Dr. Bosshardt's Blog

Radiation for non-melanoma skin cancer- look before you leap

I recently saw an 80 year old man. Ten years ago, he had a squamous cell skin cancer on his scalp. His dermatologist recommended radiation therapy. Eight years later, the treated area broke down spontaneously and for two years he has had an ulcer on top of his head that has resisted all efforts to get it healed. On his examination now, he has a 2. 5 cm (1 inch) round ulcer on top of his head. The base of this ulcer is bare bone. The surrounding scalp is fibrous with no elasticity and clearly poor blood circulation. Getting this ulcer healed will require major surgery, if can be done at all.

 

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The verdict is still out on Cool Sculpting

Ironically, It is the holy grail of plastic surgery. I say ironic because it is not really surgery at all. What is it? It is the removal of unwanted fat and tightening loose skin without having to go through an operation with its attendant costs, risks, postoperative pain, and scars. Surgery, of course, can remove large quantities of fat and tighten skin as nothing else can but has all of the aforementioned issues, making it an unattractive option for many people.

 

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What should I do to prepare for surgery?

plastic surgery Florida Patients often ask me what they can do to prepare themselves for an upcoming surgical procedure. I love this. It means the patient is invested in the surgery and actively working with me to get the best result. 

I believe the single most significant factor under a patients control is to avoid tobacco in all its forms. Smoking is, I feel, the single biggest lifestyle factor that can adversely affect surgery. In addition to being one of the worst habits anyone can engage in- I semi-seriously tell patients they would be better off shooting heroin than smoking- smoking puts patients at greater risk of surgical complications. Nicotine containing products, such as patches or gum should also be stopped. Nicotine is a potent vasoconstrictor; it causes blood vessels to clamp down for up to 24 hours. This reduces blood flow to areas, especially skin, and, combined with surgical manipulation, can reduce blood flow below a critical level where skin and other soft tissues will die. Smoking's ill effects are so serious that I will not perform certain elective operations unless the patient stops for a minimum of four weeks before surgery and does not resume for three to four weeks afterward. These include facelifts, breast lifts and reductions, tummy tucks, and any operation where the skin will be lifted and tightened. The risks just aren't worth it. 

Patients often ask about drinking alcohol before surgery. I have no problem with patients having a glass of wine, beer, or a single mixed drink on the evening before surgery. I don't feel this has any clinically significant effect on bleeding. I don't want patients inebriated the night before surgery or drinking heavily in the weeks leading up to surgery. Excessive alcohol intake creates enough problems of its own without adding this to the lead to surgery. Alcohol, like other sedatives, can affect a patient’s ability to metabolize and respond appropriately to many drugs used for anesthesia. Alcohol in excess damages the liver and this organ is crucial to the metabolism of a large spectrum of drugs as well as producing factors necessary for blood clotting. 

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Breast implants- what does your future hold?

Young women seeking breast implants often ignore a critical aspect of this surgery: they will have these implants in their breasts for years, even decades. What happens to them over time? This is an aspect of breast implant surgery that I feel many surgeons gloss over. What are the long term consequences of having breast implants?

 

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Surgery After Skin Cancer

skin cancer surgeryIf you are diagnosed with skin cancer, your doctor may recommend surgery to remove the cancer and prevent it from spreading. Depending on the type of skin cancer you are diagnosed with and the amount of skin and tissue around the cancer that must be removed, your Oncologist may recommend that you have reconstructive surgery to replace skin and tissue and minimize scarring.

Our plastic surgeons are highly trained in the reconstruction necessary following skin cancer removal. They possess extensive knowledge in the latest and most effective surgical techniques. Our plastic surgeons have performed a wide range of skin grafts and tissue transfer procedures.

They are fully skilled at the superior restoration of the skin cancer site so that it matches the remaining skin. Because they closely work with other experts in the field, they can call on any other type of medical expert needed right at our facility, including pathologists, oncologists, and dermatologists.

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Phone: (352) 742-0079

Fax: (352) 742-0059

Address:
1879 Nightingale Lane, Suite A-2
Tavares, FL
West of Waterman Hospital, just off US 441

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