Dr. Karim Kolsi
Tell us...
YOUR STORY IN A NUTSHELL:
I am a doctor, specialist in restorative and aesthetic plastic surgery at the Oncopole de Toulouse.
I was trained in Tunisia, I know the sun very well and how to protect myself from it. Both my parents are doctors, I discovered plastic surgery when I was very young and that was all I wanted to do.
I went to medicine to do this and I rubbed shoulders with the most renowned surgeons in my specialty all over the world to discover other cultures and techniques (Belgium, Lebanon & Brazil).
I was a winner of the French equivalence competition and I have been practicing in France for 4 years, at the Oncopole de Toulouse.
YOUR JOB?
As a plastic surgeon, I operate with my hand and everything that touches my hand!
Our specialty focuses on soft tissues hence “Plastic” and on the surface of our body, par excellence the surgery of the skin organ, the largest, heaviest & most exposed organ in the body. human body. This vital organ of our body is constantly attacked by ultraviolet rays, trauma, bacteria and viruses... The skin is an organ in perpetual renewal, always rebuilding itself.
The structure of the skin is made of brick, like a Toulouse wall. There is the deep basal layer, from where the cells start multiplying towards the surface forming the superficial layers of the skin and ending up desquamating in the environment.
We call a basal cell skin cancer when it originates from this basal layer. The advantage is that the tumor remembers to always extend outward, which is less aggressive. Fortunately, these tumors are the most frequent. I would even say that they are inevitable from a certain age.
Melanoma is another skin tumor arising from the melanin cells of the skin. These cells are on the other hand mobile in the brick wall to give an even complexion with their melanin secretion. We fear melanomas, due to their mobility. The tumor can be found around the initial lesion as well as it can move via the lymphatic or blood networks all over the body.
The genesis of these two tumors is proven to be favored by the sun.
My daily mission is to surgically remove these tumors as soon as possible once diagnosed. Fortunately, if they are taken care of in time, there is less risk of distant metastasis. Hence the importance of screening and prevention.
At the Oncopole, I also work in other areas that fascinate me so much! The first thing that amazed me in plastic surgery was free flaps. Microsurgery allows us to transfer tissues from one place to another in the body, restoring life through vascular reconnection under a microscope. I have also specialized in this technique which allows me to provide valuable assistance to my ENT colleagues for the reconstruction of the head and neck, and to introduce a new solution for breast reconstruction after removal of the breasts giving a more natural.
SUN EXPOSURE IN YOUR OCCUPATION?
The sun acts on the surface of our body. Being a plastic surgeon, I differentiate between 2 things: sun-induced skin tumors and accelerated skin aging.
Skin tumors that appear after reaching your sun capital: the more you are exposed to the sun, the more you are at risk of developing them.A distinction must be made between basal cell and squamous cell carcinomas, which are tumors of advanced age in general. On the other hand, in melanoma, I operated on patients at 24, 25, 29 years old. I remember well these patients, whom we see again after a few years for a second melanoma. Why?
Melanomas are the tumor of sun exposure par excellence, but not only that.
There is also a genetic predisposition to developing melanoma, and the more heredity speaks, the more tumors we will have earlier in life. This is a concordance between genetics and cumulative sun exposure dose.
Let me explain: the more we expose ourselves to the sun, the more we have a counter that marks... Up to a dose coded in our genes which gives rise to a tumor.
Aesthetically, exposed Caucasian skin will age faster than skin protected from the sun. The disease 'old age' is favored by the sun. We see it in brown spots, sagging skin and the appearance of wrinkles.
The sun is an aggressive external attack directly on the skin which tries to protect itself from it. By the secretion of melanin depositing in brown spot. Hyaluronic acid giving skin firmness is dissociated by direct action of solar heating. The thickness of the skin is refined and the radiance fades quickly.
The eyes are very sensitive to the sun's rays, we do everything to minimize the entry of rays into the palpebral cleft. This involves an intense contraction of the muscles of the periorbital region with the early appearance of crow's feet wrinkles in the corner of the eye, of the lion between the two eyebrows and wrinkles on the forehead. When these wrinkles are treated with botox, they will be much more resistant for people living in the sun and who do not protect themselves with sunglasses.
After any surgery, whether reconstructive or aesthetic, I always recommend that my patients avoid the sun as much as they can. Especially when the scar is fresh and even if it is not directly exposed. This is to avoid its pigmentation. Indeed as we said the skin is in perpetual renewal, a scar is a construction site with an intense inflammatory reaction. Any exposure to the sun will cause a chemical messenger to be secreted, distributing itself to the entire skin covering to secrete melanin. This is called tanning, and even unexposed areas still tan. Any scar is very vulnerable and can keep this pigmentation for life.
WHAT IS SUN EXPOSURE?
It's everywhere, it's everyday, even on a work-sleep journey. A 10km car journey is 10km of sun exposure. Even through a window, the sun's rays pass.
It's not just summer, it's not just the tan.
