Dr. Katie Beleznay

Vancouver Skin Care Specialist

Dr. Katie Beleznay is a leading dermatologist specializing in the latest treatments to repair and rejuvenate the skin

Trends in Dermatology for 2018

As we start off the New Year I wanted to share a few emerging trends in dermatology. In my practice I treat patients for both medical and cosmetic concerns so I will highlight some developments in both areas.

On the medical side there are a number of exciting new treatments emerging for the treatment of psoriasis, eczema and acne just to name a few!

Eczema – This chronic condition can be challenging to treat, particularly since, to date, we have had limited effective systemic medications. Dupilumab is a new biologic that was approved by the FDA in 2017 and has been approved by Health Canada for roll out in 2018. Dupilumab is a human monoclonal antibody that is designed to inhibit overactive signaling of two key proteins (IL-4 and IL-13) that are believed to be major drivers of the underlying inflammation in atopic dermatitis (eczema). We dermatologists (and our patients) have all been awaiting the approval of this new medication as the data suggests it is quite effective and safe. A number of other biologics and topicals (including non-steroid options) are also in the pipeline, promising even more options to treat this condition.

Psoriasis – There are a number of new biologics being introduced for the treatment of psoriasis as well. New IL-17 inhibitors and IL-23 inhibitors, including risankizumab, guselkumab, tildrakizumab, ixekizumab and brodalumab (all a bit of a mouthful to say J), are either recently approved or in the final stages of gaining approval to be marketed in the US and Canada. If you suffer from psoriasis you can ask your dermatologist whether any of these new medications may be right for you. Topicals in newer formulations, such as spray foam (enstilar), also continue to gain popularity for treating mild to moderate psoriasis where a high-powered biologic medicine is not called for.

Acne – In terms of acne treatments there is new evidence that certain combination treatments, such as adapalene and benzoyl peroxide (TactuPump Forte) can help treat acne, including more severe acne, and can also prevent and treat acne scarring. There are number of new topicals in the pipeline for acne treatment as well, including topical sebum inhibitors that could act to reduce “oily skin” that may drive acne in some patients.

Moving on to cosmetic treatments, there are a number of themes influencing the way we treat patients.  

Body Sculpting - Each year the American Society for Dermatologic Surgery (ASDS) surveys consumers to understand their views on cosmetic treatments. For the fourth consecutive year the treatment of excess fat ranked as the #1 thing that bothered people about their appearance. This has given rise to the popularity of treatments such as CoolSculpting. A number of new and faster CoolSculpting applicators have recently become available and I believe this treatment will continue to increase in popularity. In addition, Belkyra (Kybella in the US), which was originally approved as a treatment for double chins, is now being used (off-label) on different body sites as well to help treat stubborn fat.

Combination treatments – Increasingly you will find different cosmetic treatments, such as neuromodulators like botox, being used in combination with fillers, and lasers, for more effective results. We have moved away from simply treating a line or wrinkle to thinking of the face in 3-dimensions and focusing not only on the skin, but thinking about the underlying structures as well. The aging process is complex and while a patient may be bothered by one thing, we may approach this concern with a combination of treatments to address related concerns. Often a combination approach may provide the most effective and longest lasting improvement. 

Natural looking outcomes – While this is not a new theme, it is definitely one that continues to be important. The desire to ensure a natural look has led to the rise in treatments like microneedling and thermage, skinboosters, and the use of more frequent, but smaller treatments with filler and neuromodulators such as botox. This also aligns with the goal of prevention and using cosmetic treatments to help preserve skin elasticity and collagen, so that your skin can stay looking healthy and vibrant longer.

Focus on men - Men have always represented a smaller proportion of the cosmetic patient population but they continue to grow each year. While men make up only about 10% of the total patient population for popular procedures like botox, the number of men seeking cosmetic treatments has increased dramatically over that past several years. Understanding the unique needs of men and developing customized treatment plans to emphasize masculine features continues to be a focus.


