SPF Sunscreen: Is Higher Better?

SPF, or Sun Protection Factor, is a numeric value displayed on sunscreen labels to indicate their ability to block out harmful sun rays.

A common misconception about SPFs is that the higher the SPF, the better the protection.
While there is some truth to this, it is not quite as simple.

As the SPF increases, so does the protection from harmful sun rays, however, once you reach SPF 50 or higher there is only a slight increase in protection.

For example, an SPF of 15 will block approximately 94% of sun rays.  An SPF of 30 will offer you additional protection of about 97%.  Once you reach SPF 50, you will get about a 98% blockage from harmful sun rays, which is only a minimal increase from SPF 30 with 97%.

Thus, increases in SPF are not directly proportional and will only result in a minimal amount of additional protection as the number increases.

Excessive sun exposure increases one’s risk of premature skin aging as well as skin cancer.

We recommend the following to decrease the above mentioned risks:
• Daily use of a broad spectrum sunscreen with an SPF of at least 30.
• If you are spending more than 2 hours outside, be sure to reapply your sunscreen.
        Repeat every 2 hours at least.
• Avoid spending too much time in the sun during the peak hours of sun intensity (10am-2pm).
• When outdoors, protect exposed skin with clothing and a hat

When choosing a sun protection product, there are many options such as sprays, lotions, gels, sunblock, sunscreen, and more!

While the majority of products will work well, consider the following when making your selection:
1) Sunblock versus Sunscreen: 
                  Both will protect you from the sun, but their mechanisms of action differ.
                  Sunscreens contain chemicals such as Oxybenzone and Avobenzone that filter some of the sun’s UV rays to protect your skin.
                 These chemicals breakdown when exposed to UV light and need to be reapplied every 2 hours at a minimum.

                  Sunblock, on the other hand, acts as a physical barrier by reflecting the sun’s rays, thus, blocking harmful sun rays.
                  Most sunblocks will contain either zinc oxide or titanium dioxide.
                  Sunblocks are not broken down by UV light and will last longer provided they are still covering the skin.

2) Sensitive Skin: If you have sensitive skin, we advise you to select a sunscreen that is fragrance free, oil free, and hypoallergenic.

3) Acne: If you have acne prone skin, we recommend selecting a non-comedogenic (won’t clog pores), fragrance free, and oil free sunscreen.

4) Asthmatic:  If you or your child has a history of asthma, we advise caution if using a spray as these could provoke an asthma attack!

Desperately desire a tanned look?  See our next blog on sunless tanners!

Vanessa Lelli DNP, FNP-C 
Bryan J. Michelow, MD, FACS

Cosmetic or Reconstructive Surgery - What is the difference?

Distinctions between Cosmetic surgical procedures and Reconstructive surgical procedures may appear clear, but occasionally these distinctions may be less obvious.

Cosmetic surgery is performed on normal tissue to improve the patient’s beauty. This optional enhancement is not considered medically necessary from a health perspective, but rather a way to alter a person’s appearance to boost their self-esteem.

Examples include body contouring with liposuction, breast augmentation, face lift, and minimally invasive injections of Botox® (one of the many muscle relaxants). Cosmetic procedures are usually not covered by insurance.

Reconstructive surgery is performed to repair wounds, remove a cancer or return function to an injured body part. Some examples include treatment of accidents victims, burn treatment, hand surgery and cleft lip/cleft pallet reconstruction. These procedures are usually covered by insurance policies.

Some procedures fall into a gray area. Breast reduction, for example - if the large size of a patient’s breasts prevents her from performing her activities of daily living, then reduction surgery would be considered reconstructive rather than cosmetic.

An upper eyelid blepharoplasty (excess eyelid skin removal) would typically be a cosmetic procedure. If the patient’s visual fields were compromised, then surgery is required to improve vision. The procedure, therefore, is medically necessary for functional purposes.

When the distinctions between Cosmetic and Reconstructive surgical procedures are less clear, the need to correct a functional impairment implies that the procedure is reconstructive. If the procedure elected by the patient is for the improvement of “looks”, this is indicative of a cosmetic procedure.

Matthew Greenwald.
The Ohio State University.

Snail Slime for your Skin ... Super Food or Snake Oil ?

Lately the media is all abuzz with miracle products promising to naturally tighten, hydrate and rejuvenate your skin.

First it was the bee venom facial pre-Princess Kates wedding and now its snail slime.

