Cosmetic Dermatology and Laser Center

Indoor Tanning JUST ONE TIME!

2012-01-27T11:08:00.000-08:00

Indoor Tanning JUST ONE TIME!

Talk about depressing news! The Skin Cancer Foundation just shared a report given at a recent meeting of the Association for Cancer Research by Dr. Mingfeng Zhang, a research fellow at Brigham and Women’s Hospital and Harvard Medical School. Dr. Zhang looked at the information collected from the Nurse’s Health Study II (1989-2009) of 73,000 female nurses and found the following: High school/college age women with the history of just ONE indoor tanning exposure a year increased their risk of developing a basal cell carcinoma by 10%. If they exposed themselves more than SIX times a year, their risk was 82% greater than a non-tanner. We have to protect our young ones and ourselves.

The other depressing news is the exposure to UV radiation (sun & tanning beds) is the main cause of aging skin. If you are a frequent indoor tanner, you can be exposed to UV doses as much as 12 times higher than regular sunshine.

This confirms my mom’s often repeated saying, “The sun bathers of today are the apple dolls of tomorrow.”

Moisturizer Information

2012-01-17T12:46:00.000-08:00

New Year and new or renewed goals including blog writing! Actually, I really do like to write down what I am thinking and/or reading. It feels like I have spent too many hours coming up with good moisturizers for the different needs of my patients. I am finally happy with the list but know as always, good information about products is a continued “work in progress”! I did notice a compilation of different presentations by the cosmeceutical experts at the December meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery. The conclusion was that the most important product choices are moisturizers and sunscreen. (I personally would also add something from the retinoid family). Dr. Zoe Draelos, who is my favorite of the cosmeceuticals researchers, lists dimethicone, glycerin and/or petrolatum as key ingredients to have in a good moisturizer. So if you shop “over the counter” keep those ingredients in mind.

Tanda

2012-01-17T12:45:00.000-08:00

A Tanda Update: I have used my Tanda 3 times a week religiously for 2 months on my 66 year old, sun damaged skin. I precede the treatment with my clarisonic and a gentle cleanser and follow it with 0.025% or 0.05% tretinoin and moisturizer. My skin definitely looks smoother and feels softer. What is surprising to me is that this also includes the fine lines under my eyes and over the lower orbital bone. These come back with my day of smiling but at rest looks a little better. I just started to notice a tiny improvement in my chin “crinkles”. I am anxious to hear what my patients and several staff members think they notice on their much younger skin. My main conclusion so far is that this works for compulsive people with a reasonable understanding that tiny improvement is a fact of life in aging, sun damaged skin but better than nothing.

Clarisonic Reviews

2012-01-17T12:28:00.000-08:00

What a giggle! The Wall Street Journal December 27th, 2011 in the Aches & Claims section had an article about the Clarisonic brush entitled “Deep Cleaning Faces at the Speed of Sound”. Just last week, Tuesday, January 10th, Good Morning America’s Becky Worley had a piece on “New Face Cleaner Make’s Waves” also discovering the Clarisonic. (fashion beauty 2659) We have used Clarisonics at CDLC as part of our pretreatment prep for the past 4 years. I brought it into our clinic after reading a report of the studies in one of my professional journals and being introduced to it at the annual American Society of Dermatologic Surgery meeting. It was an immediate hit with my staff and patients (and daughter)! We were able to proceed with any of our clinic treatments with the reassurance that the skin was free of make-up or skin oil. This allows for better penetration and freedom from concern of introducing bacteria or “foreign material” into the skin.

Very clean skin also allows for better penetration of home care products whether they are for acne, aging, antioxidants, or shaving (both face and legs). We had patients come in to get a brush head for “him” because “her” device was disappearing into the shower with “him”.

I love reading journals and going to meetings for the “what’s new” and have learned many times in the past 33 years to look for the science and not the sales pitch. I have a list of luminaries whose research/conclusions I can trust and can share with my patients several months to years before the Wall Street Journal finds out about it.

Dr. Ann

More from the ASDA Meeting

2011-12-01T08:52:00.000-08:00

I love the fall surgery meeting because it is such a great source of the most up to date information. You get to talk/listen to the actual people involved in the research. The following are some of the “tidbits” from the meeting in addition to the Tanda (11/11/11 blog).

Skin Medica’s Redness Relief cream with 1% 4-Ethoxybenzaldehyde was shown to provide a 44% improvement in facial redness in 4 weeks. My favorite and most respected product researcher, Zoe Draelos MD, was behind this study so it is a very reliable report.

There is another eyelash product, RevitaLash, which was developed by an eye doctor initially to treat cancer patients including his wife. The most active and controversial chemical in it is similar to the one in Allergan’s Latisse. I have had a lengthening of my lashes with Latisse to the point of having to carefully trim them. I have reduced my use to 2-3 times per week and the amount by half without affecting the growth I have achieved. Pam, our aesthetician, has been using LiLash and her lashes have become so thick and long with an upward curl that she no longer needs to use her eyelash curler.
As a physician, I think we need to have regular eye exams, not continue with any product if it is causing irritation, follow the instructions in the package, keep the applicators and skin clean and report any side effects to the manufactures. As a female, I’m very happy to have lashes similar to the teenage male patients in my clinic. Sometimes life isn’t fair.

