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PST 004: Heading into Spring — Read the transcript

March 8, 2018

Read the full transcript of Plastic Surgery Talk Episode 4: Heading into Spring

You can also listen to the full audio here.

Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica. Hello. Welcome. Dr. Stephen Mulholland here in Toronto, Canada, and welcome to our podcast.

Today we’re going to talk about aesthetic concerns as we head into the spring, the transition from winter. What do you need to concern yourself with? What do you need to be ready for?

We’re about to transition from winter into spring. What are some of the common skincare issues you may need to deal with and address as we make that transition? We’re entering a time when the weather’s warmer, when it’s not as dry. We’ve exited a winter where we worry about moisturizing, about keeping the skin from getting desiccated, protecting it from excessive cold, and now we’re exiting that season.

We’re going to leave that season of make sure you’re always moisturized, and maybe you’re not as concerned about sunblocks, although you should have been, because you do get ultraviolet rays during the winter. We’re definitely entering into the spring where there’s more sunshine. So transition number one: You need to find moisturizers with a good sunblock, a good 15 to 30 SPF sunblock that will protect you from harmful UVA/UVB light.
Remember, UVC and infrared can still cause damage, hyperpigmentation, discoloration. So you want to minimize direct exposure to the sun, wear sunglasses and a hat where possible, and definitely use UV protection.

You’re also going to want to undo some of the damage from the winter. You’re going to have thicker skin, so you want to get into treatments that will remove some of the hyperkeratotic, or thicker layers of your skin. You can do that in the medical spa environment, the dermatologic and plastic surgery environment with microdermabrasion, with things that are keratolytics, they’re called. So home peels, office peels with chemicals, or microabrasives like microdermabrasion, or even microneedling, some way to augment the collagen production of your skin after a long winter.
You’re going to start to think about bioactive skincare through a doctor’s office that will enhance the ability to make that collagen, to rejuvenate the skin, to tighten the skin. Probably time for a good dermatologic or plastic surgery consult for skincare, skincare that respects more time in the sun and trying to undo the damage and thinning of the skin and thickening of the layer, the outer layer of the skin, the epidermis, that we accumulated during the winter.
We’re undoing a long slumber season in the winter. We want to expose that beautiful skin now to skincare treatments, moisturizing, and sun protective factors. We’re exiting winter, we’re entering spring. Following spring will be early summer. Summer comes with short skirts, bathing suits, short pants. Nothing can detract from that let’s-get-ready-for-summer season than cellulite, that lumpy bumpy cottage cheese skin.

So what is cellulite? It’s irregular texture of the skin. A lot of women confuse fat, a clump of subcutaneous tissue they can grab, as cellulite. That’s not cellulite, that’s fat. And we have nonsurgical destructive techniques for fat. CoolSculpting, SculptSure, Vanquish, Body Effects, UltraShape, VenusFreeze. These are all technologies that will reduce fat, but they don’t necessarily smooth in the skin. So cellulite is lumpy bumpy irregular skin, nodules and dimples.

Now we have some very good stuff in the modern era of aesthetic medicine to treat cellulite. We want to release the dimples, release the dimples. We have some good dimple-releasing technologies like Cellfina, which is a suction coupled little device that releases the dimples, and like the buttons on a mattress, spring up so the mattress looks smoother.

We have products like CelluTite. CelluTite has a V-Dissector or the CelluLaser that will also release dimples. These usually can be found in a plastic surgeon’s or dermatologist’s office. They can be given under local anesthesia, and it makes your skin look less pitted.

Cellulite also comes in variance where there’s nodules and laxity. So we’ve got treatments to bring down the nodules, where we can shrink the nodules with little chemical injections of deoxycholate, also called Kybella. We can also use radiofrequency probes to reduce the nodules, all under local anesthesia with no surgery.
Finally, skin laxity, particularly the front of the thigh or the back of the thigh under the buttock where the banana roll is, can be lax. We’ve got radiofrequency needle treatments and under-the-skin radiofrequency treatments with products like Fractora 3-D, the Profound, again, with CelluTite, BodyTight, and SmartLipo, where we can make the skin tighter without big surgeries.

We’ve never had more armamentarium and weapons that we can use in the assault of cellulite. The time to do it is now, as we’re still in late winter, early spring is almost upon us. You want to give yourself a good six weeks after those treatments to get the nice, smooth, dimple-reduced, nodule-reduced, skin-tight cellulite improvement. You want to start now, give yourself six weeks before you unleash those smoother thighs, the smoother buttock on the rest of the population when you put on your bathing suit and your shorts.

So start now. Have a view for a smoother skin tone, look for those technologies we talked about. There’s never been a better time to improve your cellulite than now.

One of the common concerns that vexes patients is red, ruddy-complected skin, and this can be made much worse in the cold days of winter, and it can be made worse as we head into warm spring days when the temperature and the humidity’s higher.

So what is rosacea? It’s an inflammatory condition of the skin characterized by redness and flushing; in worsening rosacea conditions, acneiform eruptions, or pimple eruptions, dilated pores, and enlargement or rhinophymatous (increase in the bulbous look) of the nose. Rosacea can start for many, many years as a simple butterfly rash pattern or red pattern across the nose, cheeks, chin, and between the eyebrows. The skin is inflamed, it’s red, it’s often flaky, it’s irritated, and it’s sensitive.

