Skin Care

It is not unusual to have redness of skin following a fractionated laser resurfacing. One week after the procedure, I may recommend a steroid cream to use for 2-3 weeks to help minimize the redness. One month after laser resurfacing, I usually place patients on a vitamin C serum, such as ProHeal by IS Clinical, to help minimize redness. As well, I usually place patients on a retinol to work synergistically with the effects of the laser treatment to further enhance the appearance of the skin. Be sure to look at our laser skin resurfacing before and after gallery to get an idea of what results typically look like.

Exilis uses radiofrequency technology to deliver heat to the tissues beneath the skin. Heat creates collagen reformation, thus tightening the skin. Excellent treatment areas of the face include the upper eyelids, lower eyelids, jawline, and neckline. This is an in-office treatment. There is minimal discomfort associated with the treatment. There is no peeling of the skin after treatment and you can resume your normal activity and skin care regimen. Best results are achieved with a series of treatments, 1 treatment per week for 4 weeks.

There is truly no downtime with this treatment.

Heat is delivered deep to skin, so there is no peeling and thus no need for a change in skin care regimen.  You will develop some redness of skin from treatment, but the redness fades away within 1-2 days and can be hidden with makeup right away.

Also, very little discomfort.  Patients experience heat, and the heat sensation will be approximately a 6 to 8 out of 10 as far as intensity, 10 being unbearable heat.The treatment time is approximately 10 minutes for both eyes, 20 minutes for neckline/jawline.

It is radiofrequency technology, which is similar to thermage. The main differences include number of treatments (Exilis is 4 treatments each week for 4 weeks; Thermage is 2 treatments separated 6 weeks apart) and discomfort (Thermage is much more painful).

As far as how long the treatment will last, results improve over several weeks to few months.  Essentially, it provides improvement, but aging process does not stop.  Every individual is different, but may benefit from another treatment in a few years.  Also, it does not replace surgery, but is simply a non-surgical option for those who want a less invasive procedure.

Posted by Rami K. Batniji, M.D., F.A.C.S.

A laser resurfacing may be a better option in addressing pre-cancerous growths, such as actinic keratosis.  As well, it is important that you wear proper sunblock to minimize future sun-damage.  We currently carry a Colorescience product and EltaMD products that contain the proper ingredients and in the proper percentage strength to protect against UV-A (types 1 and 2) and UV-B radiation.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Thank you for your inquiry. As you and your son may know, the treatment of acne is challenging. Part of the challenge is identifying the potential cause. There are many potential medical conditions that may result in acne. Therefore, the evaluation by a Dermatologist may be beneficial in the identification of the potential cause of your son's acne. When it comes to the treatment of acne, we start with an analysis of skin care used by your son. Ideally, he is on a skin care program that includes active ingredients to address his acne. As well, the addition of a retinol has been scientifically proven to treat acne. Finally, there are some ancillary treatment options, such as Isolaz acne treatment, which may prove beneficial. Since your son will need close follow up, I recommend identifying a Dermatologist in your geographic area who is familiar with the management of acne. Again, thank you for your inquiry and best wishes to you and your son.

Rami K. Batniji, M.D., F.A.C.S.

A recent study from Memorial Sloan Kettering Cancer Center looked at the 29 most popular sunscreens available on Amazon.com and found inadequate protection against UV-A1. UV-A radiation penetrates through window glass; UV-B radiation does not penetrate through window glass. Therefore, one must strongly consider ingredients in sunscreens that provide protection against UV-A. UV-A1 is long range radiation. Ingredients that protect against UV-A1 include zinc oxide. As well, avobenzone protects against UV-A1;however, it is an unstable molecule and benefits from the stabilizing effects of other ingredients, such as octocrylene. Colorescience Sunforgettable SPF 30 contains zinc oxide and is an excellent option to protect against UV-A1.

Posted by Rami K. Batniji, M.D., F.A.C.S.

This is a very complicated issue.  One important source of Vitamin D is sun exposure.  Vitamin D has been shown to be of benefit in minimizing risk for certain cancers, such as colorectal cancer.  So, while sun exposure is good for increasing our levels of Vitamin D and decreasing the risk of Vitamin D deficiency, sun exposure puts us at risk for skin cancer.  Because solar UV-radiation represents the most important environmental risk factor for the development of non-melanoma skin cancer, UV protection is important to prevent these malignancies. Consequently, public health campaigns were developed to improve the knowledge of the general population regarding the role of UV-radiation for the development of skin cancer. However, it has to be noted that vitamin D-mediated positive effects of UV light were not adequately considered in most of these campaigns, that often propose a strict 'no sun policy' without giving recommendations how to prevent vitamin D-deficiency. Under our living conditions, approximately 90% of all vitamin D needed by the human body has to be formed in the skin through the action of UV-B-radiation and it has been shown that strict sun protection may increase our risk of vitamin D-deficiency. This dilemma represents a serious problem, for an association of vitamin D-deficiency and multiple independent diseases including various types of cancer, bone diseases, autoimmune diseases, infectious diseases, cardiovascular diseases and hypertension has now been reported in a large number of laboratory and epidemiologic investigations. Although further work is necessary to define an adequate vitamin D-status and adequate guidelines for UV-exposure, it is at present mandatory that guidelines for UV-exposure (e.g. in skin cancer prevention campaigns) consider these facts and give recommendations how to prevent vitamin D-deficiency. At present, most experts in the field agree that the evidence to date suggests that daily intake of 1000-2000 IU vitamin D could reduce the incidence of vitamin D-deficiency-related diseases with minimal risk in Europe, the US, and other countries. 

