May 19, 2011

Physician Experience Is Most Important Factor for People Considering Medical Anti-aging Treatments

People who are thinking about undergoing a medical anti-aging treatment within the next two years--including treatments that involve dermal fillers, collagen replacers, and muscle relaxants like Botox and Dysport--cite physician experience and training as the upper-most factor in their mind as they decide whether or not to have a particular treatment, according to a new survey.

Other important factors that go into the decision-making process include the following: how long the treatment lasts, how much it costs, and how the product works. The survey's respondents (383 women aged 35 to 69 years) said they are also swayed by what procedure the physician recommends.

Results from the survey, which was conducted by the American Society for Dermatologic Surgery and Dermik Laboratories (a business of Sanofi-Aventis), were published in the September 2010 issue of the Journal of Clinical and Aesthetic Dermatology.

Source: Weinkle S, Lupo M. Attitudes, awareness, and usage of medical antiaging treatments: results of a patient survey. J Clin Aesthet Dermatol. 2010:3(9):30-33.

November 10, 2010

Ulthera: A New Non-Surgical Option for Tightening Skin

More and more people are opting for minimally invasive skin treatments rather than face-lifts and other full-blown surgical procedures.

As the Wall Street Journal reported earlier this fall, "a widening array of minimally invasive treatments are making facial work more accessible to many people, and becoming part of their regular upkeep."

One of the latest of these popular procedures is Ulthera, which uses ultrasound technology to tighten and lift the skin, particularly the brow. It works by delivering focused amounts of low-level heat into the dermis (the underlying layer of skin tissue), causing the skin to contract and, over time, new collagen to form. And it does this without damaging the epidermis, or the outer layer of skin.

I've been impressed with the device's results. I was involved in its early clinical trials, and was the first physician in the Upper Midwest to offer it to patients when it received the U.S. Food and Drug Administration's approval last fall.

Those trials, by the way, found that 89 percent of patients treated with Ulthera experienced a noticeable lifting, firming and tightening of their skin. Furthermore, the improved appearance was found to last an average of 10 to 12 months.

Although safe (side effects are minimal--mostly some temporary redness and swelling), the Ulthera procedure itself can be discomforting, which is why you want to make sure you receive the treatment by someone trained and experienced in its use. At Zel Skin & Laser Specialists, we have developed a careful treatment protocol to ensure our patients are comfortable with the procedure as well as with its results.

August 4, 2010

Get Your Skin Ready for Summer

Summer means, of course, switching your wardrobe to more skin-exposing clothes, including sleeveless tops, shorts and swimsuits.

It also means spending more time outdoors under the not-so-flattering glare of natural light.

If there ever was a season for wanting your skin to look its best, summer is it. Fortunately, a variety of non-invasive skin rejuvenation procedures are now available at your dermatologist's or cosmetic surgeon's office to give your skin a quick, fresh, healthier new look.

Laser hair removal Having to shave, pluck, or otherwise repeatedly remove unwanted body hair is a common summer complaint among active people. Lasers are the best, long-term way of getting rid of hair on the face, underarms, back, or along the bikini line. Treatment requires several sessions, but you can return to your normal routine immediately.

Laser skin resurfacing Sometimes called a "laser peel," laser skin resurfacing is becoming one of the most popular treatments for minimizing or eliminating wrinkles, skin discolorations, acne scars, large pores, and those tiny, unsightly blood vessels known as "spider veins." Because of its powerful effects, this treatment requires some recovery time. But with many of the newer non-ablative devices (the ones that resurface the skin's top layer, but don't remove it) you can return to most of your regular activities immediately and to your social activities within a few days.

Microdermabrasion This treatment uses various safe and painless methods to "buff" away that top layer of dead cells. It also reduces or removes fine lines and unwanted pigmentations, such as "age" spots. Side effects (usually just some redness and puffiness) are minimal, and usually disappear within a few hours.

Chemical peels These popular treatments remove the skin's top layer of dead (and dull-looking) cells, revealing a smoother, more youthful layer of skin below. Peels can also help lessen the appearance of "age" spots, fine lines, and other imperfections. Alphahydroxy (AHA) and other lighter peels require no downtime (although you will need to protect your skin from direct sunlight for a few days).

Dermal fillers and injectables A relatively quick and easy way to erase many fine lines, wrinkles, and folds is with dermal fillers (such as Juvederm and Restylane) and injectables (Botox and Dysport). Both can help give skin a smoother (and less stressed-out-looking) surface with essentially no downtime.

