All About Skin and Dermatology

Decorative tattoos have a history dating back at least 5000 years. The desire to remove them has probably existed for just as long. Early attempts to remove tattoos have had less than desirable results. The use of dermabrasion, saltabrasion and Argon or CO2 lasers have left behind scars in place of the tattoo.

The advent of Q-Switched lasers has permitted the removal of most tattoo inks with a very low risk of scarring. The Medlite Q-Switched Nd:YAG laser is the laser of choice in this class of laser. The Medlite can significantly lighten or remove a wide variety of tattoo inks.

How does the Medlite laser remove the tattoo?
The Medlite laser removes tattoo ink with the energy of light. A laser is a device which is designed to produce one or more specific wavelengths of light. Tattoo ink is removed by using this specific wavelength of light which passes into the skin, but is absorbed by the ink.The rapid absorption of light energy causes the tattoo ink to break into tiny particles which can then be removed by the body?ުs natural filtering systems. The Medlite laser provides maximum tattoo removal while leaving the surrounding skin unharmed.

What type of tattoos can be removed?
The Medlite laser can remove professional, amateur (homemade), traumatic and surgical tattoos.

How many treatments will it take to remove a tattoo?
On the average, professional tattoos require 6-8 treatments, while amateur tattoos require 4-5 treatments, all spaced approximately 6-8 weeks apart. The number of treatments depends on the amount and type of ink used, and the depth of the ink in the skin.

Does the laser remove colored tattoos?
Dark (blue, black) and red inks will resolve the best. Oranges and purples usually fade as well. Green and yellow inks are the most difficult to remove, and additional treatments are needed to produce significant fading.

Will the tattoo completely disappear?
In many cases, yes. Greater than 95% fading of the tattoo may be accomplished. However, it is important to know that there are many, many types of tattoo inks in use worldwide today, none of which are regulated by the FDA. Not knowing which tattoo ink was used, or how deeply it was applied, makes it impossible for the physician to predict the degree of removal on any given tattoo.

Is the process painful?
The Medlite laser emits light in very short pulses. The impact of the energy from the powerful pulse of light is similar to the snap of a small rubberband on the skin. The majority of patients do not require anesthesia, depending on the size and location of the tattoo. Anesthesia creams are available if needed.

What type of post-treatment care is necessary?
An antibacterial ointment and a dressing will be applied to the area immediately after treatment. Occasionally, there will be pinpoint bleeding associated with the treatment. The treated area should be kept clean. Follow your physicians instructions exactly as to what to do during the days following the procedure. A shower can be taken the next day, although the treated area should never be scrubbed. If a scab forms it is vital that you do not pick it or scratch it.

By Dr. Kwan

Almost everyone has a birthmark. Generally, birthmarks are small, and often located in inconspicuous areas covered by clothing. However, some birthmarks are clearly disfiguring, especially those that appear on the face and neck. These birthmarks can be a source of great psychological and social pain.

There are two basic types of birthmarks. Red or vascular birthmarks are caused by an irregularity in the blood vessels and are the most common type of birthmarks. Pigmented birthmarks, known as nevus (singular) or nevi (plural), are brown in color and may be very large. Many birthmarks fade before children reach school age, but more commonly, they remain if untreated.

Treatment can be accomplished with the Lasorscope laser system designed for Birthmark Removal. This procedure includes the treatment of light and dark skin tones, resulting in a higher level of patient satisfaction.

What to Expect:
(Immediately afterTreatment) Blanching/graying of the tissue immediately following laser application.

Expected Final Outcome:
May not be fully resolved. Requires multiple treatments. This procedure can be done on a lunch break and requires no recovery.

Please come and attend our Halloween Open House this Thursday the 23rd of October.  It will run from 3:30 til 6:00 pm.  We will be here to answer questions about all the cosmetic procedures that we perform in the office.  Representatives from several companies like Obagi, Medicis and Cynosure will be in attendance to also answer questions. 

This is our kick-off event for the holiday season.  Food and beverages will be catered by Premier Catering.  All are invited.

Plus we will be passing out $50 certificates that can be applied to any cosmetic service that Dr. Kwan performs.  And if you bring a friend, you and your friend will receive a $75 certificate. 

