Blog

Laser treatments can address specific concerns about the skin on the face and neck. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether a laser treatment is appropriate for your concerns. A Laser is a Powerful, Targeted Form of Light Used for Skin Rejuvenation A laser is a powerful form of light of a single wavelength that targets specific molecules in tissue. This allows specific areas of tissue to be treated without affecting the surrounding areas. There are Multiple Types of Lasers Used for Skin Rejuvenation Many lasers are used in for skin rejuvenation. Each treats specific features of the skin. Among the most used lasers are resurfacing lasers and vascular lasers. A device commonly believed to be a laser is Intense Pulsed Light Therapy (IPL). It is not, however, a laser but a device that delivers energy to the skin at multiple wavelengths – as opposed to one – at the same time. Resurfacing Lasers Can Provide the Most Obvious Skin Rejuvenation Results Resurfacing lasers such as the CO2 laser and Er:YAG laser can provide some of the most obvious skin rejuvenation results of any laser. These lasers can treat signs of photoaging such as age spots, sunspots, and fine and moderate wrinkles. These lasers target the water molecule, heating it up and vaporizing skin precisely and at a controlled depth. The skin then heals with a more youthful appearance. In contrast with the CO2 laser and Er:YAG laser, non-ablative resurfacing lasers such as Nd:YAG heat up the water in skin without vaporizing it. Ablative lasers are more effective than non-ablative lasers in treating signs of photoaging. However, the recovery is often a few days longer with ablative lasers, which many individuals feel is well worth the results. Both ablative and non-ablative lasers are now manufactured to deliver treatment in a fractional form. This means that the laser is not one single column of energy but many small columns. This leaves intact skin in small areas between these columns, which allows the treatment site to heal more quickly and with a lower risk of side effects. Strict sun avoidance is important for weeks to months after treatment with any resurfacing laser. This includes wearing hats and applying a mineral-based sunscreen of SPF30 or greater to the site after healing is complete. Harmon Facial Plastic Surgery offers fractional CO2 laser resurfacing treatments for some skin changes related to aging, because we feel it best balances providing an effective and safe treatment. A detailed conversation is had with everyone interested in this treatment about the expected results and potential risks with this procedure. Vascular Lasers Treat Skin Features Caused by Blood or Blood Vessels Vascular lasers such as pulsed dye lasers target the molecule hemoglobin, which is present in blood and blood vessels. Vascular lasers are often used to treat bruising, minute blood vessels in the face, dilated veins near the surface of the skin, rosacea, and other vascular abnormalities of the skin. It can soften scar tissue and improve redness of some scars. Intense Pulsed Light (IPL) is Less Effective but Has Less Down Time IPL delivers light in a wide range of wavelengths - as opposed to a single wavelength with a laser - to the skin. It is a non-ablative treatment (like the Nd:YAG laser) for skin conditions such as bruising, age spots, and sun spots. There is usually little to no down time after treatments. The risk of complications is usually less with IPL versus lasers. However, it is less effective than lasers and often requires multiple treatments. The Expected Recovery and Risks Differ for Each Laser The recovery and risk profile differs for each of the lasers above. It is important to have a detailed conversation with a specialist who understands the expected recovery and risks for every laser treatment as well as someone who can determine which laser treatment(s) may benefit you. Can Early Laser Treatment of Surgical Incisions Improve Healing? There are multiple factors that optimize surgical incision healing, from proper surgical technique, proper closure technique, sun avoidance and protection, and the application of antibiotics and moisturizers. However, an unsightly scar may still develop despite optimal closure and appropriate post-operative incision care. Lasers can improve the appearance of a scar. However, there are no strict guidelines dictating when to treat surgical sites with a laser. Laser treatment of incisions usually starts at a minimum of 6-8 weeks after surgery. Could earlier treatment of incisions alter the chemical cascade during healing and prevent scar formation? One of the most important differences between scar and normal tissue is the orientation of the support framework on which the skin heals (1, 2). Early laser treatment may result in a "shift" of the molecular signaling during healing, leading to the development of a more "normal" support framework. The most common lasers used to treat incisions are called fractional resurfacing lasers, which include the Erbium:YAG and CO2, which is the laser used by Dr. Jeffrey Harmon at Harmon Facial Plastic Surgery (3, 4). Studied as early as 1956, treatment of incisions 7 days after surgery or even during surgery with a resurfacing laser have shown some of evidence of their effectiveness (5 - 8). For example, the dermatologists Dr. Ozog and Dr. Moy have published on the use of a fractional resurfacing CO2 laser immediately after surgery to stimulate healing and prevent scar formation. They performed a randomized, blinded, split-scar – split scar means half the scar was treated and half the scar was not - study on 10 patients with linear incisions and found improvement in the appearance and texture of scars on the treatment side on evaluation 2-3 months after surgery (7 – 8). A French physician utilized a diode laser on incisions immediately after they were created and found some benefit to healing (9 – 11). While promising, the above referenced studies involved very few patients and relatively subjective scoring of the appearance of the scars. More research is required to identify the optimal laser and the optimal timing of laser use to reduce or prevent scarring after surgery. In the meantime, appropriate surgical technique, closure, and appropriate incision care after surgery are the best approaches to reducing the risk of excessive or abnormal scarring after surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References 1. Capon A, Mordon S. Can Thermal Lasers Promote Skin Wound Healing? Am J Clin Dermatol. 