Skintreatment.com - for the beautiful skin you have always wanted

Q. I've been reading lately that diet may really affect acne after all, what's the truth?

Q. What can I do about my acne scars?

Q. I hate my neck. What can I do?

Q. It seems there are so many choices for anti-aging skin treatment. How do I decide what I need?

A. We can help you decide what is best for you taking into account your concerns, how much time, or how convenient visits to the office are for you, the degree of improvement you want, and what you are able or willing to spend on treatment. In our clinic a basic anti-aging strategy ladder might be:

Essential Program—to prevent and treat roughness, fine lines, enlarged or blocked pores, dullness, mild brown discoloration and acne.

• Dr. Elaine's Ageless Effects Skin Care

• Sunscreen

• Retinoids like prescription Refissa, Renova, or over the counter retinol

• Light Chemical Peel

• SilkPeel

• GentleWaves

Enhanced Program—to reduce frown lines, forehead lines, crow's feet, lipstick lines, smile lines, turned down mouth, wrinkles from corner of mouth to chin, brown discoloration, dilated blood vessels and redness. Elevates drooping eyebrows, enlarges or restores lip line and lip fullness. To the above add:

• Botox

• Juvederm

• IPL

Advanced Program—restores youthful facial shape, lifts and tightens jawline, neck, cheeks and brow. Reduces deeper lines and wrinkles, acne scars and refines pore size. To the above add:

• Sculptra

• Thermage

• Fraxel

Q. I have a special event coming up soon. How can I look better before then?

A. It is remarkable how upcoming holidays, weddings, and reunions with thoughts of photos, relatives and busy days can spur us into action. We all want to look our best, both in person and in photos, even more so now when we see ourselves tagged in photos on social networks. Photos that, of course, just happen to be flattering of the person doing the tagging.

Starting or optimizing your skin care plan, adding prescriptions such as a retinoid or bleach if needed, and considering Glycolic Peel, SilkPeel and/or IPL is the first step to help with fine lines, discoloration, acne and increasing overall radiance.

Two areas that can be problematic are the frown lines between the eyebrows (the 11's) and the lines extending from the corner of the nose down past the corner of the mouth onto the chin (smile lines).

The lines between the eyebrows occur from muscle activity, are often familial and due to concentration rather than anger. Unfortunately, people with these lines are perceived by others as being angry. The lines extending from the corner of the nose down onto the chin are from a combination of gravity, facial volume loss and muscle activity. They act like an arrow pointing downward, dragging the appearance of the face down and giving an unpleasant facial expression. Both are often exaggerated by harsh or down-lighting that unfortunately often accompanies special event photos.

Treatment of frown lines with Botox injections relaxes the muscles, softening frown lines between the brows, crow's feet, forehead lines, lipstick lines and lifts the eyebrows in a "Botox Brow Lift." You look more rested.

In the lower face injection of dermal fillers like Juvederm fills in the harsh "smile" line, reducing the "hard" look. It also helps wrinkling around the lips, at the corners of the mouth, and gives increased lip or cheek volume.

Utilizing both Botox Cosmetic in the upper face and Juvederm in the lower face offers rapid improvement with minimal downtime. Both procedures make a big difference. Results of both are complete by 2-3 weeks after treatment.

Q. Why can't I get rid of these brown spots, I hate them! It can't be so hard can it?

A. Unfortunately, yes. There are things that frustrate you. There are things that frustrate me. And then there is hyperpigmentation, the medical term for increased skin pigment. I can't tell you the number of times patients have asked me in frustration—"Why can't I get rid of these brown spots, I hate them!"

Melanin is the skin's natural pigment that darkens to protect us from the sun's skin cancer causing rays. Once sun exposure stops, skin lightens back to its natural color. At least, that's what is supposed to happen. Damaged or abnormally functioning cells produce discoloration that does not fade. To some degree, the tendency to make abnormal pigment has a genetic basis tied to ethnic background. People with more natural pigment, such as Hispanic, Asian, American Indian, etc., respond to anything that injures or inflames the skin with increased pigmentation.

