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Visit Drs. Timothy and Jennifer Janiga’s blog regularly for office and product updates and information about important topics in plastic surgery and dermatology. If you have a question that you would like addressed, please contact us.

Cosmetic Surgery is on the rise. Will you partake?

Cosmetic Surgery

TIME magazine’s June 18 cover story was titled, “Nip. Tuck. Or Else. Why you will be getting cosmetic procedures even if you don’t want them.” After reading this article, I was excited to see some things mentioned, and I disagreed with one major point.

The concepts that I thought were covered well were numerous. The article also did a great job of talking about different types of surgeries and the different types of patients that are getting surgery in the U.S. The general idea that the old concept of hiding your procedures was mostly de-bunked and the new ideas of being proud of your choices were reviewed. The best part of the article, in my opinion, was the outline of the increase in cosmetic procedures. It is true that cosmetic procedures continue to increase every year as new technologies, less invasive procedures and great techniques improve. So, it’s little surprise we’ve seen a rise in procedures.

The one area that was covered extensively in this article that I disagreed with was the idea that plastic surgery is done – and will be done – because people are trying to keep up with their neighbors. In my practice, I do not find this to be true.

In general, most women (and men) come in to my office to improve a particular area that bothers them. The patient may be a mother who would like to get her pre-baby body back with a mommy makeover, a person changing career tracks and wanting to look their best with a facelift, or someone who has always been bothered by a particular area on the body such as the nose. Overall, my patients are everyday people with families and jobs who just want to look their best. These men and women are usually referred by a friend who has had surgery with me, but they do not come in because their neighbor had surgery.

The article in TIME is a good read, full of information, but a few areas should be taken with caution.

If you are considering plastic surgery, do it for you! Call us or go online to schedule a consultation with a board-certified plastic surgeon who can help you decide which procedures are best for you.

FDA approves pill to treat skin cancer – Dr. Jennifer Janiga’s take

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Basal cell carcinoma is the most common type of skin cancer in the United States. According to the Skin Cancer Foundation, close to 2 million Americans each year are diagnosed with basal cell carcinoma. If caught early, it can be treated easily. In rare cases, however, it can grow to a large size and, in very rare instances, travel to other parts of the body or metastasize. Some cancers are close to cosmetically sensitive areas such as eyelids or lips and cannot be cured with surgery. At times, patients are ill with other conditions that prevent them from having surgery. For these rare instances, a new medication has been developed for advanced or untreatable basal cell carcinoma. This medication, called Erivedge (generic name Vismodegib), has received FDA approval.

Erivedge is a pill that’s taken every day. It works on the hedgehog signaling pathway which plays a significant role in development of basal cell carcinoma. This pathway is usually inactive in adults, but is active in more than 90 percent of basal cell carcinomas.

This medication cannot be used in pregnancy and has some significant side effects similar to most chemotherapy medications such as hair loss, vomiting, diarrhea and muscle aches.

Although basal cell carcinoma is the most common type of skin cancer, when caught early it is very treatable through minor surgical procedures and topical medications. Only in advanced cases would a chemotherapy drug such as Erivedge be used, and usually this would be done with an oncologist and dermatologist working together.

The best way to treat basal cell carcinoma is to prevent one from becoming advanced, which means catching it early. An annual skin check is the best way to do this, but you should also watch for any growing, changing, enlarged, bleeding or irregular lesions when you’re performing your monthly skin self-examination. To learn more about Erivedge or other basal cell carcinoma treatments, please contact Janiga MDs and make an appointment for a consultation.

Wrinkles, Migraine Headaches and Botox

Botox, Dysport and Xeomin are improving quality of life for patients with a myriad of medical problems. Botox is the one that most people have heard of for treating wrinkles and migraine headaches, but it can also be used to treat many other conditions. These chemicals are produced from the bacteria Clostridium botulinum and are widely used by dermatologists to treat wrinkles. Besides Botox, Dysport and Xeomin, there are literally hundreds of natural and man-made neurotoxins, which are substances that alter the nervous system’s function. Some of these complex proteins include pesticides, lead, aluminum and certain insect venoms, and can lead to illness if used improperly or in high doses.

