Yes, you can reverse sundamage!
Enjoy the summer sun? Time to undo the damage!
The kids are back to school, life returns to normal as summer draws to an end. As your beautiful tan fades remorse sets in. Maybe you should have slathered on that sunscreen a bit more often. Or perhaps falling asleep on the beach was not such a great idea.
No worries, Captain Dermatology comes to the rescue! Oh, how I wish it were that easy. You cannot unfortunately magically remove the consequences of sun or tanning bed exposure. You can however significantly reduce the damage and possibly even reduce the risk of developing skin cancer in the future.
There are two sides to sundamage. One is cosmetic: wrinkles, freckling, age spots, broken blood vessels, and rough patches. The other side is melanoma, skin cancer and precancers. Depending on genetics, skin type and luck of the draw most people show cosmetic changes before cancer changes, but not always. Once there is significant cosmetic damage I recommend treating the cosmetic AND the potential skin cancers. Good news: science has given us treatments that improve both sides of sundamage. Read the full article »
A Kernel of Truth: Debunking Cosmetic Myths

The Kernel of Truth
I was reading my email this morning and up pops my daily Groupon (a popular discount coupon service that I subscribe to). Today’s offer is too good to be true 92% off spa services, so I look further. Great marketing, “made me look”! And there was an amazing statement, and I quote: “Lying in the sun causes the tiny gold deposits under the skin to heat up and explode, resulting in a million dollar tan”. Ok, nobody actually thinks they have little pieces of metal that ingnite causing their skin to change color….or does somebody take this as a truth? It got me to thinking about all of the myths and misconceptions that float around simply because someone heard someone say something. Lack of education is our problem with perhaps a tad bit of gullibility thrown in.
Here are a few myths that I hear from time to time and a kernel of truth.
- Tans are caused by exploding gold nuggets (actually this is a new one on me)
- MYTH
- Tans are a way for your skin to defend itself against the cancer causing and aging forces of the sun. Pigment (melanin) is stimulated by sun and acts as an umbrella to shield you. Culturally, we have associated tan with health (we used to also think smoking improved health but that is another story). Economically, an industry that delivers artificial yet still damaging sun rays has developed, hence the flowery language that caught my eye. Maybe people are more likely to pay for cancer inducing skin treatments if they imagine gold explosions rather than DNA damaging radiation.
- Bottom line: Stick to the spray tan or better yet, embrace your natural color whatever shade that is.
- MYTH
- Over swollen fish lips can be the only result of fillers in the lips.
- MYTH
- As much as everyone seems to be in love with Angelina Jolie, I must say that women are not in love with those lips. The most common fear expressed in my office and at cocktail parties is “I would never get my lips ‘done’!! I don’t want to look like Angelina Jolie!”
- Bottom line: Fillers are like jello, they make a change by filling space. A little filler restores the lost volume of aging. Yes, our lips get smaller as time goes on starting in the early 30’s. A lot of filler can be added to produce gigantic lips. The resulting lip depends on the skill of the physician or licensed medical professional doing the treatment. Find an established reputable medical provider and be clear on what you want. Then think of all of the areas on the face that could use just a little fill, I think you will be very pleased with what can be done.
- MYTH
- Beware the frozen face of Botox, all expression is lost.
- MYTH
- Not to pick on celebrities, but they can give cosmetic dermatology a bad rap. Nicole Kidman, as beautiful as she is, has from time to time overindulged in Botox , I think.
- Bottom line: Botox (and now its new competitor Dysport) are certainly capable of relaxing anything that moves, but who wants that? Find a capable cosmetic medical provider and their experience and your clear desires result in very pleasant softening of harsh movement related lines with out overdone “frozen face”.
- MYTH
- Sure Latisse grows great eyelashes but it will make my blue eyes brown!
- MYTH
- There is some reality here. Latisse started life as Lumigan, a prescription eye drop that is used for glaucoma. A small percentage of hazel eyed patients did see darkening of the iris. The MYTH part is that to date no reports of eye color change have occurred with Latisse which is not an eye drop but is applied to the lash line with a brush, like invisible liquid eyeliner.
- Bottom line: It seems when used correctly, applied to the lash line, not dropped into the eye, Latisse has not made anyone’s blue eyes brown.
