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!
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!
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.
Myths About Dry Skin
Even though dry skin is much more widespread during the winter months, it can still show up during other seasons and even throughout the year for some people. Although it is a common skin condition, there are still many misconceptions surrounding dry skin as well as the causes behind it. Below, we will examine some common myths and explain why they are not true.
It is commonly believed that dry skin is a result of not drinking enough water or, on the other hand, keeping your body hydrated will maintain the moisture in your skin and prevent dry skin. But, the truth is that drinking water does not have any bearing on how much moisture is present in your skin. If your skin is dry, it’s important to add moisture from the outside in, such as by suing a moisturizing wash and using creams, lotions or ointments.
It is not just the cold air outdoors that causes the skin to dry up; rather it’s also the warm dry air indoors with low humidity which makes skin dry and flaky. However, it’s important to have a more moist environment during the winter months; using a humidifier in your room can increase the humidity and keep your skin healthy.
Contrary to popular belief, hot showers do not moisturize your skin. Instead, the heat from hot water causes the natural oils in the skin to dry out which leads to dry skin. Despite how soothing it may feel, it will do your skin wonders by turning down the heat in the shower to luke warm.
Moisturizers are only effective if they have the right ingredients. Look for products that are hypoallergenic and fragrance free. Do not use scented moisturizers, since these chemicals may irritte the skin even more.
That is not necessarily the case because any harsh soap will actually strip the moisture from the skin. As a result, this can cause dry skin. So, it would be a good idea to choose a soap that is made specifically for dry skin and is gragrance and scent free.
Once again, dry skin is not something limited to certain people or specific times of the year. If you are someone who has dry skin or any other skin condition, consider booking a consultation with Dr. Goldenberg online or by calling us at 212-241-9728.
Psoriasis is a multifactorial genetic condition in which inflammation is increased and skin cells turn over at a higher than normal rate. On the outside, the increased scale is caused by rapid growth of skin cells. This in turn causes skin cells to accumulate on the surface of the skin and cause silvery scale. On the inside, there is an increase in inflammation. This inflammation causes the skin to be red and inflamed. This likely causes the itching and burning commonly seen in psoriasis.
The most common type of psoriasis is called psoriasis vulgaris (common psoriasis). These patients have insolvent of the skin extensors, such as knees and elbows, scalp and buttocks. However, every inch of skin can be covered with psoriasis in severe cases. Other types of psoriasis include inverse psoriasis, guttate psoriasis, pustular psoriasis and erythrodermic psoriasis
The inflammation that is seen in the skin of psoriasis may also be occurring in joints, causing psoriatic arthritis. It’s also been shown that patients with psoriasis are at an increased risk of heart disease, stroke, diabetes, insulin resistance, metabolic syndrome, depression, smoking and alcohol abuse.
Psoriasis is a chronic condition for which there is no cure. However, multiple treatment options exist for patients with a wide range of disease, from mild to severe. These include:
Creams and ointments are the most commonly used option by people. Light therapy has been proven to work by slowing cellular growth and nullifying the effects of psoriasis. Oral medications can help with moderate disease with a good safety record. Injectable biologic drugs target specific parts of the immune system effected by psoriasis and are administered through injections. These medicines are safe and effective for both, psoriasis and psoriatic arthritis.
To understand your psoriasis better and to find the right treatment for it, book your consultation today with Dr. Gary Goldenberg at one of his New York dermatology offices.
Caring for your skin to make sure it’s healthy and beautiful is important. However, there is a lot of misinformation about this very topic. Myths of skin care are rampant on the internet and beauty magazines. Here are some of the myths…debunked!
Myth #1: Drink more water for dry skin.
If you suffer from dry skin, you might think that drinking more water will help but dry skin isn’t as simple as that. In fact, drinking more water won’t make dry skin better. Studies have shown that water content of dry skin, normal skin, and oily skin have very insignificant differences. Dry skin occurs when the substances between skin cells are depleted and damaged; thus, becoming rough, uneven, flaky and allows water to be lost. Drinking more water won’t moisturize your skin unless the outer barrier is maintained. Therefore, the treatment of dry skin should come from the outside, i.e., by applying a moisturizer to re-hydrate their skin and maintain their outer barrier. It’s also important to protect your skin by avoiding irritating ingredients, sun damage, harsh chemicals and fragrance.
Myth #2: Tanning clears up acne.
One of the most common skincare misconception is that tanning can help with acne. First and most importantly, there is no doubt that tanning and sun exposure in general cause skin cancer, such as melanoma. Although acne breakouts are less noticeable after tanning, it doesn’t completely heal or prevent acne. Tanning covers up skin’s redness and dries up the surface of your skin, which may help some blemishes fade temporarily. However, it is not a permanent solution. In fact, tanning actually causes skin irritation and weakens your skin’s natural barrier. In addition, too much sun can break down collagen that keeps your skin elastic, which can lead to the formation of wrinkles and fine lines. I recommend that everyone wear sunscreen with an SPF of at least 30 every time they are outside, even on cloudy days. As far as acne goes, there are many safer and more effective acne treatments than exposing yourself to sun’s harmful rays.
Myth #3: It’s better to pop pimples.
Although popping pimples makes them less noticeable for the time being, it doesn’t prevent future acne breakouts and can cause scarring of the “popped” pimple. When you squeeze a pimple, the pus actually goes deeper and pushes bacteria, dead skin, and oil further into your skin. This causes more inflammation, swelling, and redness and can also lead to acne scars and even more breakouts. These acne marks can last for months or years and even create permanent lasting scars. The best treatment for acne is treating current breakouts and preventing future breakouts form happening. I also tell all patients that it is crucial not to pick at their face. The residual redness, hyperpigmentation and scarring can last for a very long time. Although it may be hard to resist, it’s better to not pop your pimples.
To effectively treat your skin care needs, consult with a dermatologist who can provide you with the best advice for treatment. Visit Dr. Gary Goldenberg at Goldenberg Dermatology to set up your consultation.