There are five triggers for abnormal pigmentation—sun exposure, inflammation, injury, hormones and aging. Each of the triggers results in a specific type of pigmentation, and each is more common among different types of patients. In medicine it's always a good idea to start with an accurate diagnosis, before deciding on treatment and prognosis. First, look in the mirror and see exactly what kind of pigment you want to improve. From easiest to most difficult:

In the mirror: Scattered pin-head to quarter size flat brown spots on face, neck, chest, forearms, and hands.
Diagnosis: Sun damage from past sun exposure, most commonly in lighter skinned people.
Treatment: Prescription retinoid creams such as Retin A or Refissa, daily sun protection, Intense Pulsed Light (IPL), laser.
Ease of treatment: Moderate.

In the mirror: Tan to dark brown flat or raised growths.
Diagnosis: Seborrehic Keratosis (age spots), often familial, and more common with age.
Treatment: First--physician evaluation to be sure they are benign, then destruction with liquid nitrogen, electric needle or laser.
Ease of treatment: Moderate.

In the mirror: Brown or red-brown discoloration of areas with past acne or injury.
Diagnosis: Post inflammatory hyperpigmentation (PIHP), most commonly occurring patients with more natural pigment.
Treatment: Prevention by treatment of acne, not picking, and caution with procedures that can cause pigment such as chemical peels and laser hair removal. Treatment with prescription skin bleach, prescription retinoid creams, and for some patients the very cautious use of chemical peels or microdermabrasion.
Ease of treatment: Moderate-difficult.

In the mirror: Large dark flat patches of discoloration, usually symmetrical, over cheeks, jawline, and forehead and/or above upper lip. It is often more obvious in low light settings, such as at sunset.
Diagnosis: Melasma or "mask of pregnancy," is caused by a combination of hormones, predominantly estrogen from pregnancy or birth control, and sun exposure. Once it starts, melasma tends to reoccur very easily with minimal amounts of sun exposure, even if the hormonal trigger is removed. I divide melasma into two types: "relatively easy" and "hard." The difference is dependent on how deep in the skin the pigmentation is found, and whether both the hormonal stimulation and sun exposure can be reduced. Deeper pigment is harder to improve.
Treatment: Involves both removing the triggers, and using creams and procedures to reduce existing pigment. Daily, year round, broad spectrum sun protection and avoidance of sun exposure is absolutely essential. Reducing hormonal triggers is often a challenge as pregnancy eventually ends, but often the need for birth control continues. Even if the hormonal trigger is removed, the melasma remains "turned on" and even tiny amounts of sunlight cause it to reoccur. Treatment at home with prescription skin bleaches, retinoid creams, and sunscreen, combined with in-office chemical peels or microdermabrasion is tried first. "Easy" melasma usually responds fairly well to this treatment. For more resistant cases, Intense Pulsed Light, laser, and deeper chemical peels under the supervision of a dermatologist experienced in treatment of pigment, are considered. Results are varied, and these procedures may actually make pigment worse.
Ease of treatment: Difficult-very difficult.

Overall abnormal pigment, especially melasma, is one of the hardest and most frustrating skin problems that cosmetic dermatologists and their patients deal with. I know, since I have had it myself.

Q. I hate my melasma, but I love the sun. Can't you just give me cream or do a peel to get rid of it, and I can still tan?

A. No.

Q. What are those "white beads" under my skin?

A. They are called milia, and are very common, benign, keratin- filled cysts. They do not have a pore, which is why you can't squeeze them out. Treatment for them is gentle pricking and draining with a sterile instrument and the glycolic acid peels that we do here in the office.

During a glycolic peel, the natural sugar acid, glycolic acid, is applied to the surface of the skin which removes dead skin cells and stimulates collagen production. Glycolic acid peels give a fresher, smoother surface and are very effective in treating some types of acne and pigmentation. At the time of treatment, our nurses also perform extractions to remove milia, black heads and acne. Patients usually schedule glycolic peels every 2 weeks for a series of 6 treatments and then maintenance treatments.

