Q&A with Dr. Brazil
Dr. Brazil's answers to patient questions, as seen in the Centralia Chronicle's Body & More magazine.
New and improved for 2010
January 2010
Q. Is there anything you can do for really intense wrinkles? I know we're supposed to avoid the sun but folks my age didn't have the benefit of that advice years ago.
A. Millions of Americans seek relief from the effects of sun and aging: fine lines, wrinkles, enlarged pores, age spots and uneven skin tone. However, for today's more active population, the prolonged healing time involved with conventional laser treatments or surgery prevents them from seeking improvement. Olympic Dermatology was the first in the Northwest to offer the benefits of the Reliant's Fraxel laser in 2004. With a series of treatments and only "social down-time," skin texture and tone could gradually be improved. But for patients seeking a more dramatic skin rejuvenation treatment, Olympic Dermatology is among the first to use the new Active and DeepFX Lumenis CO2 laser that treats fine lines, wrinkles, scars, and crepey skin in a single procedure. Revolutionary fractional technology now allows us to treat scars and signs of aging without the prolonged healing times often associated with older, more traditional treatments. A single CO2 laser treatment provides dramatic and immediate results. Treatment does more than soften the appearance of imperfections; it can actually eliminate evidence of sun damage and aging, providing a comprehensive and long-lasting solution. In fact, improvement continues long after treatment; in the months following new collagen is generated deep in the skin, continuing the improvement of skin texture. My patients are seeing tremendous improvements in the quality of their skin with minimal recovery time. The beauty of this technology is that we can achieve remarkable results and a truly refreshed, youthful looking face with less cost, risk and recovery time than conventional cosmetic surgery.
Q. I love Thermage for how it tightens and contours. But is there any way to make this treatment more comfortable?
A. Yes. You and many others will be pleased to know that Thermage with Comfort Pulse Technology (CPT™) just arrived on the market and Olympic Dermatology was the first medical clinic in Washington to offer it. This advanced technology improves key elements of the popular procedure-heat distribution and uniformity-resulting in a new ThermageŽ skin tightening and contouring laser technology that delivers more comfort and better results for the same price. It uses pulsed radio frequency (RF) energy with intermittent cooling bursts. These RF bursts are so fast that the patient's pain response is muted. A new vibrating component also dramatically improves patient comfort and a redesigned laser tip enhances the heating uniformity to increase the depth of penetration and overall skin tightening. As a result, Thermage CPT dramatically changes the patient experience. Clinical trials found that the heat sensation a patient feels with new Thermage CPT is 30% less than regular Thermage. Also, the new technology is 15% more effective in delivering uniform, deep heating to the tissue being treated. I've found that it performs even better for my patients.
Procedures That Turn Back The Face Of Time
July 2009 ~ View print version
Q. I always look tired and older than I should. I see my upper eyelids drooping, with extra loose skin and a hooded effect. My mascara and eyeliner are even difficult to put on because of this. What can I do?
A. Luckily, it's possible to have this problem corrected with a procedure called blepharoplasty; but first a bit about what you're experiencing. As the thin skin of the upper eyelid ages it becomes lax. The muscle of the upper eyelid, the orbicularis oris, is relatively heavy and pulls the loose skin down. The effect, called dermatochalasis, lowers the eyelash margin of the upper lid onto the pupil. Eventually the upper visual fields can be partially obstructed, meaning you can't see well looking up. In addition, people generally compensate for the lowering of the upper eyelid by chronically pulling their eyebrows up in order to let more light in. This can cause headaches and eventually deep forehead wrinkles. A blepharoplasty is done as an outpatient, with minor sedation and local anesthesia. The extra skin and muscle are trimmed away, and repair is done with thin suture material. The resulting scar is within the normal crease of the upper eyelid and is not generally visible, even with the eyelids closed. Recovery is quick, usually just a few days, and the sutures removed in 7-14 days. My nurse returned to work in 48 hours by wearing sunglasses. A qualified dermatologist will know if you're a candidate for this procedure.
Q. OK, what bothers me most about my appearance is that my skin tone has developed more yellow tones than I like. Brown age spots are multiplying and there are wrinkles on my wrinkles. My skin is now looser too, and seems to hang off my cheekbones instead of draping smoothly. I don't like it!
