A ^Retired Plastic Surgeon's Notebook

Got sunscreen in your glove box?  You should!

 This is an ABC news report written by Serena Marsh and edited for length by me.  This was originally posted in 2012.

Sunny Side Old: Pic Reveals Sun’s Aging Effects

William (Bill) Edward McElligott is two different ages, 66 and 86 yeaars old. 

If you look at McElligott from the right, he looks like any 66-year-old would expect to, but from the left, wrinkles and sagging skin place him far beyond his years. He is a living demonstration of the importance of protecting your skin from the sun.

“It would take me an hour to drive to work and an hour to come home,” McElligott said. “It was a semi route, I’d have six to eight stops. … 6 a.m. to 3 p.m. on the road.”

For almost 30 years, McElligott drove a truck during prime sun hours throughout the city of Chicago delivering milk to stores and gas stations.

“My left arm was always more tan than my right, because a lot of the time I had the window open (since) we didn’t have A.C.,” McElligott said.

The 66-year-old truck driver suffers from unilateral dermatoheliosis or photo-aging, which was caused by repeated, long-term exposure to UVA rays of the sun.

It was 15 years before he noticed any difference between the two sides of his face, but McElligott ignored it, that is until his grandchildren’s questions got the best of him.

Dr. Jennifer Gordon a dermatology resident at UT Southwestern saw McElligott while on a rotation at Northwestern in Chicago and submitted his case study, which was featured in the April edition of the New England Journal of Medicine.

“It was very stark,” Gordon said. “We are used to seeing photo damage, photo aging every day, (but) for it to be so one sided? We were taken aback.”

Gordon explained that since McElligott spent so much time in his car, his left side was exposed to UVA rays that can penetrate glass and cause the majority of photo-aging, unlike UVB rays, which cause sunburns.

“We think its because it (UVA) can penetrate more deeply into the skin than UVB and affect your collagen and elasticity,” she said. “When you destroy those that’s what gives you the aging appearance that we see.”

Dr. Mitchell Chasin, a dermatologist who did not treat McElligott, says it is extremely common to see patients that come in with more damage to their left side than their right.

“Most people are completely unaware and most people who come in to have sun damage treated, they often times will point to their left side saying they see more spots, more wrinkles, more aging, but never put two and two together,” said Chasin.

Chasin says that whenever people are outdoors, even when covered from the sun directly or on a cloudy day, they should be aware they are not safe from the reflected rays of the sun and should wear sunscreen.

“Sun block is the answer, really, for someone 365 days a year, whether it’s cloudy whether it’s sunny, whether someone is outdoors, in the car, or at the beach,” Chasin said. “If someone wants to age as best they can, sun protection is a daily regimen no matter what you are doing. Put sun block on before you leave the house.”

With summer approaching and vacations and road trips, it’s important to make sure your sunblock has protection against both UVA and UVB rays.

Last year the FDA demanded sunscreen manufacturers update their labels to offer protection for both UVA and UVB, as well as to stop the use of misleading claims such as waterproof. The agency recently extended the deadline to December for manufacturers to comply.

For McElligott sunscreen with UVA and UVB protection has become a daily fixture.

“When I’m out in the sun, when I’m going to be driving, I have sunscreen on,” he said. “I always carry it with me.”

Thanks for reading.  And do you have a favorite sunscreen?  Send me an email and let me know. lsowder@madisonplasticsurgery.net

Dr. Lisa Lynn Sowder

Follow me on Instagram: @sowdermd and @breastimplantsanity

Sparky is especially trained to sniff out illegal sunscreen. Woof.

This is an article from the May/June 2015 King County Medical Society Bulletin.  It’s a little long and technical but just hang onto that attention span and read it!

Packing a Sunscreen Souvenir

Tourists Grab UVA Treatments Common Elsewhere, Illegal Here

By Barbara K. Gehrett, M.D.

Some international travelers are returning with pharmaceutical souvenirs – new UVA sunscreens available in Europe, Canada, Mexico, and other countries and not yet approved in the United States.

Ninety-five percent of the solar UV radiation that reaches earth is UVA.  It has a wavelength between 320 and 400 nanometers and is present during all daylight hours, summer or winter, cloudy or clear.  UVA passes through glass and penetrates deep into skin.  It is responsible for more damage to basal keratinocytes in the epidermis than UVB.