An update on the topical neurotoxin which in the second year of phase III trials looks very promising. While it will never replace the effectiveness of Botox or Dysport, it will be able to be used under the eyes and possible eyelids which hasn’t been the case with injectables. It is hoped that it will be useful for very sweaty palms and soles of the feet also.

The Canadians were singing the praise of an even denser hyaluronic acid filler called Voluma from Allergan. It sounds like it will be similar to Sculptra in the way it will be used for facial volumizing.

While there are several treatments for acne scars, there are no magic answers. There is possibly an underlying abnormal healing response in the first place. Multiple treatments are required for a 50-60% improvement.

Dr. Danny Vleggarr, of Sculptra fame, continues to explore the 3 dimensional changes in the aging face. I was really amazed at the differences between male and females. For females, the lower face is more narrowed and recessed. For males, the upper face compresses in. The bottom line is that where we place the fillers will be different. There was another report where very dilute Sculptra was injected into the central chest “crinkles” and lasted up to two years.

LaViv (azficel-T) takes a patient’s own tissue (skin from behind the ear) and grows a “very personal” filler with the patients own fibnoblasts to be used for facial lines and folds.

Phase III trials are starting on ATX-101, a fat dissolving injection. It will treat small areas only, such as the chin. It generally takes four treatments; one month apart and certainly won’t replace liposuction.

Dr. Ann

The Tanda - New from CDLC

2011-11-23T14:09:00.000-08:00

Highlights from the ASDS (American Society of Dermatologic Surgery) annual meeting.

The Tanda

When I saw the Tanda on the silent auction table it triggered a memory of several laser meetings where red light was discussed for treating inflammation (redness) post laser treatments. Here was the same technology in a home devise and was marketed by Young Pharmaceutical, a respected medical skin care company. Once I won the bid, I headed to the exhibit hall to talk with the formulating chemist and scientific brain who founded Young Pharmaceutical. He was surprisingly enthusiastic which was an unusual demeanor for this intellectual, formal, East Coast man. He showed me a treatment pattern that he had developed for the device so it would cover the face, neck, center of the chest and the backs of the hands in 7 ½ minutes, three times a week and was sharing the changes he was noticing in his own skin. I was encouraged to follow the treatment with his vitamin C antioxidant if done in the morning or the retinol product if used at night. The treatment turned out to be very easy but, as always, I think you need to be very careful around the eyes. I added my nose to the areas to be treated not only because of my rosacea redness but the pore size from Hades. To my complete surprise, I noticed definite smoothing of my skin and pore size the morning after my third treatment. I used my prescription strength tretinoin instead of the retinol after each treatment without any problems. I am looking forward to talking with other derms and my patients as to their experiences with this technology. There is also an interchangeable blue light treatment head. This treats acne and would be great for those of us who still suffer well into adulthood. Red for beauty, blue for zits or in other words, red for mom and blue for teens.

Dr Ann

Photo Aging and 3-Dimensional Rejuvenation

2011-09-22T07:24:00.000-07:00

In the August 2011 Cosmetic Dermatology journal there was an excellent article entitled “Photo aging and 3-Dimensional Rejuvenation” by Nels Kruger, PhD and Neil S. Sadick M.D. I really liked how it was presented noting that aging and sun damage isn’t just one dimensional so we need to approach the “slowing down” of those changes by treating each affected skin layer. I want to share this approach with you via the treatments available at CDLC.

Type 1 Rejuvenation. Think of the very top layer of skin (epidermis) as your “tablecloth”. With use it becomes spotted, discolored, finely wrinkled, dull looking, even “thread bare” in some areas. This is where microdermabrasion, superficial skin peels, dermaplaning and a good home care program comes into play. Non ablative lasers help with the discoloration (both red & brown) such as age and sun freckles and broken blood vessels. Just as some table cloths require multiple spot treatments and/or long soaks, you will see continued improvement and maintained improvement if multiple superficial treatments are preformed regularly. We love the combo peels: Mini Melanage, Gloss and the VI Peel, dermaplaning and the SilkPeel microdermabrasion.

Type 2 Rejuvenation. This is the “table pad” layer where our dermis, with its fibrous network of collagen, elastin, glycoaminoglycams, veins, arteries and nerves all support the overlying epidermis. This layer is vulnerable to unprotected long term UV radiation particularly UVA. Care requires regular use of topical UV protection by sun block and/or clothing, the tretinoin creams, antioxidant and DNA repair creams. Repeated non ablative laser treatments such as CDLC’s Gemini laser and medium depth chemical peels.

Type 3 Rejuvenation. This reminds me of treating an old sun exposed wicker table. In the skin, the focus is not only on the broken-down collagen fibers in the deep dermis but actual volume loss which occurs from UV triggered lipoatrophy, the downward migration of the cheek fat pads and the receding of the facial bones (the eye sockets sink, the jaw & chin recede). This rejuvenation requires the ablative lasers such as the fractionated CO2 lasers. At CDLC, this is called the Pixel which is the name of the hand piece that fractionates the CO2 laser beam into pinpoint wounds. The wounding is necessary to stimulate the growth of new collagen more deeply. We have learned to address the volume loss with fillers of various density depending on the amount of loss and the area involved. Generally this primarily involves the upper cheek area and around the mouth (although it has been fun to smooth nose irregularities, plump up earlobes and soften jowl lines.)

