Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Acne


Agressive treatment for acne

January 22nd, 2015 — 1:44pm

Treat acne now to avoid scars later.

blog acne scarsIf, like me, you are a fan of the cable T.V. show “Justified” you recognize this man as Johnny Crowder.   I find him very attractive despite his really severe acne scarring.  Maybe it’s because he is the quintessential bad boy or maybe it’s because he has such a soft heart despite being a total sociopath.  Anyway, he was killed last season by his even more bad ass cousin, Boyd Crowder so I won’t be able to enjoy his handsome mug anymore.  But this post is not about my taste in men but about acne scars.

Acne is often thought of as just one of the many challenges of adolescence and in many cases it is.  Mild cases can often be controlled with over-the-counter treatments and usually the acne subsides once the hormones have leveled off.  But for some, acne can be a devastating disease.  When the acne lesions are deep and cystic, they can destroy the normal fat layer under the skin and cause deep permanent scars as in David Meunier, the actor who plays Johnny.   Acne scars have not kept Mr. Meunier from  finding success but they may limit his roles somewhat.  He may find himself cast more frequently as a bad guy.

So if you or someone you know has out of control acne, get thee to a dermatologist.  Those pesky “zits” of today can turn into the life long scars of tomorrow.  Oh, one more thing – treating acne scars is really difficult and only partially effective.  It’s much better to prevent them in the first place.

Thanks for reading!  And Johnny, I miss you!  Dr. Lisa Lynn Sowder

 

Acne, General Health, Scar, Skin Care

POST ACNE SKIN REHABILITATION: A LONG AND INVOLVED PROCESS

March 14th, 2012 — 11:36pm

Do you have a child with severe acne???  An ounce of treatment now is worth a ton of scar revisions later.

Left: Before a bazillion procedures. Right: After a bazillion procedures.

I have two children in high school and I often am asked for advice regarding acne.  I am not a dermatologist nor do I play one on T.V. so do not expect any advice as to the latest therapies for acne.  I do have advice, however, on whether or not one should seek therapy.   So here goes.

If the zits are small and superficial, there will likely be no lasting damage and whether or not to seek anything other than over-the-counter treatment is really a matter of how much the zits bother your child.  BUT if the zits are deep (so called cystic acne), your child needs to get treatment YESTERDAY. 

 The problem with cystic acne is that it causes inflammation deep under the skin and can result in very bad scarring that can be devastating and permanent.   And it’s not just the scarring that is an issue.  The inflammation can also cause atrophy of the fatty layer under the skin and cause sinking in of the face. 

 The example on the right shows both superficial scarring and also some deeper scarring and atrophy.  This is a mild case.  If this were a man, he probably would not have sought treatment but this is a young, beautiful, fine featured woman and this post acne scarring affects her self esteem and also results in her spending a lot of time every morning trying to cover this up.   

She an I got to know each other very, very well over about two years of procedures that included fat grafting, skin resurfacing, excisional scar revision and filler injection.  It was a long process but worth it for both of us.  She can now get on with her day without the prolonged fussing with cover-up and I just loved the bright smile on her face at her last visit. 

 Not all plastic surgeons are well suited to treat these patients because it involves a lot of patience (which I for some reason have in abundance) and a lot of hand holding. 

 But the real message here is that if you know someone with deep, cystic acne who is not under the care of a dermatologist, do what you can to get them proper care.  What seems like just a minor, cosmetic issue can be a major, difficult to treat problem later. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Acne, Children, Facial Fillers, Fat Injection, Plastic Surgery, Scar, Skin Care

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