Hope to see you all here at the new office!!

Laser Skin Rejuvenation For Wrinkles & Acne Scars

Laser skin rejuvenation is one of the latest and most exciting cosmetic procedures available. This treatment is perfect for those looking for a safe, quick procedure to rejuvenate and revitalize the skin. Laser skin rejuvenation has become the procedure of choice among top celebrities, as well the working population who cannot afford time away from work to recover from more intense procedures, or who want a better solution to sun-damaged, aging or acne-scarred skin.

How does laser skin rejuvenation work?
Collagen provides the support network to our skin. As we age, the collagen breaks down causing lines and wrinkles. The laser works by stimulating collagen production. As the new collagen is generated, lines and wrinkles are decreased. Additionally, years of sun exposure can cause discoloration, large pores, and pigmented or red areas on the skin. Patients report, and studies have confirmed that this procedure achieves a more refreshed appearance, smoother skin texture, and even skin tone, and a decrease in pore size. Those with difficult acne scarring will also notice a marked improvement.

Why should I choose this procedure?
Because the action of laser skin rejuvenation is nonablative (does not remove any skin) there are many benefits over other traditional laser procedures. The laster treatment is quick and offers no downtime, you can immediately return to your normal activities. There is minimal discomfort, and a very low risk of any complications. Patients will experience progressive improvement over several months for fresh, natural look. Laser skin rejuvenation is compatible with a whole host of other cosmetic procedures so that maximum results can be achieved.

Is the procedure safe?
The Medlite laser used for skin rejuvenation is one of the safest lasers on the market today. In the hands of trained medical professionals, the Medlite laser offers a safe and effective treatment with very little risk of complications. Patients of all skin types can be safely treated, including tanned skin.

What body areas can be treated?
The laser can be used to rejuvenate many body areas including the face, hands, neck and chest.

How many treatments will I need?
Laser skin rejuvenation is a gradual process. Usually patients need 4-6 treatments spaced at 3-5 weeks apart. Many patients choose to return for touch-up treatments after the initial treatment session ends.

What does the procedure feel like?
Laser skin rejuvenation is not painful. Many describe the feeling as a tingling sensation. Anesthesia is usually not necessary, but you may request a topical cream depending on your own experience.

What can I expect after the treatment?
This procedure eliminates the recovery associated with other ablative laser skin resurfacing treatments. Laser skin rejuvenation does not remove any surface skin or cause any visible effect beyond a mild to moderate redness, which usually fades within an hour after treatment. No specific ca re is needed after treatment, you may be asked to avoid sun and some skin products for a period of time after the treatment. It is important follow to you physicians instructions exactly.

Botox is non-surgical and can dramatically smooth and reduce wrinkles in minutes. It is so quick that some people receive the treatment over their lunch hour and still have time to eat. Botox (a purified protein produced by the Clostridium botulinum bacteria) has been used safely by doctors for many years. This drug is used in tiny amounts and is injected into your muscles thereby weakening them so that they can’t cause wrinkles.

Botox - Wrinkle Treatment

BEFORE

Botox - Wrinkle Treatment

AFTER

Many wrinkles are actually creases that have been worn into the skin by making the same expression thousands of times. Repeated squinting and frowning can cause expression lines or dynamic wrinkling of the skin. Typical dynamic wrinkles include “frown lines” between the eyebrows, “crow’s feet” around the eyes, and forehead lines. Botox works by relaxing the muscles that cause these wrinkles. A small amount of Botox is injected right into the muscles that are responsible for creating these wrinkles. Botox effectively inactivates or relaxes these muscles, allowing your skin to rest, thereby causing lines to disappear or diminish. Your skin can then re-establish it’s youthful appearance.

Botox Video
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Botox History
It has been used for wrinkle therapy since the early 1990’s with no serious side effects documented. Botox is the fastest growing cosmetic procedure worldwide - women and men alike - who want to take control of their appearance and look as good as they feel. Botox has successfully been used for over ten years to treat other medical conditions such as blepharo spasm, spasticities in children and ophthalmic conditions such as muscle overactivity.

