Physician Spotlight on Neil Alan Fenske, MD

25Jul

PHYSICIAN SPOTLIGHT: Neil A. Fenske, MD Chairman, Department of Dermatology & Cutaneous Surgery, USFCOM, Tampa

Some might think that growing up “dirt poor” on a farm in Blue Earth, Minn. would be a liability. But Neil Fenske treasures it as a character-building experience that allows him to appreciate how far he has come in life.

“I’m a guy who came up the hard way,” said Fenske, chairman of the Department of Dermatology & Cutaneous Surgery at the University of South Florida College of Medicine in Tampa. “I had to carve, scratch, dig and cajole. That’s not a complaint. It has made me stronger, Fenske said.Dr. Neil Alan Fenske, MD

How poor was his family? Fenske, the eldest of five children, wore only used clothes and one winter his only jacket was a girl’s. “I had to wear it to school because that was all (his parents) could afford for $1.50,” he remembered.

Fenske was driving a tractor and plowing fields at 10 years of age. His parents eventually purchased a small grocery store in nearby Winnebago, where he and his siblings worked at night and weekends. Fenske credits the long hours and hard work to forging his work ethic. “It was working behind the cash register where I learned to interact and communicate will people of all ages and personalities, which has served me well as a physician,” he said.

The family’s diet was low-budget and high-cholesterol. “SPAM® was a staple … and hot dogs and hamburgers were served on thin white bread because buns were ‘too expensive,’” he said, adding that an experience with a hamburger at age 12 was a turning point in his young life. “A friend’s mom took him and me for my first restaurant experience – a hamburger on a bun, French fries and a Coke. What a treat! It was at that point that I decided I was not going to be poor when I grew up. I committed myself to academic and athletic excellence throughout my high school years,” Fenske recalled.

He earned a basketball scholarship to Gustavus Adolphus College, becoming the first Fenske to attend college. He already knew he wanted to study medicine because of his teenage admiration for two family physicians. After college he enrolled in medical school at St. Louis University, where he took an elective course in dermatology and “fell in love with it,” Fenske said. He completed his internship at St. Mary’s Hospital in Duluth, and residency at the University of Wisconsin, where he met and married his wife Robyn, and soon realized “an academic career was my calling,” he said. Fenske was recruited to USF to start a residency training program in dermatology and he has been there since 1977.

But in many ways that is just the beginning of a career in which he has influenced the lives of countless patients, students and the institution he has served for 34 years. Along the way Fenske has left his mark in many ways, including being president of seven dermatologic organizations and being named the 1999 practitioner of the year by the Florida Society of Dermatology. In addition, he was chosen by his peers in the Castle Connolly Medical Ltd., directory as one of America’s top cancer doctors for five of the past seven years.

But the professional accomplishments that Fenske treasures most are his relationships with students and patients.

“I have had the privilege to educate and mentor many bright young men and women, many of whom practice in the greater Tampa Bay area,” he said. “All our grads are reputable and very highly sought-after. (Tampa-area) docs scoop up my residents all the time. I’m proud of all of them.”

Fenske said he still spends about 50 to 60 percent of his time seeing patients, which is unusual for a department chair, and that he still thrives on that interaction. “I have not lost my zeal,” he said. “I have as much enthusiasm today as when I started here 35 years ago. … I’m very motivated and high-energy.”

Others confirm Fenske’s self-evaluation. Stephen Klasko, MD, MBA, is senior vice president of USF Health and dean of the College of Medicine. “He is very well thought of by me and others,” Klasko said, pointing out his work with Fenske to transform the Dermatology Division into a full-fledged department. Klasko also noted that Fenske was instrumental in securing the endowment of the Dermatology Department Chair. It was Fenske’s relationship with a patient that made it possible.