Non-invasive body contouring Several new, non-invasive treatments--such as Thermage, Velashape, SmartLipo, and SmoothShapes--can help reduce those stubborn fat deposits that no amount of dieting or exercising seems to budge. These treatments use different energy sources (usually radiofrequency, laser light, or some combination) to melt away fat and tighten and re-contour the skin. Some also lesson the appearance of cellulite. Downtime varies from procedure to procedure, but seldom involves more than a few days.

No matter what treatment you choose to prepare your skin for the season ahead, be sure to seek care from a doctor experienced in treating the skin with state-of-the-art technologies. Your skin is too important--and visible--to put into the care of just anybody. Make your consultation appointment today. With a fresh, rejuvenated look, you'll be able to enjoy the long, warm, glorious days of summer even more.

June 18, 2010

Zeltiq Can Be a Great Fat-Reduction Option

It's been almost a year now since I became the first physician in the United States to use the Zeltiq Coolsculpting system outside of clinical trials to reduce unwanted pockets of body fat. (I had previously participated in the device's clinical trials.)

I remain impressed with this non-invasive technology.

Developed by a respected team of Harvard Medical School dermatologists, Zeltiq cools fat cells in a controlled way, a process that then causes them to break down. Gradually, the cells are eliminated from the body through natural processes.

The typical treatment takes about an hour, and requires no anesthesia. Nor is there any recovery time. Side effects are minimal, and mostly involve some skin redness and minor bruising (from the suction device used during the procedure).

Of course, not everyone is the right candidate for this kind of fat reduction treatment. Zeltiq is for people who are at their ideal weight and toned, but who can't seem to get rid of isolated pockets of fat (such as "love handles"). Because this fat-reduction solution is not for everyone, it's important that you have a thorough evaluation and consultation with your physician before starting treatment. Ask about all your options.

You should also be aware that although the U.S. Food and Drug Administration has approved Zeltiq for other medical uses, the agency has not yet endorsed it as a way of losing fat. The device is used for that purpose in Europe, however. Using Zeltiq "off label" is legal in the United States (I wouldn't be offering it if it wasn't), but doing so requires some wise judgments from the treating physician. Again, seek care from someone who's experienced in using the technology.

One final thing: The similarity between the device's name and my last name is purely coincidental. I have no proprietary interest in the device. Still, given the similarity, I'm glad the device is one that I've found to be effective.

June 9, 2010

Paying Attention to Ink and Skin Color Is Key to Successful Tattoo Removal

When it comes to tattoo removal, not all ink colors can be treated alike. In general, black and dark blue inks tend to be the most responsive to laser removal treatments, while lighter inks--particularly yellow and green tones--are much more challenging to remove.

But skin color also influences how successfully a tattoo can be removed. Tattoos on darker skin types are generally less responsive to treatment.

These factors are why it's so important to receive treatment from a physician who's experienced using different kinds of Q-switched lasers (the high-intensity, ultra-short-pulse lasers that are most effective at removing tattoos). Not all lasers (or even laser wavelengths) work equally well on all ink or skin colors.

For example, some Q-switched lasers don't work at all at removing green or red inks. And not all are effective at removing tattoos from darker-hued skin.

Other factors--such as the type of ink used, the location of the tattoo, and whether or not the ink has "blurred" into the surrounding skin--must also be considered in deciding the treatment protocol for removing a tattoo. So be sure to ask your physician about all your treatment options. You want to make sure that the laser treatment used to remove your tattoo from your skin is the safest and most effective one available.

March 18, 2010

FDA Approves Fractional Laser for the Treatment of Stretch Marks

Earlier this year, the Lux1540 fractional laser became the first such device to receive clearance by the U.S. Food and Drug Administration (FDA) for the treatment of stretch marks.

I use this new non-ablative laser in my practice, and have found that it's effective in improving the appearance of stretch marks. Clinical studies conducted by the device's manufacturer (Palomar Medical Technologies, Inc.) have shown that people treated with the Lux1540 experience a 51 percent to 75 percent improvement in their striae gravidarum (the medical term for stretch marks).

These are good results, for no current treatment can remove these marks entirely from the skin. With this laser, however, the marks can be made to be less visible--and the texture of the skin improved.

Stretch marks are very common, particularly among women. According to some estimates, 90 percent of women develop stretch marks at some point in their life. The red, purple and sometimes white marks can develop almost anywhere on the body, but usually appear on the hips, inner thighs, breasts, buttocks, or stomach.

