Scar treatments: Do they work?

January 30th, 2012

 

 

 

 

 

 

Mederma, Vitamin E , silicone gel dresssings-all promise to reduce scars. Do they really work? Several recent studies in peer reviewed dermatology journals have cast doubt on the benefits of all three. Here is a rundown of what works and what is a placebo.

Mederma:

Although it is often recommended by physicians, this scar gel, which contains an onion extract, has no solid scientific evidence to support its use.

Vitamin E:

Although it is commonly used in anti-scarring products, clinical studies are disappointing. There is little research to support the use of Vitamin E and some studies have shown side effects such as localized allergic reactions.

Silicone Dressings or gels:

These inexpensive products, found at most pharmacies, are often recommended by plastic surgeons. Originally used for burn patients, silicone dressings are thought to soften scars by improving water content and oxygen in the wound. There is little scientific evidence that shows benefit but this treatment continues to be popular due low cost and safety.

Cortisone cream or injections:

Corticosteroids injected directly into raised or keloid scars are effective in flattening the scars in 50% of cases or more (depending on the study). There is a small risk of thinning the skin or lightening of skin color which is dose related and may be reversible. Cortisone creams, on the other hand have shown no benefit as a scar treatment.

Laser therapy;

Several lasers have been used for preventing and treating scars.  The pulsed dye laser reduces redness and elevation and improves texture of keloids or thickened scars.  There is a risk of recurrence of keloids after treatment. 

Fractional laser therapy ( aka Fraxel laser) has been recently used for improving the appearance of surgical scars. There is not a lot of data but results are promising.  Healing after this laser treatment is very quick, which has increased interest in this option. There are some recently published, small studies using fractional laser pre-surgery to minimize scar formation. This is an interesting area for future study.

New therapies:

New agents that target molecules active in the healing process are currently being studied. Several agents that can be injected into surgical scars; avotermin, human recombinant interleukin -10 and insulin have shown promising results.

It may soon be possible to say “Scar be gone”

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Prepping your skin for the “Red Carpet ” how to put your best face forward for special events

January 15th, 2012

 

 

 

 

 

 

Hollywood awards season has begun. Those who follow the awards shows will be taking note of the outfits and jewelry worn by the stars as well as their hair and makeup. Without a stylist or makeup artis, here are a few tips for flawless looking skin for your special occasions.

 If you are acne prone, it is important to begin a program of treatment, either over the counter or prescription 2-6 months ahead of the date.  Most topical medications take 8-12 weks for maximal improvement. And, for more severe acne, oral medication which takes several months to work may be needed.

For uneven pigmentation, prescription skin lightening creams will also need to be started 3-4 months in advance of the big event. If improvement is not complete after a few months, peels or laser treatment may be needed for optimal results.

At least a month before the date, start a gentle program of exfoliation to help your skin to glow on the big day. If you chose to use at home products, look for a mild glycolic acid cleanser for at least once daily use. and an evening product with retinol or glycolic acid. If your skin is very sensitive, I suggest using 5% glycolic acid in a moisturizing cream one a day or every other day first and adding an exfoliating cleanser if tolerated.  Then, two weeks before the event, see an esthetician for a superficial peel, or buy a home masque. Use very gentle products without glycolic or retinol while the skin is peeling. The home masque can be repeated one week before the event. On the big day your skin will be smooth and  perfect  for applying makeup.

There are so many brands at different price points it is hard to know which products can be purchased at the pharmacy to save money and which should be purchased at the cosmetic counter. Getting the foundation and blush color right is tricky so having your makeup done at the cosmetic counter or by an esthetician can help you get that right. Some niche products such as under eye concealer are hard to find at the pharmacy. I like Laura Mercier concealer because it is not as light in color as others so it blends better. Don’t forget to apply a light moisturizer as a base to help the foundation go on smoothly. Lipstick and eyeshadows are very similar from brand to brand. In some cases the difference between the more expensive and less expensive brand is in the packaging. L’Oreal, which is the biggest beauty company in the world, makes an inexpensive line of lipsticks and eye shadows that are sold at Target and pharmacies for a reasonable price. I have used them and noticed no difference between those and more expensive brands.

