Treatments of Common Skin Conditions
There are over 1,200 disorders of the skin — more than for any other body organ. As we age, the change of acquiring one or more of these disorders rises exponentially. Because a discussion of each of these conditions is well beyond the scope of this book, we will limit our discussion to treatments of common skin conditions. These include acne, wrinkled skin, tattoo removal, and hair restoration and removal.
Acne is the most common skin condition, affecting more than 60 million American. Yet, according to The American Dermatologist Association, Only 11 percent seek medical treatment.
Essentially, acne is related to hormonal changes resulting in an increase in activity of the oil glands of the skin. Of its many causes, diet plays a big role in the development of acne.
Basically, the consumption of simple sugars and dairy products produces a spike in insulin. The insulin spike results in an increase in what’s called insulin growth factor. Which has a stimulatory effect on the sebaceous glands. Because the hair follicle opening of the skin is not large enough for the oil to drain out, an inflammatory lesion develops.
The traditional dermatology approach to treating acne is the use of prescription creams with or without oral antibiotics. The problem with this approach is that even though it works, it will take at least three months to really see the results.
If the acne is resistant to this approach, or the patient has a really bad case of cystic acne, then a more aggressive medication such as Accutane is prescribed. The effects of treatment can usually be seen in about 20 weeks.
Laser Treatment of Acne
Recently, Nd: YAG lasers have been used to treat both cystic acne and acne scarring. At lower levels, these type of laser treatments are used to stimulate the cells in the skin by heating the water molecules in the treatment area. At higher intensities, the laser is used to destroy the target tissue such as acne scars. Because of the lack of side effects and how well the treatment is tolerated, cosmetic dermatologists are beginning to integrate laser treatment with dietary changes, nutritional supplementation, topical medications, and the application of the topical herbal elements such as green tea to effectively treat acne.
Wrinkles, Crows Feet, and Sagging skin
As we age, our skin is prone to developing wrinkles. As time goes on, our skin begins to lose some of its elasticity, which leads to the formation of wrinkles. In addition, the underlying structures that support the skin begin to break down, further adding to the number of wrinkles on your skin.
Some of the reasons for the developing of wrinkles include environmental factors such as exposure to sun and winds, stress, unhealthy dietary habits, smoking, or any combination of these factors. Another factor leading to the development of wrinkles is habitual facial expressions, which are especially noticeable along the smile and frown lines.
Maintaining good skin health is the best way to prevent the development of wrinkles. Practicing good nutritional habits, avoiding excessive sun exposure, and keeping the skin clean and moisturized are the best ways of preventing wrinkles from developing prematurely.
Although wrinkles are an inevitable part of the aging process, they can be diminished and even eliminated with advanced treatment options available from a qualified cosmetic dermatologist. Effective treatment solutions to diminish and remove wrinkles include radio frequency, injectable, and fillers.
Radio frequency uses radio waves to deliver heat energy to the surface and deeper layers of the skin as well as the muscles and tissues beneath the skin. This heat stimulates the production of collagen, which in turn triggers tissue contraction.
Four treatment sessions spread over two months will yield tighter skin around the eyes, neck, and jowls. There are zero side effects, zero discomforts, and no recovery time with radio frequency treatment.
Another effective treatment to minimize, diminish, and remove wrinkles and enhance facial features is the use of cosmetic injectable and fillers.
Generally speaking, injectable provide aesthetic enhancement for a few months before requiring touch up treatments. Some of the more common injectable brands include BOTOX, Dysport, and Myobloc. For any of these treatments, results can be seen in five to seven days. They are most effective for the muscles between the eyebrows, crow’s feet, and can be used to elevate the eyebrows.
One of the newer techniques is a patented procedure called the Beverly Hills Micro Droplet Lift. The technique uses tiny drops of BOTOX injected into several locations along the frame of the eyebrows. The benefit is that fewer units of BOTOX are required and the “frozen look” commonly seen with BOTOX treatment is all but eliminated.
