Renaissance Plastic Surgery

With the upcoming Melanoma Awareness Month (May), this post will get you ready for a sun-damage-free summer.

Going back 75+ years, women never had their bodies exposed to the sun and a female would be looked down on by society if an area such as the chest, neck or even face had any signs of sun damage. People aged better then and skin cancer was very rare. As the 1950's and 60's brought less clothing coverage, the damages of sun exposure became apparent. Now, most all of us can admit to the iodine, baby oil, tanning beds, etc. We must also confess to having at least one sunburn in our lives. And most of us cannot remember ever having sunscreen applied before going out to swim, or, much less, to just go outside to play. We can for the most part claim ignorance (or we'd like to), on the damage that the sun was causing and how it would effect our skin later in life.

Well, we can no longer claim ignorance! The statistics are staring us in our sun-damaged faces:

• The percentage of skin cancer in women under the age of 40 has tripled over the last 30 years
• It only takes one blistering sunburn in childhood to more than double a person's chance of developing melanoma
• Skin cancer is the #1 cancer in men over 50, more than lung and prostate cancer
• Melanoma is the third most common cancer in women 20-39 years old
• Exposure to tanning bed UVA rays before 35 years of age increases your risk of melanoma by 75%

It is essential that we take action on what we know and protect ourselves and our families.

We know that sunscreen is one way to protect our skin from the sun. But did you realize that it is necessary to use sunscreen everyday of the year? The UVA (aging) rays are constant year round, not just on the sunny summer days. These are the rays that we now know cause the majority of the skin cancers and are responsible for 80% of the damages we see as we age: laxity, brown spots, broken blood vessels, etc. There are also the rays that penetrate through your office window, car windows, and clouds and they are the primary rays in tanning beds.

Therefore, our sunscreens need to provide protection against both UVA and UVB (burning) rays. SPF in most over-the-counter sunscreens measures the amount of time you can stay in the sun without burning, so they only measure the UVB rays. Most of these sunscreens are typically "chemical" sunscreens; meaning, they contain ingredients that are absorbed in our skin before being activated. Therefore, you must apply them 30 minutes before sun exposure! Plus, they can sometimes clog pores, causing acne or hyperpigmentation, and they should not be used on our children under 12 months old.

Zinc and titanium are broad spectrum, "physical" sunscreens that sit on top of the skin and reflect the sun's rays. Physical sunscreens cover both UVA and UVB rays. Recently, the FDA has approved the use of Mexoryl SX, which has been used in Europe for over 15 years. It is the highest protection against UVA rays and available in the daily sunscreen Anthelios, from La Roche-Posay.

Here are some other misconceptions about SPF's, sunscreens and tanning:

• "The SPF in my makeup/moisturizer will protect me from sun damage."
• "Once I apply sunscreen, I'm good for hours."
• "I need to get a good base tan before I go on vacation, so I don't burn."

Do you know how much sunscreen should be used? This is the biggest misconception on sunscreen use to this day. A proper dose is one ounce, or a whole tablespoon. The SPF in makeup and moisturizer is so diluted that it is not giving you ANY protection. We would have to use the entire bottle on our face! It is great for added protection; but, it should not be trusted as our only defense.

Sunscreen should be used daily, every morning before you leave the house. As we are out in the sun for a long period, we should reapply every 90-120 minutes. If we are swimming or perspiring, it may be rubbing off, so reapply often.

The base tan you go get before your Cancun trip does not protect you. Being darker only protects you if you are naturally that dark. Despite what the salon tells you, tanning beds will harm you even worse than the sun. A short 15 minute stint in the tanning bed is the same as being in the sun for 8 hours! The last several years have produced many self tanners that look so natural and last much longer, that there is really no need to risk the damage from tanning beds. While you're at it, buy your teenage daughters a bottle, so they too can look sun-kissed without the sun-damage.

The fact is every person should be applying a SPF 15-30 sunscreen everyday. This includes our husbands and our children. If we teach our children now by making sunscreen part of our daily routine, they will be in the habit when they are older. So as the summer sun is beating upon us, please be sun smart and protect yourselves and your families.

The internet is such a fascinating technology.  It's hard to believe that only a few short years ago we were not able to buy things over the internet, or much less, converse with friends and family.