- MYTH
- Sunblock causes cancer, don’t use it.
- MYTH
- Don’t believe it even though it has been all over Twitter lately. Yes there is a study cited (referred to as junk science by real experts from the Skin Cancer Foundation ) indicating an ingredient of some sunscreens is a problem. The ingredient retinyl palmitate is related to Retin A, one of the original anti wrinkle creams with known anti-cancer properties.
- Bottom line: Sunscreen is your best way to reduce skin cancer and aging. Use an SPF of 30 daily and don’t smear massive amounts of retinyl palmitate on your rats.
- MYTH
Live TV, the rest of the story…
If you read my previous blog (Live TV, Instant Gratification July 4, 2010) you may think that you know what happened this morning on KTVK Ch3 since I laid out how it would go. Guess again, it did not go at all the way I laid it out. This blog should be called “Live TV: anybody’s guess”.
I arrived as did my beautiful model Emily. I set up my Juvederm XC, applied a little topical anesthetic to Emily’s nasolabial folds (the groove from nose to corner of the mouth). Just before the numbing cream went on, the camera man got a “before” shot. Actually the robot camera got the shot, there are no cameramen, just weird machines that move all by themselves and suddenly you notice your face is on the monitor.
Kelly, assistant producer, cheerfully glided in and out with bits of info: we were to do a “bump” (ie: teaser shot) in a couple of minutes. This is that great shot where the guest for the next segment is spied upon while preparing. “Just try to look busy” she said. The camera robot loomed in and since Emily had the numbing cream on I just massaged it, trying to look busy. In the small studio, away from the anchor desk, you do not hear what is going over the air. What I realized later was that Tara and Kaylee (anchors) were chatting up the new, less painful Juvederm XC that gives immediate results. It looked like the Juvederm was the cream and that the results would magically appear while I massaged. Just a little confusing for the viewer I suppose.
Bump shot done and Kelly lets me know I have 2 minutes to do the entire treatment and back live with the after!! What?? I thought we were treating live! “No, we can’t . Viewers will complain, they don’t like needles, you know” Kelly explained patiently.
No sweat, but no way am I doing a lightning fast treatment on my gracious model. Two minutes is not enough. I negotiated for 5, barely enough for half a treatment if I hustled. Gratefully, Emily was game. 5 minutes later there we are, Emily with an awesome right side. Tara and Kaylee double teamed me and asked the usual relevant questions. It was a bit awkward to compare the before picture with half of an after but in reality the “half face” comparison was just as compelling. No before was necessary.
Tara’s assessment: it actually works! When can I have some? That is a great interview, when your host is convinced on and off the air.
I felt pretty good about it over all, I ran home to flip on the DVR and there I am, actually it’s mostly the back of my head with too much big hair. The guest never gets the good camera angle.
Live TV, instant gratification
“Live” on TV. Words that send shivers of anxiety through some, generally the one who is going to be “live”. Of course I am excluding the professionals. I am not one of the professionals (not a TV professional/personality I mean). I am a professional doctor and I get to play one on TV, “live”.
will be doing a real treatment on a real patient while I answer questions from our lovely interviewer
and anchor of Good Morning Arizona: Tara Hitchcock.
Friends and patients ask me if I get nervous. No, I love the camera as long as I know what I am talking about. Happily, I know what I am talking about when it comes to the subject of my July 5th, 2010 interview and demonstration of the new Juvederm XC. Juvederm has been FDA approved and widely used in the US since 2006 so this is not a “guinea pig” situation. The new part has to do with the addition of lidocaine, an anesthetic, to the mixture. We will demonstrate that this is a comfortable process, much more so than the original Juvederm. Read the full article »
Neuromodulators make wrinkles disappear, but what are they?
I spent the weekend in a conference room, 10 hours each day, both days. The room was too cold. The subject was not. The subject was one of the hottest topics in cosmetic dermatology: neuromodulators. And I am guessing that you have never even heard of the word.
It’s an awkward term that is born of political correctness. “Botox” has practically become generic for wrinkle removal. (It is so well known that Botox is to neuromodulator as Kleenex is to tissue). We needed a term that could describe the entire group of Botox-like drugs. Yes, indeed there are many Botox-like drugs. Some FDA approved, some soon to be approved. The truth is that Botox is just one of a few, soon to be many options.
