Skin Treatments

Facial Rejuvenation

Facial rejuvenation is a term encompassing methods by which to reverse the look of aging through a variety of invasive or non-invasive procedures, and topical treatments. For most people, facial rejuvenation involves treatments meant to eliminate the fine lines and wrinkles on the forehead, around the eyes, or around the mouth; and the reversal of the signs of photoaging. While there are methods by which to reduce even greater signs of aging, such as face lifts, blepharoplasties, and laser resurfacing, this article will mainly discuss some of the non-invasive ways of diminishing photoaging and fine wrinkles.

For the reversal of photoaging (mainly encompassing the appearance of redness and dark spots on the face and neck), IPL / Flash-Lamp Pulsed Dye lasers are and excellent means by which to achieve an even and immediate result. While these laser treatments are not necessarily painless, they require only minimal office time once a month and involve the use of light to destroy the underlying causes of redness and dark spots. Most treatment courses involve 3 to 5 monthly visits with no downtime between treatments. Most people can go to work the very same day without signs of even having had a treatment, except for some slight redness. Major caution must be used to ensure that no burning has occurred, and this risk may be minimized if the laser is being operated by an experienced dermatologist or laser personnel. It is wise to avoid sun exposure 2 weeks before a treatment and for several days after a treatment. As part of the treatment plan, a sunscreen should be used everyday since the damage from the sun is the primary condition being treated. Your physician may also decide to prescribe you a bleaching cream to augment the effects of laser therapy.

Resurfacing lasers (CO2, Er:YAG lasers) function to destroy the wrinkles and allow new collagen and skin regrowth. The non-ablative lasers (do not peel off the skin) have variable results while the ablative lasers (peel off the top layer of skin) are the gold standard for all types of wrinkles, but have significant downtime. Newer laser treatments include the use of fractional resurfacing laser technology (Fraxel®, Starlux®) which combine excellent efficacy with minimal downtime.
For fine lines and wrinkles, BOTOX® is an excellent option. For deeper lines and furrows, use of fillers such as Restylane®, Perlane®, Juvederm®, or Radiesse® may be used. An experienced dermatologist or plastic surgeon is the best way to find out if these options are right for you. In addition to laser therapy, the use of fillers may subtract many years from your face, and if done properly, may lead to excellent long lasting results.

For those patients requiring even more aggressive rejuvenation, a consultation with your dermatologist or plastic surgeon regarding face lifts, threading, dermabrasion, or ablative laser resurfacing may be beneficial in finding the perfect treatment for you. In addition to any treatment, a personally tailored topical regimen including a Tretinoin or retinol product, glycolic acid product, and a sunscreen, are essential.

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Tretinoin (Retin-A®) and Tazarotene (Tazorac®) Therapy

Tretinoin (Retin-A®) and Tazarotene (Tazorac®) are retinoids that work extremely well in the prevention of comedones responsible for acne formation. Both of these are prescription medications that are core components of most acne regimens.

Tretinoin (Retin-A®) should initially be applied in a pea-sized amount for the entire face. The pea-sized amount is placed on the finger tip, dabbed in different areas of the face, and then rubbed into the skin. It should initially be applied every other night in order to determine tolerance to the drying effects of the medication. If every other night application does not cause drying, then it may be safe to use the medication every night. The medication is applied at night because sunlight deactivates the molecule making morning application less effective.

Tazarotene (Tazorac®) is a very strong and irritating retinoid used for both acne and psoriasis. This retinoid is extremely effective, but must be used cautiously since the drying side effect can be quite uncomfortable. Tazarotene may be started by applying a pea-sized amount to the entire face (as described above) for 5 minutes and then washing it off. This should be done every other night and then increased to every night if tolerated. Once 5 minutes of contact every other night is deemed to be non-irritating, the time may be increased to 10 minutes and then washed off. Likewise, the contact time may be methodically increased per week to 20 minutes, 30 minutes, 1 hour, and then overnight should no irritation occur.

Both of these agents have been used as anti-aging creams as well (Renova® and Avage®). These creams were formulated to be somewhat less irritating. A prescription will be needed for either of these medications.

In summary:

Tretinoin / Retin-A® / Retin-A Micro®

• place one or two pea-sized amounts on the tip of your finger, dab small areas on your entire face, and then rub the medication in
• this medication should be applied every other night for one to two weeks; if tolerated without dryness, cracking, or irritation, then you may apply this medication every night
• if your skin becomes red, dry, scaly, or irritated, then take a day or two off in between applications
• this medication will be deactivated by sunlight, thus it is primarily applied at night

Tazorac®

• place a one or two pea-sized amounts on the tip of your finger, dab small areas on your entire face, and then rub the medication in
• this medication should be applied for 5 minutes and then washed off every other night for the first week; then, 10 minutes every other night for the second week, 20 minutes every other night for the third week, 1 hour every other night for the fourth week, then all night every other night for the fifth week, then all night every night thereafter
• if your skin becomes red, dry, scaly, or irritated, then take a day or two off in between applications

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Scabies / Permethrin

Scabies is an extremely itchy skin condition caused by infection with the mite Sarcoptes scabeii. Most infections are characterized by severely itchy red bumps and tiny blisters that may predominately reside first in the webspaces on the hands and feet, and then spread to the arms and body. Scabies is extremely contagious and may be contracted by anyone despite extremely rigorous hygiene. It may be contracted from contact with an infected person or contaminated objects.

The mite can not be viewed by the naked eye. The diagnosis is usually made by the physician on the clinical appearance and history of the eruption, or by microscopic examination. The treatment of suspected or confirmed scabies may include oral agents, but routinely consists of the following:

• Use of prescription topical permethrin 5% cream applied from the neck down at night and washed off in the morning. This treatment is then re-applied in the same exact manner in one week. It is important to apply the cream in an even layer to every part of the body including the genital areas, between the fingers, and between the toes.
• All clothes and bedding should be washer in hot water and dried on high heat. This is routinely done the morning after topical cream application (described above)
• Oral agents such as ivermectin may be given to you at the discretion of your physician.

Pregnant females or children under the age of 2 should not be given topical permethrin. A sulfur/petrolatum mixture may be used in the same method as described above.

It may also be necessary to treat everyone in the household on the same night in order to minimize reinfection.

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