Monday, Sept. 19, 12:30 p.m. ET

Saving Your Skin

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Dr. Rhoda Narins
President , American Society for Dermatologic Surgery
Monday, September 19, 2005; 12:30 PM

Dr. Rhoda Narins, president of the American Society for Dermatologic Surgery, discusses the pros and perils of common cosmetic procedures.

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washingtonpost.com: Hello, everyone, and thanks for joining us today to talk about skin care with Dr. Rhoda Narins, president of the American Society for Dermatologic Surgery. With so much buzz about botox, skin peels, laser and other procedures, we know you have lots of questions about what really works and the issue of safety. So, without further ado, let's get started.

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washingtonpost.com: It looks as if there's been a delay for Dr. Narins, but we'll begin as soon as possible.

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Washington, D.C.:

Hello. I have some minor broken blood vessels on my cheeks. My dermatologist said I could have them lasered off if they bother me, which they didn't until he mentioned it! Now, I want them off in the worst way. Is this procedure a big deal? Costly?

Dr. Rhoda Narins: It is a very common procedure and works very well. You may need 1-3 treatments with a Vbeam laser and 4-6 treatments with an IPL. The cost can range from several hundred dollars to $2000 depending on the number of vessels and the procedure. Patients love the results.

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Gaithersburg,Md.:

Please discuss the pros and cons of threadlift and whether a cosmetic (plastic) surgeon or dermatologist is better qualified for the procedure.

Dr. Rhoda Narins: Not everyone is a candidate. Both Dermatologists and plastic surgeons have been trained to do this procedure. It's best to ask your doctor to recommend someone experienced with this technique and have them discuss the pros and cons for you.

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North Salem, N.Y.:

I see advertisements all the time for laser hair removal centers? Are these places reputable? What questions should I ask in advance?

Dr. Rhoda Narins: I would have a laser treatment of any kind done in a dermatologists office for the best and safest results.

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Chicago, Ill.:

Can't I get a lot of these services, like dermabrasion, laser hair removal, etc. in a spa as opposed to a physician's office?

Dr. Rhoda Narins: A light microdermabrasion is fine in a spa. There are no lasting long term results. For a real dermabrasion, any laser treatment and certainly for injections, have them done in a dermasurgeons office for the best and safest results. Spas are great for massages, facials etc.

Go to www.ASDS.net.

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Rolling Meadows, Ill.:

What services do dermatologic surgeons provide? Do they receive additional training from dermatologists?

Dr. Rhoda Narins: Dermasurgeons can do injections of fillers, BOTOX, peels, lasers for hair removal, red and brown spots, wrinkles, acne and acne scarring, skin cancer and benign lesion surgery, leg vein treatment, safe tumescent liposuction with of all areas using local anesthesi and Thread lifts to name a few procedures. Go to www.ASDS.net to find a qualified dermasurgeon near you.

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Clifton, Va.:

I recently saw my regular doctor and then a dermatologist for a small circle of skin on my scalp where hair was not growing (I am a woman under 35). Both said it was alopecia areata and not to worry, that some shots of a steroid would bring back the hair. How common is alopecia areata? Can it mean I will lose more hair? Both doctors told me it is fairly common and that it does not mean I am going to go bald. Still, I am frightened. Can stress cause/worsen this condition? PS: The doctors ran a number of blood tests (thyroid, etc) that all came back normal.

Dr. Rhoda Narins: Alopecia areata is very common and usually the tiny small spots grow in 3-6 weeks. Stress does make it worse.

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Washington, D.C.

I'm a man with some acne scarring on my face. Its not horrible, but bad enough that I would consider some surgery to eliminate or reduce it. What are the possibilities, especially those that do not cause skin discoloration? Thanks for taking my question.

Dr. Rhoda Narins: The best treatment for acne scarring is the CO2 laser. It cannot be used on people with pigmented skin and there is recovery time. The Cool Touch laser is a series of treatments that helps acne scars 40-50% with no down time. Lasers and a filler can sometimes give wonderful results.

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Washington, D.C.:

I have a small bump on my forearm that my dermatologist told me was a fat deposit. He also said I shouldn't worry about it. What would the process involve if I wanted to remove it? Just cutting it open and removing the fat? It's not that noticeable to anyone but me, but it still bothers me. Thanks!