Tampa resident Chris Sullivan is co-founder and CEO of Outback Steakhouse, and a patient of Fenske’s for about 15 years. “I’ve dealt with a lot of skin cancer issues personally and in my family. Over time I observed how he was teaching young doctors and how innovative he was in his practice and teaching,” said Sullivan. “They did not have a dermatology chair at USF and I knew he had done a fantastic job of building that department. The idea of endowing that chair became available to me and I thought it was the right thing to do because Neil had earned that opportunity. Personally, he has impacted me very positively and I like the way he goes about his business. He’s an outstanding educator and an outstanding doctor,” Sullivan said.

Fenske said that when he and Klasko met with Sullivan to discuss a fundraising effort, Sullivan volunteered not only to endow the chair for $2 million, but he insisted on putting it in Fenske’s name. “I was caught off guard” by Sullivan’s generosity,” Fenske said. “I literally had tears welling in my eyes. Most people (who make a donation of that size) would want their name on the chair.”

But Sullivan saw it differently. “Neil’s the one who did all the work. It should be named after him,” he said.

And, Fenske said, his work is nowhere near done. Several area dermatologists and philanthropists have contributed, and one of his goals before retirement is to endow the entire Dermatology Department, which will require raising several million dollars. “It would be a great legacy for this great university,” he said.

But that doesn’t mean Fenske is eyeing retirement. “I still love going to work on Monday mornings. … Other than my grandkids and my immediate family, my work is my life and it’s a labor of love. God willing, and my health holds up, I’m here several more years,” he said.

Fenske has three children and four grandchildren and he savors the time he and Robyn spend together with them, especially during autumn at “our mountain house in the Smokies,” he said.

Reflecting on his humble beginnings, Fenske takes heart in the fact that “in America, you can still overcome it. … You’ll have to work harder than the average bear,” he said, but adhering to a simple set of principles has served him well: “Always work hard, do your best, and always do what’s right.”

Scars, who says they are permanent?

24Jun

A scar is a memento which serves as a constant reminder of an accident, surgery, illness, or trauma one has experienced.  Scars take years to reach their final appearance and go through many stages of healing and tissue repair.  Each person heals differently and therefore scars will have a diverse end result on different individuals.  The healing process of a scar has many stages and each stage may be affected by an individual’s physical health and comorbidities.  Health issues such as diabetes, smoking, poor circulation, and propensity to form keloid (or large raised scars) may all impact how a scar heals and looks.

The process of scaring and healing is long and complex. Scar formation begins with constriction of blood vessels and the body sending special cells called platelets to the site of injury to ensure that bleeding ceases.  Next, inflammatory cells and special “healing” cells from our body’s immune system help to “eat up” and remove bacteria and necrotic tissue at the site of injury to allow for healthy tissue to remain. Following the inflammatory phase, a proliferative phase occurs whereby a foundation of new healthy tissue is laid down.  During this stage, new blood vessels form to supply the tissue with nutrients and the edges of the wound begin to contract and close the wound. The final phase of wound healing consists of collagen remodeling and growth factor repair in the new tissue.  All of the phases intermingle with one another and work together in a complex process to give you your final scar result.  Knowing how intricate the healing process is, one can surely understand why each scar looks different.

A fresh scar may sometimes appear pink in color.  Many times our patients describe reddening of the scar with exercise or sweating. This color change seen in the scar is often due to tiny blood vessels feeding the newly formed tissue.  Some patients may notice bumpiness in their scars that does not allow for the skin to lay flat.  Overproduction of collagen in the final maturation phase of healing may continue longer than necessary and produce scar hypertrophy or a keloid scar.  Our acne patients are also often concerned with scarring that looks divots in their skin; this is known as ice pick and rolling acne scars, left behind from years of acne breakouts.

Scars can often affect self-esteem and may drive patients to apply copious amounts of makeup for coverage.  Fortunately, at the USF Health Cosmetic and Laser Center, we can improve the texture and appearance of scars.  Scars respond best to therapy when they are treated within the first 6 months of their development. Our scar treatments consist of a variety of modalities used to target specific scar concerns. If color of a scar is the concern, a pulsed dye laser can often be used to rid scars of their reddish appearance and any surrounding superficial blood vessels.  Texture is best improved with the use of our eMatrix Sublative™ procedure to increase collagen and elastin in the area of the scar. Sublative™ is also one of our favorite treatments employed to improve the appearance of acne scars. Texture and color can also be improved with the use of Laser Genesis, a heat based technology with no downtime. Other modalities of scar treatment such as the use of our favorite scar products Scar Esthetique®, Scar Fx®, and Rejûvasil™ may also be part of your scar treatment plan.