Botox, Dysport and Xeomin have very few side effects when used in small cosmetic doses and work by temporarily relaxing or blocking the innervation (contraction) of the muscles around the eyes, forehead and other areas of the face. The effect of this is to smooth and improve the appearance of wrinkles. These chemicals can also be approved by the FDA for treating migraine headaches and other health disorders. Botox is now used to restore movement for stroke victims, to treat cervical dystonia, chronic migraines, TMJ and urinary tract conditions, among others. The latter include overactive bladder, benign prostatic hyperplasia (BPH), urinary retention and interstitial cystitis, better known as painful bladder syndrome. Cervical dystonia is a painful and chronic neurological movement disorder that causes an involuntarily turning to the left or right, or up or down of the neck. The use of these chemicals has been shown to reduce these painful movements.

botox-for-migraines

Migraine is the neurological disease characterized by moderate to extremely severe headaches that last between 2 to 72 hours. Migraines are often associated with other nervous system symptoms such as nausea and vomiting, as well as extreme sensitivity to light, sound and smell. Some migraine sufferers actually experience an aura, which is a transient visual, sensory or language disturbance that precedes the headache. It is estimated that two percent of the population suffers from chronic migraine headaches. The range of risk factors include being female, young, having a family history of migraines or a history of head or neck injuries. It is well recognized that stressful life events such as divorce, loss of job, having a psychiatric disorder or other pain disorders are also risk factors for migraines. Some risk factors, such as the overuse of headache medication, having a high caffeine intake, being obese or having a sleep disorder including snoring, are considered modifiable. A patient who suffers from a headache 15 or more days per month for more than three months would be diagnosed as having chronic migraines.

The use of Botox can help certain types of migraines, particularly those that begin in the forehead or around the eyes. It works by blocking innervation to the sensory nerve, which runs within a muscle deep to the eyebrow near the bridge of the nose. The treatments in some patients can prevent a migraine attack for about three months. Treatment of migraines, stroke or other neurologic conditions must be done by a neurologist. If would like to discuss treatment of your migraines with Botox, Dysport or Xeomin please make an appointment with your neurologist. Bladder conditions or other urinary tract problems must be treated by urologists. Please make an appointment with your urologist to see if you are a candidate for these treatments.

As plastic surgery and dermatology providers, we administer Botox for cosmetic benefits, most commonly to treat wrinkles of the forehead, the eyes and the area between the eyes. Botox also can be used to help reduce the appearance of frown lines, lip lines and other problem areas on the chin and the corners of the mouth. If you want to learn more about cosmetic improvements with Botox, please contact Janiga MDs and make an appointment for a consultation.

Rhinoplasty: Cosmetic Benefits versus Health Benefits

best-rhinoplasty-surgeon

Rhinoplasty is one of the most common surgeries I perform. Frequently, I am asked the difference between rhinoplasty for cosmetic reasons and rhinoplasty for medical reasons and what are the benefits of each. In order to answer this question, we first need to discuss the different types of surgery that can be performed on the nose. These procedures can be performed in combination or alone depending on your specific situation.

“Functional rhinoplasty” and “septoplasty” are the terms used for internal nasal surgery performed through your medical benefits on your health insurance. This is performed when the septum (the wall down the inside of the middle of your nose) is deviated (moved to one side) and inhibiting your ability to breathe or the ability of the sinuses to drain, causing chronic sinus infections. This surgery is mostly performed inside the nose and relocates the septum to a central location, allowing both sides of the sinuses to drain and air to flow through. This type of surgery is performed purely to improve breathing or sinus drainage and does not include any external procedure to improve the look of the nose. That said, cosmetically if the septum is deviated, the nose usually appears slightly crooked. Fixing the deviated septum usually improves the appearance of a “crooked nose.”

Turbinate repair is another medical procedure that is performed inside the nose. The turbinates are the tissues on the wall of the nose that secrete mucus and swell in response to allergies. In people with severe allergies, the turbinates can swell enough to obstruct breathing and cause problems with sinus drainage and airflow. The turbinates can be lessened in size with surgery. This improves airflow through the nasal passage, decreases mucus secretion and allows the sinuses to drain better.

