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Goldenberg Dermatology, PC

14 East 75th St. NY NY 10021 | 212-405-8202 | appointments@goldenbergderm.com

5 ways to treat melasma

December 04th, 2016 | Category: Cosmetic,Dr. Goldenberg,Media

 

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.

What’s Your Skin Type?

October 28th, 2015 | Category: Acne,Cosmetic,Dr. Goldenberg,Media

 

Some people have skin that constantly begs for moisture, while others cannot seem to counteract excess oil. Genetics influence your basic skin type, but environmental factors also play a role. Moreover, skin changes over the course your lifetime. Understanding your skin type can help you make the right decisions when it comes to skin care.

Dry Skin
Dry skin is characterized by a lackluster complexion, fine lines and diminished resilience. If you have dry skin, you may see it worsen seasonally or notice a change when you are in certain climates. Winter weather can exacerbate dry skin, potentially causing rough patches, itching and scaling. A dry or windy environment can leave the skin feeling sapped of moisture. If left untreated, the skin can crack, leaving an exposed wound, susceptible to further damage and possible infection. Individuals with a history of eczema are more likely to struggle with dry skin. Age is also key: as the skin ages, it loses elasticity and its ability to replenish moisture.

Caring for dry skin: With dry skin, it is important to avoid oil-stripping products, such as harsh soaps or cleansers. Washing your face excessively or with overly hot water can rob your skin of moisture. If your skin is feeling tight, use a gentle moisturizing cleanser and avoid scrubbing your face. Use a daily moisturizer with SPF to help protect your face from the sun’s harmful rays in the morning. At night, use a heavier cream to sooth the skin. Make sure to bathe with a gentle, fragrance free wash. Detergents and fabric softeners should also be scent free.

Oily Skin
Small glands in the skin–called sebaceous glands– produce an oily substance that lubricates the skin (sebum). When the sebaceous glands secretes excess sebum, the result is oily skin. People with oily skin often have enlarged pores and a shiny complexion. Hormonal fluctuations, stress, and overuse of skin products can trigger the overproduction of sebum. Blackheads and other blemishes are often associated with oily skin.

Caring for oily skin: To keep your skin radiant, without the extra shine, gently cleanse your skin in the morning and night with a mild cleanser.Scrubs can help remove excess oil, but when overused, they can irritate the face, prompting the skin to produce more oil. Although it may seem counterintuitive to those with oily skin, it is important to apply a daily moisturizer, no matter what your skin types. Keep your skin moisturized with an oil-free lotion; it may not give a perfectly matte finish, but it will not contribute unwanted sheen. Prescription creams, such as retin-a, can also help with excess oil production. Certain laser procedures, such as fraxel dual and clear and brilliant laser can help decrease oiliness and reduce pore size.

Combination Skin
Like many people, your skin type may not fit perfectly into dry or oily categories. Combination skin describes skin that has dry or normal patches as well as oily areas. A common example of combination skin is dry-to-normal cheeks with an oily T-zone–named for the t-shape formed by the forehead, nose and chin.

Caring for combination skin: Wash your face with a gentle cleanser that is safe for all skin types. To even out your complexion, you can try tailoring your skin care routine to target different areas. For example, the dry areas may benefit from a more intense moisturizer, while the oily areas may be responsive to products that contain oil-neutralizing acids. Prescription creams, such as retin-a, can also help with excess oil production. Certain laser procedures, such as fraxel dual and clear and brilliant laser can help decrease oiliness and reduce pore size. This can particularly help with the oily areas of the skin.

Acne-Prone Skin
One of the most frustrating skin types is acne-prone skin. When pores become clogged with oil, dead skin and bacteria, pimples (acne) can form. Hormonal change, certain medications and stress are all factors that can contribute to flare ups. Acne can have a devastating effect on self-image and is one of the leading reasons people seek a dermatologist’s help.

Caring for acne prone skin: If you have a blemish, do not aggravate it. Cleanse your face using your hands and a cleanser that contains an acne-fighting agent, such as salicylic acid or benzoyl peroxide. Use moisturizers and other products that are labeled non-comedogenic–these specially formulated products will not clog pores. If you have recurring breakouts or cystic acne, it is best to consult a dermatologist. Because acne can lead to permanent scarring and skin damage, it is best get it under control as soon as possible.