Cosmetic makeup, certain soaps, and skincare can be very irritating to those patients with rosacea. Because it’s an inflammatory process, if we don’t treat the inflammation, we’re not going to get control of the condition. Unfortunately, rosacea is much like diabetes for the skin or hypertension for the skin. We can’t cure diabetes, but insulin can control it. We can’t cure hypertension, or high blood pressure, but blood pressure medication can control it. So we can’t cure rosacea, but we can control it.

Often dermatologists, medical dermatologists, family physicians will prescribe topical antibiotic for rosacea like MetroGel. MetroGel might help a little bit. You might try an oral antibiotic. Eventually, those medical treatments will fail, and you don’t want to stay on an antibiotic or topical antibiotic ointment forever. So the best treatment for rosacea that I have found over the last 20 years is light-based treatments called intense pulsed light.

Intense pulsed light is a flash of light through an applicator that we used to treat your skin. We treat every millimeter of your facial skin, the red and non-red areas. The flash of light, the IPL goes into the skin and attacks the little vessels that open up and dilate, giving you that flushing and redness. Over a series of five to nine treatments once every three to four weeks, so let’s say four to six months, with a good intense pulsed light laser like the Lumecca, the MaxG, the BBL, the ePluse, or the Versa from Venus.

With those good IPL systems, we can often make 60 to 90% reduction in your rosacea; never a hundred percent, but 60 to 90%. Now you need maintenance. About once every three or four months, you’re going to come back and treat that rosacea with IPL. We can control the inflammation, the sensitivity, decrease the redness and, therefore, the dilated pores, and all the other things that will happen with rosacea if you don’t control it will be under control.

You’ve got to do one treatment every three or four months forever, just like if you stop insulin, your diabetes gets out of control. If you stop your antihypertensive, your blood pressure gets out of control.

With six to nine photofacial treatments using intense pulsed light, we’ll get control of your rosacea. Then you need to maintain. We need to get you on a rosacea-specific skincare regime, and you need to have the appropriate approach to cosmetics, mineral makeup, non-sensitizing makeup. When you’ve done those three elements: IPL, IPL maintenance, rosacea skincare, particularly using products like Universe Skin, and finally the right makeup regime and approach, I think you’ll find that you achieve a harmony of control that leaves your skin looking bright, smooth, and even, and not red and inflamed. And then you’ve got control of rosacea. It doesn’t have control of you.

We get a lot of questions here at SpaMedica from our dermatologic cosmetic patients about thick scaly things on their skin. Generally, these are a group of reactions to the skin, pathologies to the skin called keratoses. There’s different types of keratosis: seborrheic keratosis, actinic keratosis, and then thick scaly patches of psoriatic outbreaks, so psoriasis. Those are some of the big three.

Let’s start with actinic keratoses. That’s a thick scaly area caused by chronic sun damage, typically happens in older patients: 40, 50, 60, 70, from chronic sun exposure with or without UV protection. You’re going to get changes in the skin, precancerous changes. So if you have a thick scaly patch that’s a little red, and it can be small, half the size of a dime or a penny, or large. These are precancerous cells. You need to see a dermatologist, a cosmetic plastic surgeon, or a family physician with a dermatology interest, and they need to be removed.

Many ways to remove them. Liquid nitrogen, freezing the actinic keratosis, using a hyfrecator or electricity to cauterize the keratosis, a CO2 laser to ablate the keratosis, or even topical ablative cream like methotrexate cream, but you have to ablate the precancerous cells or they could turn into true skin cancer, a basal cell carcinoma, or squamous cell carcinoma. So thick, red, scaly patches that don’t go away are not normal. If it’s on sun exposed areas like the forehead, the hands, the face, the arms, get it checked out, because it could be an actinic keratosis.

The next very common kind of keratosis, or thick scaly lesion, is called a seborrheic keratosis. These tend to be more raised. They look like waxy brown stuck-on lesions, not like the flat, scaly, red lesions of actinic keratosis. A seborrheic keratosis is not related to environmental factors like sun damage or sun exposure. Seborrheic keratosis is a genetically-programmed degeneration of the skin often with a hereditary predisposition.

These thick scaly patches are cosmetic concerns. They’re not pre-cancers. Very common on the back, on the neck, fortunately not on the central face, and sometimes the forearm. In general, when they’re small, we can use the same tactics and strategies as with actinic keratosis: liquid nitrogen, radiofrequency, hyfrecator, fractional or non-fractional CO2.

When they get larger and they look brown and they’re like stuck on, we often have to put a little freezing under them and do a little shave excision. So seborrheic keratosis can be removed because they’re cosmetic concerns. They’re not going to cause cancer. Actinic keratoses need to be treated because they could become cancer.

The last very common and annoying scaly pathologic condition of the skin is psoriasis. There’s many causes for psoriatic rough patches: environmental, genetic, food, allergic potential; but in general, it’s hereditary predisposition of inflammation in common areas of the skin: the flexure zones, the extremities, legs and arms. These scaly patches, if they are severe, need to be treated.

They can be treated with topical anti-inflammatory steroid creams, that can be fluorinated or non-fluorinated. You need to be under the care of a good dermatologist, because too much of that cream can negatively affect your skin, but not enough of it on the lesions will allow the lesions to exist. So fluorinated steroid creams. Sometimes we’ll use activated light sources and creams to treat the psoriasis.

Then sometimes even medicated creams that don’t have steroid in them can be used to provide the moisturizing effect over the areas where psoriasis will affect your skin. With aggressive and vigilant approach using these anti-inflammatory creams, generally psoriasis can be controlled.

Thanks again for joining us today at Plastic Surgery Talk. I hope you have enjoyed our podcast. If you have, please share it on all your social media channels. We look forward to seeing you again.

Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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