Medical Dermatology - Part 2

Recent posts

Treatment for Lipomas

Dr. Reichel,

Can Thermoge be done to limpomas?

-K

 

Dear K,

Thank you for your question. No Thermage can not be done to lipomas. For small lipomas, the best way to remove them is simple surgical excision. Although this does leave a small scar, it is the most successful way to treat them. Liposuction can be done for larger lipomas (bigger than a baseball). For small ones, it is almost impossible to get the liposuction cannula into the lipoma. In addition, there is a higher rate of recurrence with liposuction. In most cases, I recommend that surgical excision be done. There are no other really good treatments for lipomas. Injection with a detergent (mesotherapy) has been tried, but the success rate is very low and it often causes significant inflammation and tenderness.
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
www.pacificdermcenter.com
11011 Meridian Avenue N Suite 102
Seattle WA 98133
phone: 206-859-5777
fax: 206-859-5776

Lip fillers & Rosacea with Dr. Reichel

I am interested in trying filler for the first time in my lips and possibly other areas of my face. I also have rosacea and would like to discuss treatments.

-S

Dear S,

I would love to see you for filler for your lips (and possibly other places). For lips, the best fillers to use are either Juvederm Ultra, or Restylane. They are fairly comparable. I think Juvederm is a bit more pliable/supple, but I find that Restylane may last a bit longer. We can decide which is best for you when you come in. I am always amazed at how wonderful and natural it makes your lips look. I recommend that we do local nerve blocks and topical numbing cream to make you comfortable. People tolerate it really well. We currently charge $575 per syringe. We do run specials and one later this month on Juvederm. Check it out here

Many people worry that it is going to give them big big lips. This isn't the case with just one treatment. You should expect to see about 3-4 days of temporary swelling so don't plan any big events for that time. Other possible side effects include bruising (usually mild, about 5% of patients have more significant bruising that can last 5-10 days). Bruising can usually be covered well with make-up. Having an allergic reaction to fillers is almost unheard of.

Results usually last 6 months the first time and then, the more you do fillers, the longer the results last. We can do a cosmetic consultation to see if any other treatments would be right for you.

For your rosacea, we can talk about it at the same time. Treatments include topical medications, such as metro-cream and oral medications, such as oral antibiotics that are also used for acne. For some patients with rosacea, they may need treatment with lasers such as the V-Beam, the Aura KTP, or even just Intense Pulse Light. We can look at you and see what is best. Most insurance companies will cover the cost of an office visit, and the oral and topical medications for rosacea. Most do not cover laser treatments (sad).

I'm excited to see you.
Dr Reichel

Pacific Dermatology & Cosmetic Center

Seattle, WA

206.859.5777


Non-surgical treatments for treating scars

Dear Dr. Reichel

I am looking for Scar revision of 8 inch scar from chest surgery 15 years ago. What none surgical treatment can improve the look of this scar?

Thank you for the email inquiry. There are several non-surgical options for treating scars. It would be very important for me to see the scar in order to decide what treatment would be best. The consultation would be at no cost for you, and we may be able to do treatment on the same day.
The non-surgical options for scar improvement include injections of medications (such as kenalog) to help flatten scars. The other options include laser work. The Vbeam Perfecta laser can work very well if the scar is "heaped up" and/or red in color. It is the laser of choice if you have keloid scar formation. The Fraxel Restore laser can be used on older scars to help blend them in with the surrounding skin. Finally, a CO2 laser, such as the Lumenis Total FX can be used on tougher scars to also help to blend them in. The right procedure for you would depend on your scar.
I would be happy to see you in consultation. Please call 206-859-5777.
Thank you.
Dr R.
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center

Even with Seattle's "Not-so-Sunny" Disposition,You Still Need to Prevent Sun Damage

Sun Damage: What to Teach Your Daughter Now

Sun Damage: What to Teach Your Daughter Now

Posted Tuesday, January 31, 2012 by Shellie Terry Benson, Editor

How much would you love to turn back the clock and undo all that sun damage you exposed yourself to? It might be too late for you, but it's not too late for your children. While wrinkles and sun spots develop after many years of exposure to the sun's ultraviolet rays, getting a sunburn at a young age is one of the top indicators for developing skin cancer later in life.

A team of researchers recently studied the sun-safety habits of children and found that more than half (53 percent) had suffered at least one sunburn before age 11. Further, they found that only one in four 14-year-olds regularly use sunscreen.

But what you do to protect your skin can have a profound effect on young teenagers who, despite their behavior, still look to you for guidance. Slather on the sunscreen and then cover them as well. Or better yet, encourage them to learn to properly coat themselves. Have them wear a hat on particularly sunny days and opt for lightweight cotton clothing to add another layer of protection. Explain the dangers of sun damage, both in terms of aging and health. Plus, if you follow those rules, your children likely will, too.  Also be open to discussions about examining moles and spots on their skin that may suddenly change, this will make them aware of what the suns more harmful rays can do long-term.


Acne Problems? Our Seattle Dermatologists Can Treat Your Acne

Have you ever wondered why some of us only get blackheads while others get full-blown breakouts? Seattle dermatologist Jennifer Reichel, MD explains, “Genetics and the immune system definitely come into play. Everyone starts with a pimple, but the body’s inflammatory reaction varies from individual to individual. How the immune system responds determines if acne will progress to more severe cysts and nodules.”

A wide variety of oral and topical antibiotics are prescribed to treat acne, including tetracycline, erythromycin, minocycline, doxycycline and clindamycin. Many factors come into play when choosing the antibiotic, including a patient’s age, allergies and if they are pregnant or nursing. Dr. Reichel explains that minocycline is often her first choice, because “it’s an easy once-a-day dose and it’s well tolerated by most patients.”

