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Skin Grafting

Skin grafting

What is a skin graft?

A skin graft consists of skin taken from another part of the body and applied to the site where skin is missing. This might follow surgical removal of a skin cancer or a burn. A skin graft is thus a skin transplant. Skin grafts are performed by surgeons (including plastic surgeons) and by some dermatologists.

Why do you need a skin graft?

A skin graft is required when the area that has been cut out is too big to sew the edges together directly. The skin graft covers the wound and attaches itself to the cells beneath. If you didn't apply a skin graft, the area would be an open wound and take much longer to heal.

What is involved in having a skin graft?

Your dermatologist will explain to you why the skin lesion needs excision and why a skin graft is required. He or she will explain the procedure involved. You may be asked to sign a consent form indicating that you agree to and understand the procedure. Tell your doctor if you are taking any medication (particularly aspirin or warfarin, which could make you bleed more), or if you have any allergies or medical conditions. Remember to tell your doctor if you take any herbal remedies as a number of these can also lead to abnormal bleeding.

The area to be excised is marked with a coloured pen. Local anaesthetic will then be injected which will sting briefly. The dermatologist will then cut around and under the lesion with a scalpel and sharp scissors so that it is completely removed (excision biopsy). The lesion will be microscopically examined by a pathologist.

There may be some bleeding in the area from where the lesion has been removed. The doctor may coagulate the blood vessels with diathermy. This can make a hissing sound and a burning smell.

The dermatologist will measure the area of the wound to know what size to make the skin graft. A piece of skin will be shaved or cut from another part of your body (e.g. leg or arm) that is large enough to cover the wound. When possible, skin of similar thickness and colour will be selected.

The piece of skin (the graft) will be applied to the wound and secured in place with stitches. A special non stick dressing will be applied over the skin graft.

Usually this dressing is left in place for a few days until you see the dermatologist or nurse again. Make sure you have received instructions on how to care for the wound and when to get the stitches out.

Will I have a scar?

It is impossible to cut the skin without scarring in some way, so some sort of scar is inevitable. Scarring depends on what sort of skin graft has been applied and the size of the graft. Your dermatologist will try to excise the lesion and apply the skin graft carefully, to keep scarring to a minimum. He or she will explain to you what the scar is likely to look like although this can be hard to predict for certain.

You will have two scars, the scar where the skin graft has been applied and the scar from where the skin graft was taken.

Some people have an abnormal response to skin healing resulting in larger scars than usual (keloid or hypertrophic scarring).

What are the types of skin grafts?

Split skin grafts
This type of skin graft is taken by shaving the surface layers (epidermis and dermis) of the skin with a large knife called a dermatome. The shaved piece of skin is then applied to the wound. This type of skin graft is often taken from the leg. A split skin graft is often used after excision of a lesion on the lower leg.

Full thickness skin grafts
This type of skin graft is taken by removing all the layers of the skin with a scalpel (a Wolfe graft). It is done in a similar way to skin excision. The piece of skin is cut into the correct shape, then applied to the wound. This type of skin graft is often taken from the arm, neck or behind the ear. It is often used after excisions on the hand or face.

How do I look after the wound following skin grafting?

You will have two wounds, the site of the original lesion and the site where the skin graft was taken from.

Your wounds may be tender for an hour or two after the excision when the effect of the local anaesthetic wears off.

Skin grafts are very fragile and great care must be taken when looking after them. Leave the dressing in place as advised by your dermatologist. Avoid strenuous exertion and stretching of the area until the stitches are removed and for some time afterwards.

If there is any bleeding, press on the wound firmly with a folded towel without looking at it for 20 minutes. If it is still bleeding after this time, seek medical attention. Do not rub the area as this may disturb the graft.

Keep the wounds dry until your dermatologist advises that you can wash them. If the wounds become red or very painful, consult your dermatologist: they could be infected.

Does the skin graft always take?

Sometimes the skin graft doesn't stick to the wound underneath and falls off. This usually happens within the first two weeks after the procedure. It can happen for a variety of reasons including bleeding underneath the graft and wound infection. If this happens, your dermatologist will inform you what further treatment is required. It is quite normal for the graft to appear black and crusted on the surface when the dressings are removed. This does not necessarily mean it has failed


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Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
Dr. Rothfeld
 
 
 

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Botox: FDA Review Update

The Food and Drug Administration (FDA) is investigating rare reports of serious adverse events linked with Botox, Botox Cosmetic and Myobloc.

If you have already received Botox injections or are considering Botox injections for cosmetic reasons, here's what you need to know. The investigation is still in its infancy; this Q&A will be updated as new information becomes available.

Why is the FDA looking into the safety of Botox?

A Washington, D.C.-based consumer watchdog group called Public Citizen reviewed FDA data and found that the agency had received reports of 180 U.S. cases of people developing sometimes life-threatening conditions, including respiratory failure, after receiving Botox injections (botulinum Types A and B). Sixteen deaths had occurred, four of which were of children less than 18 years old. Public Citizen then filed a petition with the FDA calling for stronger and more widely disseminated warnings concerning these risks.

What sanctions is Public Citizen calling for?

Pubic Citizen is asking for a "black box" warning on Botox products. This is the strongest warning that the FDA can place on a product. The group also wants doctors to inform patients receiving Botox injections about the potential risks and alert them to possible warning signs of severe adverse reactions.