I have patients who tell me "I never tan on a beach", yes, but we are constantly exposed: walks, shopping, eating out, sports... the sun is always there.
We need it, for our body (Vit D), our mood, but by tempering our exposure and our consumption of sun, a few minutes a day are enough.
AS A DOCTOR, HOW DO YOU SUPPORT YOUR PATIENTS?
If I take the example of a person who comes for melanoma, the first meeting is with the dermatologist and myself (because the treatment is surgical). On the first questioning, I look for the elements favoring sun exposure, among others:
- Profession (outdoor work) and even temporary and a long time ago.For example, I had a young woman who had been a lifeguard on a beach every summer from the age of 15 to 25
- Hobbies (hiking, boating, golf, skiing, etc.)
- Travel and life on the beach Abroad (people who have lived in Africa or overseas… nowadays more Australia, Florida, California and the Middle East)
- Family history of skin tumors
Based on these factors, I will be able to define the level of risk of developing all skin diseases. I will start giving recommendations that will be reinforced by the sun protection nurse so that the message is easier to assimilate: apply sunscreen, reapply every 2 hours, always wear long sleeves for outdoor activities, wear a hat… a certain Hygiene of life rather with changes to put in place for all of us.
We have a protocol with the nurses so that they approach the subject with a different vocabulary. As a doctor, we may tend to use a lexicon that is too medical and sometimes poorly perceived by the patient. It will be smoother with a more attentive and comforting nurse, that's our policy at the Oncopole.
ANYTHING TO SHARE?
This is not an anecdote but rather a note of hope.
Many patients leave an impression on us, especially those we lose. Melanoma is really aggressive. Afterwards, I strongly advise all my patients not to go and see on the internet. Few people know it, but great progress has been made in terms of treating the disease. Now there is immunotherapy which has completely changed the prognosis.
I remember a patient with melanoma who had looked on the internet. She came to the consultation in tears saying, "I'm going to die in 6 months... can I be a little over 6 months?" »
Before 2009, metastatic melanoma was quite lethal. Now that has completely changed, with immunotherapy we manage to stabilize patients. The severity of melanoma is less but it remains a serious pathology.
YOUR PREVENTION & SCREENING TIPS?
If you are a painter in the building exterior with a family predisposition, it is radical but change your job. If you can't, you have to put in the means to protect yourself.
There's also the geographical location. If I have melanoma and my 20 year old son has decided to immigrate to Australia, he is clearly taking risks. It is better to favor countries with a lower UV index. These are radical but essential solutions to protect yourself.
Afterwards, there is the hygiene of life, like eating fruits and vegetables or playing sports. Sun protection must be taken into account on a daily basis: clothing, cream, schedule... When you go for a walk, you don't have to leave from 10 a.m. to 2 p.m., you can favor 3 p.m. too much sun exposure. And leave rather with covering clothes, a hat, glasses... it's the b.a.-ba of sun exposure. As I tell my patients, we are not moon children, we need the sun but we have to protect ourselves from it. It really is a lifestyle to adopt. This is valid for my patients but it is also valid for Mr or Mrs everyone.
There are families who know they have this predisposition, but there are also many who have no idea. I systematically ask my patients to inform their parents, children and siblings of the discovery of a melanoma. I cannot force them to do so, but this information is vital to protect those close to them.
For all families where there has been melanoma, we ask them to have an annual screening by a dermatologist on a systematic basis, all family members, ascendants & descendants This is a screening gesture. A melanoma in the first 12 or 24 months, it has no bothersome symptoms. It's a mole maybe a little dyschromic & asymmetrical but it never hurts. Its wickedness is its indolence which delays its diagnosis, generally the patients consult only for the bleeding which is really late.
Normally, we should all go to see a dermatologist regularly, unfortunately there are not enough medical specialists to provide all these consultations.
AND YOU, YOUR RELATIONSHIP WITH THE SUN?
I'm not spoiled by nature so I never go out without a hat! That's probably also why I tend to talk more easily about the hat having no hair! It is an accessory that I like and which is essential to protect yourself well. Otherwise 50 sunscreen, even if I don't always have my tube in my pocket and I have to put it on regularly during the day.
On the other hand, for my son, I put sunscreen on him spiritually, I spread it on every hour. Above all, protect the children, they are innocent and cannot do it themselves. It is up to us to give them the right habits.
A CURRENCY?
Protect rather than heal!
ANY 'GRANDFATHER'S ADVICE TO FINISH?
Trusting science.
I see it especially in times of Covid, we hear a lot 'I don't want to get vaccinated, I don't trust'. We are here for you. The medical profession and research are there for people. Personally, I tell myself that we cannot move forward without the confidence of the general population in us, the medical profession and our fellow researchers.
You have to believe in it and you also have to participate in it, with your donations & your commitments to the associative fabric around us. We saw in this period of crisis that we needed to put people back at the heart of our approach.
Find Dr. Kolsi on his account Instagram !
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