No matter what your skin type, a healthy lifestyle will help keep your skin supple, even and clear. A nutrient-rich diet loaded with fresh fruits and vegetables can help keep the skin functioning optimally. Smoking and alcohol consumption can be dehydrating, depleting the skin’s reserves and inhibiting its ability to regenerate. Staying well-hydrated and eating properly will support the skin’s overall health and appearance–whether dry, oily, or blemish-prone.

3 Pillars of Improving Your Appearance

October 18th, 2015 | Category: Cosmetic,Dr. Goldenberg,Media

 

I am happy to announce that on November 4, I will be discussing these topics with members ofThe Transition Network, NYC Chapter.

There are 3 Pillars of Improving your Appearance with Cosmetic Dermatology:
1. Skin Care
2. Improving skin quality and texture
3. Volumizing and contouring with fillers and toxins

1. Skin Care:
Skin care does not have to be complicated or expensive. Basics of skin care include sun protection, moisturization and cleansing. Use a gentle cleanser twice daily. In the morning apply sunscreen with a moisturizer. This product can be used under your makeup or as an aftershave. At night, use a rich moisturizer or a barrier repair cream.

2. Improve skin quality and texture:
Skin quality problems include pigmentation, such as melasma, hyperpigmentaion after acne or sun exposure, enlarged pores and scarring, such as after acne or chickenpox. Several lasers can help improve these issues. V-Beam laser can help with mottled pigmentation, including dilated blood vessels and hyperpigmentation, facial redness and dilated vessels and individual brown (age) spots. Clear and Brilliant Laser can help with hyperpigmentation, enlarged pores and overall skin maintenance. Fraxel Dual Laser is a resurfacing laser that can help with melasma, hyperpigmentation, acne scarring and surgical or chickenpox scarring.

3. Volumizing and facial contouring with fillers and toxins:
Toxins, such as botox, dysport and xeomin help to smooth and prevent facial lines and wrinkles. Fillers, including superficial and deep fillers, can help with restoring facial volume that is lost with aging or weight loss, and reshape and contour the face and lips too recreate a more youthful look.

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Relaxants and Fillers

September 09th, 2015 | Category: Cosmetic,Dr. Goldenberg,Media

 

Minimally-invasive cosmetic procedures have become the convenient go-to treatments for those wishing to combat signs of aging with minimally invasive, non-surgical options. In its most recent statistics, the American Society of Plastic Surgeons reported a clear spike in minimally-invasive procedures, stating that in 2014 “facial rejuvenation procedures experienced the most growth.” Of 13.9 million minimally-invasive procedures reported, relaxants and fillers were the two leading treatment categories. Both relaxants and fillers are injectables – treatments that are delivered with a fine needle – but they differ in how they produce results.

What Are Relaxants?

The most popular category of cosmetic procedures–topping the chart of all procedures, both surgical and minimally-invasive is relaxants (also known as neurotoxins or toxins). At 6.7 million injections reported in 2014, the number of relaxant treatments increased 6% from the previous year.

Relaxants rely on a bacteria-derived substance called botulinum toxin type A to smooth out creases and soften fine lines and wrinkles. When injected, botulinum toxin type A temporarily inhibits nerve activity in the muscle, reducing the its ability to contract – hence the term relaxant. In result, the facial movements that contribute to formation of expression lines and wrinkles are restricted. These agents are used mostly for dynamic wrinkles – those that are cause by muscle movements.

The most common relaxant brands include:

What Are Fillers?

The second most sought-after category of minimally-invasive cosmetic procedures is fillers. Also called soft tissue fillers or dermal fillers, these products were administered to 2.3 million patients in 2014, up 3% from 2013.

Unlike relaxants, which utilize one active ingredient, fillers vary in composition. Regardless of the type, these products are used to fill lines and reshape and restore volume in facial areas that are depleted with aging. Most fillers are temporary, but some may last longer than others. The current trend is to restore facial volume that is lost with time, to bring back a natural, youthful look. While most commonly used fillers are not permanent, all products stimulate collagen growth; this newly produced collagen can be permanent or last for years.

