Welcome to our blog. A place where our doctors and staff will be providing you with the latest information from our practice, and what's happening in our industry.
When it comes to nonsurgical cosmetic treatments, from microdermabrasion to BOTOX®, Tucson’s Ironwood Dermatology team noted with interest the recently released results of an annual report compiled by the American Society of Plastic Surgeons. Published at the start of March 2018, the report details statistics from 2017, taken from medical databases and doctor surveys. Among the many items of interest is the overarching fact that nonsurgical cosmetic treatments on the whole are growing in popularity. The entire field grew by 2 percent from 2016 to 2017, with more than 15.7 million treatments performed on men and women across the United States.
That also represents a 186-percent jump from the year 2000.
Topping the list is—as usual—BOTOX® and its fellow injectables based on botulinum toxin type A, which collectively made up almost half of the total treatments performed. With 7.2 million treatments reported, this option is unquestionably the most frequently chosen cosmetic option in the country—surgeries included.
Next on the list, with more than 2.6 million applications, is soft tissue fillers, which includes the entire Juvederm® line. There are formulas for reducing the appearance of nasolabial folds, for adding youthful roundness to the apple of the cheeks, and for subtly boosting lip contours.
Chemical peels came in third with 1.3 million applied. Though they all accomplish the same thing—removing the outermost layers of dead skin for a brighter, fresher look—they come in a variety of compounds with different strengths. This treatment also makes the skin more receptive to revitalizing serums.
Fourth is laser hair removal, a versatile treatment that can be applied virtually head to toe. Statistics show that just more than a million laser hair removals were performed in 2017, proving that bare skin made smooth without the hassle of razors or waxing remains a popular choice.
Rounding out the top five is microdermabrasion, which essentially buffs or polishes away dead skin cells in the outermost layer. Though the mechanics are different, the results are similar to a chemical peel.
The internet is rife with certain “fitness gurus” touting claims of reducing fat on the arms, thighs, or belly through various kinds of focused exercises. Unfortunately, this is not how the body functions.
While eating a nutritious diet and exercising regularly can yield significant physical and mental health benefits, and are key to maintaining a healthy weight, all they ultimately do are reduce the size of fat cells – they do not get rid of them.
As for focused exercises, the most they might do is improve muscle tone and definition in those areas to make fat look less obvious. While overall slimming down of the body is possible, it generally does not yield the extent of reduction we would like in specific areas.
This is part of what makes medical-grade, non-invasive fat reduction treatments so popular. CoolSculpting® offers Tucson, AZ, patients a pain-free alternative to surgery that is much more effective than diet or exercise at reducing fat in specific areas of the body.
The FDA-cleared device comes with a variety of applicators, each uniquely shaped and sized to accommodate almost any type of fat pocket on the body. The device cools down the area the applicator is attached to, causing fat cells to crystallize and die while leaving skin and other types of tissue in the areas unharmed.
Fat cells are much more sensitive to temperature changes, which is why they are much easier to damage with cold than other types of tissue. Once they die, the leftover matter from these cells is flushed out of the body through its natural processes.
With the right applicator, settings, and number of treatment sessions, CoolSculpting® is a quick, comfortable, and effective way to treat specific areas of fat. To learn more about the treatment, contact Ironwood Dermatology online or call 520.618.1630.
There’s a saying that beauty is only skin deep. The Ironwood Dermatology team knows that beauty is a lot more than that, but still, there’s something to be said about rejuvenating the face by focusing on the outermost layers. By working with an experienced dermatologist, Tucson-area men and women can enjoy a refreshed, revitalized look—all by merely “scratching the surface.”
Such a cosmetic change is possible because many of the visual annoyances and problems associated with aging and looking aged—like wrinkles, spots, redness, and visible veins—can be found on the surface of the skin or just below. Skin resurfacing, via a Cynosure® Focus treatment laser, does exactly what it sounds like it does: It creates a new, younger-looking surface.
The Cynosure® Focus treatment laser work by sending pulses of specific wavelengths of light into the skin where they trigger natural healing processes. The heat energy generated by these pulses damages unwanted lesions and areas of pigmentation due to the presence of melanin, which absorbs the light more than the surrounding cells do. When laser light impacts a spider vein, for instance, the dark red in the hemoglobin “absorbs” the energy, which ultimately causes the unneeded blood vessel to seal off and wither away. Soon, what was once a visible thin, red line—or, more commonly, a web of these fine lines—is no longer seen on the face.
