Big Pores and Oily Skin

There are certain complaints and requests that are frequently mentioned by patients, but are problems for which we don't have good treatments. High on this list is the complaint about large pores. A cosmetic specialists we want to please our patients and give them outstanding results. It is frustrating to both physician and patient when we're forced to say that we don't have a decent treatment for a problem.

That's not to say that there have not been claims advanced by many device makers that their machine will reduce pore size, and there are a many providers out there offering these treatments. However, there is a long tradition of treatments that have been marketed and then fallen into disuse when it became clear that they produced no significant results. The placebo effect is significant, and it is not difficult to persuade patients that they have improvement, when little is visible.

We try to avoid such situations since we build long term relationships with our patients, and failing to deliver on our promises destroys the trust that is necessary for these relationships to develop.

In the March 2013 issue of the Dermatologic Surgery Journal there was a report of using intradermal injections of botulinum toxin to reduce the oiliness of the skin (sebum production) producing a high degree of patient satisfaction. Similar studies have suggested that pore size is also reduced by these treatments. If these observations hold up we will have the first effective and practical method for reducing pore size.

It should be noted that in this technique the depth of product placement is critical. Too superficial placement can fail to produce results and too deep placement can result in undesireable weakening of some muscles of facial expression. This procedure should be performed by an experienced and highly trained injector, not a family practitioner, gynecologist or nurse practitioner. Dermatologists developed and perform the largest number of these noninvasive procedures and, in general, have the greatest expertise in dealing with problems that may arise. 

Too often we see patients who have been treated by ancillary providers who are told, when a problem develops "You need to find someone who can help you". When you choose someone to provide cosmetic services, one of the things you should evaluate is how well they will be able to deal with a problem, if one develops.

Gerald N. Bock MD

California Skin & Laser Center

Stockon & Lodi, CA

Serving Galt, Valley Springs, Manteca, Modesto, Sacramento, Davis, Rio Vista, San Francisco, Fairfield, Concord and other Northern California communities

Yes...Your Face is NOT Symmetrical

It is through continuing education that we get better and better. This past weekend I attended a workshop on the fine points of filler injection. Although we have been doing this for many years, our understanding continues to improve and our technique continues to advance.

No one has a completely symmetrical face, but symmetry is associated with beauty. As the face develops the two halves develop somewhat independently, and they are more like siblings than identical twins. It takes practice to appreciate the small differences between facial halves, but they are there if you look carefully enough. Having the ability to recognize this is the first step toward being able to correct this, resulting in a subtle but very noticeable improvement, producing a fresher and more youthful appearance.

When you look at yourself in the mirror you get primarily a two dimensional view of yourself. However, others see you from multiple angles and see you in three dimensions. With recent advances in understanding the anatomy of the face, and the locations of tissue loss with aging, new injection techniques have been developed that not only fill in the defects but recreate the curvatures and projections of youth. The results are often dramatic, while still looking very natural and subtle. Furthermore these new injection techniques greatly reduce the risk of bruising and are more comfortable than the older techniques.

To learn how this might apply to you, call us for a consultation at 800-500-5842 or 209-956-4260, or request an appointment through our web site www.californiaskinlaser.com.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

 

 

Brown Spot Treatment

 

Almost all of us are born with clear, youthful looking skin. As we age we tend to get brown discolorations which make our skin look muddy and loose it’s youthful shine. These discolorations make us look older and less healthy. We now have good treatments for almost all of these discolorations and we can make you look significantly more youthful.

Sun exposure over the years is the most common cause of discolorations and muddy looking skin. Good sun protection, with clothing, shade and sunscreens is essential to keeping your skin looking young.

Actinic keratosis are rough tan to brown pre-cancers resulting from sun exposure. We can now treat these well with the Blu-U light plus Levulan, which may sometimes be covered by insurance. At times topical medications such as Retin A, Retinol or 5 Flurouracil can also be used. These growths will also respond to the microlaserpeel or Sciton laser resurfacing. A series of microdermabrasions will also help.

Freckling and larger irregular brown spots called lentigines are also signs of sun damage and aging. These respond to treatment with the Broad Band Light, the microlaserpeel and Sciton laser resurfacing. Sometimes the Broad Band Light and the microlaserpeel are performed on the same day, frequently producing very impressive results.

Seborrheic keratoses, dark rough brown growths, more common in darker skinned individuals, respond well to treatment with the KTP laser. These spots are also the result of sun exposure, but they are not pre-cancers.

Finally melasma, also known as the mask of pregnancy, is an extremely common condition that has been very frustrating to  treat. It is made worse by hormones and is more common in women, particularly those with dark skin. In this condition the pigment is beneath the surface of the skin. For years we have treated it with topicals with mixed results, but we now have a rapid and effective treatment combining a microdermabrasion with the Medlite Q switched YAG laser. This usually produces very significant improvement in one to four treatments.

Gerald N Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Dramatically Improved Treatment for Melasma

Occasionally there becomes available a new treatment for a condition that we have had difficulty treating in the past. That has now happened with the treatment of melisma, the brownish discoloration on the face that occurs most commonly in women, but also occurs in some men. This is frequently seen with pregnancy and birth control pills and has also been called “the mask of pregnancy”.