These trends will continue to play a big role in my practice in 2018 and beyond. I will continue to keep up-to-date on the latest in both cosmetic and medical dermatology. If you have any questions or want to book a consultation, please feel free to contact us.

 

Make Yourself “No Makeup” Beautiful

This post was originally published on the Carruthers & Humphrey blog.

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During this year’s “awards season” it became clear that the new beauty trend among Hollywood celebrities is to achieve a natural look with minimal makeup. Meanwhile the hashtag #nomakeup has been trending across social media, with everyone from Cindy Crawford to Kim Kardashian to Beyonce posting selfies to show off their makeup-free looks. The move toward less makeup, or no makeup at all, is refreshing to see.

A key message from this movement is to embrace your natural beauty without the need to alter your appearance. Of course many people wonder if they can pull it off and may want to improve their skin tone and complexion before going makeup-free.

At Carruthers & Humphrey, we strive to deliver natural looking results that give our patients greaterconfidence in the appearance of their skin. While every patient receives a customized treatment plan, for those looking to go makeup-free there are a few common treatments that may be utilized to help create that effortless look.

  1. Skin care – A proper skin care routine is vital to keeping skin looking refreshed. There are a number of products that can help give your skin a healthy glow, but I will highlight a few. Topical vitamin A, known as retinol, can be helpful to minimize fine lines, reduce brown spots and improve acne. Specific formulations of topical vitamin C can act as potent antioxidants and can protect the skin against damage from UV. Sunscreen daily and sun protection strategies are also essential to maintaining healthy skin.  It is important to get into a routine with skin care to protect the skin, prevent those signs of aging and help you get that makeup free look.
  2. Lasers and light-based therapies: There are a few different options that can help you achieve your no-make up look. Clear + Brilliant is a non-ablative laser that is helpful for reducing unwanted pigmentation, while also improving pore size and skin texture. Excel V is a different laser that is commonly used to reduce redness and the appearance of blood vessels. Intense Pulsed Light (IPL) also known as a photofacial can reduce pigment, redness, even out the skin town and help to create that healthy glow. These treatments all tend to have minimal downtime. There can be some immediate redness and swelling following the procedure, but this typically subsides within a day or two up to a week or so. Once this subsides the skin will appear smoother and clearer.
  3. Skin Tightening: There are now some great non-invasive options to lift and tighten the skin. Ultherapy utilizes ultrasound while Thermage relies on radiofrequency, but both achieve similar outcomes by triggering a natural process known as neocollagenesis that strengthens existing collagen and stimulates new collagen production that is essential for healthy skin. The results are generally seen over 2-3 months as the process of neocollagenesis takes effect. The results can be long-lasting  Both of these procedures are popular due to minimal patient downtime.

By taking both corrective and preventative actions for your skin you can have the confidence to go #nomakeup.

 

Q&A on Cosmetic Treatments

I was recently interviewed for an article in the Vancouver Sun where I shared some thoughts on popular cosmetic treatments. Below is a summary:

Who is a good candidate for treatments such as microdermabrasion, dermal fillers and botox? 

Anyone looking for a little pick-me-up for their skin, whether they are looking to improve the tone and texture, lift sagging skin, or reduce fine lines and wrinkles, is a good candidate for these types of treatments. However, not everyone is a good candidate for each of these treatments. A person who has significant photoaging (i.e. sun damage) and wrinkles may not see a dramatic improvement with microdermabrasion; conversely a younger patient with good volume and minimal lines/wrinkles may not be the best candidate for filler (at that time) and may want to focus on preventative skin care strategies first.    

Are there any age ranges that are too old or too young for certain types of treatments? 

There is no optimal age for getting these treatments. It really depends on the individual and their skin. There are patients in their late 20’s who have deep frown lines and may be great candidates for neuromodulator treatment such as Botox. In fact, studies have shown that starting with minimal amounts of Botox earlier on can have a preventative effect to reduce deep lines and wrinkles later in life. On the other side there are many patients who benefit from cosmetic treatments well into their 70’s and beyond.  