2003: 4(1): 1 – 12. 2. Namazi MR, Fallahzadeh MK, Schwartz RA. Strategies for prevention of scars: what can we learn from fetal skin? Int J Dermatol. 2011; 50(1): 85 – 93. 3. Ollael S et al. Use of Lasers in Acute Management of Surgical and Traumatic Incisions on the Face. Facial Plast Surg Clin North Am. 2011; 19(3): 543 – 550. 4. Mirmanesh M et al. Peri-Procedure Laser Scar Therapy Protocol: A Pilot Survey of Plastic Surgeons' Practices. Aesth Plast Surg. 2017; 41(3): 689 – 694. 5. Laubach HJ et al. Skin Responses to Fractional Photothermolysis. Lasers in Surgery and Medicine. 2006; 38: 142 – 149. 6. Greenbaum SS, Rubin MG. Surgical Pearl: The high-energy pulsed carbon dioxide laser for immediate scar resurfacing. J Am Acad Dermatol. 1999; 40: 988 – 990. 7. Ozog DM and Moy RL. Discussing Fractional Carbon Dioxide Laser and Other Physical Treatments for Scar Prevention With Patients. JAMA Dermatol. 2015; 151(8): 815 – 816. 8. Ozog DM and Moy RL. A Randomized Split-Scar Study of Intraoperative Treatment of Surgical Wound Edges to Minimize Scarring. Arch Dermatol. 2011; 147(9): 1108 – 1110. 9. Capon A et al. Laser Assisted Skin Closure (LASC) by Using an 815-nm Diode-Laser System Accelerates and Improves Wound Healing. Lasers Surg Med. 200; 28(2): 168 – 175. 10. Capon A et al. Scar Prevention Using Laser-Assisted Skin Healing (LASH) in Plastic Surgery. Aesth Plast Surg. 2010; 34: 438 – 446. 11. Capon A, Iarmarcovai G, Mordon S. Laser-Assisted Skin Healing (LASH) in hypertrophic scar revision. Journal of Cosmetic and Laser Therapy. 2009; 11: 220 – 223.

It is important to maintain the moisture of your skin, especially during the winter months with its cold, dry air. This blog post does not promote a specific skin product. Instead, it is intended to empower those interested to better understand some of the ingredients in moisturizers. Our hope at Harmon Facial Plastic Surgery is that this will help individuals make better-informed choices. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Symptoms of Dry Skin Symptoms of dry skin include flaking and peeling, a rough texture, thin cracks, itchiness, and a feeling of tightness. Products to Improve Dry Skin Act in Multiple Ways Ingredients in skincare products moisturize the skin in multiple ways: 1. Emollients are occlusive ingredients that keep moisture in the skin that is already present, thereby softening and smoothing the skin. 2. Humectants absorb water. They are often used with emollients to help keep the moisture absorbed on the skin. 3. The skin barrier is composed of lipids that include cholesterol, fatty acids, and ceramides in a specific ratio. Many moisturizer products contain these lipids in some combination. Emollients Keep Water in the Skin Emollients keep water already present in the skin from being lost into the air. As a result, they act as a moisturizer. Emollients also soften and smooth the skin through their effects. Emollients are in almost all moisturizing products. They vary in viscosity (i.e., thickness) and effectiveness. While they are more effective as a moisturizer, thick, greasy emollients are generally not well-tolerated for long-term daily use on the entire face. One of the most used and effective emollients is petrolatum. It is found in products such as Aquaphor©, Vaseline©, ChapStick©, and many others. However, petrolatum is thick (i.e., viscous) and greasy. Products like Aquaphor© and Vaseline© that contain a large amount of petrolatum may be good options to apply to incisions after surgery and during the early stages of healing because moisture encourages healing. Another benefit is that petrolatum is non-allergenic. Another example of an emollient is dimethicone, which is derived from silicon. Dimethicone is found in many moisturizers because it is thinner and, therefore, less likely to feel greasy. Silicon-based emollients like dimethicone are major ingredients in scar gels, which are typically used for months on surgical incisions to improve healing. They are, however, less effective emollients than petrolatum. It is for that reason that petrolatum-containing products are often used early in incision healing and silicon-based scar gels are used later and longer-term. Some plant-based oils, such as olive oil, can also function as emollients. One component of olive oil, squalene, is found in many moisturizers. The hydrogenated version of squalene, called squalane, is more stable than squalene and less comedogenic (less likely to clog pores). Squalane is used instead of olive oil because olive oil contains other compounds, such as oleic acid, that may damage the skin barrier. Humectants Absorb Water Humectants absorb water. Humectants can absorb water from the atmosphere in humid conditions. However, they can also absorb water from the skin in dry atmospheric conditions. That is why humectants are often combined with emollients such as those listed above. Humectants include ingredients such as glycerin and hyaluronic acid. Glycerin is one of the longest used and most effective humectants. It can be found in