As for your attire and jewelry, take notes on what the stars are wearing tonight at the Golden Globes and at the Academy Awards. There are sure to be knockoffs we all can afford available soon. Whatever your attire, you will exude confidence knowing your skin and makeup look flawless.

 

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Combating Winter Dry Skin

November 27th, 2011

 

Winter and fall bring in dry skin in southern California. Dry, hot Santa Ana winds can make you feel parched inside and out. And, cold weather combined with dry heat indoors zap the moisture from your skin. Medications such as antihistamines and topical acne medications reduce skin hydration or skin oils. Other culprits include thyroid disease, diabetes, menopause and older age (>65).

Here are some tips to treat dry skin from head to toe:

Hair and Scalp:

Dry hair can result from chemical treatments, use of hairdryers and hair straightening irons, and over washing. A hair masque applied for 15-20 min once weekly can hydrate the cuticle and restore brittle hair. Hair oils in sprayer bottles used before or after heat drying or straightening are another good option.  

Scaling and flaking of the scalp is usually a sign of seborrhea, eczema or psoriasis. If it doesn’t clear up with regular use of a dandruff shampoo, it is time to see a dermatologist.

Lips:

Dry winter weather frequently results in dry cracked lips. Keep a tube of Vaseline or a plain lip balm or moisturizing lipstick and apply throughout the day. Avoid lip balms with menthol or flavorings as long term use can result in an allergic reaction with increased redness and dryness. Cracked skin at the corner of the mouth with redness may require the addition of hydrocortisone 1%. Failure to respond may require a visit to the dermatologist.

Hands and Feet:  

The hands and feet often show the signs of dry weather first. Putting the moisture back by using one of the many effective dry skin products usually works. Some of my favorites, available at most drugstores, are: Cerave Cream, Lipikar Balm , Vanicream, and Cetaphil Cream. For extra dry skin try Aquaphor at night with socks or gloves. 

To reduce dry skin on the hands, wear gloves for housework and gardening and use a gentle moisturizer soap. And, avoid the use of alcohol based hand sanitizers which can dehydrate the skin.

Body, arms and legs:

The best tip for all over smooth skin is to apply a moisturizer all over on damp skin after showers. All of these products mentioned above can be used all over the body and reapplied several times a day. If the skin on the arms and leg looks like peeling paint, try a moisturizer that includes urea or lactic acid. These ingredients will exfoliate the dry dead skin cells as well as hydrate dry skin. If the skin is red and very itchy and does not respond to these measures, see a dermatologist for an accurate diagnosis and treatment plan.

 

 

 

 

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Posted in Home products for skin care, Skin Care Tips | 1 Comment »

Are facials worth the money?

November 8th, 2011
Woman getting newfangled facial

Woman getting newfangled facial

I am often asked ” Would having regular facials help my skin?” 

Facials can be especially beneficial for men and women with acne prone skin characterized by lots of comedones (blackheads and whiteheads).  A skilled esthetician can use masques, steaming and mechanical extraction to get rid of the blocked pores, resulting in smoother, clearer skin. Combining regular facials with prescription topical acne medication containing vitamin A, such as Retin A, Differin or Tazarac can maintain the benefits.

For very dry or sun damaged skin, facials can aid in hydrating the skin. Mild exfoliation reduces the dead skin layer, allowing better penetration of the moisturizers and antiaging products applied afterward. After the facial, a good skin care program using cleanser, moisturizer, sunscreen and anti-aging treatment products appropriate for dry skin will help maintain the benefit.

In our fast paced and stressful world, there is psychological  benefit to 45 minutes or an hour of relaxation and pampering. For some the pampering is the main attraction.

