Ep 115: When do kids see a plastic surgeon? w/ Andrew Cohen MD

Episode 115 of Ask Dr Jessica, Dr Andrew Cohen, a board certified plastic surgeon practicing in the valley of Southern California discusses the overlap between pediatrics and plastic surgery. He explains what a plastic surgeon is and the history of plastic surgery. Dr. Cohen also shares the procedures he performs, including breast reductions for teenagers and gynecomastia surgery for boys. He provides advice on when to refer patients to a plastic surgeon for lacerations and the timing of closure. Dr. Cohen discusses aftercare for scars and addresses common questions about mole removal and dog bites. He also talks about advancements and trends in plastic surgery.

Takeaways

• Plastic surgery and pediatrics have overlapping areas, such as breast reductions for teenagers and gynecomastia surgery for boys.
• When referring patients for lacerations, consider the location and complexity of the wound, such as those near the vermilion border or involving the eye or eyelid.
• Aftercare for scars can include silicone sheeting or cream, vitamin E, and sun protection.
• Timing for scar revision surgery is typically around one year after the initial procedure.
  
  To follow Dr Cohen, he is actively on instagram: @andrewcohenmd
  His website: Drandrewcohen.com
  And his office is located at: 5400 Balboa Blvd, Suite 217, Encino CA 91316
  
  

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

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Transcript

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Hi everybody I'm Dr. Jessica Hochman, paediatrician, and mom of three. On this podcast I like to talk about various paediatric health topics, sharing my knowledge not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Welcome back to another episode of Ask Dr. Jessica. On today's episode, our guest is Dr. Andrew Cohen. And Dr. Cohen is a board certified plastic surgeon who practices in Southern California. Now have you ever wondered in what ways might the field of Paediatrics and plastic surgery overlap? Well, as you'll learn today, from Dr. Cohen, it turns out there's actually quite a bit of overlap. And there are many scenarios in which a kid would benefit from seeing a plastic surgeon. So a big thank you to Dr. Cohen for taking the time to come on. Ask Dr. Jessica. And a big thank you to my listeners. I know your time is valuable. I know you're gonna love Dr. Cohen. He's knowledgeable, personable, and I learned a lot. And a quick ask before we get started, I would be so thankful if you could take a moment to rate review and share this episode with some friends. It all really makes a difference to help spread the word about ask Dr. Jessica. Dr. Cohen, I'm so excited to have you on. Thank you so much. I have never had a plastic surgeon on my podcast before you're the first well you haven't lived. This is true. This is true. I'm so excited because you know, while the worlds of Paediatrics and plastic surgery don't always overlap. There definitely is some overlap. There are times when we definitely rely on you to help our kids. Well, I think there's actually a lot of overlap to be honest with you that you might not have thought of but but we'll get into it. That's great. No thank Thank you. So first tell everybody what is a plastic surgeon? I think there's a lot of confusion when they hear the word plastics with surgeon and there's not is there a plastic involved what what is a plastic surgeon explain it to everybody. Plastic Surgery has nothing to do with breast implants or a plastic or silicone Okay, plastic. The word plastic actually comes from the Greek word plastic COAs which means to shape or mould or reform. So plastic surgery has been around a very long time. And World War One is really where it started to take place with soldiers getting facial injuries that and the whole reconstruction of the face really started with Harold Gillies. Dr. Gillies is really the father of all this but I don't want to talk too much about that. But plastic surgery, a plastic surgeon like myself, I went to medical school, I did a residency in plastic surgery, and which was a three of Gen three a plastic, and so it's usually about a six year programme these days. And then I did a fellowship on top with that little extra training that I did in Atlanta, Georgia in some cosmetic work. But you know, when you meet a plastic surgeon, everyone likes to say they're a plastic surgeon, but it's really the guys that did a residency in plastic surgery that are boarded by the American Board of Plastic Surgery that are the real you know, the real thing. And you're the real thing. Yeah, when you see cosmetic surgeon that doesn't mean they're a plastic surgeon cosmetic surgeon means they're a dermatologist that pretends to be a plastic surgeon. So you don't really want to go to someone that just says they are a cosmetic surgeon. That's that's not real. You could be a plastic surgeon that does cosmetic surgery, but you want to see on their website that they're a board certified plastic surgeon. So first, how do you spend most of your day? What