Can everyone do this?
Botox can be used by almost anyone. But patients who are pregnant, breast feeding or who have some neurological diseases shouldn’t use Botox.

Side Effects
Typically the amount of Botox and side effects and Botox danger remains low. Any Botox side effects can typically only last 6 months at a maximum, because Botox treatments are temporary. People with neuromuscular disorders should consult with their physician carefully before having a Botox injection treatment, as cardiovascular problems may arise. Likewise, those with cardiovascular disease should also pay special attention.

It is a natural response to assume there is some Botox injection danger with a prosuct derived from a toxin, but it is in fact very safe, and has been is use for some time. It is always prudent to review the Botox injection side effects and procedure so that any Botox injection danger is know and understood.

Some patients have been known to experience the side effects of Botox of bruisng at the site of the injection. The most common Botox side effects following the use of Botox Cosmetic for glabellar lines are headache (13.3%), respiratory infection (3.5%), temporary eyelid droop (3.2%), nausea (3.0%), and flu syndrome (2.0%). Blepharoptosis is consistent with the pharmacologic action of Botox Cosmetic and may be technique related. In rare occurences Botox cosmetic can spread into neighboring muscles and cause temporary paralysis. In less that 1% of patients, this can cause drooping of the eyelid.

Less frequently side effects of Botox occurring (<3%) adverse reactions included pain in the face, erythema at the injection site, and muscle weakness. These events are thought to be associated with the injection and occurred within the first week.

A proper daily skin care regimen can keep your skin appearing healthy, while protecting it from damaging elements such as pollution and ultraviolet radiation.

Your skin care regimen should include:

Daily Cleansing - both morning and evening to remove pollutants, excess oils and make up.

Moisturizing - applying a moisturizer directly after washing will replenish moisture loss and ease the appearance of aging.

Sunscreen - limiting your exposure to the sun and using a sunscreen of SPF 15 or higher is an essential step to any healthy skin care routine. Individuals with melasma need to be even more aware of their exposure to sun. Daily use of a broad-spectrum sunscreen of preferably SPF 30 or higher is recommended - and don’t forget that wide brim hat to shade your face.

Melasma appears as brown or gray-brown patches on the face. These patches generally appear on the cheeks, forehead, upper lip, and chin. Melasma is associated with ultraviolet exposure, pregnancy, birth control pills, and hormone replacement therapy.

Postinflammatory hyperpigmentation appears as dark patches that develop from injury to the skin. Postinflammatory hyperpigmentation is caused by trauma to the skin that may be due to inflammatory skin disorders, such as acne, eczema, contact dermatitis, or by cosmetic procedures or reactions to cosmetics.

Only a medical doctor can tell you which type of hyperpigmentation you have and can provide you with options to treat it.

Risks for Hyperpigmentation
Hyperpigmentation is very common. No one knows exactly how many people have it, but some people are at higher risk.

Sun exposure:
Among patients with melasma, a combination of skin type and sun exposure may increase risk. People with light brown skin (eg, Asians, some Hispanics and some African Americans) who live in areas with high ultraviolet exposure have the highest prevalence of melasma. Patients of any skin type who are exposed to ultraviolet radiation may double the amount of pigment in their skin.

Gender:
Women are more likely than men to develop melasma. Hormones associated with pregnancy, birth control pills, and hormone replacement therapy are generally the cause of melasma in women. Melasma may go away after childbirth or after a woman stops taking hormones. Melasma in men appears the same as it does in women, but hormones do not appear to be the cause.

Skin Trauma:
Postinflammatory hyperpigmentation is caused by trauma to the skin that may be due to inflammatory skin disorders such as acne, eczema, and contact dermatitis, or by cosmetic procedures or reactions to cosmetics. Cosmetic procedures that may cause postinflammatory hyperpigmentation include chemical peels, laser skin resurfacing, waxing, and electrolysis. Postinflammatory hyperpigmentation occurs at the site of injury, which can appear anywhere on the body. Men and women have the same risk of developing postinflammatory hyperpigmentation. Other causes of melasma in both men and women include heredity, medications that cause the skin to become more sensitive to solar radiation, nutritional deficiency, and some disorders that affect the endocrine system in the body.

