Category Archives: Skin Care

Metronidazole Topical for Rosacea?

This is a note-taking blog for purposes of education – not for specific directed medical advice.

Metronidazole is a treatment available for Rosacea

  • Topical application of Metronidazole (meanning applied to the skin surface)
  • Metronidazole also comes as a pill form but this isn’t usually needed or indicated for Rosacea
  • Metronidazole is an antibiotic
  • Flagyl is the name a brand of metronidazole in pill form
  • As an antibiotic, Metronidazole is effective against anaerobic bacteria and protozoa.  It is a drug used for treating clostridium difficile infection (c. diff).
  • Topically, it comes as cream or gel
  • Metrogel is a brand (Metrogel 1%) as is Rozex.  And there are generics available for metronidazole gel or cream.
  • Many patients use metronidazole topical twice a day
  • Many patients of ours at Surgical Artistry, Modesto, report some dryness with the product and use it with a moisturizer.

Other uses of Metronidazole

  • Orally it has been used in Crohn’s disease
  • And orally, it has been used as part of the treatment for peptic ulcer disease

Obagi Rosaclear

  • a system designed by Obagi Medical for treatment of Rosacea
  • Metronidazole topical is part of the kit,
  • available as part of the rosaclear kit is a cleanser, toner, and a special tinted sunblock

What is Rosacea?

  • Some forms of it seems to be a skin infection which is related to blood vessel dilation and redness
  • Central facial redness, burning and stinging
  • visible red veins
  • bumps or blemishes
  • tight or itchy facial skin which may swell
  • Cause is unknown

What can our office in Modesto, do for Rosacea?

There are many treatments available for Roscea

  • We have Rosaclear available from Obagi
  • We have many Rosclear Sunscreen – tinted specially to hide and blend in the redness.
  • We have a vascular laser (Dornier 940, Germany) which is good for targeting the red vessels.
  • For some patients we can also prescribe clindamycin topical for rosacea

2012 Plastic Surgery Statistics Report by ASPS: Top procedures & Top age groups

Growth and statistics of Plastic Surgery and it’s relation to our practice in Modesto, CA

ASPS (American Society of Plastic Surgeons) Released its 2012 Plastic Surgery Statistics Report.

Here are the key highlights of the report as it relates to our Plastic Surgery Practice in Modesto: Surgical Artistry led by Dr. Tammy Wu, MD Board Certified Plastic Surgeon and member of the ASPS.

At the bottom of this post, I compare my own minimally invasive cosmetic procedure (ie. Botox, Veins, Fillers, chemical peels, microdermabrasion) data from Modesto, CA to the national ASPS data.  I am not an ASPS member.  Only Dr. Tammy Wu is an ASPS member.

All statistics here is 2012 vs 2011 data from the ASPS.

Cosmetic Procedures For 2012:

  • Cosmetic Procedures:  Cosmetic Surgeries vs. Minimally Invasive Procedures:
  • Cosmetic Surgeries were down 2%
  • Minimally invasive cosmetic procedures were up 6%
  • But both considered procedures, there’s an overall increase of 5%

Plastic Surgery is growing equally for men and women

  • Cosmetic procedures performed on men and women are up a total of 5%
  • Men make up 9% of all cosmetic procedures

Minimally Invasive Cosmetic Procedures Statistics

Breast Augmentation

  • Continues to be the top cosmetic surgical procedure and has been since 2006.
  • Silicone implants were used 62% of the time (saline used 38%) in all breast augmentation in 2012

2012 Top 5 cosmetic Surgical Procedures

  • Breast augmentation down 7%
  • Nose reshaping no change
  • Eyelid surgery up 4%
  • Liposuction up 1%
  • Facelift up 6%

2012 Top 5 cosmetic Minimally Invasive Procedures

  • Botox (Botulinum toxin type A) up 8% (6.1 million injections)
  • Soft tissue fillers up 5%
  • Chemical Peel up 2%
  • Laser Hair removal up 4%
  • Microdermabrasion up 8%

Other Minimally Invasive Cosmetic Procedures

  • Laser vein therapy is down -2%
  • Sclerotherapy is up 1%
  • Fat injections is down 8%
  • Cellulite treatment is down 13%

Age Demographics: 40-54 years old

  • 40-54 year olds is the group that makes the majority of all cosmetic procedures
  • 48% of the total

 

My own thoughts

FaceBook targeted demographic ads for plastic surgeons

  • It aids in marketing efforts.  Perhaps we could concentrate more around the age of 40-54 years olds in the marketing.  In FaceBook for example, ages could be targeted.  Thus selecting 40-54 as an age selection in FaceBook might be beneficial for plastic surgeons.

How does our Minimally Invasive Cosmetic Practice compare?