what procedures are you doing most of your day 70% of what I do is body work about 30% face I do mommy makeovers I do breast reductions. And by the way, breast reductions is where there's crossover because paediatricians, like you have young gals that are 16 1718 with hypertrophy of their breasts, and this can really get in the way of them exercising, partaking in physical activity, getting made fun of socially and interacting. So we actually do a lot of breast reductions on teenagers, as long as they're fully grown, or at least three years past their first. menarche is when they they've shown that we can really do a breast reduction. So teenagers aren't getting breast reductions, it is a very common thing. And so that's where some of the PDA that paediatricians calling me to do that, that's good to know. Because parents have asked me when is the best time to have breast reductions, and I've sort of steered them towards waiting till being an adult. But that's great information. But again, it's really hard if you're 17. If you had your period when you were 11, or 12. If it's beyond three years of the first period, this studies have shown that they won't regrow after the breast reduction. That's great. No, especially because there are a lot of psychological ramifications. I find that girls experience for being too large. And having said that, I don't want to forget the boys. There are boys that go through puberty and get gynecomastia. And so it's really important to to not forget about kids, okay. Gynecomastia is male breast tissue. It can be related to endocrine issues, it can be really Add to something like a mass on the testicle. So you've got examine the testicles, make sure there's not a little tumour there. But majority of the gynecomastia is redo or just from puberty to get male breast tissue. And I do liposuction and excise the breast tissue and it's flat and looks perfect. So you know, for a 1617 year old kid that's very common to so so that's, that's what we do. I do again, I do a lot of body contouring, breast reductions, Tummy Tuck breast surgery. And then we do some cosmetic work of the face as well. But the majority my dad will tell you 70% of body work. That's great. It sounds like what you do is so different from case urgent because we are plastic surgeons operate head to toe and all age groups. Okay. So it's really interesting. The field of plastic surgery is actually a lot more diverse than you would know. cranial facial surgery like children with cranial synostosis that's part of plastic surgery, hand surgery, some plastic surgeons just do hand surgery. microsurgery, doing reconstruction of the lower extremity from microsurgery and reconstructing you know someone's had a car accident and they've you know, had a bad injury to the their lower extremities burned is part of plastic surgery, breast reconstruction, Sparta plastic surgery. I mean, it's very diverse field. Yes. Yeah. Okay, so So where I personally refer the most to plastic surgeons is for lacerations. And there's always that question in my mind, Should I do it as a general paediatrician? Is this child better off seeing a plastic surgeon? Do you have any general Do you have any general advice for people when they should see a plastic surgeon? I mean, I think that every little lump or bump doesn't really need a plastic surgeon to be honest with you. I mean, I've gone to the ER, you know, with one little stitch, I mean, did it really need it, and needed it because it was gaping open, but one stitch you're gonna call a plastic surgeon for but it is Los Angeles and Los Angeles a little bit different from others from other cities. So if it's crossing the vermilion border, a lot of times that's when I get called. And so we want to really get that vermilion border together nice and pretty. So vermilion border. Sometimes the paediatricians or the ear, doctors are not very comfortable with ear lacerations. So if it's a difficult ear, laceration or lip or difficult nose or a dog bite, I get called for lots of dog bites. And, you know, that's when I think it's good to call a plastic surgeon a difficult area, or a dirty wound or a complex, difficult dog bite things like that. Can you just briefly explain where is the vermilion border? Yes, the vermilion border is where the pink and the white roll meet right here. And this part here is very important. It's Cupid's bow right there. This is the filterable columns. These are the cupid's bow, this is your commissure. So the there's the Makossa, the pink part, and then the white part on top. If you don't line that up nice and pretty. It's it can show a little discrepancy. So you really want to have, you know, a really good person to line that up. The other place that I always send to a plastic surgeon is if the laceration is anywhere by the eye or the eyelid. Yeah, I know, I think your doctors and paediatricians are comfortable. So you know, I'm happy to do it again. I guess the answer to your question is if the doctor in the ER is uncomfortable, that might be another time to call a plastic surgeon. Right? I mean, it's not always what it'll look like, it's