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E X C E R P T S
In addition to helping readers understand the field of cosmetic dermatology, .I would like to help identify trends, treatments and products that make sense. .Thus, we will discuss the rationale for much of what is being utilized in cosmetic dermatology. My own cosmetic dermatology practice draws upon a palette of procedures and skin care products from which I can create an individualized program based on each person's goals, tolerance for downtime, and budget. .A typical patient rejuvenates the outer layers of skin with some or all of the following: intense pulsed light, laser, chemical peels and topical treatments. Wrinkles due to muscle activity (such as frown lines or crow's feet) are treated with botulinum toxins such as Botox. Wrinkles due to loss of subcutaneous tissue are filled with products such as hyaluronic acids (including: Restylane, Hylaform, Captique and others), Sculptra, Radiesse, collagen and/or fat transfer. Many of my patients want minimally invasive procedures and good skincare to forestall the knife. In my practice we employ body contouring with liposuction, fat transfer and lasers to treat pigment problems, spider veins and unwanted hair.
This book will also help readers to understand how the skin functions when it is well and when it is diseased. I will discuss the structure and function of normal skin and then contrast this to skin that is effected by acne, psoriasis, eczema, rosacea, skin cancer and several other common skin problems. Hopefully, this will provide enough information to allow the reader to have an intelligent discussion with a dermatologist regarding their skin issues and to take better care of their skin.
Skincare products occupy a significant portion of time and money. While some products are brought to the public by less than scrupulous means, there are many products available today that are the result of years of research and development, from companies with long histories of skincare research.
Every patient who comes to a cosmetic dermatologist wants to look better. It is my job - both in my office as well as in this book - to provide information about the spectrum of products and procedures.
Perfect skin means never having to cover up. In order to attain skin perfection, your skin must be healthy on the inside as well as on the outside (the zen of skin health). The outer (epidermal) layers should be blemish-free and radiant, the middle layers need to be resilient, and the inner layers must be thick enough to provide support, structure and nutrition for the other two layers. If any part of this triad is deficient, your skin will not be able to look its best or last as long as it should. Since every person does not have perfect skin without some help, cosmetic dermatologists stay busy helping people have healthier and better looking skin. This book will help you navigate a path towards perfect skin by helping you to understand what happens to the skin with aging, learn about common skin problems as well as to gain some insight into treatments designed to help your skin look its best.
The renaissance presently underway in cosmetic dermatology means that this is the best time to begin the quest for perfect skin. Novel techniques, procedures and products can rejuvenate your skin while avoiding the risks and downtime of invasive surgery. The non-invasive procedures are constantly improving and I will review what is presently available and provide a glimpse into the horizon of what is in the near future. In addition to discussing the procedures, information about how the skin functions when it is healthy as well as information about common skin diseases and problems will be presented. A section about common skincare ingredients including some of the "miracle" ingredients will provide information that will help you to select the best products for your particular type of skin and your specific skincare goals. If, after reading this book, you can begin to make educated decisions about what is and is not right for your skin - and know what questions to ask your dermatologist or plastic surgeon - I will have succeeded in my goals for writing it.
Some background about dermatology in general - and cosmetic dermatology in particular - will help you to understand the information contained in this book. Dermatology is the ONLY branch of medicine dedicated to the skin. Dermatologists are physicians who have completed four years of medical school .(if they are medical doctors; there are also osteopathic dermatologists who have not gone to medical school). If they are Board Certified by The American Board of Dermatology, they have completed a year of internal medicine, pediatrics or surgery prior to spending three years studying the skin at a University Hospital where they are supervised by other dermatologists. After this training, they must pass a Board Certification exam. Some dermatologists will spend additional time completing fellowships in dermatopathology (the study of the skin using a microscope), dermatologic surgery or pediatric dermatology. Other practitioners may call themselves skin specialists or even dermatologists without being board certified by the American Board of Dermatology, but they will not have completed this type of training and typically do not have the same qualifications.