What about “oxygen” or “microcurrent” or ” ultrasound” facials. Is there any evidence that the addition of these new technologies will improve your skin? And, is it worthe $125-$400? I think there is little  scientific evidence to support the claims of the device makers. For more information on “new” facials, click here.

Based on current evidence, I  suggest facials for patients with stubborn comedonal acne that doesn’t clear completely with topicals medication. I also recommend facials for patients desiring a non invasive skin smoothing and hydrating treatment.

 Nikki Darlak, the medical esthetician in our practice, performs facials with dermaplaning , a procedure that gently removes fine facial hairs leaving the skin markedly smoother and free of hair. This treatment is especially popular before special events as it allows better application of makeup. This treatment is less costly than an “oxygen” or “ultrasound” facial and provides immediate benefit.

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Posted in Acne, Anti-wrinkle devices, Beauty treatments, men's skin care, Uncategorized | 1 Comment »

Skin Care: Anti-aging vitamins

November 1st, 2011

Skin care woman putting face creamA recent article in the Los Angeles Times Health section debunked the claims of some recently hyped anti-aging vitamins.  Proleva, a supplement that includes all the latest antioxidants: green tea, acai berries and resveratrol and Vivida, which contains algae, do not have scientific studies to back up their claims. Click here for more.

For now it may be better to eat 5 servings of fruit and vegetables and take a multivitamin than to spend a lot on special oral vitamin supplements to improve the health of your skin. No matter how much healthy food and vitamins you ingest, only a small percentage of vitamins  are delivered to the skin.

The best way to prevent and reverse signs of aging is to apply anti-aging vitamins directly to the skin.  Here are the top vitamins to give your skin a healthier glow.

Vitamin A: Best overall anti-age fighter

Available in over the counter retinol creams such as Neturogena Retinol NX as well as prescription strength products such as Renova , Retin A and Refissa.

How to use : Apply topical Vitamin A products or retinoids ( as they are known) at night. All of these products can cause irritation, redness and peeling at first. To minimize that start off 2-x/week and gradually increase to nightly. A moisturizer may  be applied  afterward. All retinoids increase sun sensitivity, making very inportant to use a daily sunscreen. After several months your skin will be smoother, fine lines will be reduced and brown spots will be lighter. These benefits have been proven by more than 700 published research studies.

Vitamin B3: Reduces Redness and Helps Hydration

La Roche Posay Rosaliac Anti-Redness Moisturizer and Olay Regnerist Micro Sculpting Cream both contain B3 or niacinamide.

How to Use

Apply twice daily for best results. Flushing or blushing from rosacea will improve. And, this vitamin increases production of fatty acids in the skin helping the skin to retain moisture.  It can be used with a retinoid to reduce irritation.

Vitamin C: Boosts the Skin’s UV Defense

Skin Medica Dermal Repair ( contains C and E) Active C from La Roche Posay, Skinceuticals Vitamin C Serum. There are many other Vitamin C serums and creams. Look for products with at least 5% V itamin C in the form of ascorbic acid. The bottles should be opaque and able to seal tightly to maintain Vitamin C activity – light will deactivate it.

How to Use :

Vitamin C can be used morning or evening to help repair free radicals generated by sun damage. When used with sunscreen in the morning, it has been shown to prevent sunburn. Vitamin C is often combined with vitamin E, known as alpha tocopherol, in antiaging creams. Vitamin C combined with vitamin E provides 4x the antioxidant activity, helping to repair skin from sun damage.

Using at least 2 of the products mentioned above, combined with a broad spectrum sunscreen will result in younger looking, healthier skin within 3-6 months.

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Banish the Bags under Your Eyes

October 17th, 2011

girlandeyemakeup

 

 

 

 

 

Dark circles under the eyes can make you look tired, unhealthy and older than you really are.  They occur in men and women often as young as the mid 30’s.

What are the causes?