Dr. Rhoda Narins: If it bothers you a dermatologic surgeon can easily remove it. Remember that you will have a small scar in the area.

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Falls Church, Va.:

It seems that all of a sudden I've developed all of these skin tags on my face and my neck. What is the best way to have them removed and will the removal leave scars?

Dr. Rhoda Narins: Removal should not leave scars and they are generally easy to remove with a variety of methods.

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Arlington, Va.:

Hi, I'm a 32-year-old male and have some wrinkles around my eyes, like crows feet. I've been using products like Kinerase and Photolagen (which I think kind of works). Is there any proof these products actually work and if not what is there any way short of Botox or surgery to get rid of or seriously minimize these types of wrinkles?

Dr. Rhoda Narins: BOTOX injections and/or filler injections are the best way to remove these wrinkles. You can also use a non-ablative laser like the COol Touch to soften the wrinkles without recovery time. The co2 or Erbium lasers also help a lot but they have down time.

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Richmond, Va.:

I have ingrown hairs on my legs and nothing seems to work short of plucking them, which I know I shouldn't do, but they get irritated and sore. Do you have any suggestions?

Dr. Rhoda Narins: Go to your dermatologic surgeon for hair removal laser as well as topical cream therapy. Plucking and waxing make it worse so stop!

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Arlington, VA: I have hereditary dark circles under my

eyes. Is there anything I can do short of

makeup to get rid of them? I don't really

want to go the makeup route as I am a

male.

Dr. Rhoda Narins: Filler injection, bleaches and certain lasers will make thee lighter. Your dermasurgeon can tell you right away if a hollow under the eye can be filled with Restylane or another filler and immediately make the circles lighter. These circles are often hereditary but get worse as skin gets looser and under eye hollows pick up the shadow more as people get older. Fillers prevent this.

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Baltimore, Md.:

Dr. Narins - After two years on birth control (pill) I decided to stop taking it. And now, it seems because I have ceased this two-year habit, my facial acne has flared up! My forehead, jaw line, cheeks and chin, basically my entire face, are breaking out and it is driving me nuts. Are there any "good" external products you could recommend that could help control the acne?

Dr. Rhoda Narins: Topical medications with benzoyl peroxide and sulphur often help. If this is not enough, see your dermatologist who can treat with prescription topicals as well as internal medicines as well as photodynamic therapy and light or lasers.

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Arlington, Va.

Is Thermage treatment effective for lifting and/or firming sagging facial tissue?

Dr. Rhoda Narins: Yes, Thermage provides some tightening and lifting and when combined with BOTOX and fillers you can get a really great rejuvenating effect without surgery.

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Greenwich, Conn.:

I'm 63 years old and notice that there's a lot of young doctors out there today. Is cosmetic surgery like heart surgery, the more times you perform the procedure the better you become? Or are the younger surgeons more in tune with what's state of the art?

Dr. Rhoda Narins: Those are great questions. That is why you go to an expert. Young or old, the more times a doctor doors the procedure, ther better she or he becomes. Dermasurgeons are trained to evaluate th face and do these procedures correctly. They generally have many modalities to choose from. Find someone who is a member of the American Society For Dermatologic Surgery at www.ASDS.net for the best results.

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Olney, Md.:

Can anything be done to permanently remove a fibro-derma?

Dr. Rhoda Narins: If you mean a dermatofibroma, they can be removed easily with only a tiny scar.

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Arlington, Va.

Is it safe to have laser hair removal and/or microdermabrasion while on Coumadin, or should I stop Coumadin and use Lovenox injections prior to the procedures?

Dr. Rhoda Narins: Your dermasurgeon will probably tell you that being on Coumadin is OK for both of these procedures.

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Upper Marlboro, Md.:

Are there any products that really works for stretch marks on dark skin?

Dr. Rhoda Narins: No.

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St. Paul, Minn.:

I recently saw an add for using laser therapy for acne. Are these procedures safe (when done in a doctor's office, etc) and worth the money? I have done the full range of acne medicine from accutane on down. My skin is still oily and prone to breakouts including cystic acne. Would laser be beneficial to me at all, or am I better off with oral and topical meds? Thanks so much.

Dr. Rhoda Narins: Lasers with photoduynamic therapy can help.

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Canton, Ohio:

Thank you for taking questions. Has anyone documented a link between botox injections and the development of optic neuritis?