Despite their nickname, stretch marks are not caused by stretched skin. Instead, they're the result of hormonal changes, particularly changes that occur during puberty, pregnancy, or weight loss or gain.

Even with the Lux1540 laser, reducing the appearance of stretch marks requires a skilled practitioner. This is particularly true for people with darker-hued skin. Make sure you receive treatment from someone who is experienced in using this device.

January 15, 2010

Survey of twins reveals factors that affect how skin ages

An interesting new study involving twins has found that three factors appear to play key roles in the sun damage and photoaging of skin: smoking, not using sunscreen, and being overweight.

Twin studies are particularly helpful for those of us who study the causes and treatments of sun-damaged skin, because they enable us to separate genetic from environmental factors. Given current knowledge, we believe that about 40 percent of skin's "aging" can be attributed to non-genetic factors.

Data for this study, which was published in the December issue of the Archives of Dermatology, was collected from 65 pairs of twins (some identical, some fraternal) who attended the 2002 annual Twins Day Festival in Twinsburg, Ohio. The twins filled out detailed questionnaires about various lifestyle factors and also submitted to an evaluation of their skin by a clinician.

The fact that the study linked photoaging (defined as coarse wrinkles, dilated facial blood vessels, and pigment changes such as brown spots) with smoking and not using sunscreen doesn't come as a surprise. We've known for a long time that people who smoke and/or who ignore warnings to protect their skin from the sun have skin that ages much faster than their peers.

The link between being overweight and photodamaged skin was a bit more unexpected, although, as the study's authors note, animal studies have suggested that the consumption of high fat foods may make skin more susceptible to damage from the sun's ultraviolet rays.

After overweight twins reached the age of 54, however, they were less likely to have a high photoaging score. The study's authors suggest that this outcome may be because excess fat masks the appearance of wrinkles in old age.

Interestingly, consuming alcohol was associated with a less photodamage. The study's authors speculated that this may be due to the fact that some alcoholic beverages, such as red wine, contain resveratrol and other polyphenols, which are antioxidants, and thus may help protect the skin from some of the sun's damage.

The take-home message from this study: If you want to keep your skin looking young, don't smoke, wear sunscreen, and maintain a healthy weight.

Of course, that's good health advice for your heart as well as for your skin.

Source: Matieres KJ, Fu P, Polster AM, Cooper KD, Baron ED. Factors that affect skin aging: cohort-based survey on twins. Archives of Dermatology. 2009;145(12):1375-1379.

December 30, 2009

Cancer a Concern for Skin of All Shades

Findings from a recent study illustrate just how important it is for people of all skin colors to be aware of the signs and symptoms of skin cancer.

Although melanoma -- the deadliest form of skin cancer -- is much more common among white populations, the lowest survival rates are often seen among black populations, in part, because of delayed diagnosis.

The study, which was published in the December issue of the Archives of Dermatology, found that at the time their melanoma was diagnosed, 26 percent of black patients had disease that had spread, sometimes to distant parts of their bodies, compared with 12 percent of white patients.

The delayed diagnosis of melanoma is also a growing concern among the white Hispanic population. The melanoma of 18 percent of white Hispanic patients had spread by the time the cancer was diagnosed.

Bring any change in your skin -- such as a new growth, a sore that doesn't heal, or an old growth (like a mole) that alters its shape or appearance -- to the attention of your doctor. If diagnosed and treated early, skin cancer has a 95 percent survival rate.

The best treatment is prevention, of course. No matter what your skin color, always protect your skin from the sun's damaging rays by wearing protective clothing and a high-quality sunblock.

Source: Hu S, Parmet Y, Allen G, et al. Disparity in melanoma: a trend analysis of melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida. Arch Dermatol. 2009;145[12]:1369-1374. 

December 21, 2009

Laser-Assisted Liposuction

My review article [click to read abstract] of laser-assisted liposuction technology was published in the December 2009 issue of the journal Lasers in Surgery and Medicine.

In the article, my co-author, Dr. Thomas Dressel, and I describe significant recent advances in the use of this minimally invasive technology for removing unwanted fat and re-contouring the body. We also clarify the difference between suction-assisted liposuction, laser-assisted liposuction, and laser lipolysis.

As our review article notes , there's been considerable confusion over the definition of procedures that use lasers for lipolysis and liposuction. If you're considering one of these procedures (or any kind of cosmetic skin procedure), be sure to ask questions of your physician to make sure you fully understand the risks and benefits of all your treatment options.