Psychology & Me

2011-08-05T09:07:00.000-07:00

In May, I had the opportunity to attend my husband’s national meeting of the Association of Psychological Science. When Roger decided in his mid life to go back to school for a PhD in Psychology, we had fun teasing him about it not being a “real” science. This was, of course, ignoring several weeks where he was immersed in the anatomy, physiology and chemistry of the brain and learning a lot more information than was available during my med school days. There were many studies presented at this conference and not only do they use a complex descriptive language, they have many more variables to control in these studies. It was fascinating but I still haven’t found the answer as to why many of us are so self critical of our appearance. It is true that as females we grow up surrounded with the focus of beauty and fashion. As a physician, I wish we grew up with the focus on health and the value of who we are as “a person”. I know this is unusual for a doc who enjoys providing aesthetic “treats” for people but I sometimes wish I could nurture the self awareness and joy of discovering the person who exists under that skin.

What's New in Cosmetic Dermatology?

2011-08-05T08:57:00.000-07:00

What’s new in cosmetic dermatology? Chemical peels are being rediscovered. I was first introduced into this area in the late 80’s when alpha hydroxys were discussed by Doctors Van Scott, Yu, and Dietre at our dermatology conferences. Glycolic and Salicylic acids helped sun damaged and acne prone skin without the significant downtime needed for the medium and deep peels. Lasers then pushed to the forefront but now chemical peels are coming back with exciting new combo variations which include some of our deep peel chemicals (phenol, trichlorectic) but in much lower strengths. While there is peeling that occurs after the peel, it is much more superficial (like a mild sunburn) and can be timed to coordinate with a person’s social schedule. The key here is to do a series of 4-6 treatments, 2-4 weeks apart and to be on a good home care program to maintain the improvement. I think the boomer generation is finally understanding that our years of fun in the sun took a toll on our skin. The chemical peel is our “resurfacing” tool and is much easier than redoing grandmother’s dresser. Check out Young Pharmaceutical’s Gloss peel and Melanage peel, Caleel’s VI peel, SkinCeuticals Pigment Balancing peel, Skin Medica’s Rejuvenize peel, Envy Medical’s SilkPeel and the new kid on the block, Ascend Pharma’s Apeele peel.

Dr. Ann

Receive Better Results with a Series of Treatments

2011-07-20T07:50:00.000-07:00

When I first started blogging, Amy, our website support guru, said people tend to be good at first and then often taper off in their dedication. She was very “right on” although I have “written” several in my head while out running.

The one regular writer that I know is Dr. Ed Lack in Chicago who writes phenomenal derm related blogs (http://blog.metropolitanmds.com). He has one of those active brains that love to explore and sometimes challenge the status quo. He is a recent past president of the American Academy of Cosmetic Surgery and a very fascinating person who happens to have the same fractionated hand piece for his CO2 laser that I do. He is one of my favorite mentors and is very good at reminding my “want it now” mind set that we will see more results if we commit to a series of treatments 1-6 months apart and let the “wounding” of the skin do its “thing” of collagen rebuilding.

I have had a recent reminder of the truth of this fact from one of my favorite long term patients with acne scars. We have tried many different types of treatments over the years and now after the 3rd fractionated CO2 laser treatment the patient is being asked about the cause behind the “looking so good” comments received. Nothing completely turns back the effect of multiple birthdays but a series of CO2 laser treatments certainly helps soften the skin texture changes.

SkinCeuticals Triple Treat

2011-04-28T12:24:00.000-07:00

Dermaplaning, Chemical Peel, Cryotherapy: SkinCeuticals Triple Treat

It all started with a phone call from someone who had moved from New York City asking if our office offered dermaplaning. I was aware of what it was and had even tried it on myself with the regular scalpel blade. Not a good idea! One of the main reasons the New Yorker and I were interested was for facial peach fuzz type hair. During the 1st step, the dermaplaning tool not only gently exfoliates but also removes this fine facial hair. The next step is to pick one of four chemical peels. These chemical peels are used to revitalize photo damaged skin, fade dark spots, improve skin tone and laxity, increase radiance, diminish fine lines, wrinkles and pore size. The peels vary by their active ingredients which include glycolic acid, salicylic acid, lactic acid, citric acid, usmic acid, vitamin C and niacin. Our training and experience helps us pick the best for each patient’s skin issues.

The final and very popular step is the cryotherapy. This not only feels good but increases skin cell turnover and calms the skin by stimulating an anti-inflamatory response. With a series of cryotherapy treatments, the skin has a radiance which comes from smoother texture and increase cell turnover.

The bottom line: This gives us a new upgrade in the old and reliable chemical peel approach to advanced skin care.

Dr. Ann

Building a Skin Care Regimen

2011-04-07T09:06:00.000-07:00

It really tickles me when I find an article in my professional journal that confirms my thoughts and conclusions on a particular subject. This just happened in the February, 2011 issue of Practical Dermatology. The article, “Building the Skin Care Regimen: Choosing the Right Ingredients,” by Vivian W. Bucay M.D. strongly paralleled the information in my “core four” handout that I use in the office when asked for a good skin care regimen.

