Ask Dr. Kerr

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This week's question.

Question: I have some areas of fat on my body that just won’t go away no matter how much I diet and exercise!  Loose skin is also a problem after having several babies.  Can you help?

Answer: In the past, a tummy tuck would be your only solution and still can be a very good solution.  Smartlipo™ is a new innovative body sculpting procedure which uses a laser to melt fat AND tighten the skin.  The best candidates are those who are in relatively good shape but have spot areas that just won’t diminish with diet and exercise. Smartlipo™ is performed under local anesthesia and has been proven to be very safe.  Complications are rare and recovery time is very rapid.  Go to www.realself.com for more information.

Previous Questions & Answers

1.  How effective is BOTOX® Cosmetic?

Results are dramatic and visible within about 48 hours on average.     In clinical trials, nearly 90% of the men and women surveyed expressed satisfaction in the improvement of the treated area.  For many, BOTOX® Cosmetic virtually "erases" lines that become more apparent as we age. Unlike surgery, BOTOX® Cosmetic is fast, simple, and minimally invasive, with no downtime or recovery.  Recommended dosages should be given to achieve the desired result. There were over 3 million treatments administered in 2005 safely and effectively.    Visit with your physician to see if BOTOX® Cosmetic is right for you.

2.  I want to get Laser Hair Removal on my back….is it painful?

The good news…Laser Hair Removal (LHR) is effective.  The bad news… it can be pretty uncomfortable for some patients depending on the area being treated.   Recently, new LHR technology has become available, making this treatment more comfortable.   The Aesthera PPx laser uses a combination of pneumatic energy (pressure) and broadband light.  Clinically proven effective, these light based treatments are 5x more efficient in the delivery of energy to unwanted hair while protecting the skin.  The PPx is 4x faster than traditional lasers making treatments quick and pain free.

3.  What causes wrinkles? 

Our skin’s surface appearance is directly related to the structure underneath.  Collagen provides structure to our skin, while hylauronic acid provides skin volume.  Wrinkles form when the natural collagen and hylauronic acid in our skin diminish with aging.   Other factors in wrinkle formation include exposure to the sun, smoking, disease, heredity and lifestyle. 

Dermal Fillers such as CosmoPlast® and Restylane® are fillers that are injected just below the surface of the skin to replenish collagen and hylauronic acid.  These act to fill lines, wrinkles and scars from the inside out, restoring a smoother, more youthful appearance. 

4.  Are dermal fillers safe?

The most common dermal fillers are FDA approved and have undergone rigorous testing in order to provide a safe product for the public.  Millions of injections are given each year with few side effects.  Common side effects may include: mild swelling, redness and temporary bruising.  Achieving a satisfactory result is highly dependent on the skill, artistic ability, and experience of the physician administering the treatment. Ask your doctor what his experience and training are in this area.  The most common products used today are gradually absorbed by the body over 3-6 months as the skin returns to its original state.

5.  What is Photodynamic Acne Treatment?

Photodynamic Therapy (PDT) is a new procedure that treats resistant, hard-to-treat active acne as well as older acne scars.  During the procedure, a clear, painless solution called Levulan® is applied to the skin, making the targeted acne cells more sensitive to light.  LED Blue Light or IPL Laser light are commonly used to activate the solution.  Prior to (PDT), the best available treatment option for resistant acne was Accutane®, which has many side effects including birth defects, depression and liver abnormalities.  Photodynamic Acne Treatment provides a viable alternative. 

6. I’ve heard Radiesse® is a Wrinkle Filler that lasts longer.  Is that true? 

Radiesse™ is the newest non-surgical facial contouring filler that delivers immediate, longer lasting results. Results can last from one to two years depending on the area being treated.  Radiesse™ is natural feeling.  Most patients express great satisfaction with how natural it looks and feels. Unlike Sculptra™, the area to be treated does not need to be overfilled to get  the desired  results.  It is most commonly used for facial contouring of the cheeks, nasal labial folds, and can be used to fill acne scars. 

7. Are there any long term side effects with Dermal Filler injections? 

Serious complications are very rare, but as with all invasive procedures, undesirable side effects may occur.  While not life threatening, a disappointing aesthetic outcome is a possibility.  Fortunately, because the body eventually absorbs dermal fillers, these results are generally time limited.  The use of fillers is as much an art, as it is medicine. It is important that the physician providing the injections have both a sound understanding of the medical aspect of the treatment, and be skilled in the artistic aspects of the procedure. 

