Melasma is a condition related to sun exposure and your normal hormones. It is more common in women, but can be seen in men as well. It is seen in patients of all skin types, with most common location on the cheeks, upper lip, and forehead.
Treatment includes the following:
1. Sun protection:
Sunscreen and sun protection are first and most important step. Daily sunscreen use in imperative, all your round. This is especially true during summer months. I recommend SPF30 and above.
2. Topical bleaching creams:
Multiple topical bleaching creams exist. Some of these are prescription, such as hydroquinone, and others are cosmeceutical and over the counter. These work best when used in combination with sunscreen and procedural modalities.
3. Microneedling with platelet rich plasma (PRP):
This treatment improves melasma by peeling the superficial layer of the skin and stimulating healthy skin to replace the sun-damaged skin. PRP, in turn, helps stimulate collagen and give the skin glow after the procedure.
4. Laser therapy:
Laser therapy is usually used to resurface the skin and peel the abnormal skin off so it can be replaced by normal non-sundamaged skin.
5. Combination therapy:
The best approach to treating melasma is combination therapy that includes all of the above options.
My patients want to look better – a little lift, smoother wrinkles and lines, no pigmentation or melasma, get rid of that acne scarring and spider veins, younger hands/neck/chest/hands, stronger/more masculine jaw (mostly men), softer features (mostly women), improved profile with decreased fat (yes, I said it, fat) under the chin, and so on. But all patients also want this: “I want to look natural”. Or, “I don’t want my friends/family/spouse to know that I am getting ‘work’ done”. Or, “I don’t want to look like one of those men/women.” In a way, this is a paradox. But in a way it’s really the right way to think about a non-invasive cosmetic patient – it’s possible to look your best and natural at the same time.
So what defines a successful cosmetic procedure:
Look natural. To me, this is most important. While non-invasive procedures really can change the way one looks, keeping your natural appearance always looks best. Just think of that friend you have that had “too much work”, or that celebrity who reappeared and looks unrecognizable. Does anyone really think they look great?!? Enhancing one’s appearance always looks better. This can easily be achieved with non-invasive treatments, such as botox, fillers, and lasers. Cutting edge technology and medical advances have revolutionized what it means to “have work done.” Microneedling with PRP can stimulate collagen and improve pigmentation. Fraxel can help smooth out wrinkles and lines, as well as acne scars. Clear and brilliant laser can decrease pore size and leave your skin glowing with fewer blemishes – all with minimal down time.
Small changes over time add up to improve one’s appearance. That’s what I tell my patients daily. Sure, we could “do it all” today. But do we want to? I would rather layer deep fillers, such as Radiesse, with more superficial ones, like Juvederm or Restylane, on different visits. Not only to avoid a drastic change in the patient’s appearance, but also because it looks better and more natural. Lasers may require multiple treatments, and “turning it up” may leave patients looking worse.
Combination of different treatments always works better. Using fillers, botox and lasers together produces better overall results. Why? Because each of these treatments is designed to improve a particular problem. No one product works for everything.
Touch ups/continued treatment are important. While some products last longer than others, no product or treatment lasts for ever. So one needs to have realistic expectations of the upkeep necessary.
Don’t forget good skin-care. Good skin-care is easy. It only required three basic things – gentle cleanser, sunscreen and moisturizer. Sure, one can do a lot more, but doing the basics can produce great results.
So next time you see me in the office for a cosmetic consultation, have this in mind. We will work together to come up with a treatment plan that will have you looking natural and your best at the same time!
Top 5 Ways to Repair Summer Sun Damage
One of the most common questions from patients after summer months are over is “How can I repair all the damage I may have done from sun exposure?” This happens to even the best of us – we try to stay in the shade, use sunscreen and wear a hat. But nonetheless, the sun penetrates our defenses and we are left with freckles, pigmentation, melasma, or (worst case scenario) abnormal moles and skin cancer. Other than getting a complete skin check to rule out any abnormal moles or skin cancer, follow these steps to improve your sun-damaged skin:
1. Skin-care: Sunscreen with SPF 30 or higher should be used daily. Just because summer is over, doesn’t mean that you aren’t exposed to harmful UV rays. Furthermore, the type of UV that caused wrinkles and hyperpigmentation is not always filtered by windows. Moisturizer is also an important aspect of daily skin-care routine. As is a gentle cleanser. I tell my patients that using these products is like brushing your teeth – you just do it every day.
2. Retinol and retinoids can help repair some of the sun-damaged skin. These products promote normal development of skin cells, and can improve the overall appearance of the skin, as well as wrinkles/lines and pigmentation/melisma to a certain degree.
3. Clear and Brilliant laser can help skin cells turn over more rapidly, producing sloughing of damaged cells and growth of new, healthy, better appearing skin. I call this a lunch-time laser, since it’s virtually painless and has minimal downtime.