Dr. Bucay lists:
1. Sunscreen
2. Topical antioxidants
3. Retinoids
4. DNA repair

My list is:
1. Sunscreen
2. Retinoids
3. DNA repair
4. Clarisonic for cleansing

In seven pages, Dr. Bucay tackles summarizing the science behind her choices and provides a table listing her favorite products which are primarily available in physician’s offices.

I love the Clarisonic Skin Machine for its ability to gently but very thoroughly get the skin clean so when you do use your retinoids and antioxidants they have a better chance to be absorbed. The size of the molecular structure and it’s stability in a product has been a big obstacle to using antioxidants topically. (There are several docs who feel its best just to eat them if you can; i.e. fruits and vegetables. Have you heard that one before?!!)

One product name that is consistently favored by derms for themselves and their patients in the antioxidant category is SkinCeuticals CE Ferulic.

New to the lists of core products is DNA repair. It is the brain child of Daniel Yarosh PhD and was first available as Remergent DNA Repair and more recently as Celfix DNA Youth Recovery. The later company has published an impressive study of 100 patients using the product twice daily plus sunscreen. The patients showed a 40-50% reduction in sun damage spots as documented in their UV photos. I have been faithfully using it once a day for the past two years and have definitely seen an improvement of the “brown” on my neck. Dr. Yarosh wrote an interesting book entitled “The New Science of Perfect Skin/Understanding Skin Care Myths and Miracles for Radiant Skin at Any Age.” It is so packed with information that it has become more of a reference book. With the copy right in 2008, some of the over the counter products will be in their 4th generation of marketing terminology but the basic information will still be there. Dr Yarosh also is introducing genomics or understanding of the human DNA code as a tool by which next generation products will be developed. A very exciting hope for us sun damaged sun bunnies.

If you would like to read Dr. Yarosh's book "The New Science of Perfect Skin", it is available at Gere Library.

Dr. Ann

CPR Training

2011-04-07T07:21:00.000-07:00

We just finished an in office CPR training/practice code blue, thanks to Lancaster County Medical Auxilary volunteer, Joan Kiple R.N.

My trustworthy brain likes to turn to mush with the tension of trying to follow all of the steps. It was so much more comfortable to be in my own office with Joan’s quiet and gentle support. I am thankful that the technique is evolving to mainly chest compressions and using an AED if available. There were several references in the American Heart Association training manual to the time consumed by trying to check pulses and give effective breaths while the brain was needing the blood to be pumped. By focusing on just chest compressions more of us will be able to help and (maybe) be helped.

Please consider taking a class or checking out a DVD at the library. I did find one at Gere Library entitled “Complete CPR” by American Safety Emergency Medical Training. John Klatt was the trainer and was excellent in explaining the rationale to the various steps and situations. While filmed in 2008, he made several references to the thinking behind the new guidelines. You can also find many (5,340) sources if you google, new guidelines for CPR.

Please take the time for an update and remember (Ann), don’t bend your elbows.

Dr. Ann

Other Pearls from the Orlando Derm Meeting

2011-01-21T07:55:00.000-08:00

The enthusiasm for fractional CO2 is still high. The challenge for skin tightening is being explored by bipolar radiofrequency, focused intense ultrasound, “the jury is still out”. The answer to one lecture entitled “Are Face Lifts Obsolete?” is a resounding NO!

The most popular laser treatment is still hair removal. A new diode laser called the Soprano will be a favorite if it really is “much more comfortable”.

There are new fillers and neurotoxins on the horizon and a better understanding of “lifting” rather than filling the valleys of the face.

Chemical peels continue to be popular particularly the superficial ones, which in a series, will brighten and lighten the skin with minimal to no downtime. The salicylic acid peels are the safest for skin of color.

In medications applied to the skin, vehicles matter. It is not just the active ingredients if they are not being delivered to their target. Intuitively and clinically this was obvious but the battles with the insurance companies and pharmacies are continuing to disregard this fact.

Treat the Outer You, Love the Inner You!

2011-01-21T07:44:00.000-08:00

Nothing like a delayed flight to give one the chance to regroup and reflect on the last three days filled from 7 a.m. to 8 p.m. with what’s new and “happening” in the world of cosmetic, surgical and medical dermatology. I love going to a meeting like the 8th annual Orlando Dermatology, Aesthetic & Clinical Conference. It keeps my “juices” flowing and a smile on my face! What I am discovering is what was “written in stone” when it was first introduced, is being polished and perfected with exciting new thoughts and techniques. I love being challenged and learning!

What was a little depressing in a few lectures was the picture of Barbie with the 50 year old changes you would see in a sun exposed, blonde, convertible owner. The juxaposition to Barbie is the currently popular Bratz dolls who have “cachetic” bodies, big eyes, big cheeks and big lips. No wonder girls grow into women who have many critical issues with the reflection they see in the mirror and then the Birthday Fairy visits! Women’s magazines, TV ads and the internet aren’t helping much either.