The best way to go about improving the appearance of your scar is to set up a consultation at the USF Health Cosmetic and Laser Center so that one of our healthcare providers can assess your scar and work with you to develop an appropriate treatment plan.  Don’t let your scar get another day older, come in and see us!

By: Erika Dare, ARNP-C, Cosmetic Practitioner

Erika Dare, ARNP-C Cosmetic Practitioner at USF Health Cosmetic and Laser Center 813-259-8694

Erika Dare, ARNP-C Cosmetic Practitioner at USF Health Cosmetic and Laser Center 813-259-8694

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When is the best time to start getting Botox?

23May

When is the best time to start getting Botox and am I too young?  These are just some of the many questions that Dr. Fenske hears from his patients on Botox.  The video link below helps you determine when the time will be right for you.

Click video link When is the best time to start getting Botox

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Is Botox safe?

23May

Is Botox safe?  It is a question that Dr. Fenske hears all of the time from his patients.  Be an informed consumer on all of the cosmetic procedures you are considering.

Link to video Is Botox safe?

Pre and Post Botox

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What is the difference between Botox and filler?

23May

What is the difference between Botox and filler? If you are confused about what you might need to correct volume loss or fine lines then click the video link below.  Nicole Hogue, ARNP and cosmetic practitioner at USF Health Cosmetic and Laser Center simplifies and explains the difference between Botox and filler.

Click video link  What is the difference between Botox and filler?

Nicole Hogue, ARNP-C, Cosmetic Practitioner

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Hello From USF Health Cosmetic and Laser Center

23May

Hello From USF Health Cosmetic and Laser Center

Click the video link below and learn about what the USF HEalth Cosmetic and Laser Center had to offer.

Click Video Link USF Health Cosmetic and Laser Center Services

Neil Alan Fenske, MD, Professor and Chair, Medical Director Nicole Hogue, ARNP-C, Cosmetic Practitioner Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner

(Center) Neil Alan Fenske, MD, Professor and Chair, Medical Director
(Left) Nicole Hogue, ARNP-C, Cosmetic Practitioner
(Right) Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner

Rejuvenation Prejuvenation

22Apr

Obagi 360 Demonstration

Rejuvenation PreJuventaion

Often patients come to our office seeking skin REjuvenation. These are male and female patients alike, typically in their 40-50’s that have been exposed to the Florida sun for a number of years and some even may be guilty of the ‘ol baby oil and iodine trick in order to get a suntan. We know that at about age 40 several ageing phenomena start to take place in the face. It is common to start to see “bags” under the eyes as the eye socket begins to recede making us look “sunken”. Additionally, wrinkles of motion start to appear at rest from being overused for several decades and actually become little etched in scars. There is a shift that takes place of our facial fat pads that can often exaggerate the lines around the nose and mouth creating a void or loss of volume. You may be starting to think to yourself that this is painting quite a grim picture. With a competitive job market and the baby boomers coming of age we see an influx of patients inquiring about cosmetic procedures.

It is interesting to note that the American Society of Plastic Surgeon Statistics show that injectables like dermal filler for instance has increased steadily anywhere from 5-10% yearly and continues to trend even higher.  What is even more interesting to note is the new group of patients that are coming to our offices seeking what we like to call “pre-juvenation”. These are young women and men in their 20-30’s that can see into the future by looking at their parents and quite frankly may not like what they see. These patients come seeking interventions that they can do to prevent the signs of aging hence we call it “pre-juvenation”.

