Friday, May 23, 2014

Spinning Brushes to Clean Your Face, a review of these home devices

Home microdermabrasion, spinning brushes (Clarisonic, etc.) are very popular right now.  Even the ProActiv info-mertial acne treatment system, added a spinning brush to their line.  So what is the deal with these brushes? Do they work?  There are a handful of mostly biased studies on home microdermabrasion devices, published by the manufacturers of these devices that show exfoliation and mild improvement in texture and tone of the skin, but not the more significant improvement seen by stronger in-office procedures like Clear and Brilliant, Chemical peels, Fraxel Restore.  Gentle exfoliation is helpful to improve acne, melasma, brown spots, and even fine lines/wrinkles.

Some patients of mine have reported that their acne or skin got worse after using the brush.  A possible reason for this, is that they are supposed to exfoliate and are often paired with exfoliating cleansers, so it is possible that acne that was deeper down in the dermis may begin to surface in the first few weeks of treatment.  I would recommend not judging the brush until you have done a trial of it for at least six weeks.   In addition, I have heard concerns from other dermatologists that the brush is grinding dirt and bacteria deeper into the skin and this may trigger more inflammation and acne.  There is just not enough data to support or dispel that notion.  So, until there is, I suggest pre-cleansing prior to using your brush with an exfoliator.  For example, washing with a gentle liquid cleanser like Cetaphil or CeraVe before starting the microdermabrasion routine.

Friday, May 9, 2014

Lip Augmentation

As we age our lips will thin and the distance from the underside of our nose tip to our upper vermilion (red portion) lip, also called philtrum, lengthens.  In women, all of this tends to age and even masculinize our face. 

The philtrum can be shortened and the lip plumped slightly to rejuvenate and feminize and even give more sensuality to the lip.

The most permanent way to achieve shortening of the philtrum and more vermilion show, is with a surgical lip lift, which is done by some cosmetic surgeons. 

A quick, natural, and shorter term way to shorten the philtrum and plump the lip would be to have a filler treatment, usually a hyaluronic acid filler or silicone.  The hyaluronic acid fillers may last 1-2 years depending on the brand, and are reversible with an enzyme called hyaluronidase.  This treatment varies in cost from $500-$1400 depending on Brand of filler, and quantity. 

Tuesday, May 6, 2014

Laser Treatment of Rhinophyma type of Rosacea

Actual Patient with progressive worsening rhinophyma, before and after a single laser treatment.
Rhinophyma is a complication of rosacea that is marked by enlargement of the nose, and change in color and texture to include redness, prominent veins, and plugged pores.  It tends to be worse in men and worsen gradually over time.  While we don't have a perfect cure for rosacea and this complication called rhinophyma, we can do alot to control it and improve it.  This treatment was done by me with the Erbium/CO2 resurfacing laser in one session, using local anesthesia.  With this treatment, there is about two weeks of healing with crusting/peeling/inflammation but one can work or do normal daily activities during this time.  Sun avoidance is crucial while healing and indefinitely thereafter b/c sun is a prime trigger of rosacea.  This is a lasting improvement;  however, not a cure for rhinophyma, and it can recur slowly if the person is genetically susceptible or fails to avoid the rosacea triggers like sun and certain foods.  For more information about rosacea triggers and prevention, I recommend going to