A consistently repeated phase at this meeting was the words soften, not completely gone. Age appropriate, genetics, past unprotected sun/tanning bed exposure, trout mouth, plastic, Michael Jackson’s nose were some of the other phrases. The focus is turning toward our Midwestern values. It’s lucky to have more birthdays, it’s super lucky to have learned to enjoy the inner you. It is ok to treat yourself to periodic maintenance treatments to pleasure yourself but who you are is still the most attractive feature.

Exciting News from the Fall Derm Surgery Meeting

2010-11-24T10:07:00.000-08:00

It’s almost been a month since my Derm Surgery meeting and I am LATE telling you about it. It was one of the best! Unfortunately, it started out with discussions on how to handle the complications of treatments by the non dermatology trained but led into new or improved procedures that detoured me from my blog writing time.

First, the Fractionated CO2 laser continues to be exciting and seems to provide the improvement we saw in the past with the old CO2 laser BUT several repeat treatments are needed for the trade of four recovery days instead of two weeks. The infection/scarring risks are definitely less.

I learned a new modification of an old standard chemical peel which is showing some tightening in one of the hardest areas, the skin under the eyes. I will try this on myself over Thanksgiving but more later on that.

There is a new hand piece for our Silkpeel microdermabrasion unit. It is specifically going after what is in the pore whether it is acne induced, aging induced or just the result of big pores that like to hang on to oil, skin cells, old makeup, etc. Pam, our aesthetician, tells me the nice word is “congestion”. The Silkpeel machine is also infusing a “clarifying” solution with salacidic acid at the same time and vacuuming up all the debride.

Finally, something for white hair or “peach fuzz”. There is a combination procedure of using a special instrument to gently remove the peach fuzz followed by a chemical peel and then a dry ice skin “cocktail” at the end. A chemical peel technique that results in light/white hair removal. WOW!

Those of you who know me know that I am busy studying these treatments “five ways to Sunday” before I am comfortable providing them to my patients but I am excited! It is going to be a fun early 2011. Whether it is bitter cold or the sun doesn’t shine, we will have skin treats so our skin can bloom with the tulips and the roses.

Highlights from the 2010 AAD Meeting

2010-08-26T12:12:00.000-07:00

There certainly was a focus on non-evasive body contouring with ultrasound, low level light, better radiofrequency tips, freezing (cryolipolysis) and a combo of laser, massage and suction. The studies of effectiveness and longevity are still being accumulated as well as those to reassure us on the safety of these treatments to the patient. There weren’t any rumors regarding results of the FDA mandated Lipodissolve studies yet.

Ablative Fractional Resurfacing (AFR), done with fractionated CO2 lasers, is still very popular with more cases achieving success in treating very sun damaged skin and wrinkles (even around the mouth). Some skin tightening is seen along with the improvement in the more difficult types of acne and surgical scars.

At least two more new neurotoxins (think Botox), will be available in the near future along with more competitive pricing and interesting micro injection techniques.

Revance, a topical product with a Botox like effect on crows feet, is starting the phase 3 trials soon. It won’t replace Botox but definitely seems to have some effect. It is also being studied for underarm sweating.

Face lifts are averaging 8 years in effectiveness, up to 10 years in the very fortunate. Barbed suture lifts are losing out to the statistics of 69% having 38 kinds of adverse events. 59% of patients required additional procedures, particularly fillers.

A consistent phase was heard: beware of the hype. We are reminded that as physicians we are scientifically trained and need competent, statistically sound studies to confirm the information provided by the companies and their representatives.

Dr. Ann

Dr. Lott on Dr. Peter Gott

2010-08-18T13:32:00.000-07:00

I admit it. I regularly read his advice column in the Lincoln Journal Star. I read it at first so I would know what my patients were referring to. I became a fan when I understood, compared to so much “medical advice” on the internet, Dr. Gott’s information is balanced, comprehensive and well researched. He is also willing to keep an open mind to stories of alternative approaches to treatments that have helped some and most importantly do no harm. History supports many of Grandma’s treatments in spite of the lack of double blind, independent studies done at several facilities with a large subject number.

What motivated this blog was the article entitled “Battling Age Spots”. Dr. Gott aptly described these gifts from the birthday fairy and what we can do about them.

First and foremost is sun protection with clothes, hats and sunscreens plus staying out of the sun from 10 to 4. (“Only mad dogs and Englishmen go out in the noon day sun”). There are over the counter bleaching creams which are half the strength of the prescription ones. These help but require regular use for months. I personally like “cryotherapy” or freezing them if there aren’t too many. They generally scab over and peel off in 7-10 days. We have a much improved chemical peel for brown especially for a lot of diffuse color. The skin peels after about 3-4 days and is more like the fine scaling of a sun burn.

The laser is particularly effective for generalized discoloration but costs more than the chemical peel. Nothing is consistently effective for Melasma (hormonal based brown discoloration). I am also seeing improvement after the fractionated CO2 laser treatments. This definitely has more downtime (4 days) because it is actual pinpoint wounding of the skin. This technique is being called Ablative Fractional Resurfacing (AFR) and is the current popular treatment for fine lines, wrinkles, sun damaged skin and acne scars.

The most important bottom line is to be sure the brown spots are from age and aren’t cancerous. When in doubt, the best is to have a skin exam at your friendly dermatology office.

