Dr. Katie Beleznay

Vancouver Skin Care Specialist

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

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Boardroom Botox: Can Cosmetic Procedures Boost Your Career?

The following Q&A was conducted with The Kit for an article that was published in October 2018.

1. When did you first notice an increase in patients electing to have procedures done because of their careers? Were you surprised at first? And how common is it now?

Looking younger and feeling better about their appearance are common reasons patients give as to why they are choosing to have cosmetic procedures and these directly or indirectly impact both their personal and professional lives. So I don't think having procedures done for career benefits is a wholly new phenomenon but rather it is becoming more top of mind for patients when they discuss their motivations. I don't see that many patients that I would say are doing cosmetic treatments solely for career reasons, but for some it may be the impetus ie. applying for a new job or wanting to look and feel on top of their game. Feeling and looking good can of course impact confidence and studies have shown that both appearance and confidence can impact job opportunity, promotion etc.

2. What are some of the things patients routinely say to you about why they’re having something done/why it’s so important?  Has anyone told you they actually felt pressure or faced comments at work that made them worry about looking older?

I have had patients who have shared personal experiences where they felt that appearing younger provided them an advantage in a business setting. And even if it is simply a matter of feeling more confident, that alone can be a major career benefit. I had one patient where in her company the people all being hired around her were younger and she felt some pressure to fit in.  For others it’s more about maintenance and prevention, so not so much about wanting to look younger, but rather wanting to work on steps to maintain healthy skin. Sometimes there is a driving force like they got their passport photo after 10 years and were surprised at the changes since their last photo or they have an upcoming high school reunion or wedding.

3. What is driving this phenomenon? Are people under more pressure to look younger in general, but especially in the context of work/career?

I think that some people express a desire (or feel pressure) to look younger, but it has also become more acceptable to talk about that and to act on it. Coupled with that is the fact that cosmetic procedures have become more mainstream thanks in large part to the many non-invasive options that require very little down time (away from work) and the open discussion and wealth of information about options on social media. People are constantly seeing before and after photos of people after various treatments and all the information about the different options is quite accessible.  I had one patient say … she invests in nice clothes and purses, she dyes her hair every 6 weeks, and she started to realize that if she’s spending so much on that, she wanted to also invest in her face to make sure she is doing what she can to keep things looking healthy and vibrant. Even though there is often a request to “look younger” I try not to focus on “anti-aging”, but rather review specific personal goals to help people feel great and look and feel rejuvenated whatever their age. 

4. Around what age do people tend to start coming to you with career-related concerns? Does it differ for men and women? What’s the youngest you’ve seen people start worrying about looking older on the job?

It varies quite a bit and really depends on the industry. For example those in the entertainment industry may start earlier. I do have patients in their 20s who see me for small treatments simply to maintain their appearance and slow down signs of aging. In fact, starting small doses of "preventative" botox early can save you from needing more significant treatments down the road.

5. What do women and men typically have done? And how does this tend to evolve over the years (for example, might someone start with Botox in their 40s, then begin adding treatments as they age?)

When people start out they may focus on their skin and developing a personalized skin care plan that is preventative and can help give the skin a little glow. Those with concerns like sun spots or redness may consider a laser or light based treatment to help. Botox and filler have become increasingly popular. They are non-invasive and there is increasing evidence on their ability to not only improve appearance, but also prevent signs of aging over time, and there has been a renewed focus on natural looking outcomes.

In terms of what options are best at which age, it has less to do with age and really is patient-specific i.e. some people in their 20s may have deep frown line and conversely someone in their 60s may not and may focus on other things such as skin tightening or body sculpting. Similarly some patients genetically may be prone to a double chin (at any age) and they may consider an injectable like Belkyra to help reduce that.

6. What are some of the most popular options out there now?

The popular options vary depending on individual patient needs. Complexion enhancing treatments are always popular, so for example IPL to help remove brown spots and reduce redness or microneedling that can stimulate collagen production and help smooth out skin and minimize the appearance of pore size and acne scars. Neuromodulators such as botox are extremely popular and can help soften lines and wrinkles in different areas of the face. Fillers can provide a little lift to help with sagging skin and can be done conservatively for a natural looking outcome. CoolSculpting is quite popular as an option to permanently reduce pockets of fat. There are many other treatments available and I like to review the patient’s main goals for treatment.

There are always new treatments in this field.  Belkrya, which we have been using to reduce the fat in the double chin area, is now commonly being used in other areas. One area we are more frequently treating is the jowls to help contour along the jawline. 

We are also more frequently seeing people for treatment of their necks. One common concern is necklace lines, so called “tech neck”. These lines may be increasingly seen from looking down at computers or phone. SkinBoosters or Volite (both a hyaluronic acid solution) can help to soften those lines. Volite is new to the market in North America, but has been available in Europe and popular there. It is an innovative injectable designed to improve skin quality and help with hydration and elasticity and is commonly used on the face and décolletage. 

If you’re interested to learn more about cosmetic treatments, contact us to book a consultation.

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.

 

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.     

Understanding chronic urticaria (hives) and how to treat it

One of the most frustrating skin conditions to have (and treat) is chronic urticaria. Urticaria, commonly known as hives, can be classified as either acute (an episode lasting less than 6 weeks) or chronic (symptoms daily or almost daily for more than 6 weeks). Specific triggers (e.g. pressure, cold) may induce symptoms of urticaria, but often there is no specific external trigger for chronic urticaria. In Canada and the U.S. this chronic condition is labeled Chronic Idiopathic Urticaria (CIU) while the rest of the world refers to it as Chronic Spontaneous Urticaria (CSU). Despite the different terminology it is the same disease.

It is estimated that CIU affects up to 1% of the population at any given time, with peak incidence in patients between 20-40 years of age. CIU generally persists in patients for 1-5 years, with 50% of cases resolving within 6 months of onset and only about 5% lasting more than 10 years.

One of the most serious adverse effects of CIU is impairment of quality of life. Diagnosis and treatment is key to helping improve quality of life for patients.

The diagnosis of CIU is a two-step process. The first step is to gather relevant history from the patient regarding time of disease onset and frequency / duration of symptoms. The second step is a physical examination and diagnostic provocation test. Following diagnosis, your doctor will likely assess the severity using the Urticaria Activity Score (UAS), looking at the number of hives and itch intensity over a 7-day period (UAS7).

The goal in treating CIU is rapid and complete symptom control. The first line of treatment is the use of H1 antihistamines. These are over the counter drugs like Claritin, Allegra and Aerius. If symptoms persist after two weeks the second line treatment is to increase the dosage of antihistamines up to four times. If symptoms are still unresolved then third line treatments include cyclosporine and montelukast (Singulair). Most recently omalizumab (Xolair) was added to the treatment arsenal.

Omalizumab was approved in Canada for treatment of moderate to severe CIU in August 2014, following approval in the US and EU earlier last year. Omalizumab is very well tolerated and has been shown to lead to rapid and sustained improvement in UAS7.

If you or someone you know is dealing with chronic urticaria and are unable to control it with the recommended dosage of antihistamines, you should speak to your doctor to review other options.