ADAS Dermatology

By David T. Harvey, MD, FAAD, FACP

Aging can often take us by suprise and can affect many locations of our skin. Many of my patients in Jacksonville, Ponte Vedra Beach and Palm Coast complain that they don’t like the look and feel of their hands. They complain that doctors can help them with their complexion and skin issues on their face and neck, but friends still notice their hands. Many are self conscious because they experience, easy bruising, skin laxity, discoloration and muscle tendon prominence.

What can I do for this doctor? is the normal question that I am asked. Can you help my hand appearance? Several years ago,  I would not have a good answer but with today’s technology, there are great solutions out there.

At our practice, we like to take a twofold approach to hand rejuvenation. first, we look at degree of 1.  hand atrophy and then assess 2. the hand skin color and laxity.  If skin fullness is an issue, we have some wonderful new fillers today. We love to use Radiesse, a hydroxyappetitie (calcium based) product that has excellent properties for filling natural skin depressions. One to two vials are administered painlessly into the back of thinned out hands. A numbing solution is mixed with the Radiesse, so this makes the procedure very tolerable.

After filler treatments,, we can perform either a Fractional CO2 or IPL (intense pulsed light) treatment to get improve skin discoloration and assit with age spot removal. Fractional CO2 is also a great way to tighten the skin. This a wonderful treatment option with one to two treatments being the norm.

So it time to ante up and show your hands at your next card game or ladies dinner. No longer do you have to worry about giving away your age…instead you will amaze.

By David T. Harvey, MD, FAAD, FACP

Eyelid Surgery is a standard therapeutic and cosmetic surgery procedure that is performed in the fields of plastic surgery and dermasurgery. We approach this procedure in a unique fashion…combining the best of cold steel surgery with “state of the art” CO2 laser instrumentation.

Traditionally, eyelid surgery involves the removal of the delicate fat pads by 1. identification of the fat pedicle with gentle skin dissection. 2. lifting of the fat pedicle 3. clamping with a forcep or “kelly” clamp 4. cutting the fat with tenotomy scissors and 5. intense coagulation (heating of the delicate eyelid tissue).

In our practice, with CO2 laser, we are able to eliminate steps 3 through 5. Once the fat is teased out, it can be genly ablated (evaporated) without the need for clamping or excessive heating. Fat which is still noted can be gently sculpted away  and the overlying skin muscle interface (septum) can be contracted without cutting using the CO2 laser in a defocused laser beam pattern.

I believe the technique minimizes the risk of the most serious side effect -retro orbital hematoma (bleeding behind the eye). It also lends itself to a much more precise type of surgery, one where the surgeon is more of an artist and less of a forger and pillager.

Check out the technique by clicking here… ah yes, the eyes ….they are indeed a beautiful sight to behold once again.

Before

  

 

 

 

 

After -7 weeks postop

By David T. Harvey, MD, FAAD, FACP

Fig 1. Evolence

I wanted to blog about a new state of the art filler that I was recently introduced to and one of the first to use in the Jacksonville, Florida  area… Evolence™. This product is the latest filler to be used by dermatologists and plastic surgeons and has quite a few advantages over others (as I pleasantly found out). First of all,  the material is very, very smooth and easy to place. I was pretty amazed when I treated a patient’s cutaneous upper lip on a smoker I was sure needed a CO2 laser procedure (Fig 2).

The material is derived from porcine (pig based) collagen. It is processed in a very unique way, which eliminates the need for pretesting. The process of ribosylation, evidently reduces some of the secondary post-op swelling that is seen with some of the other products that we commonly use (Restylane™ and Juvederm™).

Anecdotal reports have the material lasting from 15 to 24 months but I am not commenting until I see it for myself. To date, I am very impressed with how the material seems to finds the small lines and virtually erases them. Bruising is minimal. Cost is similar to the other products mentioned and varies from $600 to $800 dollars per vial.

Fig 2a. Before upper lip line treatment

Fig 2b. After treatment

A new filler, Evolence Breeze™, is set to hit the US market next year and this can be used in the lip region.

I will keep you posted of my personal experiences with this material but so far …so good.

By David T. Harvey, MD, FAAD, FACP

Fractional CO2 Technology

Recently, I had the pleasure of lecturing to fellow colleagues at the Advances in Dermatologic Surgery  Meeting in West Palm Beach and demonstrating what I  believe to be one of the greatest advancements in cosmetic laser surgery…..Fractional CO2 Laser Technology.

CO2 Laser has been around for many years. In fact, I remember that the technique was just coming out as I was  finishing my dermatology residency in 1995. It was a revolutionary laser but had many problems. First off, patients would complain of the pain and downtime. they had to have IV or general anesthesia. Another issue was that these patients would look disfigured and red for up to 14 days. Then we saw the complications (and did we!).  Poor utilization and technique as well as “off label” uses lead to unintended scarring and in some instances permanent disfigurement.

