Treating Rosacea

logo-2-02[3]   A cute cherry red nose, and rosy cheeks are often portrayed as signs of the winter season. But in reality, they are most likely signs of Rosacea. (pronounced roh-ZAY-sha). Rosacea is believed to be a chronic, inflammatory skin condition that generally manifests on the face.

  • Redness on the cheeks, nose, chin or forehead.
  •  Small visible blood vessels on the face.
  •  Bumps or pimples on the face.
  •  Watery or irritated eyes

Roseacea can take on many different appearances.  The American Academy of Dermatology has a very comprehensive library of images. Click here to view.

Rosacea is not life threatening, but it can be very uncomfortable, and cause a person to be self-conscious.  Some famous people who have struggled with Rosacea include President Bill Clinton, actor W.C. Fields, and Princess Diana. The cause is not known, although recent research shows it to be caused by chronic skin inflammation. There are triggers that set off  Rosacea, such as temperature extremes.  In the winter, it’s the cold.
Other known triggers:

  •  Alcohol/Spicy Food  & other diet issues
  • Heat
  •  Sun Exposure
  • Stress

It’s important to make lifestyle changes, to limit flare-ups. More severe cases may require treatment.  Laser and light therapy treatments are very effective in limiting breakouts.  They won’t eliminate Rosacea, but will certainly help when administered by a qualified professional. Click here for information from my website.

Another good option are chemical peels. In my office for example, we offer several different types, based on your skin and condition. Click here for details.  Rosacea never completely goes away, but can be comfortably managed with lifestyle changes and treatment.

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Injectable Cosmetic Fillers

You’ve seen the advertisements, you’ve glanced at articles. Maybe your best friend suddenly has a more youthful appearance.  You’ve considered using injectable fillers to reduce facial wrinkles. But you have questions. I hope this blog will serve as a useful guide for you.

Shortly after the invention of the syringe in the 1800’s, physicians starting using chemical agents for facial augmentation.  The first injectable filling agent was paraffin, but that caused complications. Others have followed with similar problems.  In the 1980’s though, public demand for cosmetic fillers prompted researchers to develop safer, more effective treatments. Today, many of the latest fillers are made with hyaluronic acid, Poly-L-lactic acid, calcium, collagen and other materials. Some of these substances occur naturally in the skin, but are produced in the lab from a variety of sources. These fillers all achieve similar results, but there are some differences.

  • How quickly filler responds
  • Length of time it is effective
  • Temporary or permanent

As with any procedure there are side effects and risks. Your doctor may recommend prior testing, based on your medical history and the type of material in the injection. I encourage you to click on the FDA links I have provided to get additional details on each product, precluding medical conditions and of course side effects and risks.

Ingredient: Hyaluronic Acid
*Response time: Immediate
*Length of effectiveness: 6 months +

BELOTERO BALANCE® is the newest filler on the market. It was approved by the FDA in late 2011. It has unique properties that allow it to adapt within the skin for soft and even correction. This product binds with water, and  will immediately diminish smile lines around the mouth as well as delicate areas such as fine lines above the lips and around the eyes. It is also useful for the hollows under the eyes. Hyaluronic acid injections fill the space between collagen and elastin fibers within the skin, replenishing natural volume and presenting a more youthful appearance. For more detailed information on BELOTERO BALANCE® please click here to visit the FDA link.

Ingredient: Hyaluronic Acid
*Response time: Immediate
*Length of effectiveness: Up to 18 months  with a follow-up treatment

The Restylane Regimen is a treatment plan that involves an initial treatment and a follow-up treatment 4 1/2 or nine months later. It can also be used for full correction, and is helpful in reducing deep folds. If you use this filler, you must have follow-up treatment(s) to achieve results for up to 18 months. For additional information, please click on this FDA link.

Ingredient: Hyaluronic Acid
*Response Time: Immediate
*Length of effectiveness:  Up to one year

As you can see on this blog, there are a variety of HA based fillers. JUVÉDERM® XC differs in the formulation; a special smooth-gel structure that holds up over a longer period of time. It’s FDA approved to last up to one year with a single treatment. This is used often for lip enhancement. For additional information, please click on this FDA link.

