive reduction of wrinkles (mostly sun damage). Do you think this is a way to see improvement without wasting money?

Powell: I am not familiar with the laser treatment that you mentioned. Many centers are popping up across the country using lasers for hair removal and other conditions, and I know that recently some are claiming that newer laser technology can tighten the skin from underneath with minimal damage to the top layer.

In this case, you would need to research this treatment further, make sure it has FDA approval for this indication, and talk to your doctor to find out what his experience has been with this technology, and if there might be a better treatment for you. I would discourage you from choosing a treatment based solely on its affordability.

Moderator: What is the recovery from laser surgery like? And how permanent is this procedure?

Powell: Depending on the degree of your problem and then depending on the depth of the peel caused by the laser, peeling can take many weeks to sometimes many months, in terms of getting rid of the final redness, etc.

Laser resurfacing can give a very long-lasting result. Typically patients will have improvement anywhere from six months to five years, but with laser resurfacing, usually this is going to be towards the five-year side of the range. Some patients will even get a result that is fairly permanent and will not need to be repeated.

Member question: I have a sort of strange question. Do nose or lip piercings heal up if you remove the studs or rings? Or would I need plastic surgery to cover the holes if I decide I don't want the piercings any more?

Powell: Unlike pierced earlobes, most of the time in my experience, the holes in the nose and lip do not heal spontaneously. This, of course, depends on how long you have had the lip or nasal jewelry in place.

As a facial cosmetic surgeon, I discourage piercing body parts that contain cartilage, such as the upper part of the ear and the nose, because of certain complications and deformities than can occur. I also, because of functional reasons, would discourage piercing the lip.

I realize this is a common practice, and as long as the patient is aware of the risk then this is something that remains a personal preference. Therefore, if your holes do not heal, you will need to see a facial cosmetic surgeon. It is a relatively simple procedure for him or her to close these holes, with usually minimal chance of excessive scarring.

Member question: Is there any kind or surgery or procedure that can permanently deal with oily or very dry skin so we can stop buying all those expensive skin care products?

Powell: Well, there's not a procedure for dry skin. If you have dry skin, I would encourage you to be under the care of a dermatologist, so as to keep the skin moisturized, thereby preventing excessive aging. However, if you have the thicker, oily skin, many times a skin resurfacing procedure may help to improve this situation.

Member question: I have a question regarding a scar on my face. I had a fall and scraped my upper check and it created a sort of raspberry there, below my eye about the size of a nickel. It was not an open cut but red and irritated looking. I treated it with Neosporin, vitamin E, and Scar Repair (over the counter). A doctor - not a dermatologist -- said give it time, it will probably heal. But it may have gotten some sun and it is almost brownish colored now. I found a product call Scar Guard lightener -- have you heard of this?

Powell: First, it sounds as though you had an abrasion type of injury, then you healed with a vascular or red area to the skin. You definitely need to avoid sun exposure by using and SPF 30 sunscreen to this area. However, it sounds like you have already gotten too much sun exposure to this injury and have developed hypopigmentation (the dark area that you referred to).

I am not familiar with the specific over-the-counter product that you mentioned, but there are certain skin bleaches that will help to improve your situation. Most of these, if they were going to be effective, would require a prescription. I would therefore recommend that you see a dermatologist and have this area evaluated. Sometimes a combination of Retin-A and a skin bleach can help to peel this dark layer of skin and improve your result.

At any rate, the dermatologist would recommend continued sun protection and may recommend vitamin E, other prescription creams, etc., to enhance your healing, and therefore your final result.

If the area persists, newer laser technology can be very helpful at removing a darkened area such as this.

Member: I do have an appointment with a plastic surgeon.

Powell: That's fine; this is not necessarily urgent. Just remember, sunscreen, sunscreen, sunscreen.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Dr. Powell?

Powell: The main thing that I would just tell everyone is to protect your skin from sun damage, which is a major reason for all of the problems that we see. I can't emphasize enough how important it is to protect your skin from a very early age from sun damage. This will not only prevent aging, but may also prevent a more serious problem, such as skin cancer.

Moderator: Thanks to Michael Powell, MD, for being our guest.

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