I have over 10 years experience with the CO2 laser and what I love about the fractional CO2 technology is that it finally offers us some unique advantages over traditional CO2 laser including…predictable results, off face uses, less downtime, requires topical anesthesia only, is minimally painful and very affordable. I can report from my own personal experience that this technology is pretty painless. I had my eyelids treated at low settings and found the experience to be very tolerable (reporting a 1 to 3 out of 10 pain scale.. in some areas I did not even require a topical anesthetic).

Fractional CO2 laser makes use of tiny dots which penetrate the skin and cause a disruption of the middle portion of the skin known as the dermis. Through a combination of selective tissue evaporation and heating, the dermis remodels and tightens.. This treatment is excellent for acne scars, wrinkles, oil gland enlargement, neck and hand laxity and much more. We can even use this laser in a unique way for our eyelid surgery cases. It is quite an awesome tool!

In short, I am blogging the Fractional CO2 laser because I am truly a believer of the technology. If you don’t believe me, check out our before and after pics and research the technology on your own. I am sure that you will be amazed like I was… in short order.

By David T. Harvey, MD, FAAD, FACP

Fraxel (re:store) treatment

ALA application

We then use a pulse dye laser to activate the ALA. This causes a mild redness  and induces shrinking of oil glands, blood vessels, pores and wrinkles. Down time is only a few days but redness can persist for up to a week.

before

after

    

By Dr. David Harvey, MD, FAAD, FACP

What are Omega 3 fatty acids?

Fig. 1 Salvia Hispanica

Omega-3 fatty acids are considered essential fatty acids. They are essential to human health but cannot be manufactured by the body. For this reason, omega-3 fatty acids must be obtained from food. Omega-3 fatty acids can be found in fish, such as salmon, tuna, and halibut, certain plants (including purslane), nut oils, and the natural  peruvian grain Salvia Hispanica (Fig. 1). Omega-3 fatty acids play a crucial role in brain function as well as normal growth and development.

The American Heart Association recommends eating fish or fish oils (Fig. 2) (particularly fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon) at least 2 times a week. It is advised that pregnant women and mothers, nursing mothers, young children, and women who might become pregnant not eat several types of fish, including swordfish, shark, and king mackerel. They can take omega-3 fatty acids in quality dietary supplements that are certified mercury-free by a reputable third-party lab.

Fig. 2 Fish Oil

There are three major types of omega 3 fatty acids that are ingested in foods and used by the body:

Alpha-linolenic acid (ALA)
Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA).

Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent risk factors associated with chronic diseases such as heart disease, cancer (skin cancer, prostate cancer, colon cancer), and arthritis. They are also helpful for blood pressure control, arthrosclerosis and diabetes mellitus. These essential fatty acids are highly concentrated in the brain and appear to be particularly important for cognitive (brain memory and performance) and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems as well as atopic dermatitis. Symptoms of omega-3 fatty acid deficiency include extreme tiredness (fatigue), poor memory, dry skin, heart problems, mood swings or depression, and poor circulation.

It is important to maintain an appropriate balance of omega-3 and omega-6 (another essential fatty acid) in the diet, as these two substances work together to promote health. Omega-3 fatty acids help reduce inflammation, and most omega-6 fatty acids tend to promote inflammation. An inappropriate balance of these essential fatty acids contributes to the development of disease while a proper balance helps maintain and even improve health. A healthy diet should consist of roughly 2 - 4 times more omega-6 fatty acids than omega-3 fatty acids. Many biochemists and physicians feel that the imbalance of omega-6/omega-3 fatty acid ratio is a significant factor in the rising rate of inflammatory disorders in the United States.

Uses in Dermatology

Fig 3. Acne Vulgaris

Clinical studies suggest that omega-3 fatty acids may be helpful in treating a variety of health conditions. In dermatology the benefits include, acne vulgaris(Fig 3) due to help with blood sugar control, anxiety induced(neurodermatitis), photodermatitis, psoriasis, burns, dry skin, systemic lupus vulgaris, and even nonmelanoma skin cancer (Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)). Specifically, A prospective study found that higher intakes of omega-3 fatty acids were associated with lower BCC risk. However, when non-white males were removed the association weakened (Black and Rhodes 2006 from van Dam et al. 2000). Another population-based study was able to demonstrate a lower risk of SCC with higher intakes of omega-3 fatty acids (Black and Rhodes 2006 from Hakim et al. 2000).

Risks

Omega-3 fatty acids should be used cautiously by people who bruise easily, have a bleeding disorder, or take blood-thinning medications, including warfarin (Coumadin™) or clopidogrel (Plavix™), because excessive amounts of omega-3 fatty acids (> 3 grams a day) may lead to bleeding. Ask your doctor if you are unsure about taking omega 3 fatty acid supplements.

Summary

Omega-3 fatty acids may be just what the dermatologist ordered for your skin health issues. If you are interested to learn more about the benefits of Omega 3 fatty acids, please click here or call 904-285-5880.