Hello From USF Health Cosmetic and Laser Center
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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
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.
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
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.
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
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.
By: Nicole Hogue, ARNP-C, Cosmetic Practitioner at the USF Health Cosmetic and Laser Center
For Appointments call 813-259-8694
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!!
USF Health Cosmetic and Laser Center
17 Davis Blvd, ste 402 Tampa, Fl 33606
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
Ugly toenails: There’s a fungus among us
By Neil Alan Fenske, MD
Tampa Tribune correspondence
Hot weather is still here. Grabbing the sunscreen, wide-brimmed hat and umbrella, you’re ready for a day at the beach. Much to your chagrin, as you slip into your flip flops, you notice that your toenails are thick, discolored, loose and crumbling. Moreover, the bottoms of your feet are pink, dry and scaly. Maybe you’ll stay home instead.
The unsightly condition known as tinea pedis, or athlete’s foot, is a common fungal infection primarily affecting the skin of the feet. It may coexist with nail fungus, known as onychomycosis, and be caused by the same type of microorganism (Trichophyton rubrum). Since this contagious fungus thrives in warm moist places, like locker rooms, you might avoid infection in the first place by keeping your feet dry and never walking barefoot in public places.
Fungal foot and toenail infections tend to increase as we get older, in part because of more years of exposure to the fungal spores and our diminishing ability to fight off infection as we age. Typically, the infection starts on the skin of the feet and insidiously works its way under the distal edge of your toenail resulting in a yellowish discoloration. Eventually, the entire nail plate is destroyed as the fungus spreads through the nail to the cuticle. This fungus typically causes minimal itching so patients are often unaware of the infection until it begins to destroy their nails. When just the feet are affected, many patients think they simply have dry skin.
The clue this is a fungal infection is that the scaling has a proclivity for creases and the affected areas are pink. The infection often involves the bottom and sides of the feet in a so-called “moccasin” distribution.
Treating fungal infection is important for more than cosmetic purposes. The condition will worsen over time. Microscopic cracks in the skin caused by the infection and trauma to surrounding toes by the abnormal nails create a “portal of entry” for infection by other more serious organisms such as staph and strep. For those with weakened immune systems (patients undergoing chemotherapy, those with HIV infection or poorly controlled diabetes), these secondary bacterial infections may be very serious. With antibiotic-resistant bacteria (MRSA) now more prevalent in the community, this becomes a bigger problem, even for healthy people.
Treatment is a challenge, especially for the nails. While many effective topical agents are available over the counter for treating the skin, they are generally ineffective for nails. Moreover, toenail fungus frequently recurs. Nails generally require prescription antifungal pills taken daily along with the use of topical agents during and after treatment to prevent recurrence. Trimming away the damaged portion of the nail may also help.
Older drugs such as griseofulvin had to be taken until the nails were completely clear – as much as 18 months or more for older people with severe fungal infections! This increased the risk of adverse effects. Newer antifungal medicines (terbinafine and itraconazole) deposit in the nail plate and continue working months after the drug is discontinued. They are much safer to administer since treatment typically requires only three to four months. While relatively safe, antifungals can be hard on your liver, interact with other drugs and cause skin rash. Close monitoring by your dermatologist can help minimize the severity of side effects considerably.
With proper treatment of foot and toenail fungus, there’s no reason not to enjoy your day at the beach.
Dr. Fenske is professor and chair of the Department of Dermatology and Cutaneous Surgery at USF Health.
THE SUNSCREEN & VITAMIN D DILEMMA: WHATS IS ALL ABOUT?
Sunscreens prevent skin cancer. Some epidemiologic data suggest low levels of vitamin D may increase susceptibility to internal cancer as well as infection, hypertension and autoimmune disorders. Since the sun stimulates production of vitamin D precursors in the skin while sunscreens reduce production it is speculated some of us could be vitamin D deficient and thus at risk for these disorders. Are you now thinking of tossing out your sunscreens and going to the beach or purchasing a package of tanning parlor visits? Hold on! This confusion is a classic example of a “little knowledge is a dangerous thing”.