What could possibly be better than the magnificent eraser of wrinkles? Dysport (pronounced “dis-port”) for one. Well, maybe not better but certainly right up there. Dysport is the first to follow Botox. It was approved a year ago and now has captured 20% of the neuromodulator market. There is that word again.
Sundamage Meets It’s Match
Brown spots, liver spots, age spots, whatever you call them, they are not usually thought of as a sign of beauty. They are a sure sign of sun damage though, and age of course. Lindsay Lohan started out as a cute freckle face kid. Among other unhealthy habits she seems to like the sun, the result is not so cute. In more recent photos the spots are gone! And it is not just the make up.
How did she do it? More important: how can regular folk get rid of the earliest unattractive signs on sundamage and age?
Well, there is always the bleaching cream. The most popular and most effective available in the US remain hydroquinone. It is actually not a bleach at all, it is a chemical that inhibits the ability of the pigment cell to create pigment. Please note, it only reduces pigment, it does not eliminate it . The problem is that it can take months and results are moderate.
Various methods have been used for centuries, perhaps the first recorded is the lactic acid (milk) baths that Cleopatra took. I imagine that living in Egypt without sunscreen caused some pretty impressive brown spots even on the legendary beauty (the Amazon’s version of Lindsay).
Freezing or burning brown spots is still commonly done and in some situations, is still a good approach if you only have one or two spots.
When the spots are all more numerous chemical peels including lactic acid, glycolic acid , and various other acids have been and still are used.. The light peels are great for maintaining but not great for producing improvement. Deep peels are just too toxic and are rarely done in the US for simple age spots. The medium peels (not too strong, not too weak) have been replaced for the most part with the laser.
Lasers have been around for decades (5 to be exact) but it has been the last 15 years that the cosmetic use has skyrocketed. The newest addition to the arsenal against age is the FRAXEL DUAL.
Fraxel is the gold standard in what is called “non-ablative skin resurfacing”. Essentially, it removes sundamage and stimulates collagen to combat scars and wrinkles. Down time is in days, not weeks and results occur gradually over several treatments.
FRAXEL DUAL combines the gold standard Fraxel (deep) laser with a second laser (superficial). The great advantage of the superficial laser is that the brown spots lie very close to the surface. The more laser energy that is placed in the upper layers of skin, the better the result on the brown spots. We still like the deep laser because we can get a nice improvement in scars and wrinkles. The DUAL combines both and allows the physician to use all deep laser, all superficial laser or a combination of both for optimum results tailored to the patient.
So, back to brown spot/age spot removal for the regular folk: there is something for everyone. Consult with an experience cosmetic physician to see what is best for you. For a qualified board certified dermatologist go to ASDS.net.
More Medicine in the Philippines
Picking up from the last post (clinic day 5 at Payatas, Manila, Philippines) We finished our philippino clinic experience and it was a marathon! We treated over 2100 patients and provided them with free medications! Overall the clinic experience on the last day was just like the ones before. One or two big rooms with 4-6 small tables in each. One med student per table with a translator. Two physicians circulating to answer questions and double check things like, “I think this guy has a murmur” and “does this look like scabies to you” or “what is the proper dose of amoxicillin for a 3 year old with an ear infection?” After we interview and examine the patient we decide what we can do for them and if the need to see someone at a local hospital. At the end of clinic we headed back to Taal(location of the volcano) on a 2 hr jeepney ride.
Med Student Escapades: giving back
Guest blogger Geoff’s story has moved so many that I will be posting more of his journey through southeast Asia. This is a contingent of young men and women who consider helping others to be their calling. These are tomorrow’s doctors. I am proud of them! Without further ado, Geoff:

photo by Durian67
WAY too early wake up call
Jeepney (if a jeep and a school bus had a baby covered in Jesus paraphernalia) to the site. Long time, shoddy aircon.