Chart of Dr. Lee's practice

Growth of my minimally invasive Cosmetic practice in Modesto, CA from 2009-2012

  • Bar 1 represents 2009, Bar 2 is 2010, Bar 3 is 2011, and Bar 4 is 2012 (last year) for my minimally invasive cosmetic surgery practice.
  • Our Minimally invasive practice increased 29% last year compared to the national increase 6%.  We have not yet compiled our data for surgeries.  Dr. Wu has access to that data.  I have access to my data and this is my blog.
  • The growth between bars (1-4) respectively: 42%, 23%, 29%
  • I just did our own analysis of Surgical Artistry Cosmetic popularity based on zip codes

 

Sunscreen UVA vs UVB Protection Chart

Obagi Sunshield 50.  10.5% zinc oxideSummer time – that also means SunScreen time!  I consider sunscreens even more important than Botox for anti-aging.  And of course there’s no reason why Sunscreen and Botox can’t be used at the same time.

Sunscreen vs. Sunblock: Sunscreen is the modern term.

The term Sunblock seems to be going out.  It’s considered to be somewhat misleading because the term “block” implies total protection.  Sunscreen is used in place of sunblock these days.  A while ago, sunscreen was used to talk about chemical sunscreens and Sunblock was used to describe the ingredients titanium and zinc.

UVA vs UVB

Both are ultraviolet light spectrums – which are really part of a singular continuum.  But for the sake of categorization, UVA is longer wavelengths than UVB.  UVA has more penetration ability.  Both aren’t entire good for your skin in regards to aging and cancers.  So you want to shield from both.  SPF unfortunately only reflects UVB blocking ability.

Mineral vs. Chemical

I like the idea of mineral sunscreens where it doesn’t form a chemical compound with your skin and that it works more like a mirror.  But if you really dislike ultraviolet light damaging your skin, consider both.  My favorite is Zinc Oxide.

Here’s the Chart for Sunscreen active ingredient and it’s action against UVA and UVB.

zinc chart and other sunscreen ingredients against uv-a and uv-b

 

I found this wonderful chart on the internet.  I’m not sure of the source and I’ve seen it repeated in several different places.  I had to write this blog just so that I could have a copy of this picture somewhere so that I could refer to it when talking about Sunscreen.  As you can see from the chart, it is easy to have Zinc Oxide as your favorite because of its broad spectrum.

What about Vitamin D from the sun?

The Academy of Dermatology current position updated in 2011 recommendation on Vitamin D:

There is no scientifically validated, safe threshold level of UV exposure from the sun
or indoor tanning devices that allows for maximal vitamin D synthesis without
increasing skin cancer risk.

They basically recommend oral supplementation of vitamin D.

After Microdermabrasion and other skin procedures

After a Microdermabrasion or a chemical peel, we recommend that patients protect their skin with a zinc oxide sunscreens.  We also reinforce that with sunscreens, thicker is better – in other words – the strength of a sunscreen is dose dependent.

More Sunscreen Resources:

Thank you for reading my little review of my knowledge of Sunscreens.

dr-wu-and-dr-lee

BREAST & ABDOMEN
Augmentation Options
Augmentation FAQ
Augmentation Consultation
Cost of Augmentation
Gummy Bear Implants
Running and Implants
Breast Reduction FAQ
Tummy Tuck FAQ
SURGICAL ARTISTRY
Services | Prices | SiteMap
TAMMY WU, MD
About Dr. Wu
What’s Special?
REVIEWS
Review Screenshots
Thank You Notes
FUN
Gluten Free Vegan Recipes
Modesto is Great
What is Plastic Surgery
“Cosmetic” vs “Plastic”
CALVIN LEE, MD
About Dr. Lee
Botox | Acupuncture | Veins
Anatomy for Botox
Intro to Acupuncture
Medical Education Blog
Microdermabrasion
Chemical Peel – medium
Obagi Blue Peel – deep
Compression Socks
Sunscreen
$LOW Latisse | Latisse FAQ

Lemon Water and Vitamin C

Recently my good friend Dana posted an informative blog about drinking some warm lemon infused water every morning.  Included in her blog was other recipes regarding real-fruit flavored water – some of which are found at upscale resorts.

My strange mind decided to think about the benefits of Vitamin C.

First of all, I wondered which citrus fruit had more vitamin C: Orange or Lemon?

As it turns out, an orange has more vitamin C than a Lemon.  And the grapefruit fell in between the two.  Source of info:  Livestrong.com

One of the benefits of Vitamin C is better skin

  • At our Modesto, CA office, Surgical Artistry Plastic Surgery, we carry various vitamin C serums.  Including those from Obagi.  We have a page about Obagi Peels which uses certain acids.  (Vitamin C is an acid too).  Vitamin C serum works well together with those using Botox to prevent wrinkles.
Vitamin C Serum by Obagi - comes in varying strengths

Vitamin C Serum by Obagi – comes in varying strengths

 

Vitamin C denatures with heat

denatured protein

  • There are many sources that say that 70 degrees Celsius is the temperature at which Vitamin C is denatured. 
  • Thus as a modification of what I do with warm lemon water, is I keep the temperature down a bit – I’d like to get the benefits of vitamin C.

