SKIN CANCER AWARENESS MONTH

SUNSCREENSMay is Skin Cancer awareness month, so I thought I would do a quick blog on sun protection and skin care in regards to sun exposure.

Approximately 1 in 5 Americans will have some type of skin cancer in their lifetime.  Skin cancers are the most common type of cancer in the United States of America.  Protection from damaging UVA/UVB rays can help improve ones odds significantly.

Some basic tips include avoiding sun exposure between 10-4, wearing broad spectrum sunscreen, wearing protective sunglasses, wearing broad rimmed hats and seeking shade whenever possible.  But when you find yourself in the sun, your choice of sunscreen protection is important.

When purchasing sunscreen look for broad spectrum, meaning, protects against UVA and UVB radiation.   Broadly, UVB rays burn our skin and UVA rays go deeper and damage the skins structure. Both increase cancer risk.  Both contribute to premature aging of the skin.

In the sunscreen market there are chemical sunscreens that are referred to as absorbers.  They absorb the UV rays and convert them to heat.  There are a long list of these chemical agents and some cover either UVA, UVB and some absorb  both.  There are approximately 20 FDA approved agents.  These chemical agents have a maximum amount of absorption and then loose their effectiveness unless reapplied.  Physical agents, such as zinc dioxide and titanium dioxide, reflect the UVA/UVB rays.  I always discourage patients from focusing too much on the SPF factor because an SPF of 15 filters 93% of the UV rays while SPF of 30 filters 97%.  Going to an SPF of 50, 70, 80 or 100 does not significantly improve your protection factor.  Reapplying, however, does.

I am a big fan of physical agents as they are the least likely to cause irritation, work immediately upon application and offer broad spectrum UVA/UVB protection.  When applying make sure not to miss the eye area, ears, backs of legs, feet, lips, and if you are bald or have thinning hair, the scalp.  Sunscreens with zinc and titanium are not the thick greasy kind we remember from our childhood.  They are now micronized and have a cosmetically elegant feel.  Do not under utilize your sunscreen.  When applying to your whole body you should use several tablespoons of sunscreen.

There are increasingly sunscreen garments that can add protection.  Rash guards are increasingly popular and fashionable.  When purchasing sun protection wear make sure it has a UVP rating on the label.  Do not rely solely on this as a means to protect your skin.

Finally, I wanted to review protecting eyes.  Repeated and cumulative UVB/UVA exposure to the eyes can contribute to cataracts and macular degeneration.  Eyelids (upper and lower) are one of the most common sites for non melanoma skin cancers.  The lower lids are more effected than the upper lids.  Sunscreen and sunglasses with UVA/UVB protection are vital.  Skin cancers on the eyelids do not always present the same way as elsewhere on the face.  These types of cancers tend to infiltrate and can effect ocular structures, thus putting site at risk.  Those with light colored eyes and skin are more at risk.   Ideally your eyelid skin is evaluated by your dermatologist yearly.

That brings me to the importance of yearly skin checks.   A yearly skin check should be part of your routine medical evaluation.  Depending on your risk factors a physician may determine if this should be done more or less frequently.  There are also physicians who will skin map you if you are at higher risk.  (take photos to reference back to,  helping to  evaluate changes over time)  I had mine mapped as I am a fair red head who spent part of her childhood in the South Pacific with year round sun exposure and am covered in acquired nevus (brown skin lesions/freckles).   If you feel you have too many spots to keep track of skin mapping may be a good option.

I am a huge fan of the Elta MD® line of sunscreens (thus the photo) and encourage everyone to find their favorite sunscreen.  If you love it you will use it!

Happy Memorial Day weekend!  Protect yourself while having fun out there  🙂

HOW ABOUT THE NECK?

neck

A youthful neck only lasts so long.  It is an area of the body we commonly receive consultations on.  Did anyone read Nora Ephron’s brutally honest and sarcastically funny book, “I Feel Bad About My Neck And Other Thoughts On Being A Woman”?!  She had a thing or two to say about her neck!

But seriously, we tend to take good care of our faces but neglect our necks.  There are many options for our necks.  From topicals creams,  injectables, skin firming treatments, and finally, surgery.  This will be a quick and easy breakdown of modalities to address a variety of issues that can effect the neck.

As we age the skin on our neck becomes thinner, the platysmal bands show, looking  like cords in our neck.

platysmal bands

Platysmal Bands

Our sub mental fat pads can become more apparent and we loose the definition along our jawline, altering our profile.

neck fat

Sub mental fullness

The tissues can become looser, frequently due to repeated pulling of the platysma muscle along with the loss of collagen and elastin.

loose neck

Loose skin/loss of collagen/elastin

Skin can  become discolored.  A condition called Poikiloderma is common in both men and women.  The skin is marked with a combination of hyperpigmentation and redness (from vascular injuries from sun exposure).  Poikiloderma frequently involves the chest in addition to the neck.  Most often the medial neck is not affected.

poikiloderma

Poikiloderma

I think we can agree the first photograph in this blog looks better than all the others!  So, how to get closer to that….

Platysmal bands can be easily corrected with Botox®.  Botox® is injected along the platysmal band and within two weeks the band will relax and not show.  Additionally, doses of Botox® can also be injected along the mandible (jaw bone) to improve the jawline contour.  This is sometime referred to as a Nefertiti Lift.  This is a quick, non-invasive procedure.

Sub mental fullness can be addressed with Kybella® injections.  The injection of this acid breaks down the fat which is then eliminated by the body.  A series is generally recommended.  Other than 48 hours of socially awkward swelling (think bullfrog), this is a low down time procedure.  The procedure is ideally repeated at 4-6 week intervals.  We are noticing patients experience some skin retraction with this procedure as well. (likely as a result of the inflammatory process in which collagen is stimulated)

The loss of skin turgor can be treated with a skin tightening treatment, such as Ultherapy®.  During this treatment heat is delivered deep in the tissues, using ultrasound, creating tightening and lifting.  This is also a low to no down time procedure as most people can receive an Ultherapy® and return to their activities without anyone knowing.  The improvement is gradual over the next 4-6 months as the collagen that was stimulated grows in.

Discoloration, such as Poikiloderman, can be treated with a series of IPL treatments.  Again, other than redness the day of treatment, this is a minimally invasive/no downtime procedure.  We recommend a series of 3-5 treatments.

I do not want to underestimate the importance of good skin care.  Sunscreen is a no brainer.  There are also products specifically formulated to treat the skin of the neck and décolleté.  My current favorite is Neocutis® Microfirm™.   This topical product, utilitzing peptides and glycolic acid,  increases elasticity and improves skins crepey appearance.  It can also help to fade hyperpigmentation.

microfirm

Finally, there comes a time when the tools and products we have in a medical spa are not enough.  There is a time when the neck is best addressed with a skilled surgeon.  A neck lift involves redraping the skin.  Additionally the platysma muscle is reattached and tightened.  You and your skin care provider ideally have honest conversations along the way allowing to make this call when it is appropriate.

Anyway, don’t forget your neck!  Hope this gives you some helpful tips:-)