2015 ASDS Survey on Cosmetic Dermatology

This week new survey data was released by the American Society for Dermatologic Surgery. The 2015 ASDS Consumer Survey on Cosmetic Dermatologic Procedures reflects overall consumer views on cosmetic medical treatments.

According to the results, half of consumers are considering a cosmetic medical procedure and the specialty in which the physician is board-certified is the single most important factor when selecting a practitioner for a cosmetic procedure.

The top cosmetic concerns for consumers are:

• Excess weight, 88 percent
• Skin texture and/or discoloration, 72 percent
• Lines and wrinkles around and under the eyes, 69 percent
• Excess fat under the chin/neck, 67 percent
• Sagging facial skin, 67 percent

Highlights of the survey are summarized in the infographic below.

View fullsize

What You Need to Know About Fillers

One of the topics I get asked about most often by patients who are curious about cosmetic procedures is the use of fillers. Many people don’t really understand what filler is or they may have negative association of people being “over done” with filler.

When injected by a professional filler is very safe* and can serve as a key part of an overall program to restore a more youthful appearance by replacing volume in the face that is lost through aging.

In 1981 bovine collagen became the first FDA approved substance for soft tissue augmentation. Collagen remained the only commercially available filler until 2003, when the first hyaluronic acid (HA) dermal filler was approved. This was a breakthrough because HA fillers are easier to use and demonstrate longer-lasting results than collagen.

HA is a sugar that occurs naturally in the body and the effects of HA filler can be reversed (dissolved) simply by injecting a substance called hyaluronidase. In recent years HA fillers have continued to evolve and data suggests that HA fillers can stimulate a biological response to induce production of the patient’s own collagen.

The majority of the fillers I use in my practice are HA based. Commonly I will use the newer cross-linked fillers for their volumzing properties. These products are often used to address deeper wrinkles that cannot be treated with Botox alone. They are also used to bring back contours of the face, especially in the cheeks and chin, which flatten as we age.

The use of too much filler, especially when placed incorrectly, can begin to create an unnatural look. However, when an appropriate amount is used in carefully selected areas, filler provides an essential foundation to minimize the effects of aging. In general filler treatment can last for up to 12 months, but depending on the type of filler used and location of injection the duration may vary.

If you are interested in learning more about filler or booking a consultation to discuss cosmetic options please contact my office.

*Note on safety: In May 2015 the FDA issued a warning about serious complications if filler is inadvertently injected into blood vessels. I have researched and authored two papers on complications that can arise from the use of fillers. With a solid understanding of facial anatomy and proper protocols in place the risk is very low.

The Great Sunscreen Controversy

The title of this post is a bit misleading because in my mind there really is no controversy. Based on the available evidence, sunscreen is not a danger to your health. But we know that not wearing it is!

There has been a great deal of media attention recently following the release of the Environmental Working Group’s (EWG) annual sunscreen guide, which called out several brands for “inferior sun protection” or worrisome ingredients. While I believe EWG is trying to work in the public interest, unfortunately the way this information is often reported can be counter-productive to public health when it leads to people exposing themselves to harmful UV rays because they are unnecessarily worried about the sunscreen they’ve been using.

One of EWG’s favorite targets is the chemical oxybenzone, which they claim can be carcinogenic. A study in rats showed possible estrogenic and antiandrogenic effects with exposure to a high dose of oxybenzone. However, it was estimated that it would take 277 years of daily application of sunscreen to reach the same level of exposure in humans. The safety profile of oxybenzone is supported by both the US FDA and Health Canada.

Unfortunately the EWG test methods lack the rigor of peer-reviewed, scientific evaluation. Oxybenzone has been used in the US since the 1970’s with prevalence of exposure estimated to be 96% of the population. And the Canadian Cancer Society has already issued a statement refuting the cancer-causing claim.

EWG also makes the claim that sunscreens labeled with SPF values higher than 50 do not provide additional protection. The fact is that most consumers do not apply sufficient sunscreen, generally applying only 25-50% of the amount used for SPF testing. This results in an effective SPF that is about 33% of the labeled SPF. As such, higher SPFs can help counteract the under application effect.

I wrote this to help address inquiries I get from patients and ensure people are properly protecting themselves from sun damage. I invite you to take a moment to review my Top 10 Sun Protection Tips. 

Rosacea: Facts and Myths

This April is the first ever Global Rosacea Awareness Month and I am pleased to support it. Rosacea is one of my sub-specialties and my interest in this area led me to co-found the Vancouver Acne & Rosacea Clinic with Dr. Shannon Humphrey. Millions of people suffer from rosacea, a chronic skin disorder that primarily affects the face, and the most important first step in dealing with it is knowledge. 

The onset of rosacea is typically after age 30, with symptoms appearing as redness or blushing that comes and goes initially. Over time, the redness tends to become persistent, and visible blood vessels may appear. Rosacea always includes at least one of the following primary signs: flushing, persistent redness, bumps and pimples, and/or visible blood vessels. Various secondary signs and symptoms may also develop. These include eye irritation, dry skin, thickening of the skin, red patches or plaques, and swelling.

The severity of rosacea can vary significantly from one person to another, and in most cases some rather than all of the potential symptoms appear. Many people with rosacea have a history of blushing or flushing. This is often the earliest sign of the disorder.

Rosacea may be mistaken for acne but while the two may look similar acne has a different underlying cause and needs to be treated differently. The cause of rosacea remains unknown, and while there is no cure, medical therapy is available to control, and sometimes reverse, the symptoms.

Prescription oral and topical medications are often used to treat the bumps and pimples associated with rosacea. Treatments with lasers, intense pulsed light sources or other medical and surgical devices may also be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose.

Topical ivermectin is a new treatment for rosacea that has shown promising results for treating inflammation in papulopustular rosacea. There are two other relatively new medications on the market as well. Onrealtea is a topical prescription specifically designed to treat the facial redness of rosacea. Apprilon is an oral, once-daily treatment designed to treat the bumps and pimples associated with rosacea. To find out whether any of these treatments may be right for you, speak with your dermatologist.

Rosacea is not related to hygiene but it is important to treat skin affected by rosacea gently. I recommend using a mild skin cleanser and products that are non-drying and free of alcohol or astringents. When washing your face, do not scrub, rinse with lukewarm water and pat dry. It is a good idea to moisturize your skin and use a sunscreen (SPF 30 or higher) every day.

A number of lifestyles factors may cause rosacea to flare up. Research has disproven some myths, such as caffeine and coffee causing flare ups (it was determined that it was in fact the thermal temperature of the beverage). Common triggers thought to affect rosacea include hot and cold weather extremes, sun exposure, mental stress, spicy foods and hot beverages. These triggers vary from person to person, so it is important to find out which ones make your rosacea symptoms flare up. This can help you to better manage your condition by avoiding things that may potentially aggravate your skin. 

If you have other questions about rosacea the National Rosacea Society is a great resource.