Lemon Juice and Teeth

  • Acids have been known to erode away enamel of the teeth
  • perhaps drinking through a straw might help – but this leads to some lines around the mouth which I can Botox – the name of this muscle is the obicularis oris face muscle.
  • My own adaptation:  I just swish a bit with regular water after drinking lemon water – that goes for lemon aid, orange juice, and grapefruit juice.

Please visit my friend Dana’s Blog

Visit our Plastic Surgery Home Page

 

Bits of info about Retin-A (Tretinoin)

Tretinoin

Just reading for myself to review some information for myself about Retin-A (Tretinoin).  I was curious to see what info is out there and here’s some info that I gleaned from an article in the NY times, supplemented a bit with my own knowledge.  I’m always bombarded with questions and patients with different brands at our Modesto, CA office location.  Retin-A is a brand name for the chemical name:  Tretinoin or Retinoic Acid.  Derived from Vitamin A.

Other brand name Tretinoin formulations:

  • Retin-A
  • Retin-A Micro
  • Renova
  • Avage
  • Tazorac
  • Aberela
  • Airol
  • Atralin
  • Avita
  • Retacnyl
  • Refissa
  • ReTrieva
  • Stieva-A
  • Vesanoid

Retinol and Retin-A (tretinoin) are not the same thing.  Retinol is a much less potent cousin.

  • Retin-A requires a prescription, Retinol does not.

The New York times talks about “crystal-clear demonstration…”

http://www.nytimes.com/2006/11/30/fashion/30skin.html?pagewanted=all&_r=0

“To my knowledge, this is the only drug for which there has been crystal-clear demonstration that it works on the molecular level,” said Dr. John J. Voorhees, the chairman of the dermatology department at the medical school of University of Michigan”

Retin-A (Tretinoin) is used for:

  • Diminish Acne
  • improve skin texture
  • diminish wrinkles
  • fade brown spots
  • fade freckles

“There is so much historical evidence that this ingredient works better than anything else,” said Dr. Joel L. Cohen, clinical assistant professor of dermatology at the University of Colorado and a consultant for OrthoNeutrogena, the maker of Retin-A Micro. And the effects are more than superficial. “It actually works to remodel skin on a cellular level,” Dr. Cohen said.

Helping to normalize cells:

Skin cells contain retinoid receptors that help regulate how the cell functions. As people age, their cells behave more erratically. “But consistent use of Retin-A helps normalize the cells,” said Dr. Min-Wei Christine Lee, a dermatologist in Walnut Creek, Calif.

Collagen:

Retin-A does double duty in helping to boost collagen. According to research at Michigan, it has the potential to stop photoaging before it starts. “The retinoids prevent the rise of collagenase after UV exposure,” Dr. Voorhees said. Collagenase is what breaks down collagen.

But regular use of a retinoid product also increases the amount of new collagen formed, research has found, and that new collagen will last for years.

Not just cosmetic – it treats pre-cancerous lesions too

The results are not just cosmetic. Dr. Voorhees said that retinoids have been used to treat precancerous skin cells. Studies show that after two years of use, those abnormal cells returned to normal.

So if Retin-A is so effective and so well studied, why isn’t everyone using it? Many dermatologists blame a lack of patient education. “It’s one of the most misunderstood drugs,” said Dr. Kenneth Beer, a dermatologist in Palm Beach, Fla., and a clinical investigator for Allergan, the maker of prescription Avage and Tazorac. He is also an Allergan shareholder. People use Retin-A too much, use it too often, experience negative side effects and then give up on it too soon, doctors say.

The problem with Retin-A is that it may actually make skin look worse — with redness, flakiness and peeling — for up to eight weeks. “But by 24 weeks, patients will see dramatic, marked improvements,” Dr. Lee said.

We found this same thing.  Most of our patients will have dry skin, some redness, and mild peeling for about 2-3 months first before seeing the full benefits.

25 years old – but still the best:

“I can’t say there’s anything on the horizon that will rival Retin-A,” Dr. Cohen said. “It’s exciting to see all the research going into this area, but kind of funny that the thing we’re still recommending most is something that’s 25 years old.”

————-

We carry several formulations of Retinoic Acid / Tretinoin in our office:

  • Mainly Obagi 0.025%, 0.05%, and 0.1% strengths

Our Modesto Plastic Surgery office is Surgical Artistry, 2336 Sylvan Ave. Suite C, Modesto, CA 95355.  Tel 209-551-1888.