Dr. Ann

2010 Combo Treatments are Hot!

2010-06-24T10:56:00.000-07:00

Everywhere I turned this weekend, it seemed I read another article about using combinations of treatments for aging, sun damaged skin. It started Friday with the delivery of the June issue of Dermatologic Surgery Journal. An excellent and very comprehensive review article, “Recent Advances in Combination Treatments for Photoaging: Review of the Literature”, compiled the information from a multitude of scientific studies confirming that the best results are arrived by numerous treatments of various types when using a “knife free” and “minimal down time" approach. As always, the maintenance of the improvement from these treatments has to be good home care, health and sun habits. Basically, this isn’t new information but one is always searching for the magic, one time, do it all, treatment. Some examples of these combo’s are:
1. Botox/Dysport & fillers.
2. Botox/Dysport, laser resurfacing & fillers.
3. Fractionated CO2 laser resurfacing & chemical peels or microderm & pulsed dye lasers.
4. Thermage skin tightening & fillers &/or fractionated CO2 laser resurfacing, liposuction & Thermage.

In my 30 plus years of Dermatology, many of these treatments have singly risen to the top in popularity and evolved in technique and effectiveness. Then they were sidelined as another came into the lime light. Now the combinations appear to be the best choice for help with slowing down the birthday fairy’s assaults. Even with face, neck and eye lid lifts, the texture and color of the overlying skin still needs addressed (kind of like car detailing or hair color along with the cut).
Soooooo regular, multiple types of treatments are available to keep the “factory” of skin cells busy.

Dr. Ann

P.S. I really enjoy sharing these “treats” with my patients.

Don't Let The Sun Damage Your Skin Like It Does Your Furniture!

2010-06-10T08:52:00.000-07:00

There is nothing to compare with the beauty of the Rocky Mountains! I was able to spend the Memorial Day holiday gazing through the two story windows of a Colorado cabin and the incredible bright morning sun peaking over the mountains onto the upholstered furniture and the blue to now grey rug. If this is what can happen through window glass over time, no wonder my “thirty something” skin is showing some of the same changes. My own upholstery is weathering with crinkles and irregular coloring from the unprotected outdoor sun exposure coming in through the window glass. You just have to look at this cabin’s décor or remember some areas in your “growing up” home to get the picture. Think about the webbing of our past aluminum outdoor chairs and recliners. I spent many hours reweaving new webbing to replace the disintegrated and old webbing. And then there is the issue of the paint and wood deterioration around the windows. OK, you get the point!! None of us are ready to go back to pioneer dress (but weren’t they smart with long sleeves and hats?). We can now use our much improved sun protection lotions but if you see any skin color change, this is a sign of CELL DAMAGE, not health.

I am going to list the websites of some of the companies that make light weight, easy to wear, sun protective clothing. I have personal experience with the Solumbra line from the Sun Precautions Company as they were one of the first to provide me with a big white shirt that I could wear over my hiking, biking, gardening and outdoor marketing clothes. It reminds me that my grandmother would wear Uncle Glen’s long sleeve shirt when she was gardening or chasing chickens. She also wore a big hat, which was embarrassing to me if my friends saw her. I grew up in Western Nebraska where the migrant beet workers wore big hats and long sleeves out in the field as they worked all day in the sun. The beet workers, my grandmother, the people who take siestas, those using parasols or umbrellas, those that wear foreign legion type head protection or sun bonnets are more in the skin health & beauty groove then we are.

Please take a minute to “checkout” these websites. Even if you would pick only one item to wear, you could add yourself to the role modeling we are now seeing from our movie stars. Undamaged skin, no matter what your “tone”, is a sign of health and beauty.

Dr. Ann

www.sunprecautions.com
www.coolibar.com
www.sundayafternoons.com
www.tilley.com
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Seeking Imperfection

2010-06-08T13:52:00.000-07:00

An interesting follow up to my last blog was presented in a somewhat different light on the April 29th Early Show. While the “less is more” philosophy is being discussed more and more in my recent literature and professional meeting, the casting directors are apparently of the same mind. In the piece titled: Hollywood Seeks New Perfection: Imperfection, they are looking for natural faces and bodies such as Meryl Streep and Julia Roberts. Bradley Jacobs, U.S. Weekly editor, who was interviewed on the program stated “What’s interesting is, for women who are a little bit older, maybe 40 plus working in the business, people sort of do expect them to get a little work done; but it needs to not be obvious. We need to not be able to tell, so there’s a difference between good plastic surgery and bad plastic surgery once you get past a certain age.” This is the request I hear repeatedly from my patients “I don’t want fish lips or huge cheeks, just soften the edges.”

The baby steps philosophy at CDLC is happily meeting those requests. I don’t care for the fish lips look either.