There are several procedures that are appropriate for the younger generation that wish to be more proactive in their skin’s appearance that was not available to generations before them. Immediately one very popular cosmetic treatment comes to mind, the use of neuromodulators such as Botox, Xeomin, and Dysport. We often hear in the office from a 50 year old patient, “I am not old enough for Botox”. In reality, neuromodulators such as Botox are actually preventative in nature. Understanding the science behind these injectables is crucial to knowing their role in preventing the aging face. This is a product injected into a muscle that is responsible for making a wrinkle. Days after the injection this muscle becomes weaker and unable to make the expression responsible for giving us a wrinkle!  Starting an intervention such as Botox early will literately hault the progression of aging. Most commonly patients are injecting in between the brows for the scowl lines and around the eyes in the area we refer to as the crow’s feet. Studies involving identical twins, one using Botox and one not for over 10 years yield remarkable results that attest to pre-juvenation.

Obagi 360

Obagi 360

So what else can patients do in the “pre-juvenation” realm? We always recommend starting on a good topical skincare regiment that includes active ingredient products such as retinols, antioxidants, moisturizers and of course a broad spectrum physical sunblock. Retinols slow the age related loss of important skin components while boosting collagen. Antioxidants slow down and prevent the effect of free radicals from the inside out. Other popular interventions that are appropriate for this age group are non-ablative laser and radiofrequency treatments that stimulate collagen with hopes to replenish collagen before it starts to steadily degrade. Chemical peels are also a great way to stay ahead and keep your skin looking youthful and radiant.

Waiting to see a wrinkle develop will put you behind the game in terms of aging. As the vast body of knowledge in cosmetic dermatology continues to grow we certainly see a trend of starting early. Even though we are speaking about patients in their 20-30’s it is never too late to start to pre-juvenate.

Always trust your skin to the experts, come see us at the USF Health Cosmetic and Laser Center to start your pre-juvenation today … after all it is where beautiful skin happens.

By: Nicole Hogue, ARNP-C

Nicole 1

Nicole Hogue, ARNP, Cosmetic PractitionNicole Hogue, ARNP-C

Filed in: Chemical Peel, Skin Care, Sunscreens - Comments Off

The Mask of Melasma, Brown Discoloration on the Face

15Jan

Brown discoloration on the face.  A mask that never leaves.  It’s the reason you slather on sunscreen and hide out under a hat.  Melasma is a common skin condition found in many females and a small percentage of males.  Its presence is characterized by brown and tan patches that occur on many parts of the face.   It is thought that melasma occurs when the cells responsible for making color in our skin (melanocytes) become hyperactive and produce an abnormally high level of skin color (melanin). Melasma is most often seen in darker skin types such as Latinos, Asians, African Americans, and Indians.  Many times you may hear it referred to as the ‘mask of pregnancy.’ Although we typically do see melasma occur in pregnant women, we also find that it may sometimes be inherited, or as a side effect of hormone or oral contraceptive use.

Finding the exact trigger for melasma may be difficult to pinpoint. The condition’s unpredictable nature makes it hard to prevent; however, there are ways to treat and blend melasma into the surrounding skin.  The depth of the melasma in the skin can sometimes dictate which treatments will be most beneficial and how stubborn it may be to respond.  The first step in melasma treatment typically consists of a topical regimen aimed at blocking melanocytes from the process of producing extra color in the skin.  A regimen for melasma may consist of hydroquinone and/or non-hydroquinone blending products, retinols, and sometimes gentle low strength topical steroids.  Hydroquinone based products such as Obagi’s Clear® and Blender® work to block an enzyme responsible for allowing melanin to be produced.  A non-hydroquinone product such as SkinMedica’s Lytera® works by blocking all four pathways of melanin production through the combination of antioxidants and natural ingredients such as licorice root.  These creams and lotions help to prevent the production of new melasma in the skin. Topical retinols are also important to help increase cellular turnover on the skin’s surface.  This allows for the pigment already present in the top layer of the skin to be sloughed off at a faster than normal rate.  In addition to the topical regimen, your provider may suggest exfoliating washes such as Obagi’s Exfoderm® or SkinMedica’s AHA/BHA Exfoliating Cleanser®.  Retinol and exfoliation use also allows for hydroquinone and steroid products to penetrate deeper and more efficiently into the skin.