·         Aging : the under eye ligaments get weak resulting in the normal fat pad pushing forward

·         Allergies: sinus and nasal congestion and watery eyes can cause under eye redness and puffiness

·         Heredity

·         Lifestyle factors: Lack of sleep, stress and  smoking all can cause puffiness in the under eye area

·         Pigmentation : more common in Asian, Hispanic and African-American skin

 

How can it be treated?

Mild or moderate dark circles respond to simple remedies. Getting enough sleep and   stopping smoking can result in improved eyelid appearance. Application of cold used teabags or frozen peas can temporarily reduce eyelid puffiness.  Allergy sufferers should reduce triggers such as pet dander and try a non-drowsy over-the-counter antihistamine such as Allegra or Zyrtec.  Women can conceal pigmentation or the deep trough under the eyes by applying an under eye concealer. It is best to select a color two shades lighter than the foundation color and apply lightly. For more makeup tips click here

Eye creams with anti-oxidants such as vitamin C and E reduce inflammation and can help hydrate the skin. My favorite is TNS Eye Repair from Skin Medica.

 

When to see a doctor:

·         If allergy symptoms are not relieved by an over the counter antihistamine after a few weeks, a trip to the allergist is in order.

·         If simple measures do not result in improvement, consult with a dermatologist to see if injection of Restylane into the under eye crease or “tear trough” would be helpful

·         If the under eye bags are very prominent , eyelid surgery done by a board certified plastic surgeon or opthalmoplastic surgeon may be the best option

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Posted in Beauty treatments, cosmetic surgery, dermal fillers, Home Treatments | 12 Comments »

New Way to Diagnose Melanoma

October 5th, 2011

dermatoscope1

Dermatologists may soon have a new tool to aid in the diagnosis of melanoma. MelaFind, a noninvasive computer-vision system, aids doctors in the diagnosis of pigmented lesions, helping to distinguish melanoma from benign lesions. The device is a computer on a rolling rack with an attached camera. The camera, which is placed on the skin lesion, takes images at various depths. The images are compared with images in the database to help confirm or disprove the likelihood of melanoma diagnosis. The diagnosis then needs to be confirmed by biopsy. In the company sponsored clinical trial, the Melafind was accurate 98.3% in diagnosing melanoma lesions vs.  dermatologists’ diagnoses, which were accurate 80% of the time. (The 80% accuracy in melanoma diagnosis by dermatologists is lower than other studies. One must keep in mind that this was an industry sponsored clinical trial)

The device has not yet passed all the hurdles of FDA approval. The next hurdle will be gaining approval from Medicare and other insurance plans to cover the test. Currently, there is a more cost effective diagnostic tool, the dermatoscope.This is a non-invasive handheld magnifying device that is placed on the surface of the patient’s skin, allowing the dermatologists to identify morphological structures at or below the skin surface that re not visible to the naked eye. There are specific dermoscopy patterns associated with melanoma which can help the dermatologist determine if a biopsy is necessary.  The “gold standard” for diagnosis is still a skin biopsy. The dermatoscope or Melafind can help the dermatologist analyze smaller, suspicious lesions and perhaps avoid doing unnecessary biopsies. Studies have shown that dermatologists who are experienced in the use of a dermatoscope can be 90% accurate or better in the clinical diagnosis of melanoma.

The most important partner in diagnosis is the patient. Those who are at high risk for developing melanoma are: individuals who have used tanning parlors, those with a family history of melanoma and individuals with fair skin who have had a history of severe sunburns. A yearly skin exam is important for patients at high risk. The yearly exam should be coupled with regular self-exams of the skin. If you fall into one of the high risk categories, you should schedule a skin exam with your dermatologist now. And, begin to do self-exams regularly by using the tools on the Skin Cancer Foundation website: http://www.skincancer.org/Self-Examination/ Pigmented or brown/black lesions on the skin which have grown, changed or appear different than other moles should have an evaluation by a dermatologist. And don’t forget about prevention. Apply your sunscreen…SPR 30or better.   

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What’s In A Scar?

