SPIDER & VARICOSE VEINS
Acne is a very common disorder of the skin that affects individuals of all ages. Acne is characterized by comedones (blackheads and whiteheads), red papules and pustules, and sometimes cysts and nodules. These lesions affect the face, jawline, neck, chest, back and shoulders.
While acne often first occurs during puberty, adult-onset acne is an increasingly recognized condition. Some people get acne for the first time in adulthood, even if they were lucky enough to escape it during adolescence. While teenage acne often appears in the T-zone of the face (the oily skin of the forehead and nose), adult acne is often hormonal, and occurs along the jawline and chin.
Acne lesions, particularly cysts and nodules, can be painful. Furthermore, these lesions can result in permanent scarring making early intervention critical. Acne of all forms can substantially impact an individual’s self-image and has been associated with depression.
The cause of acne is not completely understood, but it is thought to involve some combination of bacterial overgrowth, overactive sebaceous or oil glands, abnormal maturation of the hair follicle unit and inflammation. Diet, emotional stress and hormones may cause acne to flare in certain individuals.
While many topical and oral medications can be very effective at managing acne, these treatments can be combined with chemical peels or laser and light-based treatments in order to maximize results. Some patients choose to combine office-based procedures with their topical regimen, so as to minimize side effects from oral medications.
Birthmarks may be present at birth or develop shortly thereafter. Two major types of birthmarks that we treat at CompleteSkinMD are vascular or pigmented. Vascular birthmarks include hemangiomas and port wine stains. While hemangiomas typically self-resolve, port wine stains progressively darken and thicken with time, making distinction between these two lesion types important. Vascular birthmarks may be treated with vascular-specific lasers, such as the V-beam pulsed dye laser. Early intervention generally leads to more rapid resolution. Pigmented birthmarks such as café-au-lait spots, Nevus of Ota and Becker’s nevus can sometimes be improved with laser treatments. Surgical excision for congenital nevi is sometimes appropriate.
Melasma is characterized by patchy hyperpigmentation on the face and is due to a combination of hormones and sun exposure in certain individuals. Oral contraceptives and pregnancy are known to exacerbate this condition. Ultraviolet A radiation (UVA), the type of UV rays that contribute to melasma, are present year round and penetrate through clouds and glass windows. For this reason, avid sun protection is essential to both the prevention and treatment of melasma. In addition, topical agents (over the counter and prescription), chemical peels, and some laser and light treatments can be used to achieve optimal results.
Rosacea is a common condition of facial skin characterized by flushing or redness with or without pimples, most commonly on the central face. People with rosacea tend to have sensitive skin, which often stings, tingles or burns, especially on exposure to certain chemicals or products. Over time, the repetitive flushing and blushing gives rise to telangiectases, which are visible blood vessels that are often most prominent on the nose and cheeks. Other symptoms that may be associated include irritation of the eyes and in more severe cases, more prominent and disfiguring sebaceous quality of the nose and/or chin. While symptoms of pimples can often be lessened with topical and oral prescription medications, the redness and blood vessels can be equally problematic to the rosacea patient. A number of lasers effectively target the hyperactive blood vessels and can diminish the redness, blood vessels and flushing response.
Scars form in response to injury to the skin. Injury can be in the form of surgery, trauma, or acne. Scars may sometimes form spontaneously. Scars can be elevated (hypertrophic or keloidal), depressed (atrophic), white (hypopigmented), dark (hyperpigmented) or red (erythematous). Depending on the type of scar and its location, some combination of laser, surgical procedure, and intralesonal injection may be used to diminish the appearance of the scar(s).
Skin cancer occurs more frequently than all other cancers combined. Nonmelanoma skin cancers (NMSC) which include Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) are far more common than Melanoma. BCC, which is the most common, may manifest as a skin-colored or shiny bump, or a pimple that won’t go away. SCC may appear as a rough, red, scaly patch. Sometimes SCC may be tender. Both types of lesions may bleed. Although very rarely deadly, these cancers can invade local skin and deeper tissues, resulting in significant disfigurement. Treatment may differ depending on the lesion’s size, location, and other risk factors. For cancers that are high-risk, and for those that occur in cosmetically or functionally sensitive areas, Mohs micrographic surgery is the treatment of choice. Both Dr. Hale and Dr. Karen are fellowship-trained Mohs Micrographic surgeons and members of the American College of Mohs Surgery.