Melasma Pre treatment

Melasma Pre treatment

Melasma Post treatment

Melasma Post treatment

 

Many services may be combined with topical treatments for melasma. Chemical peels work similarly to retinols and can help to decrease the amount of time it takes to remove pigment present on the skin surface.  Sometimes a laser may be employed to treat melasma as well.  Q-Switched Alexandrite lasers may be used to target brown discoloration in the skin.  These lasers may help to break apart the pigment and allow it to be reabsorbed. Intense pulsed light, or IPL, is sometimes used by practitioners as a modality to treat melasma.  Unfortunately, not all lasers work for melasma.  While it may temporarily decrease the discoloration, melasma has been known to sometimes recur after laser or light has been performed.

The key to keeping your melasma away after an intensive treatment program, is to slather on that sunscreen and wear your hat! Sun exposure has been known to deepen the color of the melasma and can sometimes make the condition worse.  In addition, discontinuing or changing hormones or oral contraceptives (with your doctor’s permission of course) may help control melasma.

It is most important for a patient with melasma to consult with a provider in order to discuss treatment options most suitable for their condition.  If melasma is a concern for you, stop by the USF Cosmetic & Laser Center, and allow us to develop a personalized treatment plan for you!

By: Erika Dare, ARNP-C Dermatology and Cosmetic Practioner, USF Health Department of Dermatology and Cutaneous Surgery, USF Health Cosmetic and Laser Center

Erika Dare, ARNP-C

Erika Dare, ARNP-C

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Acne and Laser Genesis

09Dec

Acne and Laser Genesis

I never had acne as a teenage why am I 40 years old and having acne?

Adult acne is a quite common and an under-recognized problem. There are several causes of acne from hormones to bacteria. Usually understanding the cause of the acne will help guide treatment.  The important thing to note is that the traditional treatments such as a topical retinoid are still a mainstay for treating adult acne. However, what do we do when these treatments don’t seem like they are enough. The answer? Alternative therapies such as lasers and light based devices! Something called Laser Genesis is an extremely popular treatment for our patients with adult acne. Laser Genesis has little to no downtime other than mild redness allowing great flexibility in scheduling the procedure. Laser Genesis gently heats up the skin gradually stimulating collagen and also killing the bacteria responsible for causing some acne. Since Laser Genesis stimulates collagen it often helps remodel some of the scarring. We recommend that patients have Laser Genesis every two weeks for a minimum of 6 treatments to see a reduction in acne and reveal your skin’s new youthful glow.

Nicole Hogue, ARNP

Nicole Hogue, ARNP

By: Nicole Hogue, ARNP-C, Cosmetic Practitioner at the USF Health Cosmetic and Laser Center

For Appointments call 813-259-8694

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eMatrix Sublime Skin Tightening

09Dec

Are you tired of seeing saggy wrinkles when you look in the mirror?

Come check out the latest and greatest in skin contouring and skin tightening technology at USF Health.  Sublime skin tightening is a state of the art treatment specifically designed for skin tightening, combating wrinkles and is great for smile lines that are often not able to be treated. This treatment utilizes the elos technology by Syneron Candela allowing for safe delivery and exceptional results. Elos by Syneron Candela technology combines infrared and bipolar radio frequency energies to remodel the skin by stimulating collagen. Sublime skin tightening is great for the face and neck and has very minimal downtime. The best part is that some results are instant, you can see them before you leave the office. Call today to find out what the Sublime skin tightening hype is all about!!