FAQs About Hyperpigmentation

Q: What is hyperpigmentation?
A: Hyperpigmentation is a common condition that produces dark spots or patches on your skin. The spots are caused by excess melanin, the substance in your body that gives your skin its color.

Q: How do I know for sure that I have hyperpigmentation?
A: Only a doctor can know for certain that you have hyperpigmentation. Skin problems can be very difficult to diagnose and should never be self-treated.

Q: I just had a baby and now have dark patches on my face. What caused that, and will it go away?
A: You might have hyperpigmentation—only a doctor can tell for sure. But it is common to develop hyperpigmentation during pregnancy because of hormonal changes in your body. That’s why hyperpigmentation is sometimes called the “mask of pregnancy.” The dark patches may go away over time as your hormone levels return to pre-pregnancy levels. If not, your doctor may wish to treat the hyperpigmented areas. It is important that you consult a doctor about this and not try to treat it yourself.

Q: How long does it take for hyperpigmentation to go away?
A: It depends on the cause and the type of treatment approach your physician chooses. Realistically, it could take from weeks to months before hyperpigmentation disappears completely. It is important that you closely follow the treatment regimen your doctor prescribes and learn how to lower your risk for developing hyperpigmentation in the future.

Q: My doctor told me to use a sunscreen all the time, but I work in an office and don’t see why I have to bother doing that.
A: You’d be surprised at how much ultraviolet radiation you can get, even if you are inside most of the time! Everyone should use sunscreen to protect against damaging ultraviolet radiation, but if you have hyperpigmentation, it is especially important. Even the lights in your office or sunlight coming through a car or building window can expose your skin to ultraviolet radiation. Follow your doctor’s advice and use the sunscreen recommended or prescribed to protect your skin. Sunscreen is not just for the beach!

History

Since the 1920’s, tanning has maintained its fashionable trend, but as researchers in the early 1920’s discovered the connection between ultraviolet rays and sunburn, sunscreens emerged to protect the skin.   Sun tan lotion was more commonly used in the 1950’s however, it was only worn to obtain a tan without burning the skin.   Then, in the 1970’s, sunscreens like the ones we know and use today appeared in the market to provide better skin defense.

Ultraviolet

Although some may think that the only risk in tanning is the chance of getting a little too red, the exposure to the sun’s ultraviolet rays can be much more detrimental.   The sun emits two types of ultraviolet rays that could severely damage the skin: Ultraviolet A (UVA) and Ultraviolet B (UVB).   UVA is a long wave radiation that infiltrates deeper than UVB.   Not only does UVA cause the wrinkling of the skin, but it also harms connective tissues while UVB burns the skin and worsens the effects of UVA.   Both induce tanning, but at the price of potential skin cancer.

Labels and Ingredients

Sunscreens are subject to more strict rules and regulations than cosmetics because they are classified as over-the-counter (OTC) drugs according to the Food and Drug Administration (FDA).   As OTC drugs, sunscreens must comply with the OTC drug labeling requirements that authorize labels to include the concentration of each active ingredient, so distinguishing the difference between good and bad sunscreens can become difficult without the knowledge of the ingredients and terms.

Dermatologists will agree products that supply full spectrum UVB and UVA protection are important in preventing photo damage.   However, labels that contain “broad spectrum” may not necessarily indicate full spectrum protection.   In fact, sunscreens that have “broad spectrum” labels may only give defense against the near end of the UVA spectrum, according to some dermatologists.   Since the FDA lacks certain testing procedures to measure broad spectrum protection, products that give full UVA protection are hard to distinguish from insufficient sunscreens.   Although this issue has been addressed, the FDA has not taken serious action to set standards in skin protection products.

Labels that address water and sweat resistance can be differentiated more easily.   Sunscreens with labels that include “Water Resistant”, “Water/Sweat Resistant” and “Water/Perspiration Resistant” denote the products sustain their sun protection factor (SPF) after 40 minutes of water interaction.   The sunscreens with “Very Water Resistant”, “Very Water/Sweat Resistant” and “Very Water/Perspiration Resistant” indicate that they sustain their SPF after 80 minutes of water interaction.