Unlike BOTOX, which causes a relaxation effect in the muscles beneath the skin. Dermal fillers are used to fill in wrinkles and crease lines. There are several different types of fillers used, the most common being molecular hyaluronic acid. Hyaluronic acid is a natural constituent of skin and is injected either into the dermis or as deep as just above the underlying bone. Some of the common brands of fillers include Juvederm®, Restylane Silk®, Belotero®, Voluma® and Restylane Lyft®.
In addition to filling in wrinkles, we can also use dermal fillers to add volume to thin lips, cheeks, chins, jaw-lines, and temples. Depending on the filler you’re using, you can see the results in as little as 30 minutes and last in the range from one to two years. The use of dermal filler after menopause is less effective due to the lack of estrogen in the body.
Side effects of dermal fillers are rare in general but can include redness and swelling at the injection site. In addition, tiny bump many appear beneath the skin, which tends to dissipate over time.
One important note to remember is that dermal fillers that are synthetic in origin — i.e. made in a laboratory — may produce disfigurement if used incorrectly.
Traditional Tattoo Removal
A tattoo is a form of skin decoration created by injecting ink into the second layer of skin called the dermis. Tattooing is practiced worldwide as part of cultural or religious rituals and as a popular form of self-expression.
In the United States, nearly 30% of the population has at least one tattoo. Although a tattoo is designed to last a lifetime, as many as 25% of those individuals with a tattoo say they would like the tattoo removed. Reasons given for having a tattoo removed include allergic reactions, regrets about the decision, obtaining new employment, or replacing one tattoo with another.
The good news is that a tattoo is no longer considered to be permanent. A cosmetic dermatologist can safely and effectively use advanced laser technology to successfully remove tattoos with very little side effects.
Laser Tattoo Removal
Although traditional methods of tattoo removal are still practiced, the use of laser technology has produced far better results without leaving scars or patches of non-pigmented areas of skin.
During a laser tattoo removal treatment, the laser’s high-energy light beam is aimed at the color pigments in the tattoo. These short pulses of light energy reach the deeper layers of the skin and break up the tattoo ink into tiny particles, which are then gradually absorbed by the body.
When considering laser tattoo removal, the type of laser technology being used will determine the overall effectiveness of the treatment. The latest Picosecond lasers tend to have better results over the Q-switched lasers for removing ink from the skin.
Unlike the traditional Q-switched lasers, which break ink pigment into a pebble-like granule. The Picosecond lasers shatter the ink into tiny dust-like particles, which are more easily eliminated by the body. This results in greater ink removal from the skin in fewer treatments.
There are several factors determine the number of treatment sessions to remove a tattoo. These include the depth of the tattoo, the number of inks used, the color of the ink, and the age and size of the tattoo.
Traditional laser treatment can take as many as 12 to 20 sessions spread over two to three years. With picosecond lasers, the number of sessions is significantly reduced to six to eight months.
While laser tattoo removal may be slightly uncomfortable, a local anesthetic can be used to mitigate the discomfort. Mild side effects of the red and tender skin may occur following treatment, but these tend to diminish within a week.
Hair restoration — Rogaine
Hair loss affects both men and women. It occurs for a variety of reasons including genetics, iron deficiencies, hypothyroidism (underactive thyroid), stress, hormonal, menopause, and medication induced such as chemotherapy.
As for treatment, Rogaine is the standard for women. Rogaine does work in 85% of women if they use it early enough. That’s a realistic approach.
For men, Rogaine is not all that effective. It works for hair loss in the back of the head and is effective for only one in three men. That’s no big bargain.
Propecia, which is the only FDA approved the internal drug for hair loss. It works for about 58% men and it effective for most of the hair. Propecia does have the potential side effect of erectile dysfunction, which occurs in one in fifty men.
To maintain any new hair growth and prevent new hair from falling out, the use of either Rogaine or Propecia must continue indefinitely.
Hair restoration — LaserCap
Another form of treatment that is showing signs of effectiveness is the regenerative medicine procedure known as PRP (platelet rich plasma). PRP involves taking your blood, spinning it down to isolate the platelets, and then injecting the platelets into the scalp. There is some evidence that the process is effective, but how long the results will last is unknown.