Dr. Ann

Baby Steps to Skin Care

2010-05-05T13:31:00.000-07:00

Cosmetic Dermatology & Laser Center, Lincoln, NE: Up to date and experienced in Baby Steps. What makes your practice unique? I have been thinking about the answer to this question for quite some time. The marketing gurus want you to focus on what makes your clinic special. Are you more experienced? Yes, that comes with training and time. Are you specialized? Yes, that comes with a derm residency, tons of derm journals, many derm meetings and workshops and best of all, one on one training with some of the best ever derm docs. So why open Cosmetic Dermatology and Laser Center? It’s where my travel through all those work days, meetings, journals, training, and exposures has led. I love what I do and love sharing the joy of it. I am very pleased to work with my patients who have finally decided to do something themselves “for a change”. BUT they are not sure what they want and are very cautious by nature. That is where Baby Steps come in. It is a much more comfortable approach for those of us who are mid life and have grown up in the Midwest. Softening the mirror image helps us match that image to how we actually feel and act. We still want to look like ourselves but not look like the numbers of our birthdays or the hours spent in the sun. Baby Steps give comfort, experience, re-assurance so the next or repeated steps are easier.
Who am I? I am the experienced, specialized, joyful provider of Baby Steps in cosmetic dermatology. Where? In the happy, comfy place called Cosmetic Dermatology & Laser Center.

Dr. Ann

The Best ASLMS Annual Meeting

2010-04-28T07:54:00.000-07:00

As medical meetings go, this last one was one of the best. The ASLMS, American Society for Laser Medicine and Surgery, annual meeting started with a special course on laser complication taught by the best and most experienced laser surgeons. Since the majority of the presenters are derms, I had the good luck of being exposed to their extensive contribution to laser surgery. They are the ones who are in the trenches doing the studies and sharing the information. They are the mentors of my interest, then passion, for lasers. They also are the purveyors of the fact that this technology, while celebrating 50 years of existence, is still evolving in small steps. The tenor of their message was: be cautious, do no harm, take the promotional material with a grain of salt, remember your basic training in skin and its responses, look for evidence based results, don’t over promise results, tattoos are much harder to remove than obtain, home devices are safe only IF you follow the exact instructions, the evolution of lasers is amazing and on the shoulders of many tenacious people.

Dr. Ann

The Best Wrinkle Cream

2010-03-25T12:31:00.000-07:00

All I wanted was to check the wind direction before I went for my Saturday run. Just to the right of this information on the weather channel web site was this large pop-up proclaiming the top 3 anti-wrinkle creams of 2009. What self respecting female, being a dermatologist or not, wouldn’t want to know more? Thus was the start of the next 45 minutes of wandering from web site to web site. You think Alice in Wonderland was baffled!

I recently read a market research report from the NPD Group in Port Washington, NY, that anti-aging is a major reason for 75% of women buying skin care products. Guess what? Women use skin care products to look the best they can for their age. After purchasing these products, they often end up on the shelf with less than a once daily use, if that. Do I understand this? Yes, both intellectually and emotionally. We want more than any cream, lotion or serum can give us for our effort and expense. We are only beginning to understand the genes affecting our aging. We could have lead more health focused, sun protected lives. Is there hope? Yes!

I just finished reading both parts of a review article in the January and February 2010 Cosmetic Dermatology, Volume 23, #1 and #2 entitled “Use of Topical Retinoids for the Treatment of Non Malignant Photo Damage in Clinical Practice”. I emphasize again that Retinoids (aka: Tretinoin, Retin A, Renova, Tazorac) can deliver results if used regularly, for a long enough time and combined with a good sunscreen and careful sun exposure. So far this is the easiest thing you can do. You can’t fix your genes (yet).

You will need detailed instructions for successful use by a physician because Tretinoin and most Retinoids are prescription products. I love the conclusion arrived at in the review article, “Of all the topical therapies available to date, the retinoids can be prescribed with the most confidence, as the clinical evidence underpinning their use far outweighs that available for other compounds such as antioxidants and alpha hydroxyl acids”.

So Alice, climb out of the hole, clean off your shelves, mute all non evidenced based claims, simplify your life and come visit me at CDLC.

Dr. Ann

Board Certification in Dermatology

2010-01-27T13:03:00.000-08:00

What does Board Certification mean? In Dermatology, the requirement after medical school is one year of medicine followed by three years of the study of the skin (dermatology residency). At the end of the fourth additional year of training, you have to pass a series of skill and information exams. You also need to maintain 150 American Academy of Dermatology continuing medical education (CME) points in a three year period. Depending on when you passed your first boards, you periodically have to take a recertification exam.

To stay up to date, there are the 15+ journals that arrive monthly with new and reviewed research information just on the skin. Within several dermatology associated organizations there are many opportunities for advanced training in new procedures, techniques, devices and products.

The human body and its care is very complex. What is best for your skin can also be complex. Your eyes, mirror, spouse, friends and personal physician help you care for your skin. If you want specialized skin care, consider someone who is board certified or board eligible in Dermatology as a top choice.

New Year's Resolution for Your Skin

2010-01-15T07:31:00.000-08:00

Here’s a great New Year’s resolution for your skin! Put on a complete sunscreen product every morning whether you are planning to go out or not. It will help protect your skin from dry, forced air heating and the year round UVA radiation received through window glass. Sunscreens and sun avoidance are always listed as the number one thing you can do to slow down the undesirable “gifts” from the birthday fairy, whether they are wrinkles or skin cancers.

Effective sunscreens come in various types so if you have oily skin, are a heavy sweater, have sensitive eyes, hate the feel of something on your skin (you know your excuse); there will be something you can use. One of the new favorites is a powder form of zinc oxide which can be dusted on even after the first 9 holes of golf. Talk about easy and convenient for the every two hour application, just grab it out of the golf bag, purse or fanny pack and dust it on.