many moisturizers. It contributes to repair of the skin barrier. It is non-allergenic. Hyaluronic acid is another humectant and, like glycerin is non-allergenic. Hyaluronic acid needs to be small enough to be absorbed by the skin. The problem is that size of the hyaluronic acid compound is generally not specified on packaging. Humectants like hyaluronic acid are often advertised as being able to treat the appearance of wrinkles. The mechanism of action is through the absorption of water, which causes the top layer of skin to swell, thereby temporarily creating the appearance of smoother skin. The Skin Barrier is Composed of Lipids in Specific Ratios According to Dr. Leslie Baumann in the textbook Cosmeceuticals and Cosmetic Ingredients, the skin barrier is composed of lipids which include ceramides, cholesterol, and fatty acids in a specific ratio. Alterations in this ratio can damage the skin barrier. The skin barrier helps prevent water loss. Phytosterols, which are plant-based alternatives to cholesterol, are sometimes included in moisturizers. One fatty acid included in moisturizers is stearic acid, or stearate, which is FDA-approved for use in skincare. It occurs naturally in the human body but can also be found in some plant and animal butters. Its prevalence in butters makes it among the oldest cosmeceutical products currently in use. Ceramides, which historically came from animals followed by plants such as wheat germ, are now created synthetically. Naturally occurring ceramides are readily absorbed by the skin. Synthetic ceramides are less studied. Synthetic ceramides are the more commonly found ceramides in cosmeceutical products. The ingredients list for most moisturizers does not specify the ratio of lipids present in the mixture, which is important to determine how effective it is. Ingredient Labels are Incomplete It is difficult to identify the most appropriate moisturizer. Many products emphasize the ingredients that are the less effective but more distinct. Some plant based ingredients are less effective than synthetically produced ingredients and are more likely to cause an allergic reaction. The size of important compounds is not listed, which is sometimes indicative of the ingredient's effectiveness (e.g., hyaluronic acid). Finally, the relative ratios of important ingredients (e.g., ceramides, sterols, and fatty acids) are not listed, which can also be indicative of the overall effectiveness of the moisturizer. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us Reference Baumann L. Cosmeceuticals and Cosmetic Ingredients. McGraw-Hill Education; 2015.

It is a privilege to team up with dermatologists to assist in the treatment of skin cancer. As a facial plastic and reconstructive surgeon, I am enlisted to repair particularly sensitive, aesthetically important areas of the face, such as the nose. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. 1. A Patient is Evaluated and Diagnosed with Skin Cancer by a Dermatologist A patient is first evaluated by a dermatologist, who identifies an area of concern and biopsies it. If that biopsy returns as skin cancer, the patient is usually referred to another dermatologist who specializes in a surgery called Mohs. Mohs surgery involves the careful removal of skin cancer, layer-by-layer in all directions, until there is no longer cancer present at the margins of the removed tissue. The area where the skin cancer was removed then needs to be repaired using tissue (e.g., skin, fat, muscle, mucosa) from other areas of the face immediately adjacent to the defect, within the region of the face, or farther away. My services are often enlisted by the dermatologist to perform the repair. 2. The Patient Comes to Me for a Consultation Next, I have an opportunity to meet with the patient in consultation. I perform a detailed history and physical examination. The depth and extent of the defect is not clear prior to Mohs surgery. As a result, we discuss a range of options to treat the predicted defect. We always discuss the possibility that the defect will be deeper and/or wider than anticipated. As a result, it is important to have not only a "Plan A" but also a "Plan B" and "Plan C" for the repair. These plans are discussed with the patient. 3. The Dermatologist and I Coordinate a Date for Surgery My office then coordinates with the dermatologist's office to determine the most appropriate date for surgery. The patient undergoes Mohs surgery with dermatology in the morning. Our goal is to schedule the repair in the afternoon on the same day as the Mohs surgery. However, the repair can usually be scheduled for the following day if necessary. 4. I Manage the Post-Operative Incision Care I manage the post-operative care of the patient. This includes suture removal and care of the incision(s). Some patients need multiple, staged procedures to complete the repair. The team at Harmon Facial Plastic Surgery work to make the initial and any subsequent procedures as convenient as possible. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

