| Dr. Ronald M. Shelton, a member of American Academy of Dermatology. Here the Doctor has answered some of the common questions bizymoms visitors have about Cosmetic Dermatology.
Q. What is cosmetic dermatology?
A. It has a goal of improving the appearance of the skin, via improving the texture, coloration, fragility, lack of elasticity, atrophy, depression of contour, and the treatment of lipodysmorphia , or the focal accumulation of fatty deposits via tumescent liposuction.
Q. What are the types of cosmetic dermatology available?
A. Surgical would include hair transplantation, liposuction, laser resurfacing, dermabrasion, subcision, and scar revision. Non-surgical includes the prescription of rejuvenating creams and the performance of peels, laser treatment of unwanted facial redness, lentigines (brown spots) and tattoos, volume replacement with fillers and fat injections, and laser hair removal
Q. What is the difference between Cosmetic Dermatology and surgical dermatology?
A. Any procedure that violates the epidermis and involves an invasive procedure would be considered dermatologic surgery. Cosmetic dermatology includes
the non-invasive recommendations and prescriptions of products for facial rejuvenation, fillers, Botox and lasers for fine lines.
Q. What does hyaluronic acid do to facial skin?
A. Hyaluronic acid is a normal component of our dermis, the infrastructure to the overlying epidermis. The majority of the dermis is water and protein, or collagen. The water is found with mucopolysaccharides, ground substance, or sugar water molecules such as hyaluronic acid. It gives the skin structural support and by plumping it up, it helps lessen the appearance of fine lines. It can be applied to the surface of the skin and acts as a moisturizer in this way.
Q. What is your recommended treatment for facial "spider veins?" Also, what are the common associated side effects of the procedure used?
A. The best way to treat facial blood vessels is with a yellow light laser such as the V-beam laser. The pure wavelength of yellow light, such as 595nm. Penetrates the epidermis without injuring it, and is absorbed by the blood cells in the blood vessels because the hemoglobin molecules are the target for the energy of the laser. Heat is produced by this reaction, and injury to the inner lining of the vessel ensues. The body then ”eats up” the vessel. Increased redness is seen temporarily and even bruise-like coloration can occur immediately, but this can be covered with makeup. The bruising may last for two weeks in rare cases. The normal experience is to have several monthly treatments with little to no bruising at all and thee is no restriction on activities.
Q. What is the main difference in the CosmoDerm and CosmoPlast procedure from other injectible collagen treatments?
CosmoDerm is thinner and used for finer more superficial lines, and Cosmo Plast is a thicker or more cross-linked product designed for deeper folds. Both of these products are derived from a cell lineage of human collagen. It is used very rarely these days and becoming obsolete. No skin test is needed unlike the older forms of collagen such as Zyderm and Zyplast, which came from cow collagen and patients needed a skin test as 3% of the population was found to be allergic to the cow collagen.
Q. What is the difference between ablative and non-ablative laser treatment?
A. Both ablative and non-ablative laser treatment can improve wrinkles, discoloration (dyschromia) and fine lines and acne scars.
Ablative laser resurfacing means that the epidermis is ablated or removed which creates a second degree burn-type of wound. Recovery is longer and there is a risk of scarring. This procedure has significant down time. The patient needs to spend a lot of time in the first several days cleaning the skin and applying thick moisturizers. One should not be out exposed to the elements at this time. By post-operative day 12, most patients are fully healed and can start using make-up.
Non-ablative or minimally ablative laser treatment had involved the V-beam and Smooth beam lasers in the past which enter the dermis without injuring the epidermis and stimulate the collagen to produce more of itself in the dermis, thereby thickening the skin and improving the appearance. These did not produce significant improvement. A major milestone occurred when the old-fashioned aggressive, invasive carbon dioxide laser resurfacing was redesigned to not eliminate all the skin area in its path, but to only ablate a fraction of the skin. It then became known as fractional laser treatment and used a different wavelength, not carbon dioxide, to more gently create tiny laser holes through the epidermis and into the dermis stimulating the body to produce more of its own collagen. The procedure is repeated every several weeks and can improve discoloration, wrinkles and acne scars. There is some degree of minor redness, swelling and flaking that can occur over 4 to 5 days after the nonablative procedure. A fractional carbon dioxide laser, called the Fraxel RE:pair, involves up to 12 days of down time. The Portrait Plasma takes seven days to reepithelialize. There are non laser non ablative light sources such as IPL and Gentle Waves that may improve photodamage.
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