Cosmetic Dermatology
What and Why
In recent years Dermatology has become one of medicine’s most rapidly evolving specialties, and the most sought after residency for med students. This surge of interest is partly due to big advances in the science of aesthetic medicine and anti-aging. Baby boomers, who showed signs of being more total-health conscious than the previous, three-martini lunch generation some time ago, have now come of age, or in the colloquial term, of a ‘certain age.’ Concurrently, aesthetic medicine, once mainly the purview of plastic surgeons, has shifted toward the minimally invasive, offering a return to youthful good looks with virtually no medical or cosmetic risk. (And a nice reduction in financial risk as well.) Beginning with the boom created by FDA approval of Botox and long-lasting facial fillers, these developments also include great progress in laser and light-based technology for clarifying, toning and tightening the skin. And body-recontouring liposuction, with the improved tumescent technique, has become much safer and more effective than in years past. It’s true: you can now rejuvenate and reshape your body head to toe and still completely avoid the surgeon’s knife.
The recent Cosmetic Dermatology procedures, used alone or in combination, reverse the signs of aging in a subtle, pleasing way that does not appear unnatural or overdone. As an added bonus, they are comparatively inexpensive and require little to no recovery time. We are not ‘dissing all cosmetic surgery, but before you think about it, do read more about the amazing anti-aging capabilities of procedures like:
Botox (wrinkle smoother)
Titan (laser skin tightening)
Restylane, Juvederm, Sculptra and Radiesse (facial fillers)
Laser Toning (the gym for the skin)
The Triad Medical Facial, The Pedicure Triad and The Fifteen-Minute Facelift (NYDG signature medical/cosmetic treatments)
The anti-aging properties of today’s cosmeceuticals should also be considered and fully taken advantage of, but here you are wise to consult a dermatologist before you buy. Cosmeceuticals are not regulated by the FDA, and unfortunately this means that there is no way to know if a given product can do what it claims it can do, or even contains the ingredients it claims to. Here are excerpts from the Amercian Academy of Dermatology newsletter (1.2007) that addresses this issue. (Reprinted with permission)
If you are looking for a more youthful appearance and feeling overwhelmed by the options, making an appointment with a dermatologist often is the best solution. Here’s why: The U.S. Food and Drug Administration (FDA) does not regulate anti-aging products available without a prescription. This means manufacturers of over-the-counter products do not have to prove claims such as “visibly reduces wrinkles.” Even a product that claims to be a “cosmeceutical” is not reviewed by the FDA. A cosmeceutical is a product that can improve appearance and has the ability to affect the structure and function of the skin. Since the FDA does not regulate these products, there is no guarantee that an over-the-counter anti-aging product will do what it says — or even contains the ingredients on the label. Your best source for information about over-the-counter anti-aging products is a dermatologist, especially one who specializes in cosmetic dermatology. To provide their patients with the best possible care, dermatologists keep up-to-date on cosmetic procedures, prescription anti-aging treatments, as well as many popular over-the-counter anti-aging products. An overwhelming number of anti-aging products are available, and many more are making their way to the marketplace. Will the newest anti-aging cream to hit the drugstore shelves really give you younger-looking skin in 30 days? Do you need to spend $100 on a two-ounce jar to get the results you want? While the advertising may be convincing, the answers truly depend on a host of factors. A dermatologist knows how to evaluate anti-aging products to determine if a product may be suitable for a patient. Effectiveness depends on the active ingredients, the amount of active ingredients in the product, the stability of the active ingredients, what signs of aging concern the patient, and much more. Before recommending a product or procedure, a dermatologist will examine your skin, listen to your concerns, and discuss what products or procedures will be most effective. Keep in mind: Aging is a complex process, and one product or procedure rarely gives the desired results. Combination therapy gives best results. Aging causes changes in the contour, texture, and tone of our skin. Despite advertising claims, the truth is that there is not a single cream or procedure that can tackle all of the changes that occur as skin matures. To address these changes effectively, dermatologists combine treatments. Most skin rejuvenation plans include topical treatment. A procedure — such as microdermabrasion, a chemical peel, or laser resurfacing — may be added to enhance results. Dermatologists give