In addition to impacting lesions, the laser energy also encourages the rebuilding of vital skin components, like collagen and elastin. Production of these can diminish over time, so firing up cells in the skin to begin new production means that over time, after one or more treatments, the surface-level problems can fade and the nourishing benefits of replenished elements can become more noticeable.
To learn more about skin resurfacing with our Cynosure® Focus treatment laser, reach out to Ironwood Dermatology in Tucson online or phone 520.618.1630.
Gone is the age-old belief that men don’t care about their looks, as more and more of them smooth their scowls away and refresh their appearance. Data for the past few years have shown a significant increase in men opting to receive cosmetic procedures—and none more so than BOTOX®. The Tucson, AZ, dermatologists at Ironwood have noted this uptick in “brotox” and strive to educate men about how the injectable treatment works and what to expect from a session.
Aside from an overall confidence boost and a more youthful appearance, a fresh face from BOTOX® Cosmetic could help men bolster their chances professionally in a competitive job market, as well as romantically in the dating world.
BOTOX® Cosmetic works by treating what are known as “dynamic wrinkles” on the face—lines that are caused by the repeated contractions of facial muscles over time. If it is injected precisely and in controlled amounts to the muscles causing those contractions, the muscles weaken to soften the lines they would otherwise etch on the face.
While BOTOX® is FDA-approved to treat glabellar lines (also known as frown lines or 11s) between the eyebrows, horizontal lines across the forehead, and crow’s feet at the outer corners of the eyes, the injectable can also be used to correct a wide variety of facial concerns, such as:
- Vertical lip lines
- Marionette lines
- Drooping nasal tip during smiling
Note that if the wrinkles are “static” (meaning they are present even with the face resting), dermal fillers may be a more appropriate treatment option.
There is a myth that BOTOX® will make patients look unnatural or unexpressive. When administered by a licensed, skilled, and experienced injector, it can soften only the lines you don’t want, but leave the overall face entirely capable of a full range of expression.
Men in particular tend to prefer to leave small areas, such as crow’s feet, relatively unchanged, to preserve a look of experience and distinction. Since injecting BOTOX® is so precise—with the effects limited only to a small area—our dermatologists are able tailor treatment protocol to meet the unique concerns and goals of any patient.
To learn more about BOTOX® Cosmetic and determine if it’s right for you, contact Ironwood Dermatology online or call 520.618.1630.
One of the most common problems my patients have is sun-damaged skin. Over the years ultraviolet radiation from the sun causes dyspigmentation (abnormal color), atrophy (thinning), and rhytids (wrinkles).
While there are many medications, products, and procedures that can help improve the appearance of sun-damaged skin, the best way to have beautiful skin is to prevent the damage from ever occurring. I know that here in Arizona it is extremely difficult to completely avoid the sun, but there are several things you can do to significantly reduce your exposure, and thereby limit the damage to your skin and the need for restorative treatment.
The first step is to minimize your outdoor activities during the peak daylight hours (11:00 a.m. to 2:00p.m. in the winter and 9:00 a.m. to 4:00p.m. in the summer). The second step is protective clothing, including long sleeves, pants, and a broad-brimmed hat, which are more effective than sunscreens since clothing can block the sun’s rays, provided the weave of the cloth is tight enough. The last layer of protection is sunscreen. Obviously, here in Arizona this is what most of us depend on for our protection against the sun since we are outside frequently during the day, and the normal attire is shorts and a short sleeved shirt.
There are a few keys to using sunscreen appropriately that I would like to emphasize. The main key is to use enough of the sunscreen. Studies have shown that most of us use approximately 25% of the recommended amount, which manufacturers use to determine SPF (sun protection factor). What this means is that even if you have a sunscreen that is SPF 65, it becomes an SPF of 2.8 when you use one quarter of the normal amount. The other key is to use sunscreen daily. If you apply sunscreen to the same area every day, the SPF factor increases significantly because the skin retains a portion of it for several days. It will also protect you during those times that you find yourself outside when you didn’t expect to be there.
If you follow these simple guidelines you can keep your skin beautiful longer, minimize the amount of restorative treatment, and reduce your risk of skin cancer.
By Dr. Colin Trout
Many people complain of dry, itchy skin that worsens in the winter. It can frequently progress to a diffuse, red, scaly rash that is so itchy that people can’t sleep at night and have difficulty focusing on their normal daily routine. The usual cause of this is xerotic dermatitis, which some people call “winter itch”. This is extremely common in southern Arizona because the climate is generally very dry and during the winter we are inside with heaters that lower the humidity even further. This causes the skin to lose moisture and results in a disruption of the normal barrier of the skin. Once this occurs, there is an inflammatory response (dermatitis) that is very itchy. Over time, with sun exposure and aging, the skin loses its ability to hold in moisture and this condition becomes even more prevalent.
