Premium Beauty News - You are a pediatric surgeon specializing in reconstructive surgery of the child and you took the floor at the 2013 edition of the European Dermocosmetology Days on the theme of skin healing in children, what is your view about skin?
Dr Isabelle James - skin is an organ and not just a simple tissue. It is made of multiple units, which should be repaired as completely as possible if we want to obtain both an acceptable cosmetic result and most of all a satisfactory function in a growing individual. Repaired skin must follow the changes. It is a major vehicle for social integration and each problem needs to be addressed to provide well-being to the child; do they not say “feeling good about yourself?” As part of my work as a pediatric surgeon in the field of reconstructive surgery of the child, I deal with congenital malformations but also accidents, burn injuries, or any condition that is causing a tissue deterioration and which requires repair with the scarring consequences that it implies.
Premium Beauty News - What do your activities consist in?
Dr Isabelle James - One of my main activities focuses on cleft lips and palates where we follow different lines of research. The first line is prenatal diagnosis; we work in collaboration with physicians from the Collège d’Echographie Fœtale to improve sonographic signs suggesting this pathology. The second line relates to the support of families as part of therapeutic education appointments. The child and his parents are seen before the procedures by the hospital team to learn the post-operative care gestures and the diet to be less anxious on the day of hospitalization. We offer psychological counselling but also a place of exchange between professionals and parents through our association, Le Trèfle (consisting of the team treating cleft lip and palate at Ecully). In France, the proportion of cleft lips and palates is of 1 per 700 live births. The last line of research focuses on facial growth and on the optimal times for a surgical procedure. In our team, we operate as soon as the child has reached his second month with an early orthodontic treatment and secondary bone surgery and nose symmetry so that the child can enter primary school with a better facial symmetry. In the United States, some teams work in utero, which in theory is very advantageous since healing is optimal on the foetus (foetus heals by apposition of normal tissues and not by producing scar tissues) but the procedure is very delicate and with major consequences in terms of high risks of prematurity.
Premium Beauty News - Do you combine surgery with dermo-cosmetic techniques in use in adults but maybe less developed in children?
Dr Isabelle James - Absolutely, dermo-cosmetic techniques contribute to significantly improve the aesthetic results when surgery is no longer needed. Dermabrasion, skin-make-up, skin-pigmentation or lipo-filling are increasingly practised in children especially after facial skin grafts. The look can better define through dermo-pigmentations on the eyebrows, or even the eyelashes at the level of eyelids. In the case of hemangioma aftereffects, permanent labial make-up helps to symmetrise the vermilion and define the mucocutaneous line. Finally lipo-fillings on the face or other parts of the body enable to fill tissue depressions and improve the trophicity of the skin surface and also the cosmetics of the tissue volume. Dermo-cosmetics is also very present after any surgery, with in particular the prescription of skincare products, like massage creams, silicone gels or sunscreens.
Premium Beauty News - What emerging techniques in the treatment of scars seem promising to you?
Dr Isabelle James - In the treatment of scars several phases are to be considered. Firstly, prevention with the use of surgical techniques generating less scars as possible. Then, skin grafts are very interesting; they are taken from donor sites the closest as possible to the receiving site in order to optimize both the trophicity and the skin complexion. In the case of very large lesions, we can use a skin expansion technique that consists in producing tissue by placing a silicone balloon under the skin, which is gradually inflated to produce the amount of skin needed for the secondary repair. This skin can be used either as a local flap (attached to its donor site) or as a graft, moved to another site. Finally in some cases where “total skins” cannot be used it is possible to perform thin skin grafting combined to an artificial dermis. These techniques are used in emergency cases in reconstructive surgery following a trauma or severe burns and are not yet adapted to gestures with a purely cosmetic purpose given the more inflammatory scars than with the native skin of a child. The recent ReCell® technique, which associates dermabrasion and then the spraying of keratinocytes usually taken from a small incision performed behind the ear, is interesting. It enables to repair an already present scar, pigmentations of a former graft but also an acceleration of a scarring from burn wounds.
The ultimate goal of our work is, whatever the discipline, to restore a functional and aesthetic anatomy as soon as possible through a full support of the child and his family resulting in as much “well-being” as possible, even if some aesthetic or functional aftereffects may persist.