Reading SPF

Recommendations for SPF levels can become confusing because it is a controversial area.   SPF 15 filters out about 93 percent of UVB radiation while SPF 30 filters our about 97 percent which leads some to believe the use of SPF 30 to be better due to the insufficient application aspect.   Sunscreens above SPF 30 are labeled “SPF 30+” or “SPF 30 plus”.   Dermatologists who advocate SPF 30 sunscreens emphasize moderate and continuous use because in order to obtain the labeled SPF, their patients must apply the sunscreen just before going outside, reapply after 30 to 40 minutes, and continue to reapply every couple of hours, especially when active.   But SPF doesn’t always provide the necessary and sufficient UVA protection.

Knowing UVA Protection

Since the “broad spectrum” label cannot be relied upon, sunscreen buyers need to look to the ingredients to find titanium dioxide, zinc oxide and avobenzone.   Titanium dioxide provides some UVA protection while zinc oxide provides better ultraviolet radiation than any other ingredient.   Avobenzone crosses the controversial line because its stability is often questioned.   Although avobenzone seems to have the potential to be a decent UVA blocker, the combination and formulation of the sunscreen plays an important role for it.   For example, if avobenzone does appear on a sunscreen ingredient list, the sunscreen would be satisfactory as long as it also contains octocrylene, which adds photostability.

Wearing Sunscreen

Even if the sunscreens with the right ingredients are purchased and worn, they may still prove inadequate due to poor application.   No matter what sunscreen is used, the amount of sunscreen wore by the average person won’t provide more than three- to four-fold protection.   On top of that, if people wore the best sunscreens in the world and actually applied the correct amounts onto their skin, only about half of ultraviolet light is blocked.

New Research

Studies show that the body uses antioxidants as part of its natural defense against ultraviolet radiation’s oxidative stress.   Sunscreens that contain UVA blockers, such as zinc oxide, help limit the harm to the skin, but the body uses its own supply of antioxidants to fight ultraviolet radiation.   Some of the body’s antioxidants utilized are vitamins C and E, glutathione, alpha-lipoic acid, and ubiquinone.   Researchers are working in application of these antioxidants to see if they can add to the body’s own supply and improve ultraviolet radiation protection.

Vitamin C and E have both shown promise in skin application research studies.   While vitamin C can provide about two-fold protection at its full potential, vitamin E can also give about the same when maximized.   So when these two antioxidants are combined, the result is a four-fold protection effect.   This combination also improves when ferulic acid, an omnipresent antioxidant in plants, is added and this creates an eight-fold protection from ultraviolet radiation.

Although many sunscreens on the market now include antioxidants, “C E Ferulic”, or “Skinceuticals”, is the only existing product that has the correct amounts of the three antioxidants.   Most other vitamin C and E products are useless for skin protection.

Sunscreen Imports

Unlike the U.S., Europe sunscreens are classified as cosmetics instead of drugs, so approving new products is simple compared to the U.S. formalities.   The FDA established the Time and Extent Application (TEA) in 2002 which gives OTC drugs with a marketing history of at least five continuous years outside the U.S. an inexpensive alternative.   However, new companies have to file an Investigational New Drug Application (IND) and await approval or allow five years to pass.

Safer Tanning

Although many people know that sunbathing isn’t healthy for the skin, certain lifestyles are hard to break.   One substitute for outdoor tanning is dihydroxyacetone (DHA)-based sunless tans which exclude ultraviolet.   DHA tans are classified as cosmetic according to FDA so it passes the safety regulations for skin use.   The DHA tan appears more natural on skin phototypes II and III that are still young and smooth, and even then, DHA tanning still needs practice.   DHA-based products can last as long as four days, but the tan on the face generally vanishes faster because the skin is thinner and washed more.   Maintaining an even tan may become quite an obstacle with a mismatch in tan length across the body.   In addition, the DHA-based tan may include sunscreen, but the ultraviolet blockers wear off long before the color of the tan does.

A Final Note

Since the tan remains a fashionable trend today, the best people can do is appropriately protect themselves.   Knowing the facts and the latest defensive products against ultraviolet will help prevent skin cancer and other ultraviolet damages.