Q. What is the new treatment for eyelashes?

A. Latisse (bimatoprost ophthalmic solution 0.03%) is the first and only prescription treatment approved by the FDA to grow eyelashes, making them longer, thicker and darker. You apply the treatment yourself in the evening to the base of the upper eyelashes. Results start by 8 weeks with full results at 12 to 16 weeks. Mascara can still be used. If you stop using Latisse, your eyelashes return to their previous appearance over several weeks to months.

The most common side effects are itching in the eyes and/or eye redness. Less common side effects include skin darkening, eye irritation, dryness of the eyes, and redness of the eyelids. If you use medications for increased intraocular pressure (glaucoma) you should only use Latisse with approval from your ophthalmologist. Increased brown iris pigmentation has occurred when similar medications were instilled directly into the eye to treat elevated intraocular pressure/glaucoma. Although iris pigmentation has not been reported with Latisse, the potential for increased brown iris pigmentation is possible.

Often the best results are realized when you apply it every other or every third night. This gives you darker, longer eyelashes that still look natural. And saves you money.

Q. What can I do about bulges that won't go away with diet and exercise?

A. I feel your pain. While diet and exercise is the mainstay of body reshaping, many people have areas of fat that don't respond. For these stubborn areas both invasive and non-invasive body contouring procedures can help. Liposuction uses a hollow tube inserted into the fat through small skin incisions to suction out and remove fat from localized areas. Because the volume of fat that may be safely removed is limited, it is a procedure to contour the body, not for weight reduction. When performed by a qualified and experienced physician, liposuction is safe and effective. However there is some risk, recovery, and discomfort associated with liposuction which has led to the growth of non-surgical, non-invasive body contouring alternhttp://skintreatment.com/cosmetic-dermatology-center/cosmetic-dermatology-procedures/cosmetic-dermatology-coolsculpting-fat-reductionatives.

CoolSculpting reduces fat by chilling it, which provides an effective non-invasive tool for localized fat reduction. A suction applicator is applied to the skin over the target bulge and delivers precisely controlled cooling specifically targeting fat while not affecting the overlying skin. Over a four month period of time, the treated fat cells are destroyed and eliminated through the body's natural processes.

Studies have shown that CoolSculpting gives an average reduction of 22% in fat after one treatment. If additional fat removal in the area is desired, another treatment can be done which will yield an additional 20% reduction resulting in a total fat loss of 40%. Final losses may be more or less, depending on the individual. Some patients experience redness, minor bruising, tingling, or numbness after the procedure, but these are temporary. Results are permanent as the fat cells are destroyed and removed from the body. CoolSculpting's advantage is that it is completely non-invasive and extremely safe. While the results are not as dramatic as those following liposuction surgery, the absence of any downtime and the safety of the procedure make it a popular choice for fat reduction and body contouring. Like liposuction, it is not intended as an overall weight-reduction program.

Q. Does CoolSculpting hurt? What are the risks?

A. With Coolsculpting patients feel a firm compression and suction sensation to the bulge of fat that is being treated. Patients feel the sensation for the first 8 minutes or so of the treatment, then the discomfort greatly subsides. The sensation is certainly tolerable, especially since you know it will only last for a few minutes. Based both on personal experience and those of our patients, the larger attachment is more uncomfortable for those first 8 minutes than the small attachment. This is not surprising since the larger attachment treats approximately two and a half times the surface area that the smaller one does. I would describe the discomfort with the smaller attachment as minimal, with the larger one as discomfort not pain. After the first 8 minutes, patients are very comfortable. There have not been any reported permanent complications. After treatment the area may bruise, and have some tenderness for a few days. It is not uncommon to have some numbness of the area for a few weeks.

Q. Does the skin get loose after CoolSculpting?

A. Coolsculpting is targeted to reduce fat not affect the top layer of skin which is where much of the natural elasticity of the skin resides. Because the results are seen over a 4 month period, patients with good skin elasticity will often see the skin contract as the fat is slowly lost. Patients who have pre-existing skin looseness usually will not see the skin tighten, because the elasticity is already gone. Just like when you take off a bra, the elastic band will shrink down as the stretch from the body is removed, if you have good elasticity the skin will shrink down as the fat is removed. If the elasticity in your bra is shot, it won't contract, and if the elasticity in your skin is not good, it won't shrink either. Your doctor will be able to tell you before treatment whether your natural skin elasticity is good enough to contract as the fat is lost.