Dermatology has undergone a renaissance from the days when it was dominated by acne and warts. Part of the revolution in dermatology was actually brought about by managed care and health care reform. As insurance companies decided that paying for skin cancer surgery in the hospital was not cost effective, these surgeries became office based. This moved them from the province of general surgery and plastic surgery to the specialty of dermatologic surgery. At the same time, managed care prevented referrals to dermatologists for many skin care problems which were being treated by primary care physicians (with varying degrees of success or cost effectiveness). Office based surgery and the ascendance of primary care drove dermatology to evolve from a specialty concerned with writing prescriptions to one that is surgical. Of the procedures that began to interest dermatologists, many were pioneered and developed by dermatologists themselves, including: liposuction; lasers; chemical peels; soft tissue augmentation using collagen, fat and hyaluronic acids; and novel skin cancer treatments.
Skin cancer surgery which was once dominated by plastic surgeons became a procedure routinely performed in the office of dermatologic surgeons. These sweeping changes are borne out by Medicare statistics that clearly show that dermatologists are now responsible for treating most of the skin cancers in the United States.
Cosmetic dermatology incorporated major transforming products and procedures in the past few years, including novel uses for botulinum toxins such Botox® (Allergan), Myobloc (Solstice Neurosciences) and Reloxin (Inamed). Until recently, these proteins were used exclusively for frown lines. Usage has now expanded to include treatment of chin wrinkles, forehead wrinkles, crow's feet, lip wrinkles, neck bands, drooping breast skin, excessive sweat, headaches, and a plethora of other indications. Revolutionary fillers such as Restylane, Restylane Sub Q and Perlane (QMed/Medicis), SculptraTM (Dermik/Aventis), Hylaform®, Captique, Hylaform Plus, Juvederm (Inamed), Isolagen (Isolagen Inc), silicone and Radiesse FN (BioForm) have expanded a universe of fillers once limited to collagen. New lasers, intense pulsed lights, and radiofrequency devices including Thermage and Fraxel have opened up a new world of possibilities for non- invasive skin rejuvenation. Dermatologists and plastic surgeons are only recently beginning to discover the full potential of these devices, products and procedures, and are learning what can be accomplished when they utilize combinations of these products effectively.
"The "injected facelift" is now a foreseeable reality."
Whereas until recently a facelift was the only way to rejuvenate an aging face, novel techniques such as fat transfer, soft tissue fillers, volumizers, lasers, and botulinum toxins are now reversing the signs of aging without surgery. The "injected facelift" is now a foreseeable reality. Suspension sutures are now used to directly re-position the skin upward for a more youthful look. There will always be patients for whom there is no substitute for a facelift but with recent advances, their numbers are dwindling. Even for those patients who require a facelift, lasers, fillers, botulinum toxins, peels and a good skincare regimen will remain critical for optimal results.
In addition to helping readers understand the field of cosmetic dermatology, I would like to help identify trends, treatments and products that make sense. Thus, we will discuss the rationale for much of what is being utilized in cosmetic dermatology. My own cosmetic dermatology practice draws upon a palette of procedures and skin care products from which I can create an individualized program based on each person's goals, tolerance for downtime, and budget. A typical patient rejuvenates the outer layers of skin with some or all of the following: intense pulsed light, laser, chemical peels and topical treatments. Wrinkles due to muscle activity (such as frown lines or crow's feet) are treated with botulinum toxins such as Botox. Wrinkles due to loss of subcutaneous tissue are filled with products such as hyaluronic acids (including: Restylane, Hylaform, Captique and others), Sculptra, Radiesse, collagen and/or fat transfer. Many of my patients want minimally invasive procedures and good skincare to forestall the knife. In my practice we employ body contouring with liposuction, fat transfer and lasers to treat pigment problems, spider veins and unwanted hair.
This book will also help readers to understand how the skin functions when it is well and when it is diseased. I will discuss the structure and function of normal skin and then contrast this to skin that is effected by acne, psoriasis, eczema, rosacea, skin cancer and several other common skin problems. Hopefully, this will provide enough information to allow the reader to have an intelligent discussion with a dermatologist regarding their skin issues and to take better care of their skin.
Skincare products occupy a significant portion of time and money. While some products are brought to the public by less than scrupulous means, there are many products available today that are the result of years of research and development, from companies with long histories of skincare research.
Every patient who comes to a cosmetic dermatologist wants to look better. It is my job - both in my office as well as in this book - to provide information about the spectrum of products and procedures.
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