patients realistic expectations. Despite the claims, it is still not possible to get the results of a facelift from a bottle. Dermatologists know what topical products can and cannot do. During a one-on-one consultation, a dermatologist can explain available treatment options and what results can be expected from each. If a cosmetic procedure is recommended, the dermatologist will explain possible side effects, how much downtime a patient can expect, and how long the results typically last. Too much of a good thing can harm the skin. When it comes to skin care products, it is possible to do too much for your skin. In the quest for younger-looking skin, many people try numerous over-the-counter products. Trying various products or using too many skin care products at once can irritate and even damage the skin. If the skin is not given time to heal and more products are used, scarring can occur. Some people develop a skin condition called contact dermatitis, which causes itchy, irritated, and swollen skin. Without early treatment, this condition can be a challenge to treat. When searching for a way to turn back the hands of time, a dermatologist’s expertise can help you solve the mystery of what will work best for you. A dermatologist can tell you which products and procedures will benefit your skin as well as how to use products to get optimal results.
By their 40s, many people find themselves applying a number of skin care products to keep the skin feeling and looking its best. An anti-aging product, such as one that contains an alpha hydroxy acid or a retinoid, often is added to the skin care routine. Moisturizer may be slathered on after every shower and bath. If you are not getting the desired results from your skin care products, be sure to try these dermatologists’ recommendations: Apply Products in This Sequence
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Medication. When using a topical medication, it is essential that you apply the medicine first. Slathering on a moisturizer or sunscreen before the medicine creates a barrier, which can prevent the medication from penetrating the skin and working.
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Moisturizer. For best results, a moisturizer should be applied after bathing and spread on damp skin. Moisturizer forms a protective coating that reduces the amount of water lost through the skin. This, in turn, decreases dryness, itch, and cracking skin. When using a topical medication, be sure to apply the medication first. Then wait one or two minutes before applying the moisturizer so that the medication can penetrate the skin.
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Sunscreen. Wearing sunscreen every day helps prevent premature aging caused by the sun’s harmful ultraviolet (UV) rays. Dermatologists recommend applying a broad-spectrum (offers UVA and UVB protection) sunscreen with a Sun Protection Factor (SPF) of 15 or higher. To give the sunscreen time to work, be sure to apply it 20 minutes before going outdoors. While some makeup and moisturizers contain sunscreen, dermatologists recommend applying a separate sunscreen. The sunscreen found in moisturizers, foundations, and other products tends to have a low SPF, and this sunscreen usually wears off quickly.
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Foundation. Applying a foundation over other topical products allows the products to work effectively and gives the best cosmetic result.
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Powder, blush, and other makeup. Meant solely to improve a person’s appearance, these products look best when applied last.
Try Using Anti-aging Products Before Bed While studies have not been conducted that prove anti-aging products work best when applied before bed, there are reasons to suspect that this may be true:
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The active ingredients in many anti-aging products remain active longer when not exposed to sunlight. Retinoids, which dermatologists recommend for speeding up the cell turnover that diminishes as we age, becomes ineffective when exposed to sunlight. Some antioxidants, which also help diminish signs of aging, do not work as well when exposed to sunlight.
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Retinoids make the skin more sensitive, and applying other skin care products on top of a retinoid can further irritate the skin. To work, retinoids must penetrate the outer layer of skin. Many people develop redness, flaky skin, and itch. These side effects may be exacerbated when another product is applied over the retinoid.
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Active ingredients may work better when not exposed to pollution and makeup. Some anti-aging ingredients are not very stable.
If you are not getting the results you want from your skin care products, be sure to try these recommendations. You may just see a visible difference. References: Draelos ZD. “Cosmetic Conundrums.” Dermatology Times. July 2006. p. 75.