Polypectomy is another procedure that can be performed medically inside the nose. Polyps are small grape-like sacs that grow from the sinus walls in response to severe allergies. These sacs can cluster and obstruct sinus drainage, impede airflow and cause chronic sinus infections. Polyps can be removed surgically with a polypectomy. Removing these polyps allows the sinuses to empty, improves airflow and decreases sinus infections.

Most of the cosmetic procedures performed on the nose are performed to improve the external appearance of the nose. Cosmetically, there are a few areas people like to improve on the nose. The dorsal hump, nasal tip and overall size can be improved with cosmetic rhinoplasty. When performing a rhinoplasty for cosmetic reasons, it is important to always consider the functional aspect of the nose. In every rhinoplasty I perform – whether cosmetic or functional – I want the patient to be able to breathe better following the procedure.

The dorsal hump is the bone and cartilage at the top portion of the nose. At times, this hump can be more prominent and make people feel as though the nose is hooked or broken. This can be a normal anatomic variance, but it often bothers a significant number of people from a cosmetic perspective enough to seek out surgery. For this procedure, we shave down the bone and cartilage where the bump is to improve the contour and external appearance of the nose.

Tip rhinoplasty can be performed in conjunction with dorsal hump removal, but also is performed commonly alone. Tip rhinoplasty is performed on the very bottom of the nose for patients who do not like the appearance of that area. The tip can be lowered, raised, widened or thinned out without changing the shape of the nasal opening. This surgery improves the appearance of the bottom portion of the nose and the nasal opening.

When patients come in to be seen for cosmetic rhinoplasty, they often just want the nose to be “smaller.” Making the nose smaller usually involves a combination of tip rhinoplasty as well as some version of dorsal hump shaving to make the nose smaller.

Each procedure we perform is specific to your situation and can be combined with other procedures to give an overall improvement in function, cosmetic appearance, or both.

If you have a problem with the inside function of your nasal passages, please call Janiga MDs and make an appointment with me, Dr. Timothy Janiga, for your complimentary cosmetic rhinoplasty consultation or your insurance appointment.

Plastic Surgery Summer Trends

Face-Lift

As summer enters full swing, we have seen an increase in body cosmetic procedures such as breast lifts, breast augmentations, abdominoplasty (tummy tucks), mommy makeovers, breast reductions and liposuction.

With warmer weather comes bathing suits, shorts and tank tops, bringing attention to parts of your body that may bother you. As a result, people start thinking about making improvements in these areas. Breast augmentation is common throughout the year, but tends to increase in warmer months and just before wedding season. Similarly, mommy makeovers, breast reductions, breast lifts and liposuctions become more common in the warmer months.

Wedding season, New Year’s, birthdays and the start of the summer months are just a few reasons (and seasons) that motivate people to come in for a cosmetic surgery consult. Whatever the motivation and whatever the season, Janiga MDs is here to give you the best opportunity to look and feel your best.

Get ready to hit the beach with confidence. Make your complimentary plastic surgery consultation with Dr. Timothy Janiga to see which of these procedures is best for you.

Sunscreen Chemicals: The Verdict

sunscreen safety

There has been a lot of talk lately about sunscreens as they relate to chemicals, safety and SPF. Even “Good Morning America” had a recent expose on the topic. The hype in the media comes from the EWG’s (Environmental Working Group’s) 9th annual Guide to Sunscreens, the release of which has spurred a significant amount of talk.

SPF

The first controversy surrounds SPF values higher than 50. The EWG does not feel sunscreens higher than SPF 50 should be recommended. Additionally, the FDA reports that the benefits of SPF max out around 50 and notes that in Europe, Japan and Australia, any SPF claims above 50 have been banned. The American Academy of Dermatology recommends SPF greater than 35 as its threshold. The bottom line here is that, if you are applying sunscreen that is above an SPF 35, reapplying every two hours when outdoors and using a sufficient amount of the product to cover you, there is no need to choose a sunscreen with an SPF of 100. That being said, if the one you like happens to have an SPF of 100, there’s no harm in having a higher SPF rating. I tell my patients that if you wear it, it works. So, wear what you like, reapply – and apply liberally.