Q. I love the results with Juvederm and Restylane but sometimes I bruise. What can I do?

A. Anytime a needle is used there is the risk of bruising. Some individuals bruise more easily than others but following the following instructions can help you minimize bruising.

How to reduce bruising after Juvederm, Restylane, Perlane, Radiesse and Sculptra

• For one week before, and two days after, avoid aspirin, NSAID's (Ibuprofen, Aleve, Motrin, etc.), St. John's Wort, Vitamin E, Multivitamins, Fish Oils, Flaxseed Oils, Omega-3, Gingko, Ginseng, Garlic and Glucosamine.

• Buy a fresh (not frozen or canned) pineapple. Eat half the day before treatment, one quarter before you come in and the final quarter after your treatment. Pineapple contains bromelain which helps decrease bruising.

• Arnica gel is used to reduce bruising after your dermal filler injection. Starting 30 minutes after your procedure, apply Arnica gel every hour the first day and every two hours, starting the second day, while awake until bruising is gone.

• You will receive a free GentleWaves LED treatment and cold packs immediately after injection to reduce swelling and bruising.

• You may have redness, swelling or bruising for several days to a week, sometimes longer.

• Apply cold compresses as needed for the first 8 hours to reduce swelling.

• Avoid exposure to extreme heat, such as a sauna, to reduce redness and swelling.

• Avoid touching the treated area within 6 hours after treatment, except to apply Arnica. After that it may be gently washed with soap and water. Foundation may be patted on.

• Bruising may be covered with makeup. The most complete coverage is Dermablend Cover Cream (found at Ulta).

Q. How can I get rid of this hair on my face? I pluck them out but then I get ingrown hair.

A. Many women grow hair on their face and feel that it detracts from their appearance. Often it is fine, light hair, but many also have dark or gray, stiffer hairs sprinkled about caused by changes in hormones as we age. Some women have a true moustache or beard caused by more significant hormonal issues, or as a familial, genetic, or racial characteristic. While the hair itself detracts from appearance, often the results of attempts to remove it are even worse. Usually the patient has been plucking or waxing the hair. And just as often she will get ingrown hairs and red bumps that she picks at trying to remove the regrowth, resulting in chronic red bumps on her face, all the time. Later these red bumps turn into dark spots or scars. Sometimes disaster occurs if she is using a retinoid (Retin-A, Renova, Refissa, Tazorac, Differin or OTC retinol products), then waxes her face and the skin comes off with the wax. Not a good look.

When I tell patients with the fine light hair, or fine light hair with a few darker ones to shave, I get a look of horror and the response "But it will make the hair grow thicker!" "It will make the hair grow darker!" "It will make the hair grow faster!" "It will make more hair grow!" No, no, no and no.

Shaving the surface of the skin does not affect hair follicles under the skin where hair is formed. Shaving simply can't change the thickness, color, rate of growth or number of hair follicles. On the other hand, plucking and waxing are a different story. Plucking and waxing rip the hair out of the follicle by the root, stimulating more growth. Over time this also distorts the angle of the follicle so that hairs are more likely to in grow. Then you pick at them, and on and on. Depilatory creams dissolve away hair but are often irritating, as are facial bleaches to lighten hair.

The answer for the fine, light hair, is to buy a "personal" battery powered razor, which has a head about an inch long. Shave the hair off. Just like you do to your legs. That's what I do. Yes, it will feel a little stubbly when it grows out, just like your legs. So you shave it again.

If you have a sprinkling of darker, coarser hairs, either keep shaving them too, or consider IPL or laser hair removal. No IPL or laser hair removal gets rid of the light fine or coarse gray hair no matter what anyone tells you. The IPL or laser light can't "see" it.

You may want to consider also applying the prescription cream Vaniqa to slow the growth of the hair. It will not remove hair, change the color, or make it stop growing. Sometimes it makes it a little finer. Some people get irritation or acne from it.