Melanoma is far less common, but may be deadly. In recent decades, the incidence of melanoma has risen dramatically among women younger than 40. If melanoma is caught sufficiently early, the cure rate approaches 100%. If it is detected once it has already spread from the skin, the results can be devastating. Dr. Hale and Dr. Karen are firm believers in the importance of avid sun protection, self-examinations and an annual examination by a dermatologist. They perform very thorough skin examinations utilizing dermoscopy and equip their patients with the information they need to know about how to best protect themselves. They are also both skilled skin cancer surgeons, performing surgical removal of early melanomas and precursor lesions in the office.
Dr. Hale is a Vice President of the Skin Cancer Foundation (SCF) a nonprofit organization devoted solely to education about the prevention and treatment of skin cancer. Dr. Karen is also a very active member of the SCF and both are frequent spokespersons for the organization.
Skin laxity is the result of both intrinsic and extrinsic factors. Genetics, natural aging, ultraviolet exposure, lifestyle, weight fluctuations and smoking may all contribute. Laxity may affect the eyelids, face, jawline, neck, abdomen, hands and elsewhere. The optimal treatment depends on the severity and an individual’s underlying skin tone. A number of lasers and energy sources offer nonsurgical alternatives to laxity and can very effectively tighten the skin and rejuvenate. In general, these devices work by heating the skin’s deeper layers, which can stimulate new collagen deposition. Many of these procedures have very little downtime. Results are seen gradually over the first several months after treatment. Oftentimes, these energy-based devices can be combined with botulinum toxin or filler injections to achieve optimal results.
SPIDER & VARICOSE VEINS
Spider and varicose veins are a very common concern. Visible leg veins affects approximately 80% of the adult population, whereas varicose veins affect more than 50% of the adult population over age 50. Risk factors for the formation of varicose leg veins include genetics, female gender, pregnancy, age, occupations that involve prolonged standing, and obesity.
Spider veins (tiny pink, red or purple vessels) on the lower extremities are best treated with sclerotherapy, an essentially painless procedure whereby a sclerosant is injected into the unwanted vessel causing it to collapse so then the body can resorb it. Compression stockings should be worn for between 72 hours and 2 weeks depending on the size and extent of the vessels treated. Multiple treatments are typically required, but this treatment is very effective.
Varicose veins are dilated veins that are often bluish-green or flesh colored, tortuous in appearance and palpable beneath the skin’s surface. Oftentimes, varicose veins are the result of an underlying leakage. When valves within a vein cease to function properly, blood is permitted to reflux or flow in the opposite direction than it is intended to flow. Reflux leads to pressure buildup within the vein, causing the vein to distend further. When present, this condition is often associated with symptoms such as aching, burning, fatigue, itching, cramps, restless legs and swelling. These symptoms are typically aggravated by warmth and inactivity. If you have varicose veins or symptoms suggestive of underlying venous disease, a noninvasive imaging test (duplex ultrasound) can be performed to delineate the extent of the disease. You may be a candidate for endovenous laser ablation (which uses thermal energy to close the damaged vein from the inside out) or sclerotherapy injections performed under ultrasound guidance. These procedures are minimally invasive and light exercise can be resumed immediately after.
Sometimes a combination of the above treatments with one of our other vascular lasers may be used to achieve optimal results.
Actinic keratoses are precancerous lesions that occur as a result of cumulative sun exposure. These lesions are most common on the face, scalp and ears of men, chest, and backs of hands, but they can occur anywhere. Initially these lesions may be somewhat transient. When present, they manifest as rough, scaly, sometimes red, flat or minimally elevated growths that feel gritty, like sandpaper. If neglected, these lesions may progress to nonmelanoma skin cancer (basal cell carcinoma or squamous cell carcinoma). Early intervention can halt disease progression. Furthermore, elimination of these lesions makes the skin appear more healthy and youthful.