Most UVB damage occurs in the superficial layer of the epidermis, producing suntan, sunburn, and aging skin.  Protection from UVB with sunscreens reduces the risk of non-melanoma skin cancers.

Two short-acting, barrier-type UVA sunscreens have been approved for use in the U.S.  These are zinc oxide and oxybenzone.  Dermatologists argue that their protection is limited and requires repeated application because they break down quickly.

Ecamsule is a longer-acting “chemical filter” made by L’Oreal and is one component of a U.S. approved lotion, Mexoryl.  The FDA turned down the application to release ecamsule as an over-the-counter UVA sunscreen, although it has been available in Europe since the late 1990s.  It is regulated there as a cosmetic, which has a different standard than the drug category it falls into in the U.S.  All sunscreens in Europe must give both UVA and UVB protection.

Eight UVA sunscreen products have been languishing in line (one since 2003) for FDA consideration.  Congress and President Barack Obama attempted to pressure the FDA by passing the Sunscreen Innovation Act in December of 2014.  This new law requires the FDA to issue an approval or disapproval ruling within 60 days of receiving a complete application for sunscreen.   All eight of the new UVA sunscreens were expeditiously disapproved by the FDA early in 2015.

The FDA wants long-term data on safety before approval will be given.  Typically this means two Phase 3 clinical trials, which are expensive and time-consuming.  It is possible ;that future data on skin cancer protection from other countries would move the agency.  Or perhaps ;the procedural review taking place at the agency will result in a different set of criteria for sunscreens.

In the meantime, U.S. travelers stocking up on sunscreen  when they are outside the country are violating the Food, Drug and Cosmetics Act by importing unapproved drugs.  According to WebMD, the FDA does not generally pursue violators, unless the quantities involved are egregious.  One other work of warning:  online purchases should be made with caution, because of international counterfeiting of drugs.

Thanks for reading!  And keep using that lousy U.S. approved sun creen.  It’s better than nothing.   Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon spends a week in Hawaii and returns with no tan lines!

Last week I attended the annual meeting of the Northwest Society of Plastic Surgeons on the Big Island of Hawaii.  And contrary to popular belief, I actually sat in a conference room for about 5 hours a day and actually learned how to be a better surgeon.  The other 7 or 8 hours of daylight presented a bit of a challenge to a sun shunning person of pallor such as my Germanic self.  But it can be done.  Here are my rules:

1. Slather with sun block first thing after that morning shower.  The spray on stuff by Neutrogena works great.
2. Wear a hat and sunglasses.
3. Lounge in the shade.  Walk on the shady side of the street.  (Duh)
4. Wear a rash guard while snorkeling after respraying yourself with sun block.
5. Spend the few hours of the really nasty mid-day sun in the bar.  (Duh)  Drink cocktails with umbrellas.  (Duh)
6. And most of all, embrace your pallor.  I hear that the Hawaiians and Southern Californians refer to us as “Chalk People.”  Bring it on.  I won’t be spending my golden years tending to my skin cancer.
7. Oh, and look for my new book, “Fifty Shades of Sun Damage” soon to be a major motion picture staring this dude with the bad skin.

Thanks for reading!  Dr. Lisa Lynn Sowder

Pasty white Seattle Plastic Surgeon shares her view on tanning bed restrictions.

Some of the girls have spray on tanned legs but some of them have obviously been spending time in an indoor tanning salon and, as a physician, it drives me nuts. 

 The incidence of Malignant Melanoma has been going up, up, up in the past couple of decades and it’s rising the fastest in the same group that spends the most time in indoor tanning salons – young women. 

 Many countries and some states have placed age restrictions on indoor tanning.  Brazil has an outright ban on indoor tanning.  I’m not one to advocate a nanny state, but I do think that we need to protect children from their own bad choices when the stakes are very, very high.  Isn’t that why we don’t sell children cigarettes and alcohol? 

 What do you think?  Should a 12 year old be able to waltz into a tanning salon to spend her allowance on a tanning session?  Should I say something to the parents of these tanned girls?   Should I spray paint my daughter’s legs?????

 Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon discusses sun block and sun screen lingo.

Yesterday the Food and Drug Adminstration issues new rules on the labeling of sun protection products.  These rules have been many years in the making with many stakeholders involved.  This news  is welcome to me and my patients as is any regulation that promotes accurate information and truth in advertising.