Sculptra® Aesthetic
Ingredient: Poly-L-lactic Acid
*Response Time: Gradual
*Length of effectiveness: Two years +

Sculptra® Aesthetic has famously been called a “liquid face lift.” This product does not work overnight,  but over time you will see a difference.  Once injected into the skin, the prompts the body to create collagen; diminishing wrinkles and creating a more youthful appearance.It is especially useful for replacing volume lost through aging, cheek and temple hollows for example. Sculptra® Aesthetic is made of poly L lactic acid (PLLA), a synthetic biodegradable polymer that is both reabsorbable and usually bio compatible. This synthetic polymer has been used for years to dissolve stitches. For additional information, please click on this FDA link.

RADIESSE® Volumizing Filler
Ingredient: Calcium Hydroxylapatite
*Response Time: Immediate                                                                                                      *Length of effectiveness: One year +

RADIESSE® Volumizing Filler is made of tiny calcium-based microspheres which are suspended in a natural, water-based gel. These calcium based microspheres are similar to minerals found naturally in your body so allergy testing is generally not required. Over time, your body absorbs these tiny microspheres and gel, and leaves behind collagen. This is commonly used for cheek enhancement.  For additional information, please click on this FDA link.

Ingredient: Polymethylmethacrylate (PMMA) microspheres in a collagen base with lidocaine.
*Response Time: Immediate
*Length of Effectiveness: Permanent

Artefil is an option if you are looking for a more permanent solution, and your doctor feels you are a good candidate. It’s FDA approved for nasolabial folds (smile lines).  Artefill is made up of microsphere enhanced bovine collagen with lidocaine for comfort. Unlike other fillers, the tiny microspheres are not absorbed by your body. They remain intact and provide structural support to keep  wrinkles from returning.  For additional information, click on this FDA link.

BOTOX® Cosmetic                                                                                                          Ingredient: Clostridium botulinum (botulinum toxin type  A)                                              *Response Time: Within days
*Length of Effectiveness: Up to 4 months

You may have also heard about BOTOX® Cosmetic. Unlike the others, this popular injectable is not a filler.  BOTOX® Cosmetic is a drug made from a toxin produced by the bacterium Clostridium botulinum. It’s the same toxin that causes food poisoning. But used cosmetically, it paralyzes the muscle, and reduces wrinkles. BOTOX® Cosmetic is FDA approved for moderate to severe frown lines between the eyebrows (glabellar lines)   To learn more about BOTOX® Cosmetic and ALL injectable fillers, click on this FDA link.

I hope this overview of various fillers has been helpful.  Please click on this link to contact my office with any additional questions regarding fillers.  During November & December 2012, all cosmetic services and products are on special.

*Response time and length of effectiveness information provided by manufacturers.

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Improving Stretch Marks

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Stretch marks are an outward sign of changes within your skin.  Men and women can get them, but they are most notable during pregnancy.  Stretch marks do not have any affect on your health and well-being.  We just don’t like to look at them! Stretch marks can occur anywhere in the body where large amounts of fat are stored; stomach, thighs, arms, breasts and buttocks. Simply stated, stretch marks form when the skin is stretched too quickly as in pregnancy or rapid weight gain. Collagen and elastin fibers,  which support elasticity cannot keep up with rapidly expanding skin.  The skin is stretched to the point it tears.  Stretch marks may start out as reddish, purple marks that fade with time, to a more silvery tone, but they are still noticeable.

Can stretch marks be treated?

Yes, they can.  I recommend several topicals to help minimize stretch marks.  Vitamin C and A (retinol) can be used along with peptides to stimulate new collagen; glycolic acid works to exfoliate.  It’s important to use professional grade products,  because over the counter formulations just aren’t strong enough to get good results.  These products are all available on my website, but I suggest contacting my staff for guidance prior to purchase. If you are pregnant, special precautions need to be taken. Vitamin A is not appropriate, and you need to consult with your physician before using any topicals.

The laser revolution

We are seeing positive results with laser treatments.  In my office, we use theLumenis UltraPulse Encore laser to reduce stretch marks. There are different settings on the laser, I recommend Deep FX for the best results.

Fractional CO2 laser microbeams target the deep dermal layers of the skin. This deep heating causes collagen to break down and re-heal.  Downtime is minimal, and we are seeing great results in 1 to 3 sessions.

Stretch marks are a fact of life

At some point in all our lives,  most of us will develop stretch marks. Women tend to notice them more, especially during and after pregnancy.  The topicals I mentioned help reduce them, and so does the laser treatment. If you have any questions, please feel free to contact us with your questions.