Oxybenzone

Other controversies center on two ingredients in sunscreens: oxybenzone and retinyl palmitate. Oxybenzone is a synthetic estrogen that has been present in sunscreens since 1980. The controversy here exists in the concept that, as a synthetic estrogen, if absorbed by the body, oxybenzone could affect hormone levels. The EWG recommends avoiding all sunscreens with oxybenzone while the Skin Cancer Foundation suggests there is no evidence that it is absorbed in appreciable amounts and, even if it was, that there would be no adverse health effects. The original research that is cited for the dangerous claims comes from a study in 2001 that fed young rats more than 1,500 mg per kilogram per day which was in a very high dose that is not achievable in humans without oral consumption. My bottom line to my patients is that if you are concerned about oxybenzone being a synthetic estrogen, even in small amounts, there are plenty of sunscreens to choose from that do not contain it.

Retinyl Palmitate

The second ingredient in question is retinyl palmitate. Retinyl palmitate is a form of vitamin A that some people suggest may increase the risk of skin cancer. In fact, the EWG website reports that this form of vitamin A can be linked to skin damage. However, the Skin Cancer Foundation reports just the opposite, stating that, when used in this formulation for sunscreen, this vitamin A derivative may actually be an antioxidant and protect the skin. My bottom line for my patients on this ingredient is similar to that of oxybenzone; if you are concerned, there are many sunscreens that are available without it to choose from. With both oxybenzone and retinyl palmitate, the two sides cannot seem to agree. Luckily, we have many choices in the United States and we can all wait for all sides to agree and avoid these products in the meantime if we want to.

Aerosolized Sunscreens

Another area that has been discussed recently is aerosolized sunscreens. The American Academy of Dermatology and other groups have long reported that cream-based sunscreens are better. We have known for a long time that application of aerosolized sunscreens can be irritating to the skin due to the propellants and alcohol base in these products. We have also known that people do not apply them in large enough quantities to make the SPF rating as it is stated on the bottles, and more recently people have been discussing the possibility of inhaling large quantities of the sunscreens as a dangerous delivery method. This is one area where the American Academy of Dermatology, the FDA, the EWG and the Skin Cancer Foundation can agree. Each group cautions against use of aerosolized sunscreens in favor of cream-based applications.

Nanoparticles

Nanoparticles, which exist in titanium and zinc oxide based sunscreens, are another controversial topic. Zinc oxide is EWG’s first choice for sun protection. This is the famous white paste that you remember from so many lifeguards’ noses in the ‘60s. These days, we micronize zinc oxide so the application looks less white. The micronizing is the nanoparticle. The nanoparticle is essentially necessary in order for it to be clear on the skin, otherwise it would look white. Current theory from EWG, the American Academy of Dermatology, the Skin Cancer Foundation and the FDA supports that these particles do not penetrate the skin in appreciable amounts to cause damage. These are the physical based sunscreens or non-chemical that are advertised.

From my perspective, the most difficult things about a titanium or zinc sunscreen are the availability and price. Honestly, these are a more expensive type of sunscreen, sometimes costing up to five times as much as a chemical sunscreen. Titanium and zinc sunscreens can be difficult for some people to afford and difficult for some people to find in their area, and you have to become a label reader to find them. Look for labels that read “chemical free” or “physical blockers only.”  Some examples are from the Honest Company, which makes an SPF 30 called Honest Sunscreen Lotion. This product is completely chemical free. Aveeno recently came out with one that is available at regular drugstores called Aveeno Baby Natural Protection (for adults it’s labeled Aveeno Natural Protection.) These are essentially the same product with mineral-based sunscreen titanium and zinc oxide. If you can find either, they will work the same. CeraVe also produces a great line of physical blockers.

Other products we recommend and carry at our office: TIZO, Elta MD, Skin Ceuticals and Replenix all offer sunscreens that are chemical free. TIZO’s Lip Fusion is one of the only sunscreen sticks for lips I have found that is physical blocking only.

A tip I give my younger patients is to use a titanium and zinc face stick. It does a great job covering the cheeks and nose without burning children’s eyes when they rub their faces. This product has been available over the counter for more than 15 years and I have used it on my own children since they were born. I used to only be able to find it at baby stores and online, but now major drug stores as well as Aveeno have created their own, more widely available formulations.