Who and When
If, and when, cosmetic dermatology is appropriate for you is of course an entirely personal decision. You may choose to age without intervention and, if you don’t forget the sunscreen, you’ll still look good to us. Or, if you wish to stick your toe in the water and try some minimal cosmetic procedures, gentle cosmetic peels are a wonderful, non-invasive way to keep the skin fresh and looking young and healthy. The more advanced procedures like Laser treatments for tightening and toning the skin are also in this relatively carefree, needle-free category. Botox and Collagen Replacement of course require injections, though these are typically not painful and have little to no recovery time, and, if you don’t like the result, are temporary. A consultation with the doctor is advisable before initiating any cosmetic-oriented therapies. The doctor can help you fully understand each procedure in detail.
At NYDG, we develop a personalized cosmetic treatment plan for every patient, which may include any of the following options:
Injectables
Botox® Cosmetic. Smoothes wrinkles, lifts sagging
Collagen Replacement Therapy. Restores contour instantly
Advanced medical/cosmetic combination therapies:
The Triad. Laser toning, microdermabrasion and gentle peel medical facial
The Pedicure Triad. Anti-aging care for the skin of the foot
The Fifteen-Minute Facelift. Botox, Facial Filling and Skin Analysis
Laser skin and vein therapies
The Titan™. Laser skin tightening for face and body
Laser Toning. Improves skin elasticity and texture
Blue Light. Safely treats acne
Blue Light with Levulan. Addresses actinic keratoses
GentleWaves®. Photocorrects wrinkles and spots, shrinks pores
Intense Pulse Light. Improves dyspigmentation and tone
XEO Coolglide Laser. Erases broken blood vessels
V-Beam Laser. Treats wrinkles and vascular lesions
VariLite. Treats vascular and pigmented lesions
Laser Hair Removal and Grooming
Topical peels
Glycolic, Lactic, TCA, Beta or Fruit acid peels, for men and women
Microdermabrasion acid-free peeling
Fat removal
Microliposuction. Removes fat deposits, improves face and body shape
Microlipo and Fat Transfer
Anti-Aging/Anti-Stress
Acupuncture. Stress reduction and pain management
Acu-Lume. Anti-aging with acupuncture and laser toning
The Acupuncture Facelift. Twelve-part rejuvenation series
Nutrition counseling
Weight and health dietary counseling
Diet planning, supermarket tours, kitchen makeovers
Q: What kind of training does a ‘cosmetic dermatologist’ have?
A: A cosmetic dermatologist is always a medical dermatologist first, an M.D. with the full schooling and training required of a physician, plus several years of additional specialty training. Dermatology is a specialty dealing with the diagnosis and treatment of medically necessary and cosmetic conditions of the skin, hair, nails, veins, mucous membranes and adjacent tissues. A dermatologist is trained in various surgical, reconstructive, cosmetic and non-surgical methods, which may include laser surgery, cryosurgery, chemical surgery, aspirational surgery and excisional surgery. The purpose of dermatologic surgery is to repair and/or improve the function and cosmetic appearance of skin tissue. The dermatologist also has expertise in the diagnosis and treatment of patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. Dermatologists have extensive training and experience in the diagnosis and treatment of skin cancers, melanomas, moles, and other tumors of the skin, contact dermatitis and other allergic and non-allergic disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy), and infectious diseases. The dermatologist also has expertise in the management of cosmetic disorders of the skin.To be certified as a dermatologist, a physician must have had at least four years of post-graduate residency training accredited by the Accreditation Council for Graduate Medical Education. The first broad-based general clinical year is followed by three years of intensive training in dermatology including dermatopathology and dermatologic surgery. In addition to the successful completion of the four years of required training, the certification process includes a comprehensive examination administered by the American Board of Dermatology. For certain cosmetic/surgical procedures such as liposuction, additional training is required.