A. You're not alone. These are the most common problems we face as our skin ages. Some are due simply to older skin but most are from external damage, especially the sun's ultraviolet light. With 21 years of experience and an extensive investment in technology, we have created a RESTOR protocol to reverse these changes: Reproducible and Effective Skin Treatment Options for Rejuvenation. First, we rejuvenate your epidermal cells and dermal collagen with a Fraxel laser, a procedure called fractionated laser resurfacing. Depending on your skin's condition, one or several of these resurfacing procedures are done to eliminate age spots and reduce wrinkling. Your new collagen is more elastic and less yellow, with a vibrant and healthy glow. Basically, you have younger skin. Second, we perform a single Thermage skin-tightening procedure. This is a radiofrequency-based thermal heating device that stimulates collagen production in the deep dermis, and shrinks existing collagen bundles throughout. The result is a lifting and toning of your skin, which returns your face's natural contours. This is a 1 + 1 = 3 combination of treatments! If necessary, a RESTOR protocol can be expanded to include limited liposuction of the cheeks and neck to restore the angle of the jaw and lift the sagging skin below your chin. It can also include a dermal filler to restore lost volume in the lips and cheekbone areas. All of these are minimal or no downtime treatments, so you can return to normal activity quickly. The results are amazing and long-lasting. You will have younger, healthy skin and the normal facial contours you used to have or always wanted. Learn more with a free consult.
Radiant Skin for a New Year
January 2009 ~ View print version
Q. I know there are many options for improving my skin's appearance. But what if I want to start with just the basics?
A. It begins with home-based skin care. A new year is a good time to start fresh with an effective daily skin regime. Remember, looking older is not completely inevitable. With proper care, you can avoid wrinkles, age spots and coarse, leathery skin changes. I recommend the Clarisonic cleanser to gently clean your face and remove build up from pores and fine wrinkles; when used regularly, your skin moisturizing or revitalizing products will penetrate deeper and work better. Be careful to choose products that are based on scientific research, such as Skin Ceuticals or Revale'skin™ Antioxidant. Using "skin care" make up not only looks good but is good for you. I recommend Jane Iredale Mineral Cosmetics. With virtually no allergy risks, it won't block pores and is anti-inflammatory and anti-bacterial. Finally, most aging changes are due to ultraviolet damage, especially UV-A, so a broad-spectrum sunscreen used daily is critical. If damage has already occurred, I recommend asking a qualified dermatologist about other product lines that offer more active rejuvenation.
Q. I've seen how dermal fillers can work to make your face look younger but I'm concerned about cases where the treatment effect was lopsided or caused bruising. Can I expect that?
A. No, because it's all in how you inject the dermal fillers. I reviewed a 2008 article in Dermatologic Surgery on just this topic. The authors are well-known to me and I respect their data. They found that the risk of bruising, swelling and tenderness immediately after treatment with the dermal fillers Restylane and Perlane is directly related to rapid injection, overcorrection and a fanning injection technique. None of that is news to us at Olympic Dermatology but it reaffirms what we have been doing for years. Remember, experience counts, and dermal fillers are technique-dependent. In addition, when I started practicing dermatology 20 years ago we only had one dermal filler. Now there are many fillers and new uses for them. For example, an important new technique involves re-inflating the mid-face. Think of a baby's chubby round cheeks and look at an aging face to understand what has been lost. By restoring that normal mid-face volume the cheek skin lifts and a younger, natural mid-face is recreated.
Q. Although it's still cold outside, I'm thinking about smooth, sleek skin for warmer weather. Must I start now to look great later?
A. Now is a good time to begin and permanent hair removal with the Light Sheer Laser System is the way to go. Patients tell me it's a superior way to rid your face and body of unwanted hair-compared with shaving and resulting rashes, painful, inconvenient waxing and depilatories, and tedious, ineffective electrolysis. With the Light Sheer™ Diode laser, a cool gel and hand-held treatment unit are applied. Then, pulses of light safely penetrate the skin and disable hundreds of hair follicles simultaneously. When the gel is wiped off, some of the hair is removed with it. The remaining hair falls out within two weeks. There is no damage to other parts of the skin, so the procedure is extremely safe and most effective with dark colored hair. Any body site can be comfortably treated. I've found that most people get the best result with four to eight treatments.
Beautiful Skin Know How
October 2008 ~ View print version
Q. There are so many advertised products to make me look younger. Are any of them more than just "hype in a bottle?"
A. Yes. These products are called cosmeceuticals, and often rely on purchased testimonials or money back guarantees, which telemarketers know are only used 10% of the time even if the product is worthless. You must separate the science from the hype by demanding cosmeceuticals have clinical studies supporting their claims, or are based on basic science research that makes sense.