Snail slime can be found in skincare products from masks to lotions compounded for dry, normal and oily skin types.

Snail slime sales people tout the slime as being antioxidant rich and packed with hyaluronic acid - an ingredient found in dermal fillers that plump up the skin.

If this is the case should you start collecting snails for their slime?  Is snail slop really a super food, or 21st century snake oil?

As a plastic surgeon I look at the science behind the claims before advising my clients to invest in products and services.
 
A review of the scientific literature revealed a paucity of information about the actual ingredients in the slime produced by snails.  Therefore, the beneficial effect of the slime itself cannot be plugged.

It is more likely that the ingredients that cosmetic companies add into the product provide more benefit than the snail slime.  These add-ins include: Allantoin, a product that sooths irritated skin; Collagen and elastin, that are structural proteins of the skin; Hyaluronic acid, that moisturizes, lubricates and softens the skin. All these ingredients have large molecules that do not penetrate the skin’s protective barrier (stratum corneum).  Therefore, their effect is superficial.

Glycolic acid, another of the added products, is a chemical peel that exfoliates and eliminates dead cells on the skin surface.

In summary, we are unable to find any well-controlled scientific studies that support the beneficial effect of snail slime on rejuvenating facial skin.

As the snow melts and spring blossoms, hold off rushing into the garden to collect the unsuspecting snails!

They, the snails, benefit more from their slime than we humans do!   

Julie Spehar, PA Student

University of Mount Union

Bryan J. Michelow, MD

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What type of filler is right for me?

Although we cannot actually turn back time, we can enhance our natural youthfulness!

How do you see yourself when you look in the mirror? 

Do you see signs of aging?

A common concern for cosmetic patients is facial aging. As we age, our skin loses elasticity which causes it to sag and wrinkle. The sun and gravity are our greatest friends and also foes.

Fortunately, there are many options to correct facial aging, including muscle relaxants, injectable fillers, and more invasive procedures such as surgery. Many patients opt for minimally invasive procedures that include fillers to improve the appearance of their face.

Fillers vary by consistency: Gels, Putties and Powders.

Gels: 
Examples of gels are: Juvederm Ultra®, Juvederm Ultra Plus®, Voluma®, Restylane®, Perlane®, Restylane Silk®, Belotero®

Gels are thin and soft. In addition, they absorb water to plump the appearance of the skin. They can be injected into the cheeks, nasolabial folds, marionette lines, lips, and fine lines around the lips.
Gels create a subtle yet noticeable appearance to the face. This is an ideal first treatment for patients interested in trying fillers. These can last between 4 and 9 months, depending on the specific filler used.

NEW!  Restylane Silk® is an exciting new product, FDA approved, for use in and around the lips. It effectively decreases the "fine lines" and wrinkles around the lips.

Putties: 
Example of a putty filler is Radiesse®

Putties are thicker than gel fillers, which makes them ideal for improving the prominence of the cheek bones. The change that putties provide can be quite striking. This is typically a good treatment for patients who are looking for a significant change. These fillers can last up to one year.

Powders: 
Examples of a powder filler is Sculptra®
Powders are different from putties and gels. The powder is mixed with sterile water for injection. After injecting the water containing the powder into tissue, the skin looks much fuller. Over the next few days, the body absorbs the water and the fullness disappears. The powder remains in the skin and stimulates the tissue to produce collagen over the coming

months. This is the most subtle but the longest lasting treatment, lasting up to 2 years with booster treatments.

The three types of fillers can be used alone, in combination with each other, or with muscle relaxants (Botox®, Dysport®or Xeomin®) in the upper face to enhance youthfulness.

If you have any questions about “What type of filler is right for me?” please Bryan J. Michelow, MD, at Contemporary Cosmetic Surgery, 216.595.6800.

Caitlin Kyle, PA-S
Baldwin Wallace University

Bryan J. Michelow, MD

My Physician Assistant (PA) Elective experience with Dr. Bryan Michelow

The past six weeks spent with Dr. Michelow and his staff has been an absolute blessing.

I had the pleasure of meeting and assisting Dr. Michelow on my General Surgery rotation earlier in the year and had such a pleasant experience that I was elated to have the opportunity to do my elective with him in Plastic Surgery. Not only is he a fabulous surgeon and teacher, but he is a wonderful person.  He takes an interest in each and every person he comes in contact with and is never too busy to lend a helping hand.