4. Microneedling with platelet rich plasma (PRP) helps to promote turn over of skin cells, stimulate collagen and improve the overall appearance of skin. The stem cells and growth factors found in PRP have been knows to give skin a particular glow, and promote healthy, beautiful appearing skin. This procedure is virtually painless (all patients receive an anesthetic) and has minimal downtime, with redness lasting about 24 hours.
5. Fraxel Dual is a laser resurfacing procedure that can help stimulate collagen growth, improve pigmentation and melasma, as well as wrinkles and acne scarring. This procedure is performed after application of a topical anesthetic and is virtually painless when done correctly. After the procedure the patients are usually red and the redness may last about 3 days (so plan on some down time). After the redness subsides, the skin will slowly peel, unmaking healthy, beautiful skin.
With these 5 simple steps, you can repair your skin after a long summer of sun exposure. But of course, prevention is most important. So let’s try to do better next summer!
As the largest organ, the skin plays in important role in protecting your body, controlling your internal temperature, and balance of water, vitamins, or minerals. It is essential to take proper care of your skin because exposure to sun and UV can potentially lead to skin cancer. Skin cancer is a disease in which malignant cells form in the tissues of the skin. According to the Skin Cancer Foundation, approximately five million Americans are treated for skin cancer every year and about one in five Americans will fight skin cancer. The three most common types of skin cancer are basal cell, squamous cell, and melanoma.
Basal cell carcinoma is the most common form of skin cancer. Starting in the basal cells of the epidermis, basal cell carcinoma usually appears as small bumps or nodules on the skin. Overtime, BCC can spread to surrounding tissues and even affect nerves and bones, causing severe damage and disfigurement. Since the major cause of BCC is chronic sun exposure, it commonly appears on areas frequently exposed to the sun such as the face, neck, arms, and shoulders but can also develop in others parts of the body. Although it can occur in all races, those with fair skin have a higher risk of developing this type of skin cancer. People who spend long hours in the sun or tan often are also more susceptible to BCC. If diagnosed early, basal cell carcinoma can be easily treated.
Squamous cell carcinoma is the second most common type of skin cancer. Occurring in the outer layer of the skin, squamous cell carcinoma is a tumor that often appears as a red firm bumps, scaly patches, or sores. SCC can occur anywhere on the body but usually form on areas that are frequently exposed to the sun such as the face, lips, scalp, ears, etc. SCC is more likely to develop in middle aged- and elderly people, especially those with fair skin complexions. Squamous cell carcinoma can grow deep in the skin and spread to other parts of the body, causing damage and disfigurement. With an early diagnosis, squamous cell carcinoma may be treated.
Melanoma is most deadly form of skin cancer. Affecting over 44,000 people in the United States each year and causes the most deaths, melanoma usually develops as a dark mole or spot on the skin. Melanoma can develop from a mole or arise as a melanoma from the start. Excessive sun exposure and UV radiation are the main causes of melanoma; however, genetics is also a key factor in developing melanoma. Those who have family members who suffer from melanoma are more susceptible to this type of skin cancer. Melanoma spreads very quickly and can become fatal; therefore, regular check-ups and early diagnosis is crucial in order to properly treat this type of skin cancer.
Depending on the stage of cancer, there are many different treatment options. Surgery is the most common treatment for skin cancer. If the cancer has not spread to other parts of the body, surgery is usually successful in removing the cancerous mass. Another treatment option is chemotherapy, which utilizes anti-cancer drugs to destroy or control the growth of cancer cells. Radiation is also a treatment option for those who suffer from cancer. Radiation therapy uses ionizing radiation to kill or control malignant cells. Other treatment options for skin cancer include photodynamic therapy, laser surgery, or topical medications. Visit Dr. Goldenberg at Goldenberg Dermatology to if you think you may have skin cancer and for tips to prevent skin cancer.
Since its appearance on the aesthetic medicine scene, Botox has skyrocketed in popularity to become the single-most requested rejuvenating procedure in the United States. With over 6.6 million treatments reported a year, Botox and other botulinum toxin type A-based injectables (Dysport and Xeomin) eclipse both surgical and non-surgical treatments.
Despite its wide use, there are still some “Botox myths” that persist. Here are 5 common misconceptions about Botox:
People often wonder what exactly rosacea is. The simple answer is: rosacea is a chronic skin condition that appears most often on the face causing the skin to turn red and making it vulnerable to pimples and bumps. However, in certain cases, it can spread to the scalp, eyes and chest and may even make the skin swollen and coarse. This widespread skin condition is chronic and about sixteen million Americans are victims of it. Although it affects all skin types, it is most commonly found in individuals with light skin and affects women more than men.