There is a lot of information to wade through when you are a consumer. When experts disagree, it further complicates things. Either talk to your dermatologist or avoid the controversial ingredients until all the experts can agree. Personally, I have been putting mostly titanium and zinc oxide based sunscreens on myself and my children for more than 10 years. There are times when chemical sunscreens are the only thing available or affordable, so I use some of those in a pinch. Today’s children will be the first generation to have sunscreen applied to the skin from six months old on to old age. If we make the best educated choices that we can at the time, then we’ve done what we can to protect ourselves from skin cancer and maintain as healthy as a lifestyle as possible.

Hopefully this information helps you sort through what is out there and to make your own, educated decisions.

Learn more about the difference between physical and chemical blockers.

Why Eating Dark Chocolate is Good for Your Skin

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The answer begins with an understanding of free radicals, which are the biological “bad guys” that damage cell structure. In the skin, this damage leads to the breakdown of collagen and blood vessels, which then manifests as uneven skin tone as well as sagging and wrinkling. Free radicals are the result of the oxidation of atoms, or the exposure of atoms to oxygen, which causes them to break apart and become “unpaired electrons,” or what are otherwise known as free radicals. These free radicals then steal electrons from otherwise stabile atoms, thereby preventing these atoms from providing cell structure, thus impairing the cells’ ability to function in a healthy fashion.

Dark chocolate is loaded with nutrients that benefit the skin, such as soluble fiber and valuable minerals, but more importantly, it also contains antioxidants, which prevent or diminish the cell damage caused by free radicals. On a molecular level, any compound that can donate electrons to counteract these free radicals is said to have antioxidant properties. These “good guy” antioxidants either break down the structure of free radicals or they neutralize them by providing an extra electron to pair up with the loose free radical, thereby rendering it stable and no longer capable of damaging cells.

The importance of these antioxidant biological compounds such as polyphenols, flavanols and catechins cannot be overstated. In addition to skin cell damage, which leads to the signs of aging, oxidative stress free radicals have been linked to heart disease, diabetes, cancer, arthritis and eye conditions such as macular degeneration.

Unlike many of the things we love to eat which are not particularly healthy, the good news is that dark chocolate is both delicious and – more than most other foods – contains a wide variety of plant based antioxidants. To reap these benefits, be sure to eat only high quality dark chocolate with at least 70 percent cocoa content. There is not only less sugar in chocolate with a higher cocoa concentrate but, specifically from a dermatological standpoint, the flavanols in cocoa have been shown to increase the blood flow to the skin which helps to protect it from sun-damage.

Enjoy!

How Young is Too Young for Cosmetic Surgery Procedures?

There’s been a lot of hype and interest in some of the young starlets having cosmetic procedures performed at very young ages; sometimes even younger than 18-years-old. While each situation is unique – and there are specific times where cosmetic surgery can be performed for patients younger than 18 – my general rule is usually 21 or older.

Let’s first discuss some of the special circumstances that might allow someone under 21 to have a cosmetic procedure. First and foremost, parental consent is required for patients younger than 18, except those who are emancipated adults. If that consent has been obtained, some special circumstances that might allow cosmetic procedures for people under 21-years-old would include genetic abnormalities of the chest wall, hypoplastic (underdeveloped) breasts, abnormalities of the jaw bones that would impede normal chewing and development, deviated septum in the nose preventing breathing, disfiguring scars after an accident, or other abnormalities that prevent normal growth and development or are psychologically damaging.

Nose-Job

Interestingly, the FDA will not allow silicone breast implants to be placed in anyone younger than 22, even if they are born with genetic abnormalities or disfiguring medical conditions. Fillers such as Restylane and Juvéderm are not approved for anyone under 22. Botox and Dysport are approved for 18 and older. All of the above factors need to be considered in addition to a young person’s mental health, parental involvement and long-term safety.

For adults older than 21, some factors are less complicated. When you’re 18, you are considered a legal adult and can consent to surgery. The FDA will allow fillers and silicone implants for adults over 21, so those issues are removed from the equation. But, whenever I am considering an operation on a young person – whether it be for strictly cosmetic purposes or for developmental abnormalities – there are many factors to take into consideration.

Please make an appointment with me, Dr. Timothy Janiga, so we can discuss both your personal situation and what is most appropriate for you.