Pre and post Sublative treatment for acne scarring

Pre and post Sublative treatment for acne scarring

813-259-8694

USF Health Cosmetic and Laser Center

17 Davis Blvd, ste 402 Tampa, Fl 33606

http://usfcosmetics.com 

Pre and Post Sublative TreatmentseMatrix_3

Filed in: Skin Tightening, Sublime - Comments Off

Non-Surgical Skin Rejuvenation

09Dec

Video-What is Total FX

Non-surgical Skin Rejuvenation:  Making Sense out of Chaos 

You’ve looked in the mirror and had an epiphany:  My skin looks old and sun-damaged. Now what?  Do I need expensive surgery or are there less invasive, more cost effective and safer alternatives? The first decision is to ascertain what bothers you and prioritize those concerns. Secondly, do you have the financial wherewithal,   since cosmetic procedures are not covered by insurance? Lastly, are you prepared to initiate a commitment to a comprehensive skin care program consisting of a daily regimen of skin care and a healthy life style including a good diet, sun avoidance and smoking cessation. If not, don’t waste your money! Now comes the hard part:  Do I make an appointment with a dermatologist, cosmetic surgeon, visit a med spa orseek the advice of a department store salesperson. All can potentially provide you with helpful advice within their realm of expertise. You need to become cognizant of what the various “experts” possess in terms of training, expertise, and credentialing-an oftentimes contentious issue. For physicians, board certification by a skin-related specialty (e.g. dermatology, plastic surgery, facial plastic surgery, opthalmoplastic surgery etc) whose training  is governed by the American Board of Medical Specialities is a good start. Keep in mind however, that our current economic situation has generated a sea of new skin “experts” since this is cash business. Become educated and validate the provider’s credentials, don’t be fooled by a flashy web site or advertisement, bogus certifications, and don’t just shop cost. Generally, you get what you pay for.

Your dermatologist can help guide you in this adventure. Should you have marked laxity (sagging) of the skin, I generally recommend the redundant skin be removed by a cosmetic surgeon. If the laxity is more modest and wrinkles, skin texture and discoloration are your primary problem, then you are a candidate for many of the non-surgical procedures for skin rejuvenation such as Botox for relaxing muscles of expression, fillers to soften deep wrinkles and restore lost volume, and light-based systems (IPL and lasers) for textural problems, skin tightening and discoloration.  However, should you only have minor dyschromia (discoloration) and fine wrinkles, a good skin care program with  prescription strength topical agents and minor procedures like chemexfoliation (lunch time peels) and microdermabrasion may be all that is necessary. The next step for more severe dyschromia and redness  is Intense Pulse Light (e.g. Photogenesis/Solargenesis) therapy whereby the red and brown colors absorb these broad wavelengths of light and disappear. Distinct blood vessels or “broken viens” generally need to be traced out and destroyed with specially designed lasers (e.g. Coolglide/Varelite etc). Prominent pores and modest textural problems can be improved by heating the skin with lasers (e.g laser genesis) and stimulating new collagen growth.

Wrinkles and pebbly skin can be dramatically improved with new “fractionated laser technologies. Some are non-ablative (no visible tissue injury and no downtime) and require many treatments with only modest improvement. In essence “no pain-no gain”. The newest lasers now use this same fractionated technology for ablative (meaning the epidermis and some of the dermis are vaporized) resurfacing. Unlike the older, but very effective ablative lasers which had a long downtime and significant risk of scarring, these new lasers (e.g. Active FX/Deep FX/Total FX)  ablate, in a computer generated pattern, hundreds of tiny foci of skin while still leaving small islands of normal skin which facilitates rapid healing with a downtime of only 4-5 days! This technology is an excellent balance of downtime/risk/benefit and cost.

In summary, there are many interventions, both old and new, to help rejuvenate  your skin. You however must be committed to this journey and absolutely have realistic expectations.  We can drop the clock back a few years, but we can’t make you look 20 again. I wish we could.  

By: Neil Fenske, MD, professor and chair of the USF Health Department of Dermatology and Cutaneous Surgery

Pre Total FX Fractionated Co2 Laser Treatment (no Botox)

Pre Total FX Fractionated Co2 Laser Treatment (no Botox)

Post Total FX Fractionated Co2 Laser Treatment (no Botox)

Post Total FX Fractionated Co2 Laser Treatment (no Botox)