Unfortunately, there are no permanent cures for rosacea – so, even if it disappears after a treatment, it may resurface at a later time. The good news is that it can be dealt with in several different ways. There are many things which trigger its breakout and different individuals have different reasons that make them likely to develop it.
Rosacea is of different stages and subtypes. Moreover, if left untreated, it can become worse and advance through these stages. The four subtypes are:
Usually, it begins in the first stage as some redness on the face and sometimes causing blood vessels to become visible. In the second stage it evolves into bumps and pimples. After that, the third phase can results in thickened skin, especially around the nose area – in fact, the nose itself may begin to appear bulbous. Lastly, it spreads from that point and begins to cause an irritation in the eyes.
While there are topical creams and ointments available to treat the symptoms of rosacea, the results unfortunately are not always all that fruitful. This is why at Goldenberg Dermatology, Dr. Gary Goldenberg uses the V-Beam Laser and Blue Light therapy to treat rosacea. Both of these are new and innovative methods of treating a wide range of skin conditions, including rosacea.
If you are a victim of rosacea and are considering treatments beyond the typical over-the-counter products, then please schedule a consultation with Dr. Goldenberg at his New York office.
3 ways to decrease dry skin:
1. Add moisture to your skin:
Using a moisturizer regularly is one of the most important steps in restoring your skin’s moisture balance. It’s important to moisturize daily, and for those with dry skin or eczema, twice daily. Any moisturizer is better than doing nothing. But when given a choice, choose a product that’s hypoallergenic and fragrance free. It’s also important to choose a product that has barrier repair properties – helps the skin restore the normal barrier between itself and the outside world. While in the past it’s been said that ointments are better than creams or lotions, some of the new products can add the same amount of moisture without leaving a greasy residue.
2. Add moisture to your air:
This is especially important for those who live in dry climates or suffer through cold, dry winter months. Not only can dry and cold weather strip your skin of natural oils, using dry heat in your house makes it even worse. A simple solution is to add a humidifier to the heat or air conditioning unit. If that’s not a possibility, as in most apartments in New York City, adding a portable humidifier can help.
3. Showers matter:
One common reason or dry skin is long, hot showers. By turning the water temperature down and decreasing duration of your shower, you can protect your skin from becoming too dry. The soap you use in the shower is also important. “Real soap” can strip away skin’s natural oils and moisture. So unless you have real dirt on your skin, choose a gentle wash or cleanser. Soaps and washes that are fragranced can also irritate and dry the skin. An ideal body wash is fragrance free and is moisturizing.
More questions about your dry skin? See Dr. Goldenberg for a skincare consultation.
Top 5 ways to prevent wrinkles:
1. Sun protection:
Ultraviolet (UV) radiation is one of the biggest causes of wrinkles and skin aging. UV rays cause the superficial part of the skin (epidermis) to thin and become cigarette paper like. The dermis (middle later of the skin) may develop brown spots, decrease in collagen (which causes skin to thin) and dilated blood vessels. The deep layer of the skin (fatty layer) thins and causes loss of volume, which is usually seen on the face and backs of hands. Of course, these changes can be prevented with behavior modification – use of broad spectrum sunscreen with SPF 30 and above, sun protective clothing and seeking the shade.
2. Moisturize your skin:
No matter what kind of moisturizer you like, it’s better than using nothing. We know that skin that’s dry and flaky is more likely to look aged and is more likely to age more rapidly. Use of moisturizer twice daily, with sunscreen in the morning and barrier repair at night, can help add moisture to your skin and decrease appearance of wrinkles.
3. Lifestyle modification:
Any type of stress will cause your skin to age more rapidly. Stress avoidance or reduction can help restore and protect your skin from wrinkles. Poor lifestyle choices, such as poor diet, smoking tobacco or drinking too much alcohol, have also been associated with premature aging and increased wrinkles formation.
4. Prevention of dynamic wrinkles:
This is often the first cosmetic procedure most people will have – botox, dysport or xeomin injection. Dynamic wrinkles are those that are cuased by muscle movements – such as the “11” or “111” lines (angry face), horizontal lines on the forehead, and lines around eyes and mouth. By decreasing muscle movements with one of the above agents, it’s possible to smooth out those lines and decrease their progression.
5. Treatment of etched-in lines and wrinkles:
Once wrinkles become permanent (not related to muscle movements), there are only two ways to decrease their appearance – lines can be filled or volumized and laser surgery can be performed to resurface the skin to decrease appearance of these wrinkles and lines. Often the combination of these treatments is needed for optimal results. Fillers, such as restylane, juvederm and belotero, can be used to fill lines and decrease their appearance. Deeper fillers, like juvederm voluma, restylane lyft, radiesse, and sculptra, can be used to volumize and reshape facial appearance. This, in turn, will decrease appearance of wrinkles and lines. Laser resurfacing, such as with fraxel dual, is great for decreasing appearance of lines that are more superficial and present throughout.