If you have a more significant amount of darker hair that is not familial or ethnic, or if you have acne, difficulty with weight gain or irregular menstrual periods, you may have a hormonal disorder called Polycystic Ovary Syndrome. Make an appointment with your Gynecologist for diagnosis and to discuss your treatment options. So if you feel like the bearded lady, the best treatment is evaluation and treatment of any hormonal problem by your Gynecologist, then Vaniqa and IPL or laser hair removal.

Ethnic facial hair growth is the hardest problem. Most commonly seen in women of Middle Eastern, Mediterranean, or Southern European descent, it is genetic, and less often has a hormonal component. Because it is often dark hair on skin with a lot of natural pigment, IPL or laser hair removal is significantly more risky. The best treatment is shaving, Vaniqa, very careful IPL or laser hair removal in selected patients, and treatment of any hormonal component.

Q. I keep getting more of these red and brown spots on my face. What can I do?

A. One of the hallmarks of youthful skin is that it is smooth, creamy and unblemished. Over time, and especially with sun exposure the skin develops brown spots, age spots, roughness and broken blood vessels. The end result is skin that doesn't reflect light well and looks spotted and older.

Intense Pulsed Light (IPL ) Photorejuvenation treatment is used to improve sun damaged skin, age spots, freckling, brown pigment, broken blood vessels and redness. The IPL light is selectively absorbed by those targets, which are destroyed. Surrounding skin is unaffected allowing selective removal of brown and red discolorations.

Typically a series of 2 to 3 sessions are given. Patients show improvement starting with the first treatment. The procedure feels similar to a rubber band pop. We us a surface anesthetic to reduce discomfort. There is little or no downtime and most patients resume their usual activities immediately after treatment. It is important to Use broad spectrum sunscreen and avoid sun exposure for 3 weeks before treatment.

The result is skin that is smoother, creamy and reflects light better with less spots and redness. Clear the canvas and start over.

Q. I heard that the FDA is banning hydroquinone containing skin bleaching creams because they cause cancer. What is the story?

A. Hydroquinone has been used effectively for many years, both in over the counter (OTC) products with a strength of 2% or less, and higher strength by prescription. Recently questions have been raised regarding the safety of hydroquinone based solely on rodent studies. There is no evidence that hydroquinone is carcinogenic in humans.

There is also the rare condition, called onchronosis; in which skin darkens if high percentages of hydroquinone are used for unsupervised for a prolonged period of time.

Because Hydroquinone has been used for some many years, predating the FDA regulation process, it, like aspirin was not required to undergo formal testing. The FDA recently considered restricting the sale of hydroquinone containing skin bleaching products for prescription sale only rather than over the counter. It is likely that the FDA will require that all hydroquinone products will be required to conduct formal safety studies, as is currently required for all prescription medications.

Bleaching creams tend to lose effectiveness if used continuously for many months at a time. Therefore both to monitor progress, and reduce the risk of side effects we evaluate patients on a regular basis and prescribe intermittent rest periods from treatment.

Q. What is an inexpensive and popular procedure any woman can do to immediately look better?

A. A popular, inexpensive and "no down time" procedure is SilkPeel, an in-office procedure combining precision skin exfoliation with Dermal Infusion. The diamond treatment head exfoliates while delivering topical dermaceutical at controlled intensity, stimulating new cell growth. You see increased smoothness, improved natural glow and radiance. Patients with acne can expect reduced acne and blackheads. It is especially popular before a big event, like a wedding or reunion.

Microdermabrasion involves a controlled stream of particles to exfoliate the skin. Particle-free microdermabrasion treatments use a treatment tip, such as a diamond treatment head. We perform SilkPeel Dermalinfusion which uses a diamond treatment head to precisely exfoliate. Additional improvement is obtained with Dermal Infusion, the application of specific dermaceutical treatment solutions at controlled intensity based on specific skin conditions. The result is the removal of surface abnormalities, infusion of treatment solutions and better penetration of prescribed home skin treatments.