what's the comfort level? So they'll call me your little text me? And like, you know, should I even like Dr. Epstein will call me sometimes, hey, what do you think? Can I glue it? You know, honestly, if it's something right here with one stitch, you could glue it, it's not going to make a difference. I mean, I don't really have to come in for once. I'll do it if they're uncomfortable. But, you know, if it's one stitch in the forehead, I mean, you can glue it, you could tape it, you know, obviously a stitch helps to, but if it's you're on the lip or the nose that's more difficult with an area to heal. The thing I think about is the time and I'm curious what your what your expert opinion is on this. But sometimes I'll tell parents, it's better if we take care of the suture, you know, in my office, rather than waiting for the time to see a plastic surgeon, do you find that the time to closure matters? Okay, that's a hard one to answer. But I'm going to answer you. You want to get things closed as soon as possible, if you can. Having said that. I can call that eight 910 o'clock in the night and we do it the next morning and it's fine. I'm just being honest with you. You can put a bandaid on it. If a kid gets cut or hurt at seven o'clock in the evening. Can you wash them with peroxide and put a bandaid on it and I do it the next day. Let's say I'm at a town I do in the next day. It's going to heal fine. I'm telling because I'm going to clean it with bated eye very nicely, and I'm going to close. Now, if you're near the ER and you want to get it done that night, go for it and do it. But I have done things the next morning, like even if it happened at 10, or 11, or 12, we let the child sleep. Meet me in the in the office in the morning thinks he'll find So, okay. I don't know if that answers your question. There's no, you don't want to wait two days. But if you waited till the next morning, it's not the worst thing to do. If you're close to an era, one of them, just get it done and just get it done. I've heard something like every 12 hours, you wait till closure can make a difference in the cosmetic outcome. I'm not sure if that's true. I just don't believe it. And I'll tell you a story I had I'll make it short. There was a gentleman who left against medical advice to Cedars Sinai, because he was drunk this is many years ago, he had a huge lip laceration. He came in two days later, they called me because I was on call at Cedars Sinai. They said, What do we do, it's two days later, his lip is all open and split. And I said, I'm going to fix it, I'm going to sell it because he wasn't drunk anymore. He was alert and oriented. And I said, I'm going to wash it, I'm going to clean the edges and close it, we're gonna put you on antibiotics. And hopefully it'll heal, it heals fine. You know, because I washed it carefully. I trimmed the edges, I sewed a pretty kept them on antibiotics, it can heal, there's good blood flow there. So yeah, you don't want to wait more than 24 hours to sew something. But I mean, I think the cosmetic result is not as much is important as the time as who's doing it. Because you know, you could fresh in the edge of the laceration and clean it with beta nine, you got a fresh edge. And now you're restoring it together. So plastic surgeons will trim the edge make sure it's nice and pretty before we close it. I think that's the difference between going to an ER doctor or paediatrician to close it? No, that's this is really helpful. The other question I get from parents, they asked about best time to remove something that's cosmetic. So for example, the question I get all the time as a child has a mole it's on the face and they want to know, is it worth waiting? You know, if their two year old has him on that gets removed? Is that is the cosmetic outcome going to be better than if they were to wait into the well. We need to we need to talk about are we talking about a mole? Are we talking about a hem angioma? Are we talking about a vascular malformation? I mean, there's different kinds of yeah, it's just a mole. I mean, I don't really take moles off of little kids were little kids meaning five and under. I mean, I've waited for someone with 10 or 11, or 12 to tick off a mole off of her neck. I like him to be a little bit older, so I can do it awake. And it's not a big deal. I don't want to traumatise a child to take a little beauty mark off or a mole off. Because I just don't think that's necessary. Right? I guess I was wondering in terms of cosmetic outcomes or healing does age matter, but it seems like it doesn't feel great whether you're five or 10, you're gonna heal good. You're a kid you got a good college. And so I'd rather you be you know, a mole, I'd rather you be at least 10 or 11 or 12, a little bit older so we can keep you know, it's easier to handle the surgery. That makes sense. All right, so to ask you about dog bite, because unfortunately, dog bites are something that I do see with regularity as a paediatrician and that's something that we will send to a plastic surgeon. So any advice for parents on how to handle a dog bite? You know, I've seen so many