Often considered the last resort for treating acne, Accutane is an oral medication that may be the only effective treatment for persistent nodules and cysts. According to Dr. Reichel, “Accutane is the magic bullet for acne that doesn’t respond to other treatments.”

Retinoids go by many names, including tretinoin, Retin-A, Tazorac, Differin and more, but they are all derivatives of vitamin A that affect the way the skin turns over and prevents dead cells from sticking together and clogging the pores. As if there weren’t enough retinoids to choose from, there’s also a prescription called Ziana that combines tretinoin with the antibiotic clindamycin to target bacteria as well. Dr. Reichel often starts acne treatment with Retin-A because “in addition to breaking down comedones, it’s great for older acne patients who are also concerned about aging.”

Stubborn acne needs a multifaceted treatment that covers all of the acne-causing culprits: bacteria, inflammation, oil and clogged pores. A relatively new office-based treatment called Isolaz does just that, using suction to clean out the pores while pulsed light targets oil and bacteria. “Studies show it’s safe and effective for mild to moderate acne,” says Dr. Reichel

Acne on the body isn’t much different than acne on the face, and “we generally recommend the same course of treatment.,” says Dr. Reichel.

There’s also a recently approved topical called Aczone, which features the drug dapsone. According to Dr. Reichel, “This is a fairly potent antibiotic that is often used  effectively for more severe skin disorders. When taken orally it has a lot of side effects, but the topical version doesn’t seem to have these problems. Aczone has strong anti-bacterial and anti-inflammation capacity to knock out acne.”  Pacific Dermatology & Cosmetic Center accepts most major health insurance plans.  Our physicians and skin care specialists are here to assist you for all of your skin-related needs.

Call Pacific Dermatology & Cosmetic Center today, 206.859.5777, to schedule your appointment with one of our highly trained physicians and get on the right path to clearer skin.


I would like a consultation for liver spots

Dear Dr. Reichel:

I am 67 years old, and have two liver spots on my face and would like them removed. Do you have "free" consultations? Thanks J.W.

Dear J.W.

Liver spots are a common name for any sort of pigmented lesion on the skin that develops with aging. They are usually “sun freckles”, or solar lentigines. However, someone might also be referring to seborrheic keratoses when they use the words “liver spots”. I like to call seborrheic keratoses “spots of much wisdom”. Often times, we think of Liver spots as being located on the hands. However, I am sure that some folks think of Liver Spots as any brown spot on the body that has come with age, and is not a mole.

 For treatment, the easiest and fastest is still use of liquid nitrogen, or freezing. When a patient has only a few brown spots, this is often my treatment of choice. However, there are several lasers here at PDCC that we can use to remove brown spots. And, of course, I am a huge proponent of Retin-A for anti-aging.  Our cosmetic consultations are $80, however if you decide to have treatment the same day we can credit the $80 toward that treatment.  Please call our office at your earliest convenience to schedule at appointment, 206-859-05777, either Melissa or Sara can set that up for you.  I look forward to working with you.

Thank you, Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle


Dear Doctor,

I have Xanthelasma and have read that TCA peels are great for treating it, would you agree?  Or can you recommend other treatment options for me.

Thank you. D 

Dear D:

I have not had great luck with TCA for xanthelasma, but it can be an option, I do have high % TCA available . I also have a Total FX Lumenis CO2 laser I have used with good success on Xanthelasma. Or as another option I have also had really good luck with surgical removal.  I would like to see you in consultation first and then decide, together, on the best treatment options.

Please call 206.859.5777 to schedule a consultation with me, either Melissa or Sara can set that up for you.  I look forward to meeting with you to discuss your treatment options.
Thanks
Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center


Hello Dr. Reichel.......I thought I should touch base with you since my last appointment.  I saw you last July 2010 for treatment of my Syringomas with the Fraxel laser; after a couple weeks of healing I came in for a follow-up.  Neither of us were particulary satisfied with the results as the syringomas were still pronounced.  You offered another round of treatment but I haven't followed up on that, yet. I just wanted you to know that after a year, the tumors have reduced in size significantly. Having looked at a picture from a couple of years ago, the difference is quite noticable. I figured you'd be interested in hearing of this. Also, I still plan on getting another round of treatment - maybe in a year. Thank you so much for your help and excellent care.  N.Y.

Hi N.Y. 

I have been wondering how you are doing. Thank you so much for the follow-up email. That is super that your syringomas have gotten less noticeable. I remember very clearly how you looked at the follow-up appointment. They say it can take 6 months to a year to really see the results of the resurfacing laser – so that’s great to hear that yours are so much smaller.
 
Again thanks for the email. It is always valuable to hear from my patients. I look forward to seeing you again for another round of treatment when you are ready. I will always honor the follow-up treatment cost for you (even if it is in 4 years).
Dr R


I would like to know what can be done about my leg veins

Dear Dr. Reichel

Q: I have had spider veins on my legs for years and am very self-conscious about them.  I would like to know what the recovery time is after treatment and how long I have to wait before exercising again.  Do I need to wear a special garment or tights?  What can I expect to pay for this treatment so I can prepare.

A:  First off, Thank you for your question.  You will be in what are called "compression stockings" for the first 24 hours and will then need to wear them whenever possible during the first two weeks, such as standing, walking, working, etc.   You should avoid strenuous exercise for 3 days and then you can return to your normal routine.  The cost for the first sclerotherapy session can range from $400 to $550, however for very small areas it can be less than $400.  On average, you can expect to see results and complete treatment in 2-4 sessions, generally with an 80% overall improvement.  I like to space treatments about four weeks apart and recommend patients to start this treatment in fall or winter so they can be ready for summer.  Please call my office to schedule a consultation with me at 206.859.5777, I look forward to meeting you.

Thank you

Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle


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