These lesions may be treated with a variety of treatments including targeted treatments such as cryosurgery (applying a very cold substance - liquid nitrogen - to the lesion(s) causing destruction of the precancerous cells) or scraping (curettage). For multiple lesions or lesions occurring on diffusely sun damaged skin, a field treatment such as chemical peels, photodynamic therapy or Fraxel® Re:store Dual may be used, providing a dramatically refreshed look and feel to the skin.
The appearance of sunspots is a very common cosmetic problem that is increasingly common as we age. Sunspots or lentigines are discrete, flat brown lesions that occur in areas that have been exposed to the sun – the face, backs of hands, chest, arms and legs. Many people refer to these lesions as age spots or liver spots as well. Daily use of a broad-spectrum sunscreen is essential to minimize the formation of additional lesions and prevent darkening of existing ones. A number of topical agents both prescription and over the counter exist that can help to lighten these. For patients desiring complete removal, use of a Q-switched laser is a simple and often permanent solution to this common cosmetic concern. For patients with more diffuse pigmentation (confluent freckles and sun spots), a more global approach with a chemical peel or a laser such as the Fraxel® Re:store Dual or Clear + Brilliant Permea® can be used to blend in the dark spots and even out the complexion.
Excess or unwanted hair is a common cosmetic concern. Sometimes, excess hair can be a result of an underlying endocrine abnormality, a medication or disease. More commonly, it is the result of genetics. Laser hair removal is one of the most commonly performed cosmetic procedures and can be safely and effectively performed on most body parts.
Permanent damage to the hair follicle is achieved when a pigmented hair beneath the skin’s surface absorbs laser energy. For this reason, ideal candidates are those individuals with coarse, darkly pigmented hairs on a background of lighter skin. That said, laser hair removal can be safely achieved with the proper device and proper settings on individuals with all skin types.
On any given day, only a portion (about 20%) of the hairs within a given treatment area will be actively growing and thus susceptible to permanent damage. Therefore, multiple treatments are necessary to achieve the desired effect. The ideal interval between successive treatments is 4-12 weeks (depending on the treatment area).
A thorough understanding of laser-tissue interactions is essential to achieve optimal results safely and efficiently. Like all procedures, laser hair removal is performed only by board-certified physicians at CompleteSkinMD.
Skin tattoos can be decorative or traumatic. No matter the cause, their removal is often desired. Tattoo removal can be challenging and results vary dramatically depending upon the tattoo age, density, color and location. A number of highly specialized lasers exist, each with specific wavelengths to target the different pigments that comprise tattoos. Multiple treatments are the norm. The procedure is performed under injections of local anesthesia. Successful and safe removal can substantially improve one’s quality of life. Dr. Hale and Dr. Karen are participating in the American Society of Laser Medicine Surgery New Beginnings program – a national campaign to provide free radiation tattoo removal for cancer patients via laser treatment.
WRINKLES & AGING
Fine lines and wrinkles are the result of intrinsic (i.e. genetics, aging) and extrinsic (i.e. ultraviolet exposure, smoking) factors. A comprehensive approach to skin care will help to reduce existing wrinkles and prevent additional ones. Dr. Hale and Dr. Karen will help you to optimize your at-home regimen, which should include effective over-the-counter topicals and oftentimes prescription medications, as well as a broad spectrum sunscreen which should be worn no matter the weather or time of year.
Botulinum toxin injections relax facial muscles whose repetitive action leads to both active wrinkles and overtime static or more permanent wrinkles. Filler injections can help to re-volumize the face and stimulate new collagen deposition to help diminish the appearance of both superficial and deep wrinkles.
Laser and light sources can also diminish wrinkles and textural irregularities by stimulating your body to produce new collagen. Dr. Hale and Dr. Karen are believers in the benefits of “fractional” resurfacing lasers, which deliver energy to a portion of the skin’s surface, while leaving some of the skin unharmed, allowing for lesser wounding and quicker healing.