Prevention and treatment are both key. See Dr. Goldenberg for a consultation and learn how to look your best!
3 ways to decrease risk of skin cancer:
1. Sun protection:
Sun protection is most important to prevent and decrease the risk of skin cancer. This is accomplished in several ways. Sun avoidance, such as walking on the shaded side of the street, avoiding mid-day sun, and using an umbrella at the beach are important. Wearing a wide-brimmed hat and other sun protective clothing is important. Special clothes are available for outdoor activities, such as golf or tennis, running, going to the beach and etc. These clothes have “UPF” – the fabric is woven tightly to prevent sun’s harmful rays from penetrating the article of clothes. Some new options include fabrics to keep one cool and absorb sweat. Using sunscreen is one of the cornerstones of sun protection. Look for a trusted brand sunscreen with broad-spectrum protection, SPF 30 and above, and water resistance. Spray sunscreen have been recently criticized for not working as well if not rubbed in. The amount of sunscreen used is important – apply about a shot-glass amount each time. It’s also important to reapply regularly, about every 3 hours or so, especially after being in water or participating in a physical activity.
2. Yearly skin check:
The American Academy of Dermatology recommends a yearly full skin check with a Board Certified Dermatologist for those 18 years old or over. During this exam a dermatologist will check your skin from head to toe. Although skin cancer is most common on sun-exposed skin, it’s also important to check areas where “the sun don’t shine,” since some patients may develop skin cancer in those locations. This is especially true for those who’ve used tanning beds in the past. The goal of this exam is to find abnormal lesions early, either to prevent development of skin cancer or to find skin cancer when it’s least invasive. If an abnormal lesion is found, a biopsy may be performed. Depending on the results, your dermatologist may perform an additional treatment of skin cancer and ask you to follow up more often than annually.
3. Perform a monthly self skin exam:
A monthly self skin exam may help you find an abnormal mole or even skin cancer. Look for lesions that are new, changing in size, color or texture, or are painful, itchy or sore. While benign lesions may sometimes produce all of these changes, make sure to see your dermatologist to have the lesion checked.
See Dr. Goldenberg for your skin cancer screening yearly or more often if needed.
5 treatment options for adult female acne:
Acne was always thought of as a disease that mainly effects teenagers. But in the past decade the fastest growing segment of population with acne is adult women. Some of these patients never had acne as teenagers, only to develop it in their 20’s and 30’s. It’s unclear why there is such an increase, but diet, lifestyle and hormonal abnormalities have been implicated. Treatment of adult women with acne is a bit different than that of teenage acne, and should be approached on an individual basis.
Good skincare starts with a good cleanser. A gentle cleanser can be sued once daily and a medicated cleanser, such as one containing salicylic acid or benzoyl peroxide, can be used daily. A moisturizer can be used, especially if the skin becomes dry from using prescription products. Many patients with acne have combination skin – dry and oily areas. It’s important to add a moisturizer, especially to the dry skin areas.
2. Prescription topical creams:
Retinoids are a cornerstone of topical acne treatment. These are not to be confused with retinol, which is sold over the counter with claims of decreasing wrinkles and lines. Prescription retinoids are available in different concentrations and formulations. Oftentimes it’s trial and error to pick the one that will work for a certain patient, and this is something to discuss with your dermatologist. Other prescription topical agents are also available to treat acne bumps, such as combination of antibiotics and benzoyl peroxide, sulfur products and other combination products.
3. Oral therapy:
Antibiotics are commonly used to treat acne, especially moderate to severe acne in adult women. The products are especially effective for pustules (pus bumps) and cysts. However, long term safety of these products has been questioned and once acne is under control, it’s best to stop taking antibiotics.
Retinoids, such as isotretinoin (commonly known as “Accutane”) is a great option and may be the only option to offer a chance of a cure. This medication should be taken only under supervision of a dermatologist experienced in using this medication, since laboratory monitoring is needed and potential side effects need to be monitored.
Medication to improve possible hormonal imbalance may be helpful. These include birth control pills and spironolactone.
4. Procedural treatments:
Photodynamic therapy with blue light has been shown to improve acne. Blue light is likely the safest treatment option for acne during pregnancy, since no medication is used and the patient is simply exposed to blue light. This treatment has shown success, especially in patients with pustules and cysts.
Injection of cysts or pus bumps with a steroid can help improve these lesions quickly and may prevent scarring caused by inflammation.
Laser procedures, such as clear and brilliant or fraxel, can help shrink pores and decrease appearance of acne lesions, as well as even out the skin complexion in those patients who develop dark marks as the result of acne. V-beam laser can help with persistent redness often found after acne bumps resolve.
5. Lifestyle modifications:
Acne is worsened by stress and has been associated with poor diets high in non-organic dairy products and sugar.