The key to prevention and treatment of this condition is moisture. There are several ways to protect and replenish the barrier of the skin. The most important step is to use moisturizing creams daily. We recommend creams instead of lotions because they hold in more moisture and last longer than lotions. Some people do not like the greasy feeling of creams, but it is a small price to pay to prevent the development of xerotic dermatitis. Another helpful practice is to use soap-free cleansers in the bath or shower, because soap strips the skin of the components that create the barrier and contributes to dryness. Reducing the frequency of water exposure (baths, showers, pools, spa, etc.) and applying the moisturizing cream immediately after drying off will also help prevent flaring of this condition.
If you are disciplined about moisturizing and protecting your skin you can significantly reduce or prevent winter itch. If you have this problem and it is not controlled by the above guidelines, see your dermatologist for an evaluation. They may prescribe a topical steroid to get the condition under control in conjunction with daily moisturizers.
By Colin R. Trout, M.D.
Rosacea (pronounced roh-ZAY-sha) is a common disorder of the facial skin that afflicts an estimated 14 million Americans, many of whom do not know they have it. It affects mostly adults, usually people with fair skin, between the ages of 30 and 60. Rosacea is an inflammatory condition characterized most typically by facial redness and/or acne-like eruptions of the nose, cheeks, chin and forehead. Rosacea can also manifest as watery, irritated eyes or as small visible blood vessels on the face. Although rosacea is not harmful in and of itself, it is often progressive, and if left untreated can significantly impact one’s personal appearance. Surveys indicate that nearly 70 percent of rosacea patients report lowered self-esteem and difficulties with social and professional interactions.
The cause of rosacea is unknown, and there is no cure. However, medical intervention can control the signs and symptoms of this potentially life-disruptive disorder. Doctors often prescribe topical and/or oral antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. Azelaic acid, which reduces redness and inflammation, is another commonly prescribed topical medication. Because symptoms may recur when medications are discontinued, long-term treatment is often necessary.
With long-standing rosacea, the characteristic enlarged blood vessels and facial redness can become permanent. In these cases, laser surgery may be a more suitable treatment. Treatment with a vascular laser can significantly reduce the visibility of blood vessels, decrease redness and improve overall appearance.
By Robyn E. Glaesser, M.D.
Skin cancer is the most prevalent of all cancers with over one million Americans developing skin cancer this year. It has been in the media as of late with the news that the First Lady recently had a squamous cell carcinoma removed from her leg. Skin cancer is a very common occurrence here in the southwest and some statistics have indicated that the Tucson area has the second highest incidence of skin cancer in the world.
Basal cell carcinoma
- Most common skin cancer
- Appears as a pearly bump, nodule or red plaque
- Grows slowly over months
- Generally occurs on sun-exposed areas
- They can occur in areas that are not frequently exposed to the sun
- When untreated, will often bleed, crust over, heal, and then repeat the cycle.
Basal cell carcinomas rarely metastasize
- They can cause significant local damage
- Squamous cell carcinoma
- Second most common type of skin cancer
- Usually occurs on sun-exposed areas, including the ears, face (including the lips), neck and arms
- Typically appear as red, scaly plaques that may bleed and never heal
- Can metastasize to other areas of the body
- It is important to have them treated early.
- The most dangerous type of skin cancer
- It is estimated that 8,000 Americans will die from it this year
- Usually pigmented (dark in color)
- Frequently have an irregular shape
- Uneven borders
- Variations in color.
- May be larger than average nevi (moles)
- They often change in shape and/or color
- They can occasionally bleed, or be itchy or painful
- May develop in a pre-existing nevus or start as a new, dark lesion.
Prevention is the best defense against skin cancer. While sun avoidance it the best prevention, it is hard to completely avoid the sun here in the southwest. Sun protection is our next level of defense. The cowboys had it right by wearing wide-brimmed hats, long-sleeved shirts made of dense fabric, and pants. That is not the usual attire in Tucson, especially during the summer, so high SPF broad spectrum sunscreen, hats that cover the ears, and clothing designed for sun protection are recommended daily.
Skin cancer is highly curable with early detection and treatment. We recommend that patients perform a self-assessment skin exam monthly and be seen by a dermatologist at least once a year for a complete skin exam. If you have a lesion you are concerned about, have it checked by a dermatologist as soon as possible.