Along these same regenerative treatment methods, autologous stem cell therapy is showing some promising results. In this procedure, hair cells from your own skin are cultured and then injected into your scalp. More research is needed to demonstrate the effectiveness and longevity of the treatment.
A device that is FDA —cleared for women is the Lasercap® LCPRO™. This device is a cap that incorporates low-level laser light to stimulate the hair follicle cells. The device is worn 36 minutes every other day, with noticeable results being observed in 12 weeks.
There is a group of surgical hair loss treatments available. These include hair transplants, flap surgery, scalp reduction, and scalp expansion. Patients with progressive hair loss generally reserve these surgical procedures.
My personal recommendations for hair restoration are as follows:
For Men: Rogaine for limited areas and/or Propecia in conjunction with the LaserCap Pro.
For Women: Once the patient is clear of iron deficiency and thyroid issues. Treatment would include hormone regulation, herbal supplementation, and the LaserCap Pro.
Until recently, the only way to remove unwanted hair was shaving, tweezing, or waxing. While effective for short periods of time. Today a more permanent solution for removing unwanted and embarrassing hair is available. That solution is the laser.
Laser hair removal treatment can be used to reduce hair just about anywhere on the body except around the eyes. The most common treatment areas include the legs, bikini line, back, chest, upper lip, and chin.
Laser hair removal has historically worked best for people with light skin and dark hair. But recent technological advances have made treatment an option for people with darker skin. The effectiveness of treatment is totally dependent on the color of the hair. Essentially, the hair acts as a fiber optic cable that sucks up the energy of the laser. The laser energy is deposited at the base of the hair follicle, which pulverizes the hair and breaks it. Because laser energy cannot be absorbed by light hair, treatment isn’t generally effective for white, gray, red or blond hair.
Introduction of Laser Hair Removal
Depending on the area of the body being treated, treatment is performed at various intervals. This has to do with the hair growth cycles for each area. Typically facial hair removal needs to be done in four-week intervals. For body hair (legs, back, chest, etc.), treatment intervals should be 12 weeks.
There is a trick that makes laser hair removal work better — waxing. If you wax two weeks prior to a laser treatment, you target a higher percentage of the active hairs that are actively growing hairs. This is because when the hairs are plucked out, it takes about two weeks for the hair to regrow. With a higher percentage of growing hairs. Laser treatment not only becomes more effective but also will reduce the number of sessions required.
Woman with polycystic ovary disease, where their hormones are out of balance. So they need to suppress the abnormal hormones for a few months before starting laser hair removal. This can be accomplished by using products with anti-male hormone properties. The traditional drug used is a weak water pill that’s used for blood pressure management called Aldactone or Aldosterone. And both of which have an anti-male hormone effect. Used in conjunction with laser treatment, better hair removal outcomes can be obtained.
Melasma, also known as “the mask of pregnancy,” is commonly seen in pregnant women. The condition presents as irregularly shaped blotches of light to dark-brown pigmentation. These patches have high concentrations of melanin. And These are commonly seen in areas that receive greater amounts of sun exposure such as the upper lip, nose, cheeks, chin, and forehead. Melissa is thought to be caused by ultraviolet light and increased estrogen levels.
The treatment of melanoma is directed towards limited sun exposure, the use of high SPF and UVA blocking sunscreens, the use of topical steroids, skin bleaching, and chemical peels. Side effects of these treatment options include skin irritations such as redness, blistering, dryness and itching.
The use of laser therapy has been shown to be an effective and gentle form of treatment for melasma. Newer laser technology, such as the Aerolase LightPod Neo laser, targets the high concentrations of melanin in the skin. This results in the skin crusting and eventually sloughing off within a few weeks of treatments. It may require one or two treatment sessions which depend on the size of the treated area.
Rosacea is characterized by facial redness, flushing, acne, and the formation of prominent blood vessels in the face. The condition typically affects adults between 25 and 60 years of age.
While rosacea is distinct from acne, the exact cause of the condition is unknown. Rosacea is more common in lighter skinned women, people who have a propensity to become flushed, and are genetically predisposed to the condition. Other factors contributing to the onset of rosacea symptoms include sunlight, heat, alcohol consumption, and spicy food.