The English-language literature on the use of the natural ingredient bakuchiol topically as an alternative to retinols in treating age-related changes to the skin (i.e., photoaging) will be reviewed. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Bakuchiol Has Long Been Used in Skincare Retinols are compounds that are converted into retinoic acid, which has been shown to increase collagen turnover and production and has been used to treat wrinkling and other signs of photoaging. Bakuchiol is a chemical derived from the babchi plant seed (Psoralea corylifolia), an herb long used in traditional Chinese and Indian ayurvedic medicine to treat multiple skin conditions. It is now being widely marketed in Western markets as an alternative to over-the-counter retinol-containing topical skincare products. A quick search on Google will identify many articles arguing the benefits of bakuchiol as a "miracle" alternative that is just as effective as retinols. Advertisements argue that it functions similarly to retinols but without the sensitivity reactions that often occur when starting retinols. And, it is important to note, the comparisons in the media are between bakuchiol and retinols, not the more potent, prescription-strength retinoic acid prescribed by dermatologists and other physicians. Evidence for Bakuchiol's Effectiveness is Lacking A review of the English language literature produced limited information on bakuchiol. The basis for the current craze for bakuchiol is a pilot study from 2014 (1) and a small trial from 2019 (2). Both of these studies utilized a very small study group and had multiple limitations, largely functioning as "marketing" studies for this product rather than rigorous studies comparing the actual effects of bakuchiol with retinols. In addition to a small study size, the time frame of the studies were too short compared with the known time to effect of prescription-strength retinoids. Future Research on Bakuchiol is Worthwhile It now seems like there has been an explosion of products that contain bakuchiol, usually included in mixture that has glycolic acids or other chemicals that resurface the skin. This suggests that there is very little evidence demonstrating the effectiveness of bakuchiol as an alternative to retinols for photoaging of facial skin. There is also some concern about whether individuals can experience an allergic reaction to this plant-based compound. That being said, future research is warranted. Bakuchiol may, in fact, prove a useful and effective adjunct to skin care regimens for treating photoaging. The available studies, however, do not definitively demonstrate this. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References Chaudhuri RK, Bojanowski K. Bakuchiol: a retinol-like functional compound revealed by gene expression profiling and clinically proven to have anti-aging effects. Int J Cosmet Sci. 2014 Jun;36(3):221-30. doi: 10.1111/ics.12117. Epub 2014 Mar 6. PMID: 24471735. Dhaliwal S, Rybak I, Ellis SR, Notay M, Trivedi M, Burney W, Vaughn AR, Nguyen M, Reiter P, Bosanac S, Yan H, Foolad N, Sivamani RK. Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. Br J Dermatol. 2019 Feb;180(2):289-296. doi: 10.1111/bjd.16918. Epub 2018 Sep 21. PMID: 29947134.

You are likely aware of silicone-based scar gels by seeing ScarAway© or another over-the-counter brand in your local pharmacy. Surgeons in all specialties as well as dermatologists recommend these scar gels after procedures to promote healing and reduce the risk of scarring. But how well do they work? I reviewed the literature in order to determine whether silicone gels, placed post-operatively after surgical incisions have healed, can help reduce the appearance of incisions. Not surprisingly, quality studies are difficult to find. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. There are two ways of describing an abnormal scar, hypertrophic and keloid. There may seem to be little distinction between the two. However, the underlying process that causes them to form is radically different. Basically, a hypertrophic scar remains within the boundaries of the original incision or injury. A keloid, on the other hand, expands beyond it. The goal of silicone gels and patches are to not only reduce the risks of hypertrophic scar or keloid formation, but also to reduce the redness of an incision and accelerate the fading of the appearance of a scar. The two major problems with the studies I reviewed are 1) few of the incisions examined were located on the face and 2) silicone gels were usually compared with another treatment rather than no intervention at all (placebo). The second problem is unavoidable because it would be unethical to allow the control group to heal without an accepted alternative treatment to reduce the appearance of a scar. One of the most promising studies was a randomized, placebo-controlled, and double-blinded clinical trial evaluating whether silicone gel prevents hypertrophic scar development on chest (sternotomy) incisions. The researchers found that silicone gel application resulted in a better-appearing scars 3 months after surgery. However chest (sternotomy) incisions are notorious for poor healing and frequent scarring (1). This is unlike the skin of the face, which is widely understood to heal much better than other parts of the body. Also, most of the patients, in addition to heart problems requiring a chest incision, had other medical problems that could lead to poor wound healing such as diabetes. It is possible the silicone gels are more effective in patients with a much higher risk of poor healing. That being said, another quality study found no difference in healing with the addition of silicone gel to the incisions of those considered similarly "high risk" of forming an abnormal scar (2). The only randomized, placebo-controlled, double-blinded clinical trial focused exclusively on facial incisions I found was from 2018. The researchers looked at the use of silicone gel on forehead incisions for brow lifts (3). Only 13 patients participated, which is a very small number. No difference in the appearance of the incisions was identified at 6 months. Other, similar studies have shown no clinically meaningful difference in scar formation with the use of silicone gels on breast reduction incisions (4) and cesarean section incisions (5). The bottom line: First, it is important to note that we still do not know how silicone gels work to reduce the appearance of surgical incisions. It may be that silicone gels function like an occlusive