Some commonly used fillers include:

 

Quick Facts about Relaxants and Fillers

 

Relaxants

Fillers

What they treat

Frown lines; furrows between eyebrows and on the forehead; crow’s feet

Loss of volume, particularly in the cheeks; deep set wrinkles; nasolabial folds; smoker’s lines around the mouth, thin, downturned lips

Treatment time

10-15 minutes

Less than 1 hour

Duration of results

Temporary, with touch up treatments needed every 3-6 months.

Temporary, depending on filler. Temporary fillers can last 6 to 12+ months.

Active agent

Botulinum Toxin Type A

Varies: hyaluronic acid (HA) or a synthetic compound

How they work

Restricts facial movement to help smooth out lines

Replenish volume that is lost with time and plump up lines that become deep with time; stimulate collagen production

Downtime

None

None

Risks and side effects

Bruising, drooping if over corrected.

Bruising; temporary swelling and redness at the injection site

 

Which is the best choice for you?

When deciding on a rejuvenating treatment, there are several factors you should consider:

  • Area of concern. Are you looking to lift your cheeks or smooth your brows? If you are after volume, your best bet is a filler. If you would like to soften lines, a relaxant treatment might be the most convenient..
  • Medical history. In general, most treatments are well-tolerated, but if you have a history of allergies to a product, make sure to tell your dermatologist.
  • Maintenance. How often are you willing to go to the office for upkeep.

For most patients, the best option is a combination of fillers and relaxants. These products may also be combined with laser treatments to improve the appearance of overlying skin and give you the best results.

Ask for natural results:

Most patients want natural results with improvement over time. Make sure to discuss this with your dermatologist and point out the exact areas of concern.

Relaxant and Filler Treatment with Dr. Goldenberg, New York

Dr. Goldenberg understands that the range of rejuvenating treatments can be overwhelming. During your consultation, he will evaluate the overall condition of your skin and facial structure to design a customized rejuvenation plan. Contact his office to schedule your visit.

Signs of Skin Cancer

July 28th, 2015 | Category: Dr. Goldenberg,Media,Skin Cancer

 

Number  of skin cancers has increased dramatically in recent years. This includes both melanoma and non-melanoma forms of skin cancer. Melanoma cancer originates from melanocytes, skin cells which give pigment or color to our skin. It is estimated that 1 in 50 Americans will develop melanoma in their lifetime. One patient dies from melanoma every hour. Non-melanoma skin cancers, mainly basal cell carcinoma and squamous cell carcinoma, are very common. Approximately 3.5 million cases are diagnosed annually.

Skin cancer can start as an innocuous appearing spot. These lesions can grow and become symptomatic, with bleeding, crusting, scabbing, and pain.  Lesions can also grow rapidly, change in size or color.

So, what are the signs of skin cancer? Non-melanoma skin cancers usually present as red, crusted, bleeding, scabbed or scaly lesions. Some lesions, especially nodular basal cell carcinoma, can look like a flesh colored bump with dilated blood vessels. These skin cancers are usually on sun exposed skin, with scalp, face, hands and forearms being the most common locations.

Melanoma can present as a new “mole” or a changing mole. These lesions are usually dark in color, but can vary in color from light brown to dark brown, black, blue or red. A rare subset of melanoma, known as amelanotic melanoma, can present as reddish or flesh color bump. When examining moles, it’s important to remember the ABCDE’s:

  • A is for Asymmetry: You may find that a new mole has appeared which has an irregular shape or its two halves look different from each other.
  • B is for Border: The edges of the mole do not appear as they normally should. For instance, the edges are rough or blurred or jagged.
  • C is for Color: Moles generally tend to be of a single color with shades of brown being the most common colors. Melanoma usually presents with multiple colors or shows color irregularity.
  • D is for Diameter: Moles larger than 6 millimeters (about size of a pencil eraser) are worrisome for melanoma.
  • E is for Evolving/Elevated: Moles that are changing or elevated (raised) should be checked to make sure they are not melanoma skin cancer.

