Blog

Living With Rosacea, by Cynthia Abbott, MD

2012-04-18T15:28:46Z

(Since April is National Rosacea month, Cynthia Abbott, MD will be doing a 3 part blog series on her own experiences with rosacea. This is the first part of the series that looks at her specific case and what it means to have rosacea.)

I think of my rosacea patients as “hot house flowers.” They have to be kept at the perfect temperature, have the right soil or food, be watered, and refreshed regularly, but never with fertilizers or chemicals that are too harsh or abrasive. Only the perfect combination will do. Their environment needs a little moisture, just enough to replenish the skin, but never enough to make them get red, wilt, or sweat.

(Being against the before and after back drop makes Dr. Abbott laugh, but when she faces forward it is still hard to see her rosacea. She doesn’t have on any make up and the slight blush in her cheeks belies the rosacea. We will take a closer look below)

Occasionally their dead blooms and leaves must be “deadheaded,” snipped, lasered or treated to look their best. When everything is in equilibrium, rosacea patients can have gorgeous, healthy complexions. But if a blast of hot air or cold air or a stressful situation enters their greenhouse world, their faces immediately show it. Unfortunately, the world most of us live in is not the perfect greenhouse environment. Life comes at you fast and furious.

(Dr. Abbott uses a dermalite to show what is behind those blushing cheeks, more pics below).

As a rosacea patient myself, I make choices every day that could make my rosacea flare. But there are certain things I am not going to give up. I’m still going to exercise until my face is beet red, and I know my chosen forms of exercise - running, biking, and hot yoga - are not ideal. I realize swimming or regular yoga would be better for my complexion. I know a glass of red wine and cheese at a dinner party will give me a bit of extra rosy glow, but every once in a while . . .

(When we compare the Dr. Abbott’s “blushing cheeks” with the skin above her lip, where there is not rosacea, we can clearly see that there are a great deal more broken capalaries in the picture on the left.)

I choose to use my medications and “deadhead” or laser those capillaries every few years. It’s all about the choices you as a patient make and what makes sense with your lifestyle.
I am happy to educate each patient on their individual triggers and let them make their own choices. I’m glad to be here when patients fall off the horse and pick them up with a few laser treatments and medications to get them back on track.

(Check back on later to hear more about the actual v-beam laser procedure Dr. Abbott mentions in this blog. You will get to see what your skin looks like directly after the procedure. Then at the end of the month we will see Dr. Abbott’s healed and improved skin 4-6 weeks after her initial laser treatment.)