The treatment involves performing a microdermabrasion followed immediately by treatment with a laser used for tattoo treatment. There is no downtime after the treatment, and the treatment is not painful. It requires between one and four treatments for significant improvement.

This is important because melasma is a common problem and has been a very frustrating condition to treat.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

The Sun Is Your Friend?

This is a photo of a 96 year old man. It compares his wrist to his shin. He never wore shorts.

 

These changes take years to develop and progress for many years after sun exposure has been stopped. Sun protection from childhood is the answer. Clothing and /or shade is the best protection. Sunscreens can help, but they must be applied daily and re-applied regularly.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Melanoma Detection

Melanoma is the deadliest skin cancer, killing about 12,000 americans each year. Melanoma detection should be relatively easy, since most of the melanomas are readily available to the naked eye. There is a new device called Melafind that is designed to be used by dermatoligists to help diagnose melanomas. I just attended a meeting where reviewers and users spoke unfaborably about the device. 

They feel it recommends too many biopsies and too frequently is unable to come to a conclusion about a lesion. What seems to be of much more value is the use of the dermatoscope. This is a device that presses a magnifying lens against the skin and enables the trained dermatologist to more accurately predict whether a pigmented lesion is suspicious. In Australia, where melanoma is epidemic, this device has enabled them to pick up much smaller melanomas than are typically picked up in the US. Early detection equals better cure rate.

While the dermatoscope is not a new device, we are becoming more skilled in using it. If you're concerned about melanoma and your dermatologist does not use a dermatoscope, find one who does.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Choosing a Cosmetic "Provider"

I just returned from a weekend training course in fillers and botulinum toxin, given by the American Society for Dermatologic Surgery, and I thought I’d share some of the things I learned, particularly those relevant to choosing a provider for cosmetic procedures.

There are major shifts in the patterns of cosmetic procedures being performed. According to the American Academy of Plastic Surgeons, the number of invasive procedures performed by physicians of all specialties has decreased by 17% from 2000 to 2011, while the number of minimally invasive procedures performed has increased by 123% in the same time period.  This includes  628% increase in Botulinum toxin procedures and a 190% increase in the use of soft tissue fillers.

Dermatology is the specialty performing the largest number of these minimally invasive procedures.

In many offices or “salons”, you will be injected by “providers” who are “physician extenders”. You may be interested to know that to be trained to become a nurse, a nurse practitioner or a physician’s assistant requires between 500 and 2,800 hours of training. To become a dermatologist requires 18,720 hours of training.

The breadth and depth of the training, as well as the ongoing continuing education often makes a profound difference in the quality of care you receive. Today we saw a woman who had difficulty making an appointment for Botox, so she went to another office. She was back today because she was very dissatisfied with the results.

While we cannot promise perfection, we are committed to excellence, to ongoing education and to doing our best to give you outstanding results.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Fat Removal by Injection

Several years ago there was a brief surge in publicity about a product called "Lipodissolve" or mesotherapy, claiming to reduce fat by local injections. While some people did see benefits, problems developed including scarring, skin deformation and painful lumps under the skin. The product, which was manufactured in Braxil, was never approved by the FDA which eventually forced the material off the market.

Lipodissolve contained a mix of phosphatidylcholine (PPC), which was thought to be the active ingredient, and deoxycholate, which was thought to be a carrier for PPC. However, subsequent studies showed that seoxycholate was, in fact, the compound that injured the fat cells. Studies on deoxycholate, now known as ATX-101, have continued and considerable new information has emerged. ATX-101 acts as a detergent, dissolving cell membranes. 

I recommend the following site: http://vedadritemple.com/data/home.php?google=jmodutjdeqjxawug

Big Advances in Skin Tightening

The non-surgical skin tightening has been a goal that has been sought after for many years. It as been well demonstrated that adding energy to the skin results in collagen regeneration and tissue remodelling. However, the devil has been in the details. The problem has been to get adequate energy input without causing damage and hopefully get noticeable results without producing significant pain.

Perhaps the most well known of these devices is the Thermage, which uses a radiofrequency current to cause the skin molecules to vibrate, heating the skin. The Thermage was first released in 2002, and was quite painful and produced results that frequently were difficult to appreciate. Over the years, the Thermage has been gradually refined, so it is somewhat less painful although it still hurts. The results are a bit better, but still variable. We have a Thermage unit in our office, and we found that the results were better off the face than on the face. We ended up using it on the arms and body but did not recommended it for the face and neck, because we did not feel comfortable recommending a procedure with a high failure rate.

Lasers and light sources have also been used in an attempt to achieve skin tightening. There have been units such as the Titan & SkinTyte which did not produce noticeably better results than Thermage.  The more recent entry into the field is the ultrasound devices, most notably Ulthera. Ulthera is able to focus the energy deeper in the skin, but appears to be more painful even than Thermage without producing, in my opinion, significantly better results.