Here is information from the National Cancer Institute... "Although people obtain some vitamin D from dietary sources, most vitamin D is made in the body after the skin is exposed to sunlight. Despite the known and potential health benefits of vitamin D, increasing sun exposure increases the risk of skin cancer. In general, most experts believe that people should continue to use sun protection when UV levels are moderate or higher. Some researchers have suggested that brief daily exposure to UV will ensure adequate vitamin D production, but many variables (such as skin color, latitude, and season) can affect the production of vitamin D, and such recommendations have proven controversial. Other experts recommend vitamin D supplementation to avoid the problem of increasing skin cancer risk." 

Here is information from the National Institutes of Health’s Office of Dietary Supplements... "Most people meet their vitamin D needs through exposure to sunlight. Ultraviolet (UV) B radiation with a wavelength of 290-315 nanometers penetrates uncovered skin and converts cutaneous 7-dehydrocholesterol to previtamin D3, which in turn becomes vitamin D3. Season, geographic latitude, time of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. The UV energy above 42 degrees north latitude (a line approximately between the northern border of California and Boston) is insufficient for cutaneous vitamin D synthesis from November through February ; in far northern latitudes, this reduced intensity lasts for up to 6 months. In the United States, latitudes below 34 degrees north (a line between Los Angeles and Columbia, South Carolina) allow for cutaneous production of vitamin D throughout the year.

Complete cloud cover reduces UV energy by 50%; shade (including that produced by severe pollution) reduces it by 60%. UVB radiation does not penetrate glass, so exposure to sunshine indoors through a window does not produce vitamin D. Sunscreens with a sun protection factor of 8 or more appear to block vitamin D-producing UV rays, although in practice people generally do not apply sufficient amounts, cover all sun-exposed skin, or reapply sunscreen regularly. Skin likely synthesizes some vitamin D even when it is protected by sunscreen as typically applied.

The factors that affect UV radiation exposure and research to date on the amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide general guidelines. It has been suggested by some vitamin D researchers, for example, that approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and that the moderate use of commercial tanning beds that emit 2%-6% UVB radiation is also effective. Individuals with limited sun exposure need to include good sources of vitamin D in their diet or take a supplement.

Despite the importance of the sun to vitamin D synthesis, it is prudent to limit exposure of skin to sunlight and UV radiation from tanning beds. UV radiation is a carcinogen responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States. Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes. It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun."

For more information, please visit the National Cancer Institute website (http://www.cancer.gov/) and the National Institutes of Health website (http://www.nih.gov/). 

Posted by Rami K. Batniji, M.D., F.A.C.S.

Yes, you should wear sunscreen on both sunny and cloudy days. In a recent study published in the journal, Archives of Dermatology, it was found that many people inaccurately associate temperature and cloud cover with UV exposure. Though UV radiation is lower in the winter compared with the summer, there are large variations in UV exposure during the winter...this means that UV radiation can reach very high levels even in the winter time. Bottom line: wear sun protection this winter when hitting the slopes and re-apply sunscreen approximately every 2 hours to minimize your UV exposure and thus minimizing your risk of skin cancer.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Following rhinoplasty, I usually place a dressing, also called a dorsal splint, on the nose for approximately one week. Once I remove this dressing or dorsal splint, the skin of the nose can be rather oily. Therefore, one of the services that we provide complimentary to our patients after I remove this dressing is a glycolic facial by our aesthetician. Using this glycolic facial helps to cleanse the skin of the nose. During the initial consultation for rhinoplasty, we incorporate a comprehensive skin care analysis. After the initial plastic surgery, we strongly feel that skin care is an essential part of plastic surgery and of your overall care for your face. Therefore, our aesthetician evaluates the current skin care protocol you use and makes recommendations as needed regarding other products that may provide further benefit. Following rhinoplasty and following the glycolic facial, we usually incorporate complimentary products for skin care for our patients depending on the skin conditions the patient may experience. Approximately three weeks after the glycolic facial, the patient may resume such things as exfoliants and/or masks.