 

It is recommended for everyone to have a skin check every year. If you are concerned about a specific spot, get it checked sooner. Depending on what the doctor thinks, he or she may decide to do a biopsy which will then confirm if there’s any cause for concern. If it turns out that the lesion is indeed cancerous, then the doctor will book you for surgery. The cancerous cells will be surgically cut out through excision. To learn more about this particular surgery, click here.

If you haven’t had a skin check this year or have a concerning spot, schedule an appointment with Dr. Goldenberg for a consultation.

Sun Protection

July 14th, 2015 | Category: Cosmetic,Dr. Goldenberg,Media,Skin Cancer

 

Summer is here! Hello sunshine and warm weather. With summer in full swing, you’re probably spending a great deal of quality time outdoors, running, biking, hikingor hangouts on the beach. Spending more time in the hot sun can wreak havoc on your skin, even damaging your skin. This summer, fight back against the sun’s harmful effects by exercising good suncare.

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Although most people understand the importance of applying sunscreen, there are still many misconceptions revolving around SPF. Many people believe that higher SPFs mean more protection against the sun and therefore you can spend more time in the sun; however, this is a huge myth. High SPF sunscreen can provide a false sense of security, but skin damage and sunburns are still likely if you aren’t reapplying sunscreen, seeking the shade, and wearing sun protective clothing. No sunscreen product can provide 100% protection. Another major misconception is not wearing sunscreen on a cloudy day. Just because there are overcasts, doesn’t mean you’re safe from the sun’s harmful rays. People are actually exposed to as much as 40% of UV rays during cloudy days. Even when the sun is not shining, you are still exposed to UV rays and could still get sunburn. Furthermore, applying sunscreen once is not enough. It is recommended to reapply sunscreen every 2 hours, more often if you are in and out of the water. In addition, always check the expiration date of you sunscreen products. Expired sunscreen may not provide protection from the sun because the formulation has broken down. This summer, be aware and cautious of our sunscreen products. Make sure to always check the SPF and expiration date and reapply often, even during cloudy times.

These SPF misconceptions can lead to serious lack of sun protection that can cause major risks. High exposure to UV rays from the sun target the collagen and elastin fibers in our skin, breaking down the existing molecules and weakens the production of new molecules. With little or no protection from this UV exposure, skin loses its ability to repair itself over time. Without these connective tissues and the ability to repair itself, the skin loses its flexibility and strength which can lead to pre-mature aging, making people look much older much faster. In addition to pre-mature aging, poor suncare can lead to a higher risk of skin cancer. According to the Skin Cancer Foundation, in the United States, approximately five million people are treated for skin cancer every year. In a lifetime, about one in five Americans will develop and fight skin cancer with an estimated number of 9,940 people dying of melanoma skin cancer in 2015. Because poor suncare makes the skin more susceptible to aging and skin diseases such as cancer, it is very important to properly protect your skin from the sun.

With these risks of lack of sun protection, it is vital is exercising good, proper suncare. When searching for a sunscreen product, keep in mind the SPF. It is recommended to use a product with a minimum daily SPF of 50. Generously apply sunscreen at least 15 minutes before going out into the sun. It usually takes the skin about 15 minutes to fully absorb the product. Remember to use enough sunscreen to cover all exposed parts of the body, even the hard-to-reach or easily forgotten places such as the feet, back, behind the knees and behind the ears. To protect your lips, use a lip balm with at least an SPF of 15. Reapply sunscreen every two hours throughout the day or after swimming or excessive sweating to ensure maximum sun protection. Also, to further protection your skin from the sun’s harsh rays, wear large brim hats and sunglasses. Larger brim hats provide shade for your face while sunglasses protect your eyes from the sun. Sun protective clothing with UPF is widely available and should be worn during the periods of sun exposure. It’s also important to seek the shade, especially during the hours of 10am-2pm. Be sure to keep these tips in mind so you can have good suncare and properly protect yourself.