Another very important resolution is to check your skin for any spots that are new and or growing. Check out the skin of your family and friends. Too many of us, who grew up in the “sun bunny” generations, are paying the price now. We are also adding in younger people with tanning booth exposure.

At CDLC, we are very happy to help you find a sun screen that you will love and use regularly.

PS: Be sure to check the expiration date on your products.

Dr. Ann

Colorescience Pro Products

2009-12-02T09:46:00.000-08:00

The American Academy of Dermatology’s annual meeting is an incredible source of “what’s new and exciting” in dermatology. I am always amazed at the size of the exhibit hall. I was wandering through with my “must do” list and noticed a huge gathering of women dermatologists at this one bright and cheery booth. In the center was Michael McCarthy, the nationally known make-up artist for the Colorescience Pro product line. He was helping these busy working women find quick and effective products to protect and enhance their individual beauty needs. He is coming TO OUR OFFICE, December 19th, to spend 30 minutes with 12 lucky patients to design a quick and effective beauty regime just for them.

My staff and I love Colorescience products because of their quality and focus on the bottom line, beauty and sun protection. There is no easier way to comply with the “reapply every two hours” sun protection rule than with the dust on Sunforgettable products. I have men who carry it in their golf bags to re-apply after 9 holes. Generally, they aren’t concerned about beauty but want to keep me from treating so many of their pre-cancers.

This is a great “guy” or gal Christmas stocking gift!

Dr. Ann

P.S. If Michael is willing, we will try to lure him back another time. We have to “borrow” him from his responsibilities with the Seattle Opera Company.

Lasers and Lipo

2009-11-19T08:15:00.000-08:00

More from the ASDS meeting:

So what’s the story?

The new “hot” laser technique is the ablative (fractional) CO2. It takes our old CO2 resurfacing lasers and “breaks” the 6 mm pulse into 49 pinpoint wounds leaving the adjacent skin untouched to help heal the damage. This technology may replace the “non-ablative” lasers due to the improved results in fewer treatments with similar to only slightly longer downtime. It is being used off the face but we are being advised to be much more respectful of these areas that have fewer follicles to help repopulate the wounded areas. Those of us who have experienced the improvement with the original CO2 resurfacing were consistently underwhelmed by most all of the subsequent non-ablative lasers. Finally, we are seeing results that are similar to that of the older technique, particularly if a series of 2-3 treatments are done. The “checking” of the skin that happens with age and accumulated collagen breakdown from solar radiation is nicely smoothed with these treatments. We are also seeing response to the “hill and valley” acne scars and the toughest, ice pick acne scars.

Right now, the non-invasive lipo devices are still in the learning curve phase. When listening to the lectures, several referrals were made to “manage the patient’s expectations”. These comments take me back to my experiences with endermologie for cellulite. The phase means not “there” yet.

Dr. Jeffrey Klein, the father of tumescent liposuction surgery, still seems to be underwhelmed with the value of adding any laser to tumescent liposuction surgery. My fellow lipo doc friend, who owns the lipo laser, confided that it slows the surgery down and hasn’t significantly improved the result to justify the $90,000 cost. It is, however, popular and glamorous.

One of the big issues with lipo surgery is the fact that it should be mainly preformed in diet and exercise resistant areas referred to as “the family curse area”. If you are eating too many calories for your activity, they will have to be stored somewhere and it isn’t good if that happens to be the omental fat pad (intra-abdominal) which is associated with an increased risk of heart attacks. Liposuction is not a weight reduction technique but your workout clothes will fit better.

NEXT, I’ll talk about our Colorescience products.

Dr. Ann

Annual Meeting Thoughts

2009-10-29T06:27:00.000-07:00

Wow, I am finally jumping into the world of blogging. Considering how much I like to talk and how excited I am when I discover new dermatologic information, this should be a lot of fun! The challenge will be to keep it brief.

I have many thoughts to share after the recent American Society for Dermatologic Surgery’s annual meeting. I felt like I was attending a class reunion. Most of the presentations and conversations were with the derm docs that have experienced the evolution of cosmetic dermatology with me. Sclerotherapy and chemical peeling started the interest for me, and then lasers, lumescent liposuction, botox, laser resurfacing, skin tightening and now fillers. There has certainly been considerable refinements in technique and equipment in all of these areas.

There was a huge and expensive learning curve where technology was early and sounded a lot better than it delivered. I think the message of this meeting to all of us was to renew our pledge as physicians to evidence based medicine and not to the newest promise for easy rejuvenation and return on investment.

We had considerable discussion on split face study, blinded observation, statistical significance, safety and risk, both short and long term. There was an “eye opening” demonstration on the existence of camera based improvement in before and after photos caused by the tilt of the head, the shadows, the lightening, make up etc.

Conclusion: photos are very hard to repeat exactly, so buyers beware.

Bottom line? It is our responsibility as the specialist of the skin, to interpret the large amount of information and protect our patients from unsafe, poorly studied sham products and procedures.

More later,
Dr. Ann

Welcome to our Blog!

2009-10-29T05:41:00.000-07:00

Visit our blog often for the latest in Cosmetic Dermatology news!