dressing, holding moisture in and keeping bacteria out. It may also modify the underlying inflammatory process that occurs with any incision during healing. Either way, the end goal is to have an incision as soft, smooth, and flat as possible. There are few studies of quality design available to review. Those available are plagued by the same problems with other studies of this type, including small numbers of subjects. To make matters worse, these studies rarely focus on incisions on the face or on the most important outcome to me, the appearance of incisions after surgery - not simply the prevention of abnormal scarring (e.g. hypertrophic, keloid). On the other hand, there is little risk with the use of silicone gel, barring some limitations around the eyes and mouth as well as for those who are allergic to silicone. And silicone does help keep healing incisions moist, which is essential to healing. As a result, I encourage almost all of my patients to start using silicone gels after all sutures are removed twice daily for weeks to months as the incisions heal and blend in with the rest of the skin. I expect additional studies may result in evidence that this approach can help improve the appearance of incisions. In the end, factors other than whether or not silicone gels are applied are more important to the healing process, including proper closure technique, tension-free skin re-aaproximation, a healthy diet, adequate sleep, and sun protection with mineral-based sunscreens. References: Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M. A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg. 2005 Sep 15;116(4):1013-20; discussion 1021-2. Gold MH, Foster TD, Adair MA, Burlison K, Lewis T. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg. 2001 Jul;27(7):641-4. Cadet N, Hardy I, Dudek D, Miszkiewicz K, Boulos P, Nguyen Q, Wong J. Prospective case-control trial evaluating silicone gel for the treatment of direct brow lift scars. Can J Ophthalmol. 2018 Feb;53(1):29-33. Niessen FB, Spauwen PH, Robinson PH, Fidler V, Kon M. The use of silicone occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation. Plast Reconstr Surg. 1998 Nov;102(6):1962-72. Lin YS, Ting PS, Hsu KC. Comparison of Silicone Sheets and Paper Tape for the Management of Postoperative Scars: A Randomized Comparative Study. Adv Skin Wound Care. 2020 Jun;33(6):1-6. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us

It is challenging to identify skin care products based on strong clinical evidence and a strong safety profile. The skin care products I currently use are not perfect. Therefore, my choices may not be well-tolerated or beneficial to others. Every individual's skin is different. Consider an evaluation by a dermatologist to help determine the best tolerated, safest, and most effective products for your face. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. It is Difficult to Identify a Skincare Routine with Strong Clinical Evidence Supporting its Safety and Effectiveness I and many other physicians find it difficult to assemble strong data to support the effects of many skincare product ingredients. The cost of skin scare products sometimes but do not always reflect their effectiveness and safety. As a result, the products I use that are listed below are not a medical/professional endorsement of the brands or the products specifically. They have simply worked for me personally with little-to-no skin irritation. The Environmental Working Group (EWG) Has a Guide Called Skin Deep© to Help Consumers Choose Products with a Favorable Safety Profile EWG is a nonprofit organization founded in Washington, D.C. in 1993 whose stated mission is "to empower you with breakthrough research to make informed choices and live a healthy life in a healthy environment." While any organization with a lobbying arm and funding from outside organizations – including organic agriculture organizations – should be judged with some level of skepticism, EWG has been consistent in advocating for the removal of harmful chemicals in personal care products consistent with standards established by chemical safety laws in the European Union (EU) and California, which are among the most stringent in the world. My wife, Fara, and I use an EWG app on our phones when we shop for home cleaning products as well as products for our son, Babak, and daughter, Roya. Fara and I also reference EWG's Skin Deep© rating system when we shop for our own skincare products. It is not a perfect system, but we feel like it has empowered us to make somewhat better, healthier product choices for ourselves and our family. However, as you will see below, I do not depend entirely on EWG to make purchasing decisions. For example, some of the most effective ingredients in cosmeceutical products do not pass EWG's muster. Also, many products highly rated by EWG have a high potential for allergic reaction due to their contents. This needs to be considered with all buying choices. Every individual needs to use their own resources and make their own decisions regarding what products they place on their face. Skinceuticals© CE Ferulic and The Ordinary© Pycnogenol 5% for Antioxidants There is evidence for the effectiveness of some topical antioxidants, not only to slow the development of the signs of aging but also to act as a photoprotective agent complementing a mineral sunscreen. As a result, I have chosen to apply antioxidants to my face. Please see a previous blog post discussing the changes that occur in the skin with aging for a more detailed description of the effects of Vitamin C. Pycnogenol is another antioxidant that has long been in use and is derived from a Mediterranean tree bark in France. There is evidence that it can act not only act as an antioxidant but also prolong and recycle the