For those concerned about sun-damaged skin, Dr. Goldenberg provides many treatments such as the V-Beam, Fraxel, and chemical peels to help rejuvenate and repair skin.This summer, protect your skin from the sun’s harmful rays by taking the necessary precautions and exercising good suncare. If you are concerned about sun-damaged skin, visit Dr. Goldenberg’s New York practice for a consultation.

New Option for Psoriasis Treatment Just Approved!

January 31st, 2015 | Category: Dr. Goldenberg,Media,Psoriasis

 

Good news for those that suffer from psoriasis – a chronic, inflammatory genetic immune condition. A new biologic COSENTYX was just approved by the FDA for the treatment of moderate to severe psoriasis.

This medication works by blocking a specific component of the immune system called IL-17. By doing so, the drug decreases inflammation caused by psoriasis and improves the patients skin. In studies. over 65% of patients were clear or almost clear after 12 – 16 weeks of treatment.

While like all systemic medications, cosentyx has some potential side effects, with careful lab monitoring and follow up, the drug can be used safely.

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Self Skin Exam Can Save Your Life

January 21st, 2015 | Category: Cosmetic,Dr. Goldenberg,Media,Skin Cancer

 

Skin cancer is a real epidemic. The number of cases keeps climbing. Younger and younger patients are getting skin cancer, likely to tanning bed exposure. And there is a shortage of dermatologists in US to take care of this growing problem.

Which is why it is so important for patients to be pro-active and perform self skin exams monthly. I recommend this to ALL my patients. It’s really very easy and can be made easier if you have someone to help look at your back and back of your legs. Explicit instructions can be found HERE, on the American Academy of Dermatology site.

So even if you are getting your skin check with your dermatologist annually, which everyone should do, perform a self skin exam monthly in the interim. It may just save your life!

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New Treatments for Adult Female Acne!

January 21st, 2015 | Category: Acne,Cosmetic,Dr. Goldenberg,Media

 

The fastest growing population of acne is in adult females. Some think this is hormonally mediated. Others point to food and lifestyle. In reality, hormones are probably involved most commonly. A study that we published this year showed clear association of acne flares with menstrual cycles in women we surveyed. The good news is that there are several treatments that work well for this specific condition.

A drug that’s been on the market for a few years that I’ve used with great success is ACZONE GEL. This medication is applied twice daily. It dries very quickly so it’s easy to apply make up right over it. Another new topical cream, just approved, is ONEXTON. ONEXTON is applied once daily and works particularly well in female patients (it works in men too, but not as well).

If topicals fail, there are other options. One of my favorite is blue light with or without ALA. This is an in office procedure that works for acne that’s deep underneath the skin. While not approved for acne specifically, I have used it with considerable success. Lots of patients prefer it because it’s a procedure and there is little for them to do at home and there may not be a need to take systemic medication (pills).

But when all else fails, isotretinoin is the treatment of choice. You may know this drug as accutane, but that’s no longer available. My favorite and the newest of all isotretinoin medications is ABSORICA. The reason this drug works so well is that ic can be absorbed on an empty stomach. Other generics require a high fat meal for absorption and therefore may not work as well. This medication is safe, although lab monitoring is required. The most important thing is to avoid pregnancy while on medication, as this drug can cause severe birth defects.

It’s also important to address any scarring or persistent redness or blemishes that may remain as the result of acne. These can be easily treated with lasers such as FRAXEL, and V-BEAM, and fillers such as BELOTERO.

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How to treat facial redness of acne and rosacea? V-Beam Laser!

September 12th, 2014 | Category: Acne,Cosmetic,Media

 

Facial redness is a very common complaint from patients. it may be caused by rashes, or acne, or rosacea, or a combination of all these conditions. Dilated blood vessels (known as spider angioma or telangiectasia) can also be caused by aging and sun exposure. Acne scarring is another common cause of facial redness.

Patients may dislike facial redness and dilated blood vessels for various reasons – cosmetic, feeling flushed or hot, or symptoms with exercise, drinking coffee or wine.

the cosmetic appearance of facial redness can be treated. Various modalities exist. My favorite is v-beam laser. This is known as pulsed dye laser and it specifically targets the blood vessels that cause the redness or are dilated. The procedure is usually painless and post procedure redness or bruising is easily covered up with make up.

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