How are the Botox manufacturers responding to this investigation?

Allergan, the company that manufactures Botox and Botox Cosmetic, fully supports the investigation and is working with the FDA to ensure that it has all of the information needed for a thorough review. The company stands by the safety of its product.

"Since its approval, over a million people have been treated with Botox Cosmetic," said Sef Kurstjens, MD, chief medical officer for Allergan, in a written statement. "In its entire history, there has never been a single reported death where a causal link to Botox Cosmetic was established."

In addition, Solstice Neurosciences, the manufacturer of Myobloc, stated that it fully supports the FDA review of Botox and remains committed to providing the agency with any information it needs.

Did any of the reported adverse effects occur in people using Botox to reduce fine lines and wrinkles?

No. The most serious adverse events occurred mainly among children with cerebral palsy who were treated for spasticity of their limbs. This is not currently an FDA-approved use of Botox injections in either adults or children.

Were the Botox injections defective or tainted?

No. No evidence exists that the Botox products were defective in any way. The FDA stated that these adverse effects may have been related to overdosing. According to some reports, these children may have been receiving a dose up to 28 times greater than the amount injected into cosmetic Botox users.

How did the Botox injection in the limbs affect these children's lungs?

The active ingredient in Botox, botulinum toxin Types A and B, may spread from distant parts of the body to the muscles that affect breathing. This is reflected in current product labeling.

Is Botox safe?

Yes. Very. According to both the American Society for Aesthetic Plastic Surgery (ASAPS) and its sister organization, the American Society of Plastic Surgeons (ASPS), Botox is extremely safe. More than one million people have received Botox injections. Year after year, Botox ranks number one among nonsurgical cosmetic procedures among both men and women. Complications are rare; the most common side effects include bruising and numbness at the injection site, headache, nausea and flu-like symptoms.

How can I ensure that I am safe if I decide to receive Botox injections?

Step 1. Do your research. ASAPS suggests asking your doctor the following questions before you receive Botox injections:

  • What is your board certification? (Doctors certified in either plastic surgery or dermatology are most qualified to give Botox injections.)
  • How were you trained to do injectable treatments?
  • Do you regularly provide Botox treatments?
  • How many people have you treated who have a condition similar to mine?
  • Will you personally inject me? If not, what are the qualifications of the person who will?

Step 2. Be alert to signs and symptoms of serious problems. Although serious complications from Botox are extremely rare, their warning signs including worsening or unexpected difficulty swallowing, slurred speech, trouble breathing or muscle weakness. Seek medical attention if any of these symptoms occur. These effects have been reported as early as one day and as late as several weeks after Botox injections.

Are other injectables safe?

The new investigation concerns only Botox. It does not relate to — or affect — other available injectables on the market or in the pipeline. Each injectable has its own benefit and safety profile. Talk to your doctor about which one is right for your needs.


What is Botox?

Botox is produced from the bacterium Clostridium botulinum, which is commonly associated with food poisoning. In small, diluted amounts, however, Botox can be injected directly into specific muscles, causing a controlled weakening. It has cosmetic and medical uses.

Are there different types of Botox?

Yes. Botox Cosmetic and Botox are both derived from botulinum toxin Type A, and Myobloc is derived from botulinum Type B. Another type of Botox may be available someday soon. Already approved in more than 60 countries, Dysport/Reloxin, an injectable form of botulinum toxin Type A, is moving down the pike. Stay tuned.

What are the approved — and unapproved — uses of Botox injections?

In April 2002, the FDA approved Botox Cosmetic for the treatment of moderate to severe frown lines between the eyebrows (glabellar lines), but often it is used off-label on crows' feet, forehead creases and bands on the neck. Botox is approved for spasm of the eyelids (blepharospasm), severe neck muscle spasms (cervical dystonia) and excessive sweating (severe primary axillary hyperhydrosis). Myobloc is approved for the treatment of adults with cervical dystonia. (It has not been tested sufficiently in children with cervical dystonia.) Currently Botox is being studied to treat a laundry list of other conditions, from knee and hip osteoarthritis to migraine headache and benign prostatic hyperplasia (BPH).

What is off-label use?

Off-label use refers to the somewhat common practice in which doctors use an approved medication for a reason that has doesn't have FDA approval. This practice can be both legal and ethical in many situations.

How does Botox affect wrinkles?

Certain wrinkles are created when nerve cells within the skin's muscles release a chemical called acetylcholine. Acetylcholine, in turn, triggers muscle contractions that create wrinkles. Botox blocks the release of acetylcholine, which paralyzes the muscle, stopping the contraction and erasing the wrinkle.

How long do the effects of Botox last on wrinkles?

Typically the effect of Botox injections on wrinkles lasts three to six months.

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Trained in Dermatology, NYC Dermatolgy by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips. 
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During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

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NYC Dermatology - Manhattan Dermatology - Skin Institute of New York - Skin Cancer Doctor- NYC Cosmetic Dermatology-  Cosmetic Dermatological Surgery - New York City - Board Certified Dermatologist

Manhattan Office 

 Dr. Gary Rothfeld
NYC Dermatology - Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
212.644.9494
1.800.BLEMISH
  


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