As a skin care specialist one thing that is concerning about the internet is the self-diagnoses and self-treatment that occurs because of the products available for sale online.  People can log on and diagnose themselves with something like rosacea, then shop online, and buy a prescription cream from, say, a Canadian supplier, and self-treat.  This undermines the education that a physician or specialist have and the expertise they can provide.  Yes, it is more convenient to shop from home and often less expensive, but how could it be safe?

Buying products over the internet can pose some real dangers.

• What is truly in the bottle?
• Is it expired?
• How long was it sitting on a shelf?
• Was it sitting in extreme temperatures that may have ruined the efficacy of the product?
• If there are any problems, would the website accept the return of your product?
• Are there any licensed practitioners who would be available if you have questions?
• Who would be available for you to meet with if you have an adverse reaction?

If some type of reaction occurs, the most likely call will need to be to a true skin care practitioner who can help.  But, if the doctor or nurse has not treated you or recommended the products being used, then how can the practitioner effectively help when he or she doesn't know the answers to the above questions?  Reputable companies only have their physician-strength products available at a physician's office, where experts can monitor and direct the use of each product for each patient, individually.   

Here is another concern.  Anyone can buy chemical peels and microdermabrasion machines.  Do they know the risks involved and how they could damage or scar their skin if they don't apply the peel or use the machine properly?  Are they choosing the treatment that is right for their skin condition or type?  We have seen the effects of self treatment as they come in, asking us to fix the problems that have been caused by at-home treatments.  When it comes to your face, you definitely want someone that is qualified to help, diagnose, and treat you.

True skin care practitioners and specialists have extensive training in skin care, plastic surgery and skin care products to ensure patient safety and the best results.  You can also expect them to have continuing education and product-specific training to reinforce their expertise.  Please for your own skin and health safety, trust the knowledge, education and experience of true skin care specialists.

For many years women have been plagued by the discoloration of the skin known as Melasma. The pigmentation typically presents itself in a symmetrical pattern on the face either on the cheeks, upper lip, forehead, etc. It may start very faint especially in those with fair skin. Those with darker skin types especially Hispanic and Asian skin types may notice this more often and it may present itself darker.

Not only can pregnancy cause this skin condition but it has also been linked to birth control pills, oral acne antibiotics, anti-malarial medication as well as hereditary factors. Some people may notice it later in life and can attribute it to excessive sun damage to the deeper levels of the skin. Some people may also notice this after certain types of skin care treatments at spas.

So how can this condition be treated?

First, know that this condition has no long term effects or harm to the body. Treatment is completely cosmetic. Treatment in some individuals can be very costly depending on the severity of the case. Also note that all treatments are only minimizing the pigmentation and that with sun exposure and other hormone related issues the pigment can return or get worse. Our pigment cells called melanocytes have a memory and with any type of triggers they can, and will, release more pigment. That is why first and foremost sunscreen is a must! It is recommended you use more physical blocks such as zinc and titanium. Chemical sunscreens, which are most of the over-the-counter sunscreens, contain chemicals that can actually trap in the heat and stimulate worsening of the pigmentation. A favorite sunscreen for those with melasma is the Colorescience Sunforgettable powder sunscreen because it is a physical block but, unlike creams, it lets the skin breathe and does not trap in the heat. It is also very water resistant!

Prescription creams such as hydroquinones (4% or higher) and Retin-A are also a gold standard in caring for melasma although they can not be used while pregnant or breastfeeding. Hydroquinones work by suppressing the melanocyte cells so that they do not overproduce pigment. The Retin-A works by stimulating cell turnover which will bring the pigment to the surface to be exfoliated. Best results are found when these two prescriptions are used together. But be cautious, these are prescriptions and need to be used under physician supervised care and that hydroquinones are not intended to be used daily for the rest of your life. It is best to be used short term and then intermittently as pigment returns.

Certain types of peels such as TCA peels, certain lasers such as IPL or BBL, and light resurfacing treatments are also used to speed up the process of evening out the tone of the skin. Although, there are small risks associated with these deeper treatments such as scarring or worsening of the pigmentation. Regardless of any in-office treatments, it is always recommended you pretreat with hydroquinones and Retin-A (such as Tri-Luma cream) prior to treatment and resume when your skin care specialist or physician recommends.

Whichever option you and your skin care specialist or physician choose, be aware that your treatments are only minimizing the pigment and that you will always be working on maintaining the health of your skin. Discuss with your physician and don't forget that sunscreen and minimizing sun exposure is #1 in preventing and maintaining your melasma.