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Update on New FDA Sunscreen Regulations

The new FDA sunscreen labeling regulations have been delayed, and will not begin until December 17, 2012.  Originally slated to start last month, (June 2012) the FDA decided to give sunscreen manufacturers additional time to comply. According to the FDA, enforcing the change during the summer could create a sunscreen shortage.

Under the new regulations, sunscreen products that protect against both UVA and UVB rays will be labeled “Broad Spectrum” and “SPF 15” (or higher) on the front. On the back, the labeling will also tell consumers that “Broad Spectrum” and “SPF 15” or higher will protect against sunburn and can reduce the risk of skin cancer and early aging. Click here to see what the new labeling will look like regarding SPF 15 or higher.

By contrast, broad spectrum sunscreen below SPF 15, or is NOT broad spectrum, will be labeled as only protecting against sunburn. Click here to see a labeling example.

The final regulations will include these provisions. The following is a direct quote from the FDA: 

  • “Sunscreen products that are not broad spectrum or that are broad spectrum with SPF values from 2 to14 will be labeled with a warning that reads: “Skin Cancer/Skin Aging Alert:  Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”
  • Water resistance claims on the product’s front label must tell how much time a user can expect to get the declared SPF level of protection while swimming or sweating, based on standard testing. Two times will be permitted on labels: 40 minutes or 80 minutes.
  • Manufacturers cannot make claims that sunscreens are “waterproof” or “sweatproof” or identify their products as “sunblocks.”   Also, sunscreens cannot claim protection immediately on application (for example, “instant protection”) or protection for more than two hours without reapplication, unless they submit data and get approval from FDA.” Source: FDA

I know these changes may seen confusing, but I think once in place, the labeling will help consumer make better informed choices. I also want to mention an ingredient in some sunscreens called “oxybenzone.” Certain consumer groups claim it is linked to hormone disruption, and can ultimately trigger skin cancer. The American Academy of Dermatology maintains it is safe, and provides effective broad spectrum protection.  “Available peer-reviewed scientific literature and regulatory assessments from national and international bodies do not support a link between oxybenzone in sunscreen and hormonal alterations, or other significant health issues in humans.” “Scientific evidence supports the benefits of sunscreen usage to minimize short- and long-term damage to the skin from UV radiation and outweighs any unproven claims of toxicity or human health hazard,” said Daniel M. Siegel, MD, FAAD, president of the Academy. I concur with that position. I recommend a broad spectrum sunscreen of 30 SPF or higher. Reapply it after swimming or exertion for 40 minutes.  We do sell high-quality professional grade sunscreens on my website, click here for information.  My signature brand, Melablock is made with micronized zinc oxide and antioxidants.  Larger sunscreen manufacturers will be making labeling changes this year, with smaller ones to follow next year. I will be very pleased to see these new labeling guidelines in place.

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Skin Cancer and Dark Skin Tones

Historically, people with light skin have been at greatest risk for skin cancer. While that still remains true,  data shows that melanoma,  the most deadly form of skin cancer not only occurs in darker skin,  it is often discovered in the later stages and is fatal.

It’s perceived that darker skin “has more immunity” to skin cancer, and in some ways that is true.  According to the National Institutes of Health, people with white skin are approximately 70 times more likely to develop skin cancer than those with black skin. From a medical standpoint, it is complex how people end up with different shades of skin. But the key component is Melanin, which is produced in the epidermis layer of the skin.  Melanin absorbs damaging UV rays from the sun. Dark-skinned people have more Melanin than light-skinned people. But this doesn’t give people with darker tones a pass to stay in the sun unprotected. Even though a significantly lower percentage of Melanoma cases are discovered in the early stages of darker skinned people, than with Caucasians, I recommend sunscreen for ALL SHADES of skin.  Dark tones should use at least SPF 30 with UVA and UVB protection and contain photostable sunscreen agents. That means the product needs to remain stable and protect when exposed to light.  High quality sun protection can be purchased through my website.

Interestingly, while direct sunlight can be harmful, there are also benefits.  The Skin Cancer Foundation reports that Melanomas in African-Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, (lighter areas) with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.  This may be caused by a lack of Vitamin D, which is believed to fight cancer. It is produced naturally when skin is exposed to sunlight.  In darker shades, where larger amounts of Melanin are present, Vitamin D production is suppressed, so it takes significant time in the sun to generate it. Supplements can help overcome this deficiency, and you avoid putting yourself at risk to extended sun exposure.  Please review my previous blog on Vitamin D to learn about safe levels, as you can overdose on it. Overall, the Melanoma survival rate for African-Americans is only 77 percent, versus 91 percent for Caucasians. Click here to see what melanoma looks like.

