Dr. Dayan - Blog

Other novel instruments touted to reduce cellulite and fat include waist-vibrating belts and electrical-stimulating waist belts. While electrical stimulation has shown benefit in wound healing and increasing blood supply to an area, it has no spot-reducing effect. Truthfully, these machines are basically “snake oil” and haven’t changed their tune much in decades. I’ve seen advertisements for similar devices in 1950s fashion magazines, and now they show up on late-night infomercials. Pass them up!

In 1998, the FDA approved a machine for achieving temporary improvement in cellulite, and since then about 20,000 Endermologie centers have been established throughout the world. Endermologie is a large cumbersome machine that uses suction to pull the tissues up between the rollers to be massaged. Proponents of Endermologie recommend five to ten treatments two weeks apart. When combined with diet and exercise, the machine temporarily reduces the appearance of cellulite. In theory, the machine and massaging action break down fat, which the body then absorbs. But it’s more likely that it works by removing excess fluid around the fat cell. Endermologie’s website says that the treatment expels toxins and relieves abnormal fluid retention. I’m not really sure what this means. Unfortunately, the treatment is cumbersome and time-consuming and the results are temporary. For these reasons, I don’t recommend the treatment.

Alpha hydroxy acids, better known as fruit acids, include glycolic acid, citric acid, and malic acid. Using fruit acids for cosmetic purposes has a long history, too, and even the legendary Cleopatra was rumored to have used wine resins on her face to improve the appearance of her skin. Alpha hydroxy acids work by extending their effect through the protective barrier of the epidermis and into the living skin cells of the dermis. However, penetration is designed to be limited to the upper layers of the dermis.

In the United States, Allergan’s Botox is the only FDA approved version of botulinum toxin A. However, in other countries another botulinum toxin A is approved and used as commonly as Botox is in this country. In Europe, this competing brand is called Dysport and is manufactured by IPSEN, a Danish company. As of 2007, this product has completed a Phase III FDA trial and should receive FDA approval in early 2009. I am one of the investigators in this project and I am not at liberty to discuss my clinical impressions of this product until it gains approval. This product will be sold under the name Reloxin and is the first agent to compete with Botox. Other neurotoxins are also undergoing testing and soon, multiple brands should be available.

Older scards are defined  as more than one year old, are often pale in color, have irregular edges, and are associated with a shadow-catching depression in the skin. Once a scar has reached this point, we can get effective results with the ablative laser, but the impact isn’t as great as what we achieve with a scar in the early phase. In these cases, only a surgical scar revision will bring the desired result, but then the patient has to accept the risk that another scar will form and take a long time to heal.

If you use a topical antibiotic ointment, such as Bacitracin or Neosporin, on any healing wound, apply it for only 24 to 48 hours and then switch to Vaseline or Aquaphor. This can be left on for approximately a week. Antibiotic ointments can irritate the skin and you don’t need the topical antibiotics after 48 hours anyway because the body in most cases has already placed a protective film over the wound.

Both hypertrophic and keloid scars are more common in the thicker, oilier skin of those of African descent, including African Americans, and those of Mediterranean descent. A hypertrophic scar is an enlarged, widened scar, but it stays within its borders and does not grow in size. It can usually be eliminated by excising (cutting) it out and re-sewing the edges back together.

If too much collagen is laid down in a haphazard manner or the normal process of collagen remodeling doesn’t occur, then a hypertrophic or a keloid scar forms. In general, those who are older with thinner, fair skin tend to heal with less chance of scarring than a younger person with thicker, darker skin. Younger people with thick skin tend to have robust collagen-producing cells that respond strongly to an injury by creating an abundance of collagen.

As the wound heals, new, tiny red blood vessels are stimulated to grow toward the wound to provide more avenues to transport bacteriafighting cells and collagen-producing cells. The fibroblast, the collagenproducing cells, lay down new collagen, and we see evidence of their presence as the edges of the skin contract to close the wound. As the wound heals, the collagen continues to remodel itself in an attempt to fall within the natural tension lines of the skin. As time passes, the wound contracts and often forms a depression in the skin. When they’re no longer needed, red blood vessels retreat, which is why the scar becomes pale white. New collagen layers do not contain pigment or hair cells, in contrast to the tissues surrounding the wound.

Our bodies have an amazing ability to repair injuries. If a skin wound stays superficial and doesn’t penetrate completely through the layers of the skin, then the skin is able to repair itself without leaving a visible scar. This kind of wound is similar to a scraped knee, or an intentional wrinkle-reducing laser burn. A visible scar forms when an injury breaks the integrity of all the layers of the skin to the underlying subcutaneous tissues.

The next time anyone tells you to keep your skin wound dry, you can say that times have changed. Up until the late 1960s, most doctors believed that keeping a wound dry was the best way to promote healing, but studies now definitively prove that a fresh, non-infected wound heals better and faster in a moist environment. The goal is to avoid a wound scab, because scabbing prevents optimal healing and can lead to an unsightly scar. Today, many doctors recommend covering the wound with an over-thecounter antibiotic ointment such as Neosporin or Bacitracin for the first 24 to 40 hours. After 24 hours, most of my patients then switch to Aquaphor or Vaseline. Up to 10 percent of the population may be sensitive to antibiotic ointment and can develop rashes and inflammation from continued use.

On the other hand, “cold lasers” are non-ablative, meaning they don’t wipe away the superficial skin layers. Non-ablative lasers, which are best known for treating brown spots and red blood vessels, work below the skin’s surface. Some evidence exists that these lasers can also remove wrinkles and tighten the skin.

Alative(removing) laser therapy (CO2 and erbium) is sometimes referred to as laser resurfacing, and it has emerged as a common treatment for sun-damaged and aging skin. Different types of laser techniques are used in an effort to rejuvenate the skin by removing the outermost, and, therefore, the most sun-damaged, layers of the skin, which results in tightened and more youthful looking facial skin. Because this treatment is associated with heat, you may hear it referred to as the “hot laser.”

Many women in their thirties and up may benefit from hyaluronic fillers such as Restylane and Juvederm. These fillers can enhance the lips quickly and naturally, with minimal risk and downtime. Those with already full lips can benefit from a bit of definition around the lip borders; those with smaller lips may want to plump the red lip body itself, thereby creating a fuller pout. Maintaining a healthy-appearing smile is part of recapturing a youthful look, so fillers are also appropriate for women in their forties, fifties, and up. To that end, minimal lip augmentation, which involves lining the lip with Restylane or Juvederm filler, helps define the lip border and prevent lipstick from bleeding into fine creases and lines that creep into the lip. It’s important that the results of these treatments are within the range of what we expect to see for your age group. Most of us find it bizarre to see mature women with over-inflated lips or frozen smiles, which is why it is important to consult an experienced cosmetic physician.

Fillers, Botox and laser treatments are office-based procedure available to treat the mouth and lips. It's important to note that laser treatments for the lips are not a quick fix, and you must expect some downtime. Temporary fillers, specifically hyaluronics, are available to treat vertical lines around the mouth area, the corners of the mouth, and for lip augmentation, that is, to achieve greater volume in the body of the lip itself.The temporary fillers offer significant advantages in that treatments can be tailored to the individual and are reversible. Botox can be used to weaken the orbicularis muscle, a circular sphincter muscle that surrounds the mouth. Partially weakening it with small doses of Botox makes the deep vertical lines become less noticeable. However, those who need to maintain their full “oral competency,” such as singers, trumpet players, and scuba divers should be very careful, because the muscle is deliberately weakened. For all ages, cosmetic dentistry, including teeth whitening and veneers can for improve the appearance of the mouth.