8. What is LED light therapy? 

Light Emitting Diodes (LED) light therapy promotes wound healing and human tissue growth.  Energy delivered by the LED accelerates the repair and replenishment of damaged skin cells, as well as stimulating the production of collagen.  It is a non-invasive treatment, painless, with absolutely no down time.  Light Therapy can be used alone or combined with other treatments such as microdermabrasion or photodynamic therapy (PDT).   Blue Light targets bacteria that cause acne.   Red light promotes collagen production, and smoothes skin texture; improves skin firmness, increases circulation, and   reduces the appearance of aging skin, such as fine lines, wrinkles, & superficial hyperpigmentation.  

9. My hands look weathered.  What can I do to improve their appearance?

We often forget about our hands when thinking about skin rejuvenation.  Sometimes our hands show the most premature aging.  To combat sun spots, sun damage, and brown pigment, a combined approach is often the most effective.  Microdermabrasion, LED light therapy, and chemical peels are inexpensive options but may take longer to achieve the desired result.  IPL pulsed laser light, PhotoDynamic Therapy, and other lasers treatments are more expensive, but require less treatment time.  

 
10. What areas of the face are most commonly treated with wrinkle fillers?   

Most clients don’t want the “overfilled lip look”. Subtle use of fillers may enhance and restore your natural beauty without the “worked on” look. 

 The lip border is often filled to add definition while volume may be added to give a fuller look.  “Smoker lines” around the mouth virtually disappear.   A more youthful look is achieved by filling smile lines around the nose and mouth.  Acne scars may also be filled to achieve a smoother contour.    Combination therapy using both fillers and small amounts of BOTOX®, often enhance and extend the treatment. 

Hyperhidrosis or excessive sweating problems are caused by the nervous system. BOTOX® effectively blocks the impulses sent from the brain to the nerves that cause excessive sweating. 

Deodorants and antiperspirants control sweat by clogging the pores, but are not effective on people with hyperhidrosis. Surgical treatments for hyperhidrosis include cutting out the sweat glands or cutting the nerves that lead to the glands. These surgical treatments can cause permanent scars and nerve damage.

BOTOX® treatments for hyperhidrosis take 10 to 20 minutes.  The treatment begins working within the first week and last for six to twelve months.

12. What’s the difference between an AHA and a BHA chemical peel? 

AHA’s (Alpha Hydroxy Acids) are a glycolic or lactic acid, both of which have been shown to increase collagen in sun-damaged skin and reduce pore size, redness, blotchiness, and fine lines. 

BHA (Beta Hydroxy Acid) is a salicylic acid, often recommended for oily complexions because it is effective in fighting acne.  Its exfoliating properties help loosen blackheads and whiteheads.

We use AHA peels for aging skin and BHA peels for acne prone skin types.  Many skin product lines use these acids as well, with varying potency.  A physican’s line of home care products will have higher concentrations of these effective acids to help with skin maintenance.

13. What is Sculptra™? 

Sculptra™ is a synthetic injectable material that is biocompatible (does not harm the body) and biodegradeable.  Sculptra is injected below the surface of the skin in the area of fat loss and provides a gradual return to skin thickness.  Unlike other “fillers”, Sculptra will stimulate the body to produce new collagen and underlying tissue, creating a fuller, more youthful appearance.  One of the advantages of Sculptra, is that it may used for larger areas that are in need of greater volume.  Unlike other fillers that only last 3-6 months, Sculptra lasts up to two years.

14. My friend had freckles all over her face and neck  and now they’ve disappeared.
      She said she’d had an IPL treatment.  What is that?

Intense Pulse Light (IPL) is often referred to as photo rejuvenation.  Non invasive pulsed light treatments are used to treat freckling, sun damage, age spots, rosacea, small vascular imperfections, and fine lines and wrinkles. 

A broad spectrum of light reaches deep down within the skin, targeting pigment and promoting collagen production.  Most common areas treated are, face, hands, chest, back and arms.
IPL treatments can also be combined with other therapies  like Botox, Injectable Fillers, and other lasers to restore the skin to a more youthful appearance. The number of treatments required depends on the degree of sun damage that exists.  Typically 3-6 tx are performed at monthly intervals.

15. Can BOTOX® treat Migraine Headaches?

In the 1990’s, it was discovered that patients receiving BOTOX® for cosmetic reasons reported less frequent migraine headaches.  Approximately 28 million Americans suffer from Migraine headaches, headaches that can be so severe that sufferers often describe them as blinding or paralyzing.