An Indepth Look at the SmartLipo Process, By Cynthia Abbott, MD

2012-04-11T11:07:50Z

It’s always good to see an old friend, and that is how it was with Geonni. I had treated his lower abdomen with Smartlipo four years ago, and now he was back for more. Geonni, usually a very active person, had experienced a sports injury and had been unable to work out for months. His lower abdomen still looked great, but he was depressed when he walked into the gym. He had put on about 10 pounds that he couldn’t get off on his flanks and upper abdomen.
He wanted to do Smartlipo again, and had tracked me down as I changed practices. It made me feel great when he said he only wanted me to do it, although there are several Smartlipo surgeons around. He searched for me. He was going home to Costa Rico for a family event in 2 weeks to see many old friends and wanted to look good.... fast. This was Monday...could we do his case Friday?
Geonni was an excellent candidate. He knew he needed to wear a garment for one week 24/7, then he could reduce wearing it to about 12 hours per day intermittently. I told him he couldn’t get in the water for 2 weeks, and sun exposure during the immediate healing period was discouraged because of potential darkening of the skin from the sun in an uneven fashion. He was motivated, and promised to follow directions. So we scheduled his surgery for the end of the week.
Although I have been doing Smartlipo for almost five years, and had been trained to do regular liposuction for almost 15 years, some of my new office staff had not seen the procedure before. My experienced nurse of four years asked Geonni if he would be willing to let some of the staff watch. He didn’t mind, and probably enjoyed the extra attention!
On surgery day, the excitement was evident. He was ready to get rid of his extra fat. Each area was only about as large as the palm of my hand, but they bothered him. Pictures were taken; he was marked and given one Vicodin to take the edge off of the numbing. Since he knew what to expect, he used his iphone to catch up on emails during the surgery. He requested ELO music playing in the room during the surgery.
Geonni was happy to answer any questions about how it felt during the surgery. The numbing was a little uncomfortable as we infused the saline/lidocaine solution, then we dimmed the lights and all watched the little red light from the laser under his skin as it melted the fat. Geonni was fascinated, since we could actually see the laser light melting away his fat.
During the laser treatment, the cannula moves easily through the tissue melting fat like butter with very little trauma. After the laser application, the room lights were turned back on and I started suction to remove his melted fat with a small liposuction cannula. Geonni found this a very satisfying part of the procedure, as he could say goodbye to his fat and watch it as it went through the tubing to the waiting collection canister.
Sometimes we would talk about what a good fat pocket we were emptying, judging by the copious amount of butter colored fluid streaming through the tube. We discussed world events, summer plans, music: we had a great conversation, as he is quite a chatty person. This isn’t always the case. Sometimes patients would rather doze off or just close their eyes and disappear into their music. Some patients want to know everything that is happening, and some patients would rather not know or see anything. I try to make patients comfortable with their experience.
Afterwards, my nurses and I felt for any areas we may have missed. He did a sit up and we all looked to see if everything looked even. We found a small area near his belly button that needed a bit more work. Geonni was so excited as he did his sit up, joking that he had always known there were muscles there! He thanked us for taking his fat blanket off so he could see his rock hard abs again. A bit of an exaggeration, yes, but the nurses were astounded at the noticeable improvement.
I put in a dissolvable stitch over each incision site and covered them with paper tape. We then helped him get into his garment. Little pads were placed under the garment over the lower incisions to catch any drainage over the next 12-24 hours. We gave him a couple of extra pads in case he needed to change them later that evening.
We called our insured and bonded driver to take him discretely home, as the surgery was a secret from even his closest friends. I do not allow patients to drive themselves home, even without pain medication, as fluid shifts can cause unexpected dizziness during the first 12 hours. I have had patients from out of town who have felt great after SmartLipo and wanted to take advantage of a great shopping sale. I allowed them to go shopping only if they stayed right with their friend and driver in case they felt dizzy. Patients don’t have any pain post-procedure, although some may be sleepy, depending on the medication used during SmartLipo.
Generally it is best to just go home and relax for a day or two, as the dressings are bulky the first day and soreness will occur after the numbing wears off in 6-12 hours. Frozen dinners and a movie are a great idea that first evening.

Bridal Beauty Boot Camp, by Corinne Erickson, MD

2012-03-19T17:30:01Z

It was a beautiful Sunday afternoon. My boyfriend Will and I were walking our Yorkie around Piedmont Park and admiring Midtown’s skyline reflecting on Lake Clara Meer. Suddenly, he twirled me to face him, got down on one knee, and asked me to marry him. I hyperventilated, said YES(!), and then dove headfirst into the hectic world of wedding planning.

Ask any bride-to-be, and you’ll find that selecting the perfect font or fondant is the easy part. The pressure is on the bride herself to look and feel her best on her wedding day as family and friends and complete and total strangers stare at her and cameras flash and photos are taken that are passed down for generations and oh my this is a lot of pressure! I imagined my future great great grandchildren looking at my wedding photo and asking “Is that a zit on great great grandmommy’s nose? Wasn’t she a skin doctor? Ew!!” And so begins my own bridal boot camp for my skin. I have approximately 6 months until Aisle Time, and this is my bridal beauty boot camp.

The Ground Rules:

Every boot camp has ground rules, like being awake at 5am and running up and down muddy hills, and this boot camp is no exception.

Know thy skin before embarking on any skin regimen. Oily or dry, light or dark, sensitive or tough as nails, your skin type is complicated and will dictate what types of products and procedures are safe and effective for you. Your dermatologist can help you with this.
Establish your goals. Are you concerned about controlling unruly acne, or repairing sun damage? Are wrinkles your issue, or problem pigmentation?
Know your timeline. You should never try a new procedure or product three days before your wedding . There is always a risk that you have a negative side effect, or that it won’t work at all, and you won’t have time to fix it. Then panic will really set in.
Know your budget. The budget is a key aspect of wedding planning, and that goes for your prewedding preparation as well. Decide on your priorities and what you are comfortable spending to make sure your skin care bill doesn’t put any wrinkles in your budget or your forehead.

