With summer weather having already  begun, Chattanooga, TN and the southeast  is getting ready for a long,  hot, and sunny season. Dr. James Shire of Shire Facial Plastic Surgery says we all need to know the dangers of the sun and how to protect ourselves and our families. What use to be thought of as a “healthy tan” look  is really not very healthy at all.

The sun is not our friend, and the more sun we get the greater the damage that is caused. The sun is known to cause skin cancers such as Basal Cell Carcinomas, Squamous Cell Carcinomas, and Melanomas, which can be not only deforming but also be life threatening.  The sun causes wrinkles, loss of elasticity and sagging, leathery skin, and brown sun spots called solar dyschromias and solar kerratosis. The damage one sees in their 40′s , 50′s and 60′s really occurred when they were in the sun as  children and in their teens.  So it is extremely important to protect yourself, and your family as early as possible.

How To Deal With The Effects of the Sun

To deal with the  affects of the sun we must block the UV radiation that is causing the damage. There are two types of UV radiation, UVA and UVB. To be protected you MUST block both UVA and UVB! If you only block one type of UV radiation, you are not protected. Many people wear sunblocks and think they are doing the right thing and are protecting themselves, but they are not. The problem is that the majority of the information on the front packaging of many sun care products are false, exaggerated and, at times, outright lies! This information unfortunately is not regulated. As an example, the SPF number is used only as a marketing tool to help sell the product and is not an indication of the amount of protection you should expect. (Note the SPF number is an old nomenclature that refers only to UVB, and not UVA.)

The good news is that most all sun screens will block UVB, it is very easy to block. The problem  is that it is very difficult to block UVA. Very few products will block UVA. A number of the so called UVA blockers lose their ability to block upon exposure to sunlight or UV radiation. So within minutes of being in the sun one has lost their UVA protection. There are two approved UVA blocks available in the U.S. and which are ZINC OXIDE and TITANIUM DIOXIDE. Any sun protection you use must contain either zinc or titanium or both. So if you can’t believe what is written on the front of the package, what should you do? On the back of every product is a box or section labeled “Active Ingredients”. The manufacturer must truthfully disclose the ingredients, so you need to find zinc or titanium listed as one of the ingredients, and if so you will get UVA and UVB protection. But since the SPF number is unreliable, how do you to tell the strength or amount of protection present?  Well, after each ingredient there is a percentage. The higher the percent the more protection you will receive. The minimum percent of zinc should be 4%. (15% is the highest available)

There are a few more things you should know about sunblocks. The sunblock should be applied approximately 40 minutes before you are exposed to the sun. It takes that long for  it to be effective, so don’t wait till you are in the sun to apply it. Also, there really is no such thing as waterproof. If you are swimming or sweating, you must keep reapplying and reapplying.

Recommendations from a Facial Plastic Surgeon on protecting your skin

UV radiation is everywhere, therefore Dr. Shire recommends wearing sun protection everyday, rain or shine, inside or outside, 365 days a year. Glass and windows do not stop or block UV light, and a white cotton shirt is the equivalent protection of the old SPF=4 rating. So be good to your skin now and for the future.

And if you were wondering about the safety and effectiveness of tanning beds, hopefully recent negative publicity has shed new “light” on the subject and will permanently discourage you from ever using them.  They are concentrated UV radiation. If you must appear tan my recommendation is spray tans or tan from a bottle. There are some very good ones on the market.

Botox before & after Crows' Feet

James Shire, M.D., F.A.C.S. was the first person to preform cosmetic Botox® in the Chattanooga TN area. With over 16 year of experience in treating patients with Botox®, this article will provide the information that all patients should understand about Botox®. This is one of the safest and most effective treatments there is.