July 27, 2009


I Joined Twitter

I finally took the leap and joined the Twitter community. You can follow me at

I will regularly update my Twitter with all of the new happenings in my office.

June 9, 2009

I was recently interviewed by the team at The Patient's Guide about fractional resurfacing for treatment of acne scars. Below is an excerpt of that discussion:

"What we have really found the fractional technology to be useful for is acne scarring. Previously we have used dermabrasions and laser peels, Ultrapulse CO2 lasers and erbium lasers, along with fillers and excision to treat acne scars. Now with this fractional technology, using an either coagulative form or ablative form, we can get significant improvements over a series of treatments."

I am a big believer in the efficacy of fractional laser resurfacing for this application.

March 17, 2009

Combination Therapies Are Often Most Effective for Treating Acne

One of the wonderful benefits of attending a medical conference, particularly one as prestigious as that held each year by the American Academy of Dermatology, is finding out what other laser researchers are doing.

At the Academy’s meeting earlier this month, Dr. Macrene Alexiades-Armenakas of Yale University reported on her results from a small study that looked at the effectiveness of a particular combination laser therapy for the treatment of moderate to severe acne.

The specific treatment she investigated is known as PDT ALA. It combines photodynamic therapy (PDT) with topical 5-aminolevulnic acid (ALA), which is then activated by a pulsed-dye laser. ALA is a solution that penetrates deep into the skin’s oil glands, sensitizing them to the light of the laser—and, thus, enhancing the effectiveness of the treatment.

Dr. Alexiades-Armenakas treated 14 acne patients with ALA PDT. The treatment sessions numbered from 1 to 6, depending on the severity of each patient’s symptoms. These patients were also given topical acne medications to use on their skin. Another 4 patients were in the “control” group. They received either medications (oral or topical) or a kind of laser treatment different than ALA PDT.

The results: All 14 of the ALA PDT-treated patients experienced a complete clearing up of their acne, but none of the patients in the control group had a complete recovery. Dr. Alexiades-Armenakas also reported that the ALA PDT patients saw some easing of their acne scarring. Side effects—mostly redness—were minor and lasted less than 48 hours.

I’ve always believed in individualizing treatments for my patients, and combination therapies offer great tools for such individualization. For acne, those tools include combinations of phototherapy, laser therapy, microdermabrasion, and chemical peels.

Each year, the technology—and the treatment results—get more impressive, even for the most stubborn cases of acne.

March 10, 2009

New Rosacea Study: Another Reason to Stay Out of the Sun

Some intriguing new research about rosacea emerged from the American Academy of Dermatology’s annual meeting, which I attended earlier this month. [CK]

Dr. Alexa Boer Kimball, who teaches dermatology at Harvard Medical School, reported that if you have a family member with rosacea, your chances of also developing the skin disorder is triple what it is for someone without such a family history.

Equally interesting, however, was Dr. Kimball’s finding regarding sunburns: Of the people in her study with rosacea, 44 percent reported having at least one blistering sunburn during their life. This compares with only 5 percent of people without rosacea.

Rosacea is a chronic skin condition characterized by redness, swelling, bumps or pimples, and enlarged blood vessels. It mainly affects the face, a factor that can make the condition socially embarrassing—and debilitating.

Dr. Kimball stressed that she didn’t yet know, based on her research, if the sunburn was a cause of the rosacea or if people with the condition were using the sun to try and lessen their symptoms. Still, we all need to protect ourselves from the sun. And if you have a family history of rosacea, you may need to be particularly on guard. Minimize your risk of sunburn—and that of your children—by wearing sun-protective clothes and a broad-spectrum sunscreen with an SPF (sun protection factor) of at least 15.

Should the symptoms of rosacea develop, seek the care of a dermatologist as soon as possible. Although there is no cure for rosacea (yet), we can treat the inflammatory condition with medications. Then, once the inflammation is under control, we can further improve your skin’s appearance with cosmetic procedures, such as chemical peels, laser therapy, and phototherapy.

January 29, 2009

Welcome to this Blog

The nature of this Blog is to highlight new non or minimally-invasive energy based therapies for dermatologic applications. Other ramblings and tangent thoughts may also be discussed.

Fractional resurfacing technology: Not all fractions are created equal. It is important to know the histologic injury produced by each device as that will define its therapeutic potential.