effects of Vitamin C. Neither of the products above have resulted in skin sensitivity and rash for me, though that is a potential risk with the use of antioxidants such as these. These products are not rated by EWG. Vanicream© Daily Facial Moisturizer I have been using Vanicream© moisturizers for many years. I found my son's skin tolerates one of their moisturizers well. The company's products are inexpensive and can be found at most pharmacies. The Vanicream© Daily Facial Moisturizer blends well into my face and does not cause an itching rash that some moisturizers have caused me with frequent use. This product is rated 1 (best) by EWG. Mineral Sunscreen A mineral sunscreen, meaning a sunscreen with a physical barrier such as zinc oxide, is superior to a chemical sunscreen. A mineral sunscreen provides more effective coverage against both UVA and UVB sun rays than a chemical sunscreen. And some chemical sunscreens in the United States have ingredients that are known or potential carcinogens at high doses. The problem with a mineral sunscreen is that it can be difficult to blend in with the skin and it often leaves the skin feeling caked and uncomfortable. The "right" specific product may differ between individuals. The Lesson: Skincare is Difficult and Imperfect The evidence base for cosmeceuticals is generally weak because they are not regulated by the Food and Drug Administration (FDA) like medications. For example, there may be new evidence in the future that one or more of the ingredients in the above products are not beneficial. I work hard to adhere to the most consistent, highest quality, established evidence for the effectiveness of certain products. I also try to avoid the most harmful chemicals as determined by the entities that have passed the strongest chemical safety laws. However, I will likely make changes to this regimen over time with a goal of minimizing what I apply to my skin, though I will likely always apply a mineral sunscreen. I also hope to add a retinol to my regimen in the future. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face and/or neck. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us References Baumann, L. (2014). Cosmeceuticals and Cosmetic Ingredients (1st ed.). McGraw Hill/Medical.

Retinoids are derived from Vitamin A, which a common vitamin in human skin. They can be naturally derived or synthetically (i.e., lab) derived. Most retinoids are applied to the skin (i.e., topically) to treat age-related changes to the skin and/or prevent age-related changes to the skin. Those changes, called photoaging, include wrinkles, dark spots, and texture irregularities. Retinoids exert their effects by encouraging the formation of youthful collagen and discouraging the breakdown of collagen in the skin. Retinol is a form of retinoid. Tretinoin is another form of retinoid. Retinoids achieve their effect by acting as hormones. They are easily absorbed by the skin, which is unique compared with other products applied to the skin. This likely contributes to their effectiveness. It is important to have a discussion with a physician as to whether a retinoid such as retinol or tretinoin is appropriate for your face. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Tretinoin is an FDA-Approved Prescription Retinoid Tretinoin is the best-studied prescription retinoid medication for photoaging. It is important to note that, although tretinoin has been FDA-approved for the treatment of photoaging, there is strong evidence for its effectiveness in preventing the effects of photoaging as well. Even better, much of this data utilizes high quality research, including randomized, controlled studies, which I explain more about in this blog post. Retinol is a Cosmetic Ingredient that is Not FDA-Approved Retinol is a metabolic precursor to tretinoin. This means that, when retinol is applied to the skin and absorbed, it is converted into tretinoin over multiple steps. Tretinoin is the compound with the anti-aging effects. Retinol is included in many over-the-counter skincare products but is not FDA-approved. That is why it is not a prescription medication. There is evidence, however, that it is also effective in treating the signs of photoaging. Both Tretinoin and Retinol are Effective Topical Retinoids First and most importantly, the evidence in the medical literature demonstrates that both tretinoin – the FDA-approved prescription medication – and retinol – the cosmetics ingredient that is not FDA-approved – are effective in treating age-related changes to the skin. The earliest and best data came from research on tretinoin. More data, however, is being published to support the effectiveness of retinol. It is just that no company to date has chosen to go through the time-consuming and expensive process of getting FDA approval for retinol in one of their cosmeceutical products. The lack of FDA approval does make it difficult to choose the best over-the-counter product, because it is not regulated like a medication. Therefore, it is difficult to determine the most effective retinol-containing product. Side effects of retinoids include redness, skin irritation, and skin peeling. The severity of these symptoms is dependent on both the dose and frequency of use. However, people tend to develop tolerance to these compounds over time. Retinols are less likely to cause the above symptoms. Therefore, some suggest starting with retinol and transitioning to tretinoin with a gradual increase in dose and frequency of use once tolerance has been built. One also should consider the fact that the ingredients are very sensitive to the sun, becoming inactive very quickly with sun exposure. Many recommend applying them at night for this reason. It is important to discuss any plans to start using tretinoin or retinol with a physician. Bakuchiol is Being Promoted as an Alternative to Topical Retinoids There is a plant-derived product called bakuchiol which is currently being marketed as an alternative to retinoids (e.g., tretinoin and retinol) with fewer side effects. There is a long history of its use in Chinese and Indian medicine. However, the evidence for its effectiveness is currently weak. See this blog post for more information on bakuchiol. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. It is important to seek the advice of a dermatologist if you have concerns about your skin and feel a prescription retinoid such as tretinoin may be helpful to you. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us Reference Baumann L. Cosmeceuticals and Cosmetic Ingredients. McGraw-Hill Education; 2015.

