WLM: Many years have passed since Seinfeld’s famous “Dr. Pimple Popper” episode. What does today’s dermatologist do?
Dr. Tanya Futoryan: Dermatology has always been multifaceted.
First, there’s the medical side of it, dealing with skin cancer detection and treatment. We also treat rashes, acne and rosacea -the adult form of acne - and we still “pop” or inject pimples with anti-inflammatory medicine to quickly shrink them.
Then there’s LASER dermatology. Lasers use light to treat a specific target molecule, such as oxyhemoglobin in redness and broken capillaries, r melanin in brown spots, or water in dermal collagen. Laser light will produce heat and improvement of target tissue.
I believe in treating specific issues in the skin with lasers because of their specificity and precision with little to no collateral damage.
In addition, there’s the aesthetic anti-aging field of dermatology which addresses the three dimensional changes that occur in our faces over time. Those changes occur in bone, fat or soft tissue, and in the skin. Skin is only a few millimeters deep and can be treated with lasers. The fat, muscle, and bone must also be considered and treated when addressing the aging face.
To reach the soft tissue and bone, one can do surgery or use injectables. Cutting should be reserved for people with excess fat and/or skin. For others, the aging process is gradual and can be treated by restructuring with injectables.
WLM: What injectables do you recommend?
TF: I work with all of them to get the right match for the area of the face I’m trying to improve. When working over bone, I use thicker sturdier fillers, while when working in the fat, I prefer fillers with good volume and lift, and the thin/gentle tissues around the eyes and lips require a thinner or softer product.
WLM: When should a patient start with injectables?
TF: I recommend patients start when there are early signs of aging, usually in their mid to late 30’s or early 40’s. When patients start to notice deeper folds and flat or hollow areas on and around the face or when the proportion of bone to soft tissue/ fat changes, we start to notice aging. After about age 35, you see collagen degradation bone loss and fat/soft tissue loss, and shifts (some due to gravity). Much of what we see as wrinkles in the skin is a result of these changes. In addition, skin will show aging due to UV light. UV damage leads to loss of elasticity and decreased collagen production. Think of skin as sheets on the bed, the mattress as the soft tissue beneath, and bone as the frame holding both up.
WLM: What are the three main things we can do to maintain the health of our skin?
TF:
1. Use sunscreen to protect the skin.
2. Regular checks for skin cancer are important at any age.
3. Get Skincare education / advice from your dermatologist who knows the most about active ingredients and products which will benefit the health of your skin.
WLM: There are SPFs up to 100 and more. What’s the most effective SPF and how often should one apply it?
TF: Apply the highest SPF your skin will tolerate. I advise patients to use physical sunscreens such as zinc oxide or titanium oxide. These reflect all UV light off the surface of the skin much like a mirror does. They don’t absorb any of the light. For that reason, physical sunscreens are safer for kids and adults and provide better UV protection because they reflect/ screen out all rays.
WLM: Don’t they make your face white?
TF: Zinc oxide and titanium dioxide are naturally chalky white and can appear white on the skin. However, sunscreen manufacturers have made the particle size smaller and therefore less noticeable on the skin. Some of the formulations also come tinted. You’ll need to try out a few sunblocks to see which one looks best and is easiest to use.
WLM: How often do we apply the sunscreen?
TF: If you’re going to work for the day, apply sunscreen in the morning. If you’re outdoors doing activities and sweating, you’ll have to reapply every 4 hours or as indicated on sunscreen packaging. The rule of thumb is, if you’re not tanning, then your sunscreen is working well. If you’re tanning or turning red, it’s not.