Some other interesting facts regarding skin cancers in minority populations:

  • Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, Japanese, and other Asian populations. Click here to see BCC.
  • Squamous cell carcinoma (SCC) is the most common skin cancer among African-Americans and Asian Indians. Click here to see SCC.
  • Squamous cell carcinomas in African-Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading). Sounce: Skin Cancer

The best medicine is always prevention. Whether your skin color is light, medium or dark, anyone can get skin cancer. It’s important to be examined by a health professional on a routine basis, and also keep an eye out for any growths, lesions or changes to your skin with self-examination.






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Why Skin Cancer Screening Is Important

Once again this year,  my office is offering FREE skin cancer screenings the week of April 23, 2012.   Contact the office to schedule!

Skin cancer is one of the most treatable forms of cancer IF it is detected and treated in the early stages.  If it’s not treated, it’s one of the most deadly cancers. Untreated skin cancer can spread like wildfire and metastasize in the body.  Renegade cells can go far beyond the depth of the skin and infiltrate the lymph notes and vital organs. This is why it’s so important to watch for moles that change shape or color.

As a general rule, look for uneven borders and sides, a change in color or size, and moles larger than ¼ inch .

I do want to stress that even if you aren’t out in the sun regularly, or you are dark-skinned, you can still be at risk.  Even tanning in a sun bed can elevate your risk. In fact, you may be surprised how much sun exposure you can get during an average day.  Read more about it in a fact-sheet from the American Society for Dermatologic Surgery.

A highly effective form of treatment is Mohs Micrographic Surgery.  This procedure is more involved than just “cutting out” the skin cancer. The tumor is carefully taken out layer by layer, while healthy tissue remains.  I am certified in this procedure, and actively involved with  Mohs College.  There is a wealth of information about it on the organization website

Sunshine is a marvelous gift; it brings us light and sustains the earth. Enjoy the spring and summer months. Just be wise about it, by limiting your exposure.  Please visit my previous blogs for the very latest on sun protection!

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Vitamin D and Sunshine

Direct Sunlight is  double-edged sword. When the body is exposed to it, sunlight produces Vitamin D, an important nutrient to the body. Vitamin D helps maintain strong bones, help muscles move and nerves carry messages. Vitamin D also helps the body fight off bacteria and viruses. Vitamin D and calcium help protect against osteoporosis. A new recently published study shows it may also help fight Alzheimer’s.  Without it, bones become soft, thin and brittle; it’s called rickets in children.

Sun Exposure. The other side of the equation is if your skin is exposed to too much sun, you can develop skin cancer. Casual sun exposure needs to be minimal; it’s best to wear sun protection even though Vitamin D production is limited and/or prohibited with sunscreen.

Vitamin D and Food. It naturally occurs in very few foods. According to the National Institutes of Health, fatty fish such as salmon, tuna, and mackerel are good choices. Beef  liver, cheese, and egg yolks provide small amounts. Vitamin D is also found in mushrooms.  Almost all of the U.S. milk supply is fortified with Vitamin D although foods made from milk, such as cheese and ice cream, are usually not fortified. Vitamin D is added to other foods such as cereal, orange juice and yogurt. You need to check the label for information. Vitamin D is also available through supplements.

Recommended Dosage. How much Vitamin D do you need? According to the National Institutes of Health the recommended amount for Vitamin D is:
Age                                                               Recommended Amount
Birth to 12 months                                     400 IU
Children 1–13 years                                  600 IU
Teens 14–18 years                                    600 IU
Adults 19–70 years                                  600 IU
Adults 71 years and older                        800 IU
Pregnant and breastfeeding women     600 IU

Interactions. If you are taking any medication or even supplements, you should check with your primary physician before starting Vitamin D; as your situation may vary from the general guidelines. Vitamin D can interfere with certain supplements and drugs such as steroids and drugs to control epileptic seizures. Toxic reaction almost always occurs from overuse of supplements. Excessive sun exposure doesn’t cause vitamin D poisoning because the body limits the amount of this vitamin it produces. But again, I recommend sunscreen to protect your skin from exposure. I also want to mention that if you do have sun damage, we also offer peels to minimize discoloration and damage both medically and cosmetically.

I hope you will find this discussion about Vitamin D helpful. Use sunscreen to protect yourself but also make sure you include this vital nutrient in your diet.

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