Scar treatment can address specific concerns about the appearance of a scar on your face and/or neck. There are four general categories of treatments for scars, each of which may or may not benefit you. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether - and which - scar treatment is appropriate for your concerns. Topical Treatments Can Improve Healing and Reduce the Risk of Abnormal Scarring The enemy of surgical incision healing is sun-exposed, dry skin. To that end, topical treatments that keep surgical incisions moist and protected from the sun can improve healing and reduce the risk of abnormal scarring. The first few days after surgery require a topical antibiotic to both keep incisions moist and to reduce the risk of infection. Next, an occlusive moisturize such as Aquaphor© is used to continue to hold moisture in the skin around the incision. Finally, a silicone-based scar gel layered over with a mineral-based sunscreen with an SPF of 30 or greater is applied for months until the incision is completely healed. Injectable Treatments Can Reduce the Risk of Abnormal Scarring and Improve the Appearance of Scars Incisions can (rarely) scar excessively, resulting in discoloration and contour abnormalities. Careful use of dilute steroids injected into these scars starting a few weeks after surgery can soften them and improve their contour, making them flatter and more even. Fluorouracil is a medication that has been used early in the healing process after eyelid surgery (blepharoplasty) to reduce excessive scarring which can result in incomplete eye closure, called lagophthalmos. It is injected deep into scars just as they are starting to form. Resurfacing Treatments Can Improve the Color and Contour of Scars Resurfacing lasers, including the Erbium:YAG and CO2, are potentially excellent tools for treating excessive scarring. Similarly, chemical peels which also resurface the skin can be used to treat excessive scarring. Both lasers and chemical peels can improve the color and contour of scars. But both do involve a recovery process during which the top layers of skin heal. Unfortunately, resurfacing lasers and chemical peels cannot be used on darker skin tones due to the risk of skin lightening associated with these treatments. Surgical Scar Revision Can Remove Abnormal Scars Scars that do not improve with topical, injectable, or resurfacing treatments may require surgical removal. Surgical scar revision involves the excision of the scarred skin and closure of the normal surrounding skin. The purpose of this procedure is to allow the skin another opportunity to heal with more aesthetically pleasing results. Surgical scar revision surgery can also reorient scars in ways that better camouflage them on the face. Botulinum Toxin A (e.g., Botox©) is Used to Reduce Scarring It was first theorized that botulinum toxin A (BoTA) could be used to reduce scarring in 2000. While the use of BoTA for this purpose is considered FDA off-label, more research is being published to suggest that it could be effective when injected either during surgery or shortly after (1, 2). The potential mechanisms of action are the following: Reduced tension on the incision site. Increased tension at the incision site increases the risk of excessive scarring. This is the reason why deep plane facelift surgery, including the extended deep plane facelift, reduces the risk of abnormal scarring compared with other non-deep plane techniques. Reduced fibroblast hyperproliferation. Fibroblasts build connective tissue and excess proliferation can result in excess scarring. Reduced deposition of collagen. Fibroblasts produce collagen. Fluorouracil is Used to Reduce Scarring Fluorouracil is another medication that is used FDA off-label to reduce scarring. It is a chemotherapeutic agent that is commonly used in dermatology to treat pre-cancerous and cancerous skin growths. It functions as an antimetabolite, which means it stops the growth of particularly fast-growing cells. Fluorouracil is probably most used in the lower eyelid after lower eyelid surgery (blepharoplasty) to reduce the risk of and treat scarring that can lead to retraction of the lower eyelid, which can cause problems with eye closure. Like BoTA and steroids, it is important to have a detailed discussion of the risks, benefits, and alternatives to the use of this medication with your physician prior to considering these treatments. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about abnormal scarring in the face and/or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us References 1. Bi M, Sun P, Li D, Dong Z, Chen Z. Intralesional Injection of Botulinum Toxin Type A Compared with Intralesional Injection of Corticosteroid for the Treatment of Hypertrophic Scar and Keloid: A Systematic Review and Meta-Analysis. Med Sci Monit. 2019 Apr 22;25:2950-2958. 2. Kasyanju Carrero LM, Ma WW, Liu HF, Yin XF, Zhou BR. Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. J Cosmet Dermatol. 2019 Feb;18(1):10-15.