We have known for many years that sunscreens prevent sunburn and skin cancer by blocking the UVB rays that vary in intensity throughout the year. We now know that longer, more deeply penetrating UVA rays which account for more the 90% of UV light and stay relatively constant throughout the year also play a role in skin cancer as well as skin wrinkling. This is why dermatologists now recommend the newer generation of “broad spectrum” sunscreens that block both groups of rays. SPF rates the amount of UVB protection and the FDA will soon be releasing a new 4-star UVA rating system to quantity the amount of UVA protection. For day to day use (unless you work out of doors or plan recreational sun exposure) a SPF 15 is more than sufficient for most of us. Unfortunately, some commit “sunscreen abuse”, meaning they now go out much longer than before with the false expectation they are getting no sun damage. They may rationalize that by increasing to a SPF 30 they have doubled their protection. Not so fast! A SPF 15 sunscreen blocks 93% of UVB rays, while a SPF 30 blocks 97%–not much additional protection for the increased cost and irritancy!
A few years ago, some studies disclosed a relationship between internal cancer (esp. colorectal cancer) and vitamin D deficiency. In other words, vitamin D perhaps served a “protective” role and since suncreens and/or strict sun avoidance reduced vitamin D production it was speculated by some and politicized by others as a rational to abandon photoprotection altogether. Making matters worse, some suggested that the vast majority of Americans were vitamin D deficient, while others stated the daily recommendation for vitamin D was too low. Some are now promoting increased sunbathing and utilization of tanning salons, despite the mounting evidence that UVA (the light rays emitted by tanning salons) causes skin cancer, in particular, melanoma and premature aging.
Many subsequent studies assessing the role of vitamin D in “protecting” against internal cancer have conflicting results and it will take many years with long-term prospective studies to know for sure. As well, there is controversy regarding the extent, if any, of significant vitamin D deficiency in Americans. Nonetheless, you can obtain vitamin D from diet (e.g. salmon, fortified milk and orange juice) without subjecting yourself to the risk of sun exposure. The National Institutes of Health claims it doesn’t take much sunlight to make adequate vitamin D-likely as little as 30 minutes twice a week without sunscreen!. Alternatively, simply taking supplemental vitamin D (1,000 IU) if you have had skin cancer, are at risk for skin cancer, or simply want to avoid the unsightly wrinkling and discoloration caused by habitual sun exposure is a much safer way to assure adequate levels. My closing recommendation is moderation and see your dermatologist annually!
Article written by: Neil Alan Fenske, MD, Professor and Chairman of the Department of Dermatology and Cutaneous Surgery at USF Health
Cosmetics for Men
The secret is out. Long gone are the days of female only clientele in the cosmetic and laser office. Men have discovered the fountain of youth and are now making their presence known in the aesthetic world. The use of minimally invasive cosmetic procedures in men has increased substantially over the past decade. This means that males, like their female counterparts, are choosing to undergo treatment to enhance their appearance with fillers (e.g., Restylane®, Juvederm®, Radiesse®), neurotoxins (e.g., Botox® and Dysport®), chemical peels, and lasers. Nowadays it is not unusual to come across lotions and potions in the department store marketed “for men” due to the increasing demand by the male consumer. Medical spas labeled “for men only” are popping up all around the country. Looking at these trends one may ask, do men really need cosmetic treatments and why are they becoming so popular in this demographic?
In order to answer whether or not aesthetic treatments may be beneficial for males, we must first visit the skin on a cellular level. Although men experience typical wrinkling and volume loss with age like their female counterparts, males do indeed exhibit some differences. Researchers have found that males possess thicker superficial layers of the skin. Moreover, there is evidence of dermal thickness deterioration starting 30 years earlier in males than females. In women however, the dermal thickness remains steady until menopause, after which a rapid decline occurs. Higher amounts of androgen hormones in males are responsible for more oily skin and larger pore size. In comparison to females, men have a lower skin pH and are prone to more robust skin discoloration after UV exposure. For these reasons there are skincare products tailored to the specific needs of men. Thus, it is important for men to understand that their skin is not as tough as once thought and that it does deserve a little TLC every now and then.