in my career, I think, you know, you got to make sure you know, it's gonna happen. It happened to my own child, my own son who's 23 just got bit by a dog, our dog Bernie bit, my son and his eyebrow was off. I mean, he was missing tissue. And this was on Father's Day last year. So oh my goodness, you know, number one, I had to bring him into my office and do it in the yard because I wasn't comfortable doing it at home, obviously. But I think if you have a dog bite and it's extensive, you need to see a plastic surgeon. If there's just a bite and it's a puncture, we wash it out. You were probably trained to not close dog bites and I close dog bites all the time. Okay, I just washed it out carefully beta nine and I close it and suture dissolvable stitches will use dissolvable stitches on all kids so you don't have to remove this stitch later. But after about five to seven days I'll snip the knots I don't see a line a dot from the suture on their face. So it's a dissolvable stitch but I cut the knot and wipe it away. So the stitch doesn't stay in too long to leave a.on either side of the suture line okay, but I do close dog bites whether it's a puncture or just a big cut we do so the month you know doctors are trained that it could get infected but you know you put you on augmentin so that you don't get infected. The other one they cautioned us about is cat bites because the puncture so deep that we're supposed to not close cat bites, but same same principle just clean the wound well. I mean, if it's just a puncture, it's probably gonna heal fine without a stitch. If it's something big and gaping, I'm gonna close it. Yeah, I'm gonna wash it and close it. Yeah. Good, because I want the best result. But yet I really clean it with bated on really, really well. I mean, I really get in there and scrub. Do you feel like most dog bites are preventable? When you hear the stories about why they occurred? You're asking God to set up his kid on Father's Day and his kid was 23. Was it preventable? Yeah, he hugged Bernie and got too close and knew not to. And Bernie was scared. My dog's name is Bernie. My son is no But Bernie is the dog. He beat him in took off half, you know, portion of his eyebrows. So if they're available, yeah, you don't want to put your face near a dog. Sorry. But I mean, the kid is going to do it. How are you going to prevent a kid from hugging the dog? Yeah. So no matter what I say? It's like a change that you need. You know, people love their pets. Yeah, I do too. So you know, we have a new dog. We have a puppy who's now four months old, and my son loves roughhousing with the dog. And I get so nervous because I've seen enough dog bites in my day. And he'll get on the floor with her and he's roughhousing with her and as soon as she growls, I get very paranoid, but you're right. Hopefully nothing will ever happen. But you have myself. You know who to call. Thank you. But that does give me peace of mind. So now I have a question about aftercare of scars. A lot of parents asked me what to do once their kid has had a laceration repair. Should they use vitamin E? Should they use sunscreen? Should they use scar away some other fancy products? No. Okay, we're really big with silicone sheeting, or silicone creams, silicone has been shown to really help a scar heal. Now a lot of parents love the derma because it's gotten a good name, but Maderna is just onion extract, there's nothing in the derma that's been proven to do anything, just the fact that you're massaging and might be helping. So I don't recommend the derma you can I mean you know, but we know silicone works a little bit of silicone and we still Stratton it here. And then sunblock and keeping it out of the sun. If it's a tummy tuck or a breast reduction, because remember all your kids, all the kids you treat have a mom that might want a mommy makeover one day. So for all those mommy makeovers, we put silicone sheeting on there after about two or three weeks. It puts pressure on the scar and gets it hydrated. So it helps. What about vitamin D? I love Vitamin E too. Yeah, vitamin E. If you break a pillow, rub it on, that actually does help. There's something about Vitamin E that helps if you're African American. Honestly, when I'm doing African American moms, cocoa butter works phenomenal. And I think as as vitamin D and they're cocoa butter for darker skin is great. And then how long do you recommend that people use these products for two to three months and then after that to stay out of the sun or but use sunblock, but at least two months. Now this is great advice because I I'm never sure if the silicone Is this really necessary or not. But that's good to hear that it's helpful. I think it's helpful, I think that it hydrates a scar to get the read out to do silicone creams are cheating. And again, they're over the counter to you don't the bind for me, you go on Amazon and you said scar away. I mean, there's silicone in that. So it helps it's been proven that silicone sheeting or, or anything really helps. So it's hard for a kid to keep a silicone sheet on there. So they just rub a little silicone on it. Okay. Now