In studies, it has been found that 80 percent of migraine patients who underwent BOTOX® injections experienced migraine relief for four to six months. Studies also found that patients injected at various sites sometimes experienced immediate relief from migraines.

Doctors believe that the mechanism behind the BOTOX® migraine relief is that, in addition to relaxing muscles, the drug may interfere with the transmission of nerve pain signals.

16. Do I need an allergy skin test before getting an injectable filler? 

Many of the original dermal fillers used bovine collagen and required allergy testing.  The FDA approved dermal filers that we use do not require skin testing and are very safe.  In the thousands of injections I have administered, we have had no long term allergic reactions.  You may however experience some temporary swelling in the treatment area.  If you have allergies or easily react to minor skin irritations, you may choose to have skin testing and return at a later date for definitive treatment. 

17. Doesn’t most sun damage occur before age 18?

This is a common misconception.   A recent study revealed that we actually get only 23 % of our total UV exposure by age 18. At age 40 it reaches about 46 %; by age 59, 74 %.

The important thing is that you can still prevent sun-induced aging other skin conditions such as skin cancer by getting serious about sunscreen.

18. What is PrevageMD?

Prevage MD anti-aging treatment contains 1% idebenone, scientifically shown to be the most powerful antioxidant available in a skin care product today. PrevageMD protects your skin from environmental stressors known to cause skin aging including UV light, air pollution, ozone, and cigarette smoke.

The antioxidant power of PrevageMD anti-aging treatment has been shown to reduce the appearance of fine lines and wrinkles, as well as skin roughness and dryness, and to even skin tone to restore youthful looking skin. PrevageMD can only be purchased in a physician’s office.   

19.  What is hylauronic acid?

Hylauronic acid is a natural sugar found in the fluids surrounding cells and tissues. It is found in the skin, cartilage, joints and the eyes. In skin tissue, hylauronic acid fills the space between collagen fibers.  The role of hylauronic acid in skin is to deliver nutrients, to hydrate the skin by holding in water and to act as a cushioning agent. 

Restalayne®,Juvaderm® , Hylaform® ,  and Captique® are dermal fillers made of highly purified natural hylauronic acid. When injected these products temporarily add volume to your skin by mimicking the hydrating effects of your skin's natural hylauronic acid.  These FDA approved products are widely used to restore skin to a fuller more youthful state.

20. What skin care products can I use to help give my skin a healthy glow?

First, sunscreen is an absolute must to protect the skin.  In addition, there are several well documented options for obtaining skin with a ‘healthy glow’ including skin rejuvenating products withglycolic acid, retinoids, and/or Vitamin C.

A newcomer on the market is Prevage (Idebenone). It is a highly effective topical antioxidant.  You can buy it over the counter at 0.5% strength or at a physician’s office in a 1% strength.  

More specific information on your skins condition can be assessed by experienced skin care professionals who can tailor specific treatments and products to your individual needs.

21. Do I need to take time off from work to recuperate after Collagen Replacement
      Therapy?

Collagen Replacement Therapy is a simple procedure with a quick recovery time.   Most patients feel comfortable resuming their normal activities immediately following treatment. You are free to eat, drink, or wear makeup and sunblock shortly after treatment.  Temporary puffiness of the treated areas should be expected.  As with any injection, you may also notice temporary redness, slight bruising and tenderness around the treatment site.  If bruising occurs, it is generally limited, lasting a few days to a week or more.  Bruising can be avoided by following your physician’s pre and post instructions. 

22. What’s the difference between Idebenone and Idebenol?

Idebenone is a highly effective antioxidant with good studies that prove its effectiveness.  You can buy it over the counter in a 0.5% strength (Prevage) or at a physicians office in a 1% strength (PrevageMD).  

A client pointed out that she could buy what she thought was the same product at 2% strength on the internet.  A closer look disclosed that this product had “Idebenol” which has none of the active ingrediant “idebenone”.  In fact in very small print on the bottle it proudly claimed: “ 100% idebenone free”.  Buyer beware!!!

23. What are collagen dermal (skin) fillers?

Collagen is the most abundant natural protein found in the body and provides structural support to skin, muscle, tendons and bone. Fibers of collagen are woven together, like threads in fabric, to form a framework into which new cells can grow. In the skin, collagen provides texture, resiliency and shape.

