Burgess               

Our expert is Cheryl Burgess, MD, FAAD, founder, Center for Dermatology and Dermatologic Surgery in Washington, DC.

If there is a medical topic you would like to see explored here, please let me know!

Very best,

Mitzi Perdue

MPerdue@LiebertPub.com


ATTITUDES TOWARDS PLASTIC SURGERY HAVE CHANGED

Back in the 1960s, people were embarrassed to admit they dyed their hair.  Maybe you’ve heard of or remember the Clairol slogan, “Does she or doesn’t she? Only her hairdresser knows for sure.”  Up until recently, people were likewise embarrassed to admit to having plastic surgery. Today, however, this attitude has almost reversed. Many people want to look young for as long as they can, and they don’t want to “let themselves go.” This can be particularly important for career women in highly competitive big city markets.

PLASTIC SURGERY HAS MADE SIGNIFICANT ADVANCES IN THE LAST 10 YEARS

Up until roughly 10 years ago, the cosmetic norm for dealing with wrinkles was to inject filler in every line. Today we know that fillers and neuromodulators such as Botox will be more effective and longer-lasting when strategically combined. Fillers work well enough when there’s skin laxity or the line is static. The issue is that not every line is static and filler isn’t as effective when there’s muscle movement beneath the skin that’s causing the line.

THE ORDER FOR APPLYING FILLER AND NEUROMODULATORS MATTERS

The order I recommend is using the neuromodulators and then waiting two weeks. When the patient comes in at the end of this time, I like to assess the face again. Often I find that I don’t need to use as much filler because, once the muscles are relaxed, the lines are no longer prominent and some of them may even be gone. For patients who are thinking of doing something about their wrinkles, recommend that they see a doctor who knows how to use both products and the order in which they should be used.

SKIN TIGHTENING DEVICES

Devices that use radiofrequency and ultrasound are available for noninvasive skin tightening. These devices target collagen and after delivering energy deep into the skin, the underlying collagen contracts. A controlled wound-healing response occurs, and over time this is associated with the growth of new collagen. The tissue tightening that results will typically last for 18 months to two years.

NOT ALL SKIN TYPES WORK FOR SKIN TIGHTENING PROCEDURES

Women of color, men, and Irish-Nordic types are likely to do well with skin tightening procedures. However, there are other groups that typically do not. The Fitzpatrick Skin Type scale can help predict this. This scale is a classification of a person’s skin’s tendency to sunburn when exposed to UVA/UVB radiation.  On the list you’ll see below, people with skin Types II and III on average do not do as well as the Types I, IV-VI. The issue for Types II and III is the collagen seems to be thicker, and there’s less contractibility.

The Fitzpatrick Scale:
•    Type I (scores 0–6) always burns, never tans (pale peach; blond or red hair; blue eyes; freckles).
•    Type II (scores 7–13) usually burns, tans minimally (peach; fair; blond or red hair; blue, green, or hazel eyes)
•    Type III (scores 14–20) sometimes mild burn, tans uniformly (light brown; fair with any hair or eye color)
•    Type IV (scores 21–27) burns minimally, always tans well (moderate brown)
•    Type V (scores 28–34) very rarely burns, tans very easily (dark brown)
•    Type VI (scores 35–36) never burns, always tans (deeply pigmented dark brown to darkest brown

BE CAREFUL ABOUT BUYING NEW SKIN CARE DEVICES

Sales people may come around telling you about the money you can generate with their new skin care device. However, going to a weekend course and assuming you’re ready to use it can be a mistake. Check out the complications that occur before you decide to buy. If you don’t understand the biochemistry and physiology of skin, and if you can’t handle the complications, you’re better off not buying the device. 

THE FEATURES THE PATIENT MOST CARES ABOUT ARE WHAT IS IMPORTANT

When a patient comes in, I give her a mirror, and I ask, “What features do you like about your face?” I find out what’s important to her and that’s what I’ll work to enhance. Maybe she likes her high cheekbones or her lips or her eyes. I’m sympathetic to the fact that she wants to keep herself up and look her best. We know that aging is going to happen to everyone, but just as a woman who a few years ago decided she wasn’t going to let her hair go white, today she may want to minimize her wrinkles to stay younger-looking.