Only sun protection products that protect against a broad spectrum of ultra- violet rays can claim protection against skin cancer and skin aging.  No product can call itself a sunblock.  Strong sunscreen, yes but sunblock, no.  The SPF system will be redone to give patients a more accurate way to measure protection.  No longer will we see promotions of SPF 100 which really does not exist (SPF 100 means you can spend 1500 minutes or 25 hours in the sun without getting much more than a little “color”).    Also, sweatproof and waterproof labels will disappear.

So expect some better information on sun protection products’ packaging and remember:  It only works if you use it.

Here’s wishing you a great and tan free summer.  Thanks for reading.  Dr. Lisa Lynn Sowder

Can you guess which twin spent years with a “healthy” tan?

Seattle Plastic Surgeon discusses sun damage and skin protection – again.  Inags because Icare.

Summer officially starts in two weeks and it’s time for my yearly scold about facial tanning.  As usual, a picture is worth a bajillion words so take a look at these twins.  They have had no surgery or skin treatments and neither one smokes.    They are the same age (duh) and the same weight.

Take a look at the damage that years of sun exposure have caused in the twin on the left.  Not only does she have fine wrinkles and uneven pigmentation, her face is less plump than her younger looking twin.

I am often asked which sunblock is the best for the face.  My answer is the sunblock that you will use every day.  It may take a while to find the one you like the best but shop around.  There’s one out there for you.  I really like one of the non-greasy sunblocks that Neutragena makes.  I have yet to find a sunblock compatible with my very sensitive eyes so I skip that area.  But I do have a great pair of shades that I live in when outside and I have a collection of hats.

Remember, the skin tans as a response to injury.  So take care of your largest and most visible organ and it will take care of you.

Thanks for reading!  Dr. Lisa Lynn Sowder

Smoothing out those wrinkles

Seattle Plastic Surgeon discusses facial rejuvenation with skin resurfacing.

Many of the streets in my Seattle neighborhood are being repaved and it’s about time.  I’m happy to trade some slowdowns and detours for the potholes.  Today I drove by a big rig that was tearing up the old surface of the road so the new asphalt could be laid down by the dump truck and then smoothed out by the steamroller.  I then passed from the detour lane onto some brand new smooth roadway and my car just glided over that new surface.  Sweet.

This, of course, reminded me of Plastic Surgery because almost everything reminds this Seattle Plastic Surgeon of  Plastic Surgery.  I don’t have a one track mind, just a very, very elastic one.  Sooooo…..

This morning I was reminded of skin resurfacing.  There are many ways to resurface the skin but they all involve first removing the old and worn out surface.  Dermabrasion sands off the old surface, chemical peels burn off the old surface and lasers vaporize the old surface. 

Removing the old surface allows the middle part of the skin (the dermis) to regenerate.  The miracle of  skin regeneration occurs mostly from the pores.  The cells that line the hair follicles, sweat glands and pores divide and push their way up to the surface and then spread over the surface.  Growth factors which are stimulated by the removal of the old layer stimulate collagen growth and new blood vessels.  Newly healed skin is fresh looking and nice and smooth, like that new pavement.

And no big dump truck of asphalt or a steamroller is needed.  All that is needed is good health and a lot of patience.  Medium and deep resurfacing procedures can be very challenging for patients because the healing period can look very frightening.  But the benefits of resurfacing can be amazing and often cannot be achieved any other way.  Check out my photo gallery for resurfacing examples. 

I’m looking forward to driving home on that brand new asphalt.

Thanks for reading!   Dr. Lisa Lynn Sowder

Beautiful moss weather we’re having

Seattle Plastic Surgeon discusses the joys of a soggy climate.

The front page of the Seattle Times today featured a great story on moss. We’ve had one of the wettest and coldest springs in recent memory and the moss is just loving it. I must admit, when I was in college and taking botony, I had a great admiration for moss, especially when I got down to moss level and really looked at it. And under the microscope – wow.

Everyone with a moss garden is estatic about this weather and I also think anyone who cares about their skin should be estatic too. I spend the winter months slathering on skin cream because I get so dried out and the summer months I slather on sun block, but the last two months I’ve headed out the door with just a dollop of sun screen on my face and that’s it. It’s so moist here, my dry skin just soaks up the ambient humidity and with this cloud cover, I can be a little lax about endless my battle with the UV. Let’s here it for Seattle’s moisture festival!

Thanks for reading!  Dr. Lisa Lynn Sowder