How do people go about finding a reputable practitioner? Especially when it seems like almost every salon and spa offers some type of non-surgical treatment? 

Trusting the practitioner you see is important, not only for best outcome with the treatment, but also for reducing complications. When it comes to injectables there are certain risks that can be mitigated when being treated by a physician who has specialized fellowship training in cosmetic medicine. I think it is worthwhile to review the credentials of the practitioner and meet with them for a consultation to make sure you feel comfortable proceeding with the proposed treatment plan.

How do medical professionals manage people’s expectations pre and post-treatment? 

Managing expectations is a very important aspect of what medical professionals need to do. It is important for patients to have a thorough consultation with their physician up front to make sure they know how many treatments will be required, anticipated effects from the treatment, how long the treatment will last, etc.  With any treatment, some people are going to be on the lower end of response and others may get a dramatic improvement. So it’s important to counsel around that.  For all cosmetic treatments we do photos before the treatment and at follow up after the treatment, so that we can review together the progress that is being made - this is especially useful for treatments that require multiple visits.     

Botox Basics

Some of the most frequent questions I get asked are about Botox and how it works, so I wanted to share some basic information for anyone thinking about getting botox treatment. Botox can be used for many things, including treatment of migraines and excessive sweating, but this post will focus on cosmetic Botox treatments for reducing wrinkles.

Botox is a brand name for botulinum toxin A, a neurotoxin that causes the condition known as botulism. The type of botulism most people have heard about is food borne and can be very serious if not treated as it can spread through the blood stream. In the use of injectable Botox, botulism occurs in a contained location, specifically where it is injected in the face. Here the botulinum toxin attaches to nerve endings. Once attached to the nerve endings it inhibits the release of the neurotransmitter responsible for triggering muscle contractions. 

Essentially Botox “freezes” the muscle, thereby reducing the appearance of wrinkles as muscles remain relaxed. The effects of Botox will last for 3-6 months.

One of the most common uses for cosmetic Botox is to treat the hyperdynamic lines, often called “worry lines” or "frown lines" found in the upper third of the face. These lines are formed due to repetitive muscle action in specific areas. A specific area of use is the glabella, where Botox is used to treat the “11s” (the lines made when you furrow your eyebrows). Botox can be used to treat horizontal forehead lines, “crow’s feet” and "bunny lines." We also use Botox to provide a lateral eyebrow raise, to help with dimpling of the chin, and to minimize large masseters (the muscle on the lateral face that we use to chew). There is a large list of areas that can be treated with Botox but these are the most common.  

Many people think of wrinkles and assume Botox is the best treatment. However, it’s important to understand that Botox works to treat dynamic wrinkles, not static wrinkles.  Dynamic wrinkles only appear when you make facial expressions, for example when you furrow your brow, frown, or smile, so you don't see them when your face is still. Static wrinkles, on the other hand, are wrinkles you have even when your face is at rest. For example, if you have 11s in between your brows without moving your face, those are static wrinkles. 

If Botox were to freeze the muscles around a static wrinkle, it wouldn't make that much of a difference in the appearance since the wrinkle would still be there with or without any muscle contraction. However, with long term use, Botox can help prevent shallow static wrinkles from growing deeper. 

The bottom line is that Botox can help reduce wrinkles in motion, not wrinkles at rest. Botox will not help for lines that are deeply etched in your skin. For these static wrinkles we often need to consider soft-tissue fillers.

Obviously the decision of whether or not Botox (or any other cosmetic treatment) is right for you is one that deserves careful consideration and should include consultation with a dermatologist trained in the use of injectables. My hope with this post was simply to provide a better understanding of how Botox works. For additional information, there is a good post on Real Self that addresses some common myths about Botox.