I have learned so much throughout this elective rotation.  I was encouraged to think abstractly and apply my knowledge and skills while in the office and in the operating room.  I was given the chance to assist on the majority of the cases that were encountered during my time here including: skin grafting, skin cancer excisions, panniculectomy, blepharoplasty, breast augmentation, mastopexy, incision and drainage, breast reduction, and various hand surgeries.

In addition to assisting in surgery and seeing patients in the office, Dr. Michelow took me to a conference on Pediatric Emergency Medicine, and arranged for me to take a private suturing class.  I was also able to attend his monthly hand clinic and gain insight into the management of debilitating hand injuries.

I am so thankful to have had this opportunity and to have met such wonderful people.  The information and skills that I have learned here are invaluable.  I have no doubt that my experiences here have given me perspective and have solidified my interest in the extraordinary and challenging world of surgery.

Thank you Dr. Michelow, Cheryl, Roxanne, Andrea, and Jill for such a welcoming and rewarding experience!

Alexandra Messmer
Physician Assistant Student – University of Findlay

Calciphylaxis - an unusual but interesting condition

During my elective rotation at Dr. Michelow’s office, I was able to see a large amount of patients with a vast array of conditions.

One particular case that sparked my attention was a woman with presumed calciphylaxis of the lower abdomen. I was so intrigued by this condition that I decided to do my end of rotation presentation on calciphylaxis. 

Here is what I found:

Calciphylaxis is a condition where calcium is deposited in the subcutaneous and cutaneous tissue, as well as in the vessel walls. The continued calcification leads to vascular occlusion which impedes blood flow and ultimately leads to necrosis of the tissue. 

The exact etiology of calciphylaxis is unknown, however there are many risk factors that predispose a patient to this condition. The most noteable risk factor is chronic kidney disease, especially those patients requiring dialysis. The kidney does not properly excrete calcium and phosphate and often the dialysate utilized is high in phosphate and/or calcium. The calcium and phosphate then bind and precipitate, thus causing vascular occlusion. 

Another risk factor includes uncontrolled Warfarin levels. Warfarin inhibits a vitamin-K dependent factor that is responsible for inhibiting vascular calcification. 

Additional risk factors for calciphylaxis include alcoholic liver disease, diabetes mellitus, connective tissue disorders, glucocorticoid use, chronic inflammatory conditions, and clotting disorders.

Calciphylaxis typically presents as a tender, erythematous areas of skin. The lower extremities are most commonly affected (90%). Other areas that may be involved include the abdomen and the buttocks. These lesions progress to reddish-purple plaques and ultimately end up as a black stellate eschar overlying gangrenous ulcers and patches of ischemic necrosis.

Diagnosis is typically made by deep tissue biopsy. Incisional biopsy of the skin could result in a non-healing ulcer which increases risk of mortality 2-fold. Additional diagnostic tests that may help include plain films showing calcium deposits in the vessels.

The goal of treatment of calciphylaxis  is to lower calcium and phosphate in the blood. This is accomplished by Cinacalcet, which makes receptors more sensitive to calcium, and Sodium Thiosulfate which increases the solubility of calcium deposits. A non-calcium phosphate binder such as Sevelamer will decrease phosphate levels. Wound management should be optimized and prophylactic antibiotics may be necessary to prevent secondary infection. Surgery may be considered to excise the areas of vascular compromise if the patient is fit for surgery.

Unfortunately, the mortality rate for calciphylaxis is 85%. The 1-year survival rate is 45% while the 5-year survival rate is only 35%. The most common reason for mortality is sepsis. Factors that increase mortality rate include proximal lesions and ulceration.

The plan for the patient that I saw was to undergo a deep tissue biopsy to confirm the diagnosis. Once confirmed, she will be started on Cinacalcet or Sodium Thiosulfate. Wound management will be optimized with a multi-disciplinary approach and strict adherence to the medical regimen. Her prognosis is guarded.

Julie Shawver PA-S

Mount Union Physician Assistant Program

Beautiful, Natural, Noticeable

Breast Augmentation so naturally attractive you will forget that you have implants.

Dr. Michelow's "Hidden Incision" combined with the new tear-drop shaped, high-strength, cohesive silicone gel implants add volume and fullness where these should be...for natural breast enhancement.
Tighten, lift and achieve the silhouette you want and an appearance that will turn heads

www.DrMichelow.com


3733 Park East Drive Suite 107
Beachwood, OH 44122
216 595 6800

Best Results Obtained When Your Surgeon is Certified by the American Board of Plastic Surgery

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