Based upon these ground rules, I have laid out the following boot camp schedule. I’ll give you examples of products and procedures I plan to use, but remember, everyone is different and needs to work with their dermatologist to design a customized skin care plan.
As I go through my personal prep procedures, I’ll update you on my experience and any new suggestions!

6 + Months to Aisle Time:

This is the time to look carefully at your skin and decide on your priorities. Are you battling break outs or perplexed by pigmentation? If you’re wearing a strapless or backless dress, is there any acne or sun damage on those areas that needs to be addressed? This is the time to talk with your Dermatologist about your goals and start on a skin care program that is appropriate for your skin type that helps you meet your goals.

For example, I have started using a topical retinoid every night to even out my complexion and prevent break outs. (Read more here on Retinoids) I have also found an eye cream that smoothes out fine lines and brightens dark circles (Lumiere), and a face moisturizer with sunscreen that also contains growth factors to further fight off wrinkles (Journee). These treatments don’t work overnight, so starting them now gives my skin time to improve gradually and be in great shape by September.

This is also a good time to get to know your aesthetician and have regular facials to clean out your pores and possibly even a series of peels to bring out healthy, glowing skin. We have three fantastic aestheticians in our office who give fabulous and effective facials, and who perform a variety of peels. The combination of great skin care products and facials alone will make a huge difference in your skin quality and texture.

Early preparations will ensure that you skin looks as lovely as your bouquet!

4-6 Months to Aisle Time:

You have seen your Dermatologist, are using the right products for your skin type, and now you’re ready to make some more specific improvements in your skin. This is the perfect time for more targeted treatments, including lasers, peels, botox, and fillers depending on your priorities. You have plenty of time for any side effects from the treatments such as redness or bruising to resolve, time to see a benefit, and time for additional treatments if needed before your wedding.

My dress is strapless, so I am undergoing IPL treatments for the sun damage on my face and chest. (Dr. Forney discusses IPL treatments here) IPL stands for Intense Pulsed Light and targets both red and brown sun damage, with an added benefit of having no downtime. If broken blood vessels and redness are giving you a permanently flushed appearance, the VBeam would be a perfect laser treatment. At this point, you have time for several treatments of either laser with plenty of recovery time as well.

I have also started working on those lines between my eyebrows, because H-E-Double Hockey Sticks wedding planning can be stressful! I catch myself furrowing my brow and raising my eyebrows skeptically at the cost of cake, and then realize I’m forming crevices in my forehead. My solution to this issue is Botox. Botox lasts for 3-4 months and is used to prevent wrinkles in the upper face that form with movement. By preventing these active wrinkles from forming, you don’t end up with permanent static wrinkles in their place over time. I also don’t want crow’s feet in my photos, which Botox also corrects. I recommend starting 3-4 months pre-wedding. You’ll need a touch up treatment at least 2 weeks before your wedding day to allow it to take full effect and for any bruises to resolve.

While Botox and Dysport help dewrinkle your upper face, fillers can be used to smooth out lower facial wrinkles like the parentheses around your mouth. Brides seeking the perfect pouty lip or simply more definition of their lips will love effect of fillers. The major side effects are swelling and bruising, so this is not a procedure to save for the last minute. If this is your first time getting filler, I recommend the treatment at least 4 months before your wedding day so that you can start slow, decide what you like, and add more if wanted.

Preparing you skin includes the skin on your chest and back that might be exposed depending on what style of dress you choose.

2-3 Months to Aisle Time:

This is a maintenance and protection phase for your skin. First and foremost, you need to protect your skin from the sun. Tans actually make your photos look worse, and will change the way the color of your gown looks against your skin (and not in a good way). You also need to keep in mind that all of the peels and IPL and topical retinoids you have been using make you more sensitive to the sun. One afternoon by the pool could completely reverse the benefits you’ve achieved (not to mention make them a complete waste of your money).

If you have had a few peels and liked the results, it would help to have another one as a refresher around this time, as well a facial to clear out any congestion in your pores.