July 23rd, 2011

Well know actress Tina Fey has a facial scar

Every day patients ask me if I can improve scars. Here’s what you need to know. There are several types of scars, indented scars and raised scars or keloids. Many skin imperfections that patients call scars are actually red or brown color change in the skin that will usually resolve.

 Individuals with darker skin types can develop dark spots after acne, skin rashes or any injury to the skin. The medical term for this change is post inflammatory hyperpigmentation. It is the way dark skin responds to injury. The good news is that it is not scarring, rather, it is a temporary change and can be easily improved. The most common treatment for pigmentation is a prescription fading cream, hydroquinone 4%. For best results, it is combined with an exfoliating agent such as tretinoin (prescription strength vitamin A cream) which enhances penetration.

 Another color change of the skin is redness.  This change can occur after acne as well as in surgical scars.  Typically red scars will fade within 6 months. If they don’t fade as expected, one or two treatments with a pulsed dye laser can significantly eradicate redness.

Acne scars or chicken pox scars are usually indented. They may look like someone poked holes in the skin. Fortunately, the newer lasers for skin smoothing; Fraxel or Fractionated CO2, can improve this type of scar by 50-75%. Fraxel laser may require a series of 4-5 treatments with a short healing time of 2-3 days. Fractionated CO2 takes a week to heal but can achieve results in 1 or 2 sessions.

Keloid scars are raised, thickened scars. Keloids can occur after ear piercing, surgery, severe acne or burns. Treatment with injections of cortisone into the lesion can soften and often flatten this type of scar. Laser treatment using the pulsed dye laser may also be used to flatten the scars and to reduce redness. Scar dressings or gels containing silicone such as Ketocote scar gel may also aid in flattening scars. How these gels or dressings work is a bit of a mystery but they do work for some patients. When keloids are resistant to these treatments, surgical excision, combined with cortisone injection is an option. For large or resistant keloids, low dose radiation therapy may be used after surgery to prevent recurrence.

The good news is there are successful treatments for all types of scars. Most scars will be significantly improved and some can be made almost invisible.  

 

 

 

 

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Liposuction: Are the results temporary?

May 5th, 2011
post liposuction

post liposuction

transparentbgA recent health article in the New York Times reviewed a scientific, controlled study on liposuction. One group of non-obese women were randomly assigned to have liposutransparentbg1ction on either their protuberant thighs or stomach. A control group was not treated but given the option of treatment when the study was over. The result after one year, was that all the fat returned, not in the same place, but in the upper abdomen, shoulders or arms.  To read more click here:

I performed liposuction for many years and observed that outcome -return of fat in another location – in some of the patients I treated. Many did not return for a 1 year follow-up so statistics were hard to track. It is important that this study was done. Surgeons who perform liposuction need to counsel patients  that the fat can recur in a new location. Based on this new information, exercise may work better than liposuction for localized fat deposits.

There has been recent good news for those who are obese and unable to lose weight. Recent obesity research has focused on the metabolic changes that occur in patients who are overweight by 40 pounds or more. The cause of weight loss resistance is understood to be a condition called insulin resistance or prediabetes. Many obese patients produce too much insulin causing the body to deposit more fat. Treatment with a combination of oral diabetes drugs: Actos and Metformin, will reduce insulin production, resulting in weight loss and prevention of diabetes. Patients who change to a low carb diet and increase their exercise, in addition to the medication can successfully lose weight and keep it off.
Conclusion – there is no shortcut to healthy habits when it comes to losing weight but medication may help for the severely obese but liposuction is not a long term fix.

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Posted in cosmetic surgery | 3 Comments »

Update on the safety of Brazillian blowout hair treatment

March 16th, 2011


I recently wrote about the medical risks of the Brazillian Blowout hair straightening treatment.  The Oregon environemental safety department had found high levels of formaldehyde in in tests of the product. Click here to learn more: Cosmetic industry review critiques Brazilian blowouts’ safety. Based on this information, I recommend living with curly hair.

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