By Dr. Colin R. Trout, M.D. Dermatologist. Tucson Arizona.
A wide variety of temporary and permanent fillers are now available. They can be used to restore youthful facial contours by eliminating frown or smile lines, crows feet and scars and they can be used to augment specific facial features such as lips, chin, and cheeks.
Over time, these products have become safer, easier to use and more accessible to the patient. The number of products also allows physicians to treat a broad scope of problems in various ways, leading to much greater flexibility in treatment and optimum results.
The temporary fillers include collagen, hyaluronic acid, calcium hydroxylapatite and poly-L-lactic acid. With all fillers, short-term redness, swelling and tenderness at the injection sites can occur.
- Collagen has been used for over twenty years as a filler and is the gold standard that all other fillers are compared to. Collagen can be obtained from cow hide or from manufactured human skin. A skin test with the cow derived collagen is required prior to the treatment to determine whether the patient is allergic to the implant. The effect of collagen usually lasts two to four months and can be used to treat lines and wrinkles in the lower half of the face as well as lip enhancement.
- Hyaluronic acid is also available from an animal (rooster comb) or a non-animal source. Allergy testing is not required prior to using the animal derived product but there may be a low incidence of allergic reactions. HA is often used for lip enhancement but can also be used for filling facial lines and contouring. The animal derived HA usually lasts between three and six months and the other slightly longer.
- Calcium hydroxylapatite not only replaces volume to folds and wrinkles but also stimulates the body to produce new collagen. As a result, this product can last more than a year. Poly-L-lactic acid is used primarily to sculpt or repair facial defects and is not recommended for lip augmentation or treatment of superficial lines and/or wrinkles. Skin testing is not required for either calcium hydroxylapatite or poly-L-lactic acid.
Semi-permanent to permanent implants such as fat injections, and physical implants can be effective for deeper lines, furrows and folds as well as lip and cheek enhancement. Placement of these can be more complex and time consuming but relatively safe.
Filler technology is rapidly expanding and there are many more cosmetic options on the horizon. This is an exciting time in the field of cosmetic rejuvenation!
One of the most common reasons for seeking dermatologic care is for the evaluation and management of acne. Although primarily a disease of adolescence, acne can afflict infants, young adults and people in their forties and fifties. In simple terms, acne results from the action of hormones and other substances on the sebaceous (oil) glands and hair follicles. The sebaceous glands make an oily material called sebum that normally empties onto the surface of the skin via openings in the hair follicles (pores). Oil and cells that line the follicle (keratinocytes) can plug the opening. This, in turn, allows bacteria that live on the skin surface to grow and produce chemicals that attract inflammatory cells. The wall of the hair follicle can then rupture, spilling sebum, keratinocytes and bacteria into the surrounding skin. This results in the formation of “pimples”.
There are several types of acne. Comedones are plugged follicles without associated inflammation. Papules are small inflamed acne lesions that are red and tender. Nodules and cysts are deeper, painful inflammatory lesions that can lead to scarring.
The cause of acne is unknown and probably multifactorial; nevertheless, there are many myths on the subject. Chocolate and greasy foods do not cause acne, nor does dirt on the skin. However, there are things that can exacerbate acne in those with the disease: changing hormones (in adolescence or before menstrual periods), stress, oil in skin products, pressure from sports helmets, squeezing acne lesions and scrubbing of the skin.
Just as there are multiple types of acne, many treatments exist. There are over-the-counter and prescription medications that are very effective in treating acne. Depending on the type and severity of the condition, your doctor may recommend topical therapies, oral medications or both. The mainstays of therapy are topical retinoids (vitamin A derivatives) to unclog pores and topical or oral anti-inflammatory medications and antibiotics. For girls and women with acne, oral contraceptives and other medications that regulate hormones are used. The treatment of choice for scarring acne is isotretinoin (Accutane), and use of this very effective medication must be monitored closely by a dermatologist.
In addition to medications, there are cosmetic procedures which can improve acne. Chemical peels with exfoliating substances such as glycolic acid can be quite beneficial as an adjuvant to traditional acne therapy. Some relatively new, innovative treatments for acne using certain wavelengths of light and lasers are becoming more popular.
About the author
Doctor Robyn E. Glaesser is a practicing Dermatologist at Ironwood Dermatology located at 1735 E. Skyline Drive • Tucson, AZ 85718 • 520-618-1630 • Fax: 520-618-1636