~ Dr. Timothy Janiga

Secret to a Picture Perfect Face

Summer means vacations, special events, weddings and photographs. How do you keep a picture perfect face?

face cream

First and foremost is keeping your face protected from the sun. Sunscreen with an SPF greater than 35 will keep your face clear of brown spots, freckles and peeling sunburns. This has long-term benefits by preventing sun damage and skin cancer, but also helps the appearance of the face immediately by decreasing the amount of brown spots that form. Additionally, the sun exposure will cause blood vessels to grow. By protecting your face from the sun, you’ll see a decrease in those red lines and blotches on the nose and cheeks.

The second best piece of advice is to wear a wide brim hat. Hats with a brim larger than four inches will protect the face and neck from unwanted sun exposure. Combined with sunglasses (the third best piece of advice), this will prevent squinting that causes lines around the eyes and forehead to etch. This has the short-term benefit of making you look better now and the long-term benefit of preventing those squinting lines later.

A makeup containing titanium and zinc oxide will keep the skin even. These are mostly water- and sweat-proof. My favorite is Shiseido’s Urban Environment UV Protection Cream – SPF 40. This is non-comedogenic (meaning it won’t cause acne), and gives the skin a nice, even tone and texture. It can also minimize the appearance of pores with its matte coverage.  As an added benefit, it doesn’t feel oily or greasy on the skin.

Lastly, there is still time to have laser for brown and red areas of the face before your first summer event. Call Janiga MDs and schedule a laser consultation with my mid-level, Melanie Buckley, or myself.

~ Dr. Jennifer Janiga

The Best Season for Your Skin

Although Reno is enjoyable year-round, spring is definitely my favorite season. The days are longer and warmer and, with the help of daylight savings, we have those extra couple of extra hours each day to hike or mountain bike or walk the dogs. While those of us who live in the Reno area are fortunate to have easy access to all of our favorite outdoor activities without having to bundle up, we must not forget to care for and protect our skin. Here are some tried and true skin care tips for you to follow.

Brow-Lift

Skin thrives in the higher humidity and warmer temperatures but after the cold, dry winter we must prepare for the warmer months. When the skin transitions from cold to warmer temperatures, the temperature increase can cause the sebum, or oil, in the pores to liquefy which gives the skin a shiny or greasy appearance.  So, as part of your spring cleaning, when you sort through your skin products and toss out those that have expired, consider switching from a heavier winter hydrating cream to a slightly lighter cream. For spring and summer, I like to use lotions containing a tint or self-tanner.  Using an oil-absorbing product such as oil-blotting papers can also help avoid this greasy look issue.  It is recommended that you exfoliate your skin regularly, but extra exfoliating is probably needed after the long winter. In the slightly higher springtime humidity, the drying or irritating effects of exfoliants are less of a concern. I personally use AmLactin, a daily-use body moisturizer with an alpha hydroxyl exfoliant additive. Also, several times each week, I apply Skin Medica Retinol Complex to my face at bedtime.

Keep in mind that the severity of many common chronic skin conditions can change with the seasons.  Thankfully, psoriasis and eczema flare ups, which are mostly associated with the dry cold months, tend to lessen in the spring. Rosacea and acne may also subside as spring arrives, though for some patients their disease actually worsens. It is good idea to take note of your skin’s particular trends and develop a plan with your dermatology provider to treat any worsening symptoms.

We recommend the use of sunscreen every day of the year, however, it is especially important to remember to re-apply sunscreen while outdoors during the warmer months. If you are not planning to spend time outdoors, the application of a SPF 15 once in the morning to the face, neck, ears, upper chest, forearms and hands should be sufficient. On the other hand, if you  plan to be outside hiking, running, biking, or simply walking then you should use at least a SPF 30 and carry enough of the product with you to reapply every two hours.  My favorite brand is Elta MD because all of their products contain zinc, a physical block, rather than a chemical block, and their application is aesthetically appealing with no white tinge left on the skin. Elta MD also makes a sport product which is water and sweat resistant and an aerosol product which I find more convenient when I am outside exercising.

Now that the snow and ice have melted, the numerous hiking trail networks in Reno and Tahoe are opening up and inviting you to visit.  I encourage everyone to take advantage of the outdoor activities this area has to offer, but please protect your skin while doing so.