Laser resurfacing of the face can address wrinkles and other irregularities of the tone and texture of the skin resulting in a softer, more youthful appearance to the face. Good skin care after treatment with a resurfacing laser is essential. The following post describes this process. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. The Skin Heals in an Average of Seven to Ten Days After Laser Resurfacing The first seven to ten days are essential to the healing process after laser resurfacing of the face. The top layers of the skin are healing. It is essential to avoid the sun during this time. It is also essential to keep the treatment areas moist and clean. A Skin Protectant/Moisturizer Such as Aquaphor© is Applied While Healing It is important to keep the treated skin moist while healing. A moisturizer such as Aquaphor© is applied to the skin twice daily until the top layers heal. The Face is Cleaned with Water and a Gentle Cleanser While Healing The face is generally washed with lukewarm water and a gentle facial cleanser while healing. A solution of diluted vinegar is sometimes used as well. Antibiotic and Anti-Viral Medications are Taken Every patient takes antiviral medications and antibiotics to reduce the risk of a bacterial infection and/or the activation of a dormant viral infection that also causes cold sores. A Moisturizer and Sunscreen are Applied After the Skin Has Healed The healing process does not end after seven to ten days. A slight pink hue often develops in some areas after the skin has healed, which usually fades during the first few months after treatment. It is important to avoid prolonged sun exposure for months after surgery during this time. It is important to keep a moisturizer on the skin in addition to wearing a hat and sunglasses and applying a mineral-based sunscreen. A good moisturizer is the Skinceuticals© product Epidermal Repair. My patients apply Epidermal Repair to the treated skin for approximately three months after the skin has healed. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

Smoking cessation for many weeks prior to and after surgery is essential to maximize healing and reduce the risks associated with poor wound healing. The components of cigarettes that affect healing include nicotine, carbon monoxide, and hydrogen cyanide. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. Nicotine Constricts Blood Vessels and Encourages Blood Clots Present not only in cigarettes but also liquid vaping products, cigars, smokeless tobacco products, and hookah tobacco, this highly addictive substance acts on tissue in two ways. First, nicotine constricts small blood vessels, restricting the flow of oxygen and nutrients to healing tissue. Second, nicotine encourages blood to clot, which also serves to restrict blood flow to healing tissue. We counsel patients to avoid all nicotine-containing products, not just cigarettes, peri-operatively. Carbon Monoxide Reduces the Ability of Blood to Carry Oxygen and Release It to Tissues Carbon monoxide, a well-known poison that is released from fireplaces, wood-burning stoves, gas ranges, and furnaces in homes, is also present in cigarette tobacco. Carbon monoxide acts to impair healing in two ways. First, carbon monoxide reduces the ability of blood to carry oxygen to tissue by replacing oxygen in the hemoglobin contained in blood. Second, carbon monoxide reduces the ability of blood to release oxygen to tissue due to the changes that occur to the hemoglobin in blood when carbon monoxide binds to it. Hydrogen Cyanide is a Poison that Prevents Cells from Utilizing Oxygen Originally used as a chemical weapon, hydrogen cyanide is present not only in cigarettes but also in pesticides, fumigants, and plastics. Hydrogen cyanide is a poison that stops the ability of cells to utilize oxygen delivered to it by the blood. This results in cell death and, as a result, poor healing. The Effects of Nicotine, Carbon Monoxide, and Hydrogen Cyanide are to Impair Healing and Increase the Risk of Infection The risk of infection and abnormal scarring increase significantly with smoking. The risk of poor tissue perfusion to the skin also increases, potentially leading to loss of skin after facial plastic surgery procedures, including facelifts, neck lifts, nose surgery, and eyelid surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us