Three sites/neighborhoods so far
Site one: Baseco
Partnered with students from the Filippino medical school in a tiny building we set up clinic taking care of ANY problem that came to us. Our patients were very poor and cannot afford to buy medicine or see a Filipino doctor. We rode a plywood “canoe” through garbage passing many industrial ships to a jetty with shacks. As we walked along the jetty through the community, we passed dirty and crowded “homes” that were perched off of the jetty. We came to a beach which was more garbage than sand and met a man who had sold his kidney for the equilvalat of $1,100. It was very strange to us but not uncommon in this community.
For clinic that day we say almost 200 patients. It was exhausting, interesting, enlightening and hot. We all learned so much about ourselves as future physicians, friends, human beings and sweating Americans. Day two at Baseco we saw about 300 patients, with some interesting cases including heart murmers, CP, fungal infection, impatigo, lots of gross abcesses we got to pop and squeeze.
Day three and four were in Laguna, a community about 1 hour outside of Manila. We spent the first day in a VERY small building, setting up stations in two rooms and the pharmacy in the kitchen. In Lagnuna, there are 200,000 people per 5 hecacres. That’s pretty darn dense! Day one went well. We served 400 patients and it was crazy, hectic and there were many volunteers from the community.
Day two in Laguna (clinic day 4) was intersting and inspirational. We showed up to an empty courtyard in the blistering heat with one small canopy. The community came out and sheltered us with tarps and parasols. There were an incredible number of friendly and enthusiastic children who made us smile and challenged the tall guys to basketball competitions and puppet shows. Overall the experience was quite unique. We have been able to give out antibiotics for infections from our shanty pharmacy in the gambling room. Many of these people do not see a doctor due to cost and we have been able to see and treat many diseases at very advanced stages. Up till now we have seen over 1100 patients. Tomorrow we travel to another part of town to get back to work. For now know that we are all doing well and are excited about our work
Medical School Field Trip

Philippines Clinic by besighyawn
My guest blogger is Geoff Hays, he just completed his first year of medical school at Creighton University Medical School. His summer off: manning free clinics in Manila, Cambodia and Malaysia. Listen in….
“So far the patient count is up to 1500 and we have seen heart murmurs, a child with CP, and a woman with botched cosmetic surgery. Skin stuff is mostly fungal or impetigo, scabies, or chicken pox. We usually give out minocycline, amoxicillin, or Keflex for bacterial stuff, tylenol or mefanamic acid for pain, and hydrocortizone for the rashes. There have been some interesting developmental disorders like polydactaly, and growth stuff with one leg larger than the other. Having two doctors with us has been great and they rush around between the twelve of us answering questions. We usually flag them down when we get lost, give drugs, or find something unusual or strangely abnormal. The communities have been very poor and we usually have nursing students translating for us. The streets are dirty and covered with trash, the street is the bathroom, and people live in shacks on top of each other. The smell is pretty bad too. Everywhere we go people follow us trying to sell something.
We usually have to drive about 2 hours to get to the clinic sites, work for about 6 hours, and then head back to the hotel. We had to pay extra for hotel rooms with AC (money well spent). The clinics are usually empty rooms that used to be daycare centers without and sort of cooling so the heat can get pretty bad. Clinic is loud and people form crowds outside the front door. We set up at little tables with the translators and get to work, usually with 8 of us seeing patients, 2 in the pharmacy, and 2 runners. First clinic was Baseco, the Laguna, then Payatas.
We were told today that the people of Payatas are trash collectors that gather garbage from other towns to gain income. Tomorrow we are traveling to see garbage mountain (photos are not allowed, i guess it could bother the garbage) Apparently last year some of the garbage got loose in some sort of landside and crashed into houses in the community so we are going to try to avoid that.
After tomorrows clinic we will head to the Taal volcano! While there we will visit an island in a lake in a volcano on an island in a lake (or some such nonsense like that)
more to come tomorrow (or probably in a couple days, we dont know if the volcano is wired for internets…)”
Skin Cancer vs Vitamin D

Is the risk worth it?
A lot has been talked about when it comes to skin cancer and its cause. Ninety percent of non-melanoma skin cancer is caused by sun exposure. Oddly enough one way we generate a very important vitamin (vitamin D) is from sun exposure! What to do? Expose skin to sun and risk cancer or become housebound avoiding all light from the sun and risk vitamin d deficiency?
Fact: Vitamin D is very good for you.
Fact: Sun is not. Read the full article »