For years men didn’t take advantage of cosmetic procedures simply because they were either never asked, were too embarrassed, or simply too ‘macho’ to inquire. Over the last few years, we have seen more men asking about aesthetic treatments. Globally, aesthetic procedures are on the rise, exposing men to cosmetics through their significant others and in turn prompting them to seek treatment themselves. Currently men make up 6% of neurotoxin and 5% of dermal filler procedures performed. Clearly, a change is happening. There are a multitude of reasons as to why men may seek aesthetic treatments, one of them being a mounting concern of age discrimination in the workplace. The U.S. Equal Employment Opportunity Commission has reported a steady increase in charges filed for age discrimination. This being said, many men may feel the pressure to maintain a more youthful appearance in order to keep or land a job. Today’s society is in tune with the way we are perceived by others. A vast majority of our male clienete are seeking treatment because they are told by others that they look “angry” due to their accentuated scowl lines. They are concerned with this perception of themselves in the workplace and at home. In our practice some men seek cosmetic treatment to simply enhance their appearance and self-confidence.
The presence of males in our Cosmetic and Laser Center practice is testament to the new norm. In our experience, we also frequently treat men for skin discoloration, facial redness, facial blood vessel destruction, skin tightening, and softening of dynamic expression lines. Cosmetics treatments no longer come with the stigma of being called a ‘metrosexual,’ as evidenced by the many masculine gentlemen who partake in aesthetic procedures today. Regardless of age or socioeconomic status, men are taking the initiative to make a change in their appearance now more than ever before. While the saying goes, “Men are from Mars and women are from Venus,” both genders should agree on one thing- aesthetics are essential for everyone.
By: Neil Alan Fenske, MD, Professor and Chairman of USF Health Dermatology and Cutaneous Surgery, Medical Director of the USF Health Cosmetic and Laser Center
Giacomoni PU, Mammone T, Teri M. Gender-linked differences in human skin [published online ahead of print July 1, 2009]. J of Dermatol Sci. 2009;55:144-149.
Cosmetics and lasers for skin of color
Open up a cosmetic online forum or an aesthetic magazine and you are bound to read horror stories which recount laser treatments gone wrong on those with skin of color. Unfortunately, when laser is placed in the hands of poorly trained individuals or an inappropriate device is used, adverse reactions can occur in darker skin types. The truth is that people who have an olive complexion or even darker skin color can still have a good majority of the laser treatments available to lighter skinned individuals; however, the provider must use the appropriate device for their skin type. At USF Health Cosmetic & Laser Center, we use 1064 wavelength lasers to treat our patients with darker complexions. Using this type of device and customized, conservative energy settings, we can treat target lesions such as hair or texture with a much lower risk of causing severe burns or hypo/hyperpigmentation. With a 1064 wavelength device, we enable our laser to focus on the target and less on the pigment in darker skin. While no procedure is 100% without risk, a conservative approach with the right tools and consistent follow up is the most effective way to prevent complications.
Another common misunderstanding we hear in patients with skin of color is that they have been told there are very few cosmetic treatments appropriate for their skin type. While some treatments may remain off limits, there is still a plethora of cosmetic goodies and procedures that can be used on darker complexions. In addition to cosmetic procedures, we offer customized skin care plans and products safe for use on skin of color. At USF Health Cosmetic & Laser Center we can help darker skin types with issues such as:
If you have a darker skin complexion and cosmetic concerns, stop by or call to set up a consultation. It is important to meet with one of our providers to further assess your skin’s needs and develop a comprehensive plan tailored to your specific skin type.
by:Erika Dare, ARNP-C, cosmetic/dermatology practitioner at USF Health Cosmetic and Laser Center