Q. It seems as though everyone I know has rosacea. Is it really that common?

A. Rosacea is usually correctly diagnosed by experienced dermatologists. There is a spectrum of characteristic findings which include redness, dilated blood vessels, bumps, pustules, skin thickening, and oil gland growths. Patients with sun induced dilated blood vessels, acne, perioral dermatitis, sensitive skin, and lupus can sometimes be incorrectly diagnosed with rosacea.

Q. What can I do about the redness, flushing and blushing from my rosacea?

A. Redness, flushing and blushing from Rosacea is a frustrating problem that people who have never experienced it usually don't understand. We have very good results with a series of Intense Pulsed Light (IPL) treatments. Treatments must be done by a physician experienced with intense pulsed light for this difficult problem. Topical or oral treatments don't reduce the overall redness, flushing and blushing; they do help with red bumps, pustules and general skin sensitivity.

Q: I've really been working out, and my body looks great but my face looks worse. Why is that?

A. It is one of the unfortunate facts of life that as we age the effect of weight loss or significant aerobic exercise disproportionately show on our face. Although you can often get away with it when you are young, as you approach 40 this effect is added to the natural loss of fat and bone structure already accompanying the aging process. The result is a face that looks gaunt, haggard and tired. Or, to paraphrase of a bit more colorful quote often attributed to French actress Catherine Deneuve, "After a certain age, you have to choose between your face and your fanny."

As you start to lose facial volume, your eyes look slightly sunken, cheeks hollow out, and skin loses its firmness and elasticity. The fat pads under the eyes go first, then, then the cheeks. At the same time, gravity comes into play; elastin and collagen fibers that allow skin to stretch and spring back weaken, causing skin to sag. This has been termed "Runners Face," the marked loss of fat leading to a prominent appearance of the bones, accelerated development of skin sagging and deepening of wrinkles.

One way to replace the lost volume is with dermal fillers like Juvederm. Another is the bio stimulatory filler, Sculptra Aesthetic. Designed to be completed over several treatment sessions, Sculptra is injected over a broader area including the temples and upper cheeks as well as the jawline. Sculptra stimulates your body to make its own collagen, restoring youthful fullness to the upper face and tightening the looseness in the lower face. It gives natural looking improvement which increases over time. Results last up to two years, or longer in some patients.

Q. Other Than Volume, What Are the Benefits of Facial Enhancement Using Sculptra?

A. Sculptra restores youthful shape, improves texture, and helps results with other cosmetic treatments. It is bio stimulatory filler, which means that it helps your body make its own collagen. Results appear gradually over 6 months, and last for at least 24 months. By putting your cells into a "happy, more youthful" state, you will respond better to other cosmetic treatments such as laser resurfacing, skin tightening, and intense pulsed light photorejuvenation. It can also improve texture, fine lines, pore size and pigmentation on its own. We do Sculptra as part of an overall anti-aging strategy.

Results of treatment are very dependent on injection technique and the skill of the physician injector. See a board certified dermatologist or plastic surgeon who is experienced in Sculptra treatments for best results and to lessen the risk of side effects or suboptimal improvement. Gradual improvement over time is great for a natural-looking, long term anti-aging program that avoids sudden changes to your appearance.

Q. Doesn't laser treatment give better results without pain for spider veins on the leg?

A. Although laser treatment at times can be effective for treatment of spider veins on the legs, it is both more painful and less effective than sclerotherapy (injection of a solution into the vein). Both laser, IPL (Intense Pulsed Light), and sclerotherapy are mildly uncomfortable, but certainly tolerable.

Physicians who are experienced in the treatment of spider veins of the leg most often use injection sclerotherapy, as it usually the most effective with the least number of treatments, and with the least amount of discomfort. For certain patients or in certain circumstances IPL or laser treatment is indicated.

Q. Is there a topical product that can be applied to the skin to get rid of small broken capillaries?

A. If it sounds too good to be true, it often is. While there are many topical therapies to lessen skin redness, there is no topical therapy to decrease small broken capillaries, called telangiectasia. Fortunately, however, facial telangiectasia responds well to Intense Pulsed Light (IPL) treatment.