Dr. Rhoda Narins: No. BOTOX has been proven very safe and has been used for cosmetic reasons since the early 1990s. It is now also used for excess sweating, facial tics, painful scars, rigid muscle problems in cerebral palsy etc., lifting breasts, migraines, blepharospasm, strabismus etc.

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Gaithersburg, Md.:

Hi Dr. Narins, I am Native American, medium complexion. I have unwanted hair on my chin and upper lip and would like to try laser hair removal. I have read that different lasers should be used on the skin of people of color. Is this true and if yes, how do I go about finding a dermatologist who treats people of color?

Dr. Rhoda Narins: Go on the www.ASDS.net web site.

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Washington, D.C.:

Short of surgery, can you recommend a procedure and/or cream to eliminate under-eye bags and crepey eye lids?

Dr. Rhoda Narins: Lasers, fillers and BOTOX in combination can be a great way to rejuvenate around the eye. These are usually done at the time of the visit and have little or no recovery time.

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Washington, D.C.:

I'm 31 years old and NEVER go in the sun. For the first time, I notice slight lines underneath my eyes, which become more evident when I smile. I have a very rigid skin care regime that I do every day with Yonka products and get facials regularly. How do I get rid of these lines? Do I have to accept them as part of the aging process???

Dr. Rhoda Narins: The easiest answer that so many people have done is BOTOX.

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Brown spots:

Hi, I'm 46 and noticing these pesky spots suddenly showing up on my face. Can they really be eliminated, or do cosmetic procedures just lighten them? Thanks.

Dr. Rhoda Narins: The IPL (Intense Pulsed Light) is a home run in getting rid of brown and red spots and smoothing the skin without down time. You may need 4-6 treatments. A medium peel that heals like a sunburn is also wonderful for brown spots. Get it done!

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Washington, D.C.:

I was thinking about getting botox injections in my underarms in order to stop, what seems to be excessive, underarm sweating. When I am nervous, hot, excited, my underarms sweat. Is a botox injection to this area of the body dangerous? What are the potential side effects? How long will the medicine last and curb the sweating?

Dr. Rhoda Narins: It is very safe and generally lasts about six months and my patient say it changes their lives.

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Bethesda, Md.:

Is there any cosmetic procedure to help minimize "marionette" lines/folds in the face? Does it require plastic surgery to fix or are there other less invasive procedures?

Dr. Rhoda Narins: Using a filler such as Restylane can work wonders on those frown lines especially when used in combination with a tiny amount of BOTOX. You're right o be concerned. The frown and "marionette" lines are the most aging lines on the face!

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Washington, D.C.:

I have very red cheeks with some spider veins showing. Is this worthy of a trip to a dermatologist or is there something over the counter I can use?

Dr. Rhoda Narins: Here I would definitely go to the doctor for Vbeam laser or IPL (Intense Pulsed Light). They can get rid of those red rosy or flushed looking areas that get worse with sunburn, windburn, hot food , spicy food, caffeine or alcohol.

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New York, N.Y.:

What is a beta peel? Do peels work at all?

Dr. Rhoda Narins: A Beta peel is a salicylic acid peel. Peels certainly work. While light peels like glycolic acid do not have long term benefits, medium and deep peels can get rid of brown spots and wrinkles and smooth the skin. Ligh peels like the Beta peel and glycolic acid help with blackheads and give a temporary glow.

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Rockville, Md.:

Why is it important to go to a dermasurgeon for laser treatment instead of a spa or salon? Can you educate me about the differences between a dermasurgeon and a plastic surgeon?

Dr. Rhoda Narins: Dermasurgeons are trained physicians who experts in treating the skin. That's what we do. We generally have many different procedures and lasers available so we can pick the best one for your particular problem. A spa is nice for nails and massages etc but you need a doctor to do lasers and injections safely. Often there is no physician on staff. Look what happened to those poor girls ho dies from using too strong and too much of a local anesthetic cream on too large and area. They died. A doctor would have understood the absorption properties and danger of lidocaine and an overdose. Go to www.ASDS.net to find a dermasurgeon near you who can safely help with your problem.

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Dr. Rhoda Narins: Thank you for your questions. I am sorry we could not get to all of them. For the best results with the safest outcome, got to www.ASDS.net and find the dermasurgeon for you.

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