2-4 Weeks to Aisle Time:

If you have been getting botox, it’s time for a final touch up. You may also want to get one final facial and “mini-peel” so that you are all aglow for show time.
The most important thing in these last few weeks is not overdo it with new treatments that your skin hasn’t experienced. Don’t panic because you see a blemish and start a new, aggressive acne treatment. There are no last minute skin perfecting miracles. If you find yourself in the midst of an acne flare, relax, call your Dermatologist who has plenty of emergency tricks up her sleeve.

Days Before:

Resist the urge to change anything! If a last minute stress zit pops up, pop by your Dermatologist’s office for an intralesional steroid injection to melt it away. . Protect your skin from the sun to avoid any unsightly burns or spots. Get rest, stay hydrated, and you will be beautiful!

You are finally ready for the big walk down the aisle!

Can I Pop This? Real Treatments for Acne, by Corinne Erickson, MD

2011-11-03T17:47:06Z

I come from a family of persistent poppers. I am the oldest of three sisters, and the youngest could be a board-certified bathroom surgeon. I remember sitting with her on the beach, she was 6 and I was 11, and letting her convince me that there was a tiny seed inside the mole on my left wrist. “Can I pop it out?” she asked, eyes wide with anticipation. Disgusted with the thought of a seed in my wrist, I replied, “You can try.” She pinched and squeezed until it bled. “I don’t think you can pop this,” I said and rescued my wrist from her small but strong fingers.

Today she is a 26 year old, mature married woman who continues to have a penchant for popping. On a recent family vacation, she found me in the kitchen with a large “sub-dermal” on her chin with tell-tale fingernail marks surrounding it. “Can I pop this?” she asked sitting down with her coffee. I handed her a warm wet wash cloth and instructed her to apply it intermittently to try and bring the beast to a head.

The next morning, her red sub-dermal had a nice white pustule on the surface. “Can I pop it now?” she asked. I told her to go take a shower and leave it alone. 10 minutes later she burst into kitchen. “It popped itself in the shower!” she shouted with mix of joy and shock. “Great,” I said. “Now leave it alone.”

Banish the Magnifying Mirror!

These stories about my sister really illustrate to me a particular challenge in treating acne. The world is full of young bathroom surgeons, many equipped with extractors and the most dreaded of all: the magnifying mirror. Armed with a magnifying mirror my sister has claimed to actually pop her eyebrows. I didn’t ask but suggested she try tweezers. The magnifying mirror shows us every pore, follicle, dark spot, light spot, and we want to banish every last one of them.

When I talk to patients, both adolescents and adults, about their acne, I often ask if they own one of these dreaded mirrors. If the answer is yes, I request that as part of their regimen they remove it from the bathroom. I don’t mean to imply that all of those whiteheads and blackheads have to stick around for ages.

There are safe and effective ways to extract them that we perform regularly in the office. The problem is that by trying to pop your own pimples, you introduce more bacteria into the area, cause more inflammation beneath the skin, and can end up with an even larger, more painful acne lesion that will take months to clear.

It’s frankly counterproductive. Just like pulling your finger out of a Chinese finger trap makes it tighter and harder to escape, trying to pop your own pimples just worsens the inflammation and gives you larger and angrier acne with a higher risk of permanent scarring.

Clearing Up Acne

So if we ban bathroom surgery, how do we abolish those pesky pimples? It’s really different for everyone depending on the type of acne a person has. The comedonal acne, or whiteheads and blackheads, responds great to a topical retinoid, such as adapalene, tretinoin, or tazarotene and can benefit from extractions in the office. Note that last part: extractions IN THE OFFICE. The red, painful deeper bumps are inflammatory acne, and sometimes nodulocystic acne. This is a different animal, and often needs topical and systemic antibiotics, and at times isotretinoin. The deeper lesions may even need an injection of steroids. It really is different for every patient and every pimple.

So acne patients unite! Toss out those magnifying mirrors, put away your sharp extracting devices, and cut your fingernails. Together we can clear you up in a way that doesn’t leave ice pick scars and open sores on your face. You may not be able to pop your acne, but understanding that puts you months closer to clearing it.