Botox® is  botulinum toxin type A and is a product that is made in a laboratory. It was first developed in the 1940′s and has been used for years treating neuro-muscular problems throughout the body.  1988 was the first time it was used to treat a wrinkle. What Botox® is actually doing is preventing the muscles from contracting, thus eliminating the wrinkles. We use Botox® to treat the frown lines, forehead lines and crows’ feet. It is not recommended for the area around the mouth or under the eyes. These muscles are in your face for a reason, and it is not for wrinkle -making; they are brow depressors, pulling the brows down. Therefore, with Botox®, not only do the lines and wrinkles disappear but by knocking out the brow depressor muscles, you can also get a little browlift, which is the reason it looks so good.

Botox before & after, frown lines

Botox® is very predicable and very safe. The variability in results is not from the Botox®, but from who is preparing and giving the Botox®. It must be reconstituted properly. We reconstitute to 2cc for 100 units. Beware of those who over dilute it with 5cc or even up to 10cc per 100 units, this will make the product less effective and will not last as long. That is why you can find it advertized  so cheaply, but in reality, what are you getting?………saline! There are other variables that can also affect Botox®. It should never be shaken, it must be stored at the correct temperature, and alcohol will make it ineffective. There are also different injection techniques that can produce different results such as raising or lowering the brows. The doctor injecting the Botox® must know and be able to control this.

As was mentioned, Botox is extremely safe with little if any complications. The one complication that is talked about the most is an eyelid ptosis,or a drooping eyelid. This can be caused by an improper injection in the wrong location or injecting too large of a volume in an area. But in most cases it is caused by the activity of the patient after the injection. Since we instruct all our patients that they must not rub or massage their face, bend, lift or excerise for about 5-6 hours after the Botox® injections, we have not had this problem.In summary, there is no treatment that can improve and remove wrinkles as well as Botox®.  As a patient and a consumer, please remember that when deciding on treatment, you must consider how the Botox® is made, how it is stored, how it is being injected and who is doing the injections. Botox® is just the tool, it is who is using it and how it is being use that really matters.

Making decisions for medical and surgical cosmetic procedures have gotten more difficult for the patient/consumer. With the decrease in medical reimbursements to doctors and the increase popularity in aesthetics, many physicians and even non-physicians are entering the cosmetic surgery market. This is also promoted by the onslaught of advertising and media hype that surrounds it. The consumer reads about the “newest” product in a magazine, sees “cheap” prices that are too good to believe, and hears about exaggerated or misleading claims. What is a patient to do? How can the patient make a good educated choice?

James R. Shire, MD of Shire Facial Plastic Surgery in Chattanooga, TN explains “As an example, if you are given a paintbrush and paint and asked to create a self portrait, and the same paintbrush and paint were given to Rembrandt to paint a self-portrait, which painting will be better? It is not the tool (or product) but who is using it that really makes the difference in the final outcome”.

In these difficult economic times everyone is cost conscience. But the last thing you want is cheap surgery. It is reasonable to try to get the best deal you can. This works well with TV’s and refrigerators, but you never want to get the cheapest parachute, fire extinguisher, or surgeon. Especially if it is your face!  Always remember, your face goes before the world.

Whether it is cheap Botox, a great deal on fillers or deciding which filler to get, the patient must be an educated consumer. The first step is to find a qualified and well-trained DOCTOR who specializes in the area you are interested.  Beware of spas with nurses, aestheticians, techs performing medical procedures, or out of field doctors (such as family doctors, ER doctors, OB-GYN doctors, dentists, etc.) trying to cash in on the aesthetic wave. One does not see these doctors trying to be pediatricians or cardiologists. A clearer example would be that you would probably not want to take your new Mercedes to the corner gas station for its repairs, you would want a specialist for that type of car. If the person is not able to handle the complications of a procedure, they are not qualified to do the procedure in the first place. These non-invasive procedures may be marketed as simple and easy, but in reality they are real surgical procedures with real complications that can and do occur all to often. We see in our office more and more people with unsatisfactory results coming in for us to correct and repair their bad surgery, filler injections, and/or Botox. Some of these situations can be corrected, but many times they can not be corrected or that the result of fixing the problem may leave the patient worse than before.

In addition, with all the emphasis on rapid or instant recovery time and non-invasive surgical alternatives, there is one thing that should be kept in mind. If there is no recovery required, then there will be no lasting result!