what if people got this is another scenario that I see pretty often or often enough? If somebody goes to the ER and they're not, and they're not happy with the cosmetic result of the scar? How long should a parent wait to make sure the scar is not to their liking? And when should they see you and can you do a scar revision? I could do a scar revision I like waiting closer to a year, you know, eight months, nine months, 10 months to a year before doing a scar revision. Because you want to wait a full year for it to really heal. Okay, now that's really helpful. It's closer to a year. But again, I mean, if it's looking pretty healed at month, seven or eight, I might consider it. You know, it just depends how it's looking. Now that's really helpful. Okay, is there anything else that you think parents should know? Or any misconceptions about plastic surgery or when parents should think about seeing a plastic surgeon that we didn't talk about? You know, some people just call me for advice, or they come in for a visit to show me the laceration repair. What do you think? Or did they have me take out the stitches? I think you should always make sure to ask for dissolvable stitches. If your kid child is six or seven or younger, they shouldn't be putting in stitches that have to be removed. Okay. And you know, the ER shouldn't be putting in a stitch it has to be removed on a two year old because your two year old is going to be screaming and crying a week later to get the stitches out. So number one, I mean what kind In stitches, are you using doctor are these dissolvable? That's a good question to just ask, it's not being a pain to ask that. Because majority of time, I'm going to do dissolvable stitches, so we don't have to remove them. But like I said, at the one week mark, I'll trim the knot. It's very I distract the child and just go snip the knot. So we don't see a stitch mark on either side, from the suture itself. So why not? Why shouldn't we always use dissolvable sutures? Is there any reason not to? I mean, sometimes I wonder if they're not going to hold up as well? Well, yeah, I mean, if it's on the lip, like if I'm doing a lip, and it's a 10 year old or 12 year old, you're eating, I'll do the proline, and I'll remove them later. So sometimes in certain areas that people are active, or you got a teenager or a kid who's 16, who plays sports. I mean, I'll just do intro to proline and take them out after a week just to make sure it didn't pop open. Yeah. So you know, it just depends. It sounds like what you do is really fun. Actually, it is why don't you come over and watch us. I might take you up on that. We have We actually teach I teach the the Milken high school my kids went to Milken, which is a Community High School here. And so the kids come and watch me observe for like a week at a time we had three students over the summer that come for weekend deserve me. So it's kind of cool. That's so much fun. Do you feel like you're always learning? Do you feel like there's always a new advancement in plastic surgery? There actually is, it's very interesting, because, you know, we just posted lip lifts. And you know, there's always new things a new laser a new procedure, like lip lifts. I mean, not that that's new, but it's just, you know, very common now. There's already notice there's trends, like what's the most in procedure right now? I think everyone right now is talking about deep plane facelift, which I do, and we've been doing it since the late 90s. And but now because of some internet and social marketing, you know, deep plane facelift, oh my god, it's new. There's some new nuances to it. But a deep plane facelift has been around a long time. I don't even know what that is. What is it definitely facelift. This is a type of facelift. And then buckle fat pad excision people remove the buccal fat pads to look thinner here. That's not new that's been going on for a long time. But then social media picks it up and acts like it's new. It's a buccal fat you remove the cheek fat. I mean, that's not that new lip lifts we make an incision here on lip the lip, we lift the lip with a scar because as ladies get older or even men, but mostly women get older, this distance gets longer. And so if you're in your 50s, or 60s or 70s, and you want to look more youthful when we're doing a facelift, we could put a little incision underneath your nose and lift the lip to really give a better contour. So yeah, there's there's always new little things and new lasers and things. That's fun. Well, thank you so much for sharing your knowledge. It's been really fun to talk to you. And I'll make sure and link your Instagram Andrew Cohen, MD below. So everybody follow Dr. Cohen. And I hope you have a have a great day. Thank you for coming on. Thank you for your time. You too. Appreciate it. And we look forward to seeing you soon. Thank you for listening and I hope you enjoyed this week's episode of Ask Dr. Jessica. Also, if you could take a moment and leave a five star review wherever it is you listen to podcasts. I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica See you next Monday.