CosmoDerm® and CosmoPlast® are two examples of collagen dermal (skin) fillers made from purified human collagen and injected just below the skin's surface to smooth wrinkles, fill in deep furrows and folds, and restore the lip border. These newer collagen dermal fillers are FDA approved and generally do not require allergy testing, unlike older bovine collagen injections.

24. My eyelids are starting to droop, but I’m not quite ready for surgery.  Is there
      anything I can do?

A few units of BOTOX, properly placed, can help to relax the muscles that pull the brow downward.   When injected with BOTOX, those muscles relax, allowing the muscles of the lateral forehead to slightly lift the eyebrow.  This causes an eye opening effect, often improving drooping eyelids. It is important that the physician is trained in facial anatomy and that he or she is skilled in assessing the individual’s facial muscles.  Every individual is unique and it is important that the BOTOX be placed correctly to avoid a poor outcome. 

25. What is the best makeup to use to avoid acne breakouts?

Quality  “mineral makeups” are generally the best for keeping skin healthy.  Quality mineral makeups are: non-comedogenic (will not block skin pores), have no allergy risks, have broad-spectrum UVB and UVA protection, have anti-inflammatory properties, and contain no talc or paraben.  The best products will allow the skin to breathe and function normally while still protecting it from air-borne pollutants.  Look for brands with staying power even while exercising. Many companies label their products as “mineral makeup”, but look closely at the ingredients.  If minerals are not listed as one of the top few ingredients, it would be wise to look elsewhere. 

26. What is the best time of year to do Laser Hair Removal (LHR)?

Winter is perfect because your summer tan will have faded.    Best results are achieved when the skin is light because there is no surface tan to “steal” the treatment energy from the pigmented hair follicle.   If your tan hasn’t faded yet, treat lighter areas such as underarms and bikini line.

Since tanning ages the skin more rapidly, we encourage our clients to protect their skin throughout the year with sunscreen.  We have great sunless tanning products that can give you a very natural looking tan with out the health and cosmetic risk of excessive tanning.     

27. I have bumps and ingrown areas in areas where I shave. Is there a treatment?

Folliculitis Barbae, is the medical term for the bumps and ingrown hairs on the face and neck for men, and the legs or bikini area for women. Not only is the condition unsightly, but can become inflamed, infected, and painfully uncomfortable.

Laser hair removal can permanently destroy the hair follicles and restore the skins smoothness. In addition, microdermabrasion, chemical peels and other exfoliating skin care treatments can help reduces the number and occurrence of ingrown hairs. There are several topical applications to ease the condition, as well.

28. I have very dark circles under my eyes.  Is there anything I can do besides using
      makeup to conceal them?

Many factors may contribute to dark circles under the eyes including heredity, sun damage, and allergies, as well as, normal aging.  Dark circles caused from pigment changes in the skin can be resolved by using skin care products with Vitamin C or K, and/or other bleaching agents.

One aspect of aging is significant thinning of skin around the eyes and loss of the “fat padding” in the face, both of which can result in dark circles under the eyes.  Careful placement of dermal (injectable) fillers such as Restylane, can add volume and restore the eye orbit to a more youthful and “rested” appearance.  This is an advanced technique that should only be performed by an experienced physician. 

29. How do over the counter microdermabrasion products compare to the clinical
      procedure?

Microdermabrasion uses both exfoliation for the outer surface of the skin and suction for the inner layer of the skin.  Microdermabrasion’s abrasive cleansing results in a smoother more glowing epidermis with less clinically evident pores.  Some studies have suggested that suction  stimulates the dermis and increases both collagen and elastin. While microdermabrasion skin care products are beneficial in exfoliating the skin, they do not have the suction capability and do not allow for the trained eye of a skin care specialist to play a role in treatment therapy.  Therefore, they should be used as an adjunct rather than a replacement for microdermabrasion services performed by a talented and experienced skin care professional.

30. My skin is so damaged from sunbathing in my youth.  What can I do?

The first thing I’d recommend is to get a Digital Photo Skin Analysis of your skin.  This is a diagnostic tool that provides a clinical measurement of the surface and subsurface skin irregularities and pigment conditions.  It examines various age-related conditions such as fine lines and wrinkles, age spots, enlarged pores, skin tone evenness, bacterial growth and sun damage.  After getting this Digital Skin Analysis you will be provided with a baseline of your skin’s condition.  This will help you to know whether products or cosmetic procedures are improving your conditions in the future.  For more information click here.