Treatment of rosacea includes anti-inflammatory supplements and skin care products. The use of effective sunscreens and sun avoidance are important in controlling symptoms as are avoiding high-anxiety situations, which exacerbates skin flushing. Incorporating topical or oral antibiotic therapy to control the inflammatory process is also often helpful but will have little effect on the underlying blood vessels.
Another effective form of treatment for rosacea is laser therapy. Laser treatment focuses the larger area of redness first followed by the targeting of broken capillaries and larger vessels. The treatment for Rosacea is both gentle and quick, usually requiring one to two visits.
Scars and Stretch Marks
Whether it’s from trauma, surgery, serious acne, weight gain, or pregnancy. Scarring and stretch marks can have a profound impact on person’s physical appearance and quality of life.
Injury to the skin results in a series of events collectively known as wound healing. In an ideal world, the best possible scenario of wound healing would be the complete restoration of the skin’s esthetic, function and structural integrity. Unfortunately, in the majority of cases, the endpoint of wound healing is scar formation.
Several factors determine whether an injury will result in a scar, including the severity and location of the wound, along with the person’s age, gender and ethnicity. There are many different types of scars, including acne scars, keloid (raised, pigmented scars that extend beyond the boundary of the original wound) and hypertrophic scars (similar to keloids, but do not extend beyond the boundary of the original wound).
In contrast, stretching of the skin due to a rapid growth spurt, change in weight, or pregnancy can lead to the development of fine lines in the skin called striae or stretch marks. Initially, these lines are red or purple, and eventually, fade to white or silver. It is estimated that 90% of all pregnant women develop stretch marks either on their breasts and/ or abdomen by the third trimester.
For scarring, to understand the presenting clinical problem is the goal of treatment (i.e. identifying the type of scar being treated) before addressing the aesthetic issues. For stretch marks, the goals of treatment are to make changes in the pigmentation and texture of the stretch marks, while minimizing any potential side effects.
Treatment of Scars and Stretch Marks
Lasers are now being used successfully to improve various types of scars and stretch marks. Lasers can be very effective in restoring the evenness of healing tissue following surgery or trauma and improving the surface texture and uniformity of the skin. They are also effective in reducing redness and diminish or fade hypertrophic scars, acne scars, and stretch marks.
Although no currently available treatment for scarring and stretch marks in 100% effective, outcomes, nonetheless, are very favorable. Studies have demonstrated an improvement in the appearance of acne scars by as much as 50% after a series of four to five treatments performed on a monthly basis. For hypertrophic scars, improvements in the range of 50% – 80% after 2 laser treatments have been reported. Because they are more fibrotic, keloid scars usually require additional laser treatment to achieve desired results. As for stretch marks， 4-6 laser treatments are typical. A series of treatments may be required, it depends on how extensive a body area needs to be treated for stretch marks.
For either scar or stretch mark management, it performs treatment in the office with no down time. Side effects may include redness and swelling for a day or two.
Whether you want to improve the appearance of an existing scar or minimize the appearance of unsightly stretch marks, a cosmetic dermatologist can determine the best way to help you achieve the results you want and improve the quality of your life.
Spider veins (not to be confused with varicose veins) are a group of dilated or stretched blood vessels appear close to the surface of the skin and look like spider webs or tree branches. Red or blue in appearance, spider veins are commonly found on the legs and face and tend to increase in number and visibility with age.
Spider veins are the result of weak or damaged valves in the vein. These valves do not open to allow blood to leave the veins. Consequently, blood backs up causing the veins to swell.
Traditionally, spider veins have been treated with a procedure known as sclerotherapy. Sclerotherapy involves the injection of a chemical into the veins, causing them to seal shut, thereby, erasing them from your skin. It takes every four to six weeks to repeat the treatments.
Laser technology can also treat with Spider veins effectively. The laser directs a high-intensity beam of light to the spider veins. The high energy light creates a heating effect within the veins, which in turn causes the blood within the vein to coagulate or clot. As a result, the vessel slowly and naturally disappears. It typically requires one to three treatments, separated by six to twelve weeks between each treatment session.