For example, I researched and recommend Remergent™ skin care, a new class of cosmeceuticals that incorporates DNA repair enzymes. Damaged DNA is the result of free-radical attacks on skin cells. This damaged DNA is often repaired by natural enzymes but when that fails the damaged DNA leads to abnormal cellular function that produces abnormal skin appearance, including roughness, sallow tone, discolorations and wrinkles. Remergent™ has the power to assist natural DNA repair and rejuvenate sun damaged skin. Nothing like it has been on the market before. I also recommend NeoCutis cosmeceuticals, which utilize human skin growth factors to rejuvenate skin. Similarly, Revaleskin™ and Vivite? are also based on scientific studies; the first uses a coffee berry extract to provide unparalleled antioxidant protection and the latter incorporates glycolic acid and antioxidants to protect and rejuvenate skin.
Q. My eyes look tired and heavy, even when I'm rested. How do you fix that?
A. A drooping upper eyelid results from several problems. One is when the brow sags and the upper eyelid is forced down. When this happens, the natural eyebrow curve is flattened too. If the impact is severe, a surgical brow lift is required. When it's mild to moderate, the forehead skin can be tightened with Thermage™. This procedure utilizes radiofrequency energy to heat, tighten and rejuvenate the collagen bundles within the forehead skin. For most people a single treatment is all that's needed, and the results are very long lasting. It's noninvasive and no down time is expected.
Another cause of a drooping upper eyelid is excessive and inelastic eyelid skin. When it's severe, the skin can obstruct the upper visual fields. It's corrected with Blepharoplasty; a surgical procedure done under local anesthetic and mild sedation. The extra skin is carefully identified and outlined, then removed with the underlying muscle that is adding excess weight to the eyelid. If necessary, bulging fat pads are also removed to provide a smooth, streamlined upper eyelid. Recovery is short and the results predictable and extremely gratifying.
Q. I'm tired of the redness and blotchy discoloration in my face. I see too many spider veins on my cheeks and nose. It makes me look old and like a heavy drinker, even though I barely touch alcohol. Help!
A. Genetics and sun damage lead to these problems. Some people also have rosacea, which produces similar symptoms and can also cause pimples. Sunscreen and proper skin rejuvenating products are how you manage this condition over time. A Fotofacial™ procedure is how we reverse the damage. Fotofacials utilize Intense Pulsed Light energy to rejuvenate the face. There is no expected downtime, and a series of three to five treatments is done to maximize the benefits. Olympic Dermatology has been forming Fotofacials for more than 10 years, and we use the Lumenis OneŽ, a true fourth generation Intense Pulsed Light system with patented state-of-the-art technology to optimize power, pulsing and light delivery to provide maximum results, comfort and safety.
Helping You to Look Your Best
Extreme Measures Are Not Always The Best Answer
June 2008 ~ View print version
Q. I loved my Japanese calligraphy tattoo until I found out it said "Dog Taco Pants." Then when my pregnancy changed a blue and red lotus flower into a science fiction creature, I decided it was time to remove or change it to something else. Any advice?
A. Don't fret. As more people want their tattoos removed or updated, laser technology is meeting the need. We offer the most advanced laser tattoo removal system available. The MedLite C6 Q-Switched YAG laser creates four different wavelengths of laser light to effectively treat red, black, browns and now light blues and greens. It minimizes the risk of scarring and pigment changes and decreases patient discomfort and the time needed for tattoo removal. It's comfortable, safe and very effective. We successfully treat all kinds of tattoos including permanent cosmetics. We can also modify tattoos so that a new, more desirable one can be created. A free consultation with our staff can help design a treatment plan specific to your lifestyle and needs.
Q. I've noticed changes in my face's contours. My cheekbones now look flattened, and where once I had fullness there's a depression below my eyes that makes me look tired. Do I need a facelift?
A. Probably not. The aging face loses volume and some of the fat pads in the cheeks are pulled down by gravity. A facelift only pulls skin tighter and can look unnatural, besides being a significant invasive procedure. We focus on recreating the natural curves of your face with facial fillers like Radiesse. It's injected into your skin just below the fibrous layer, and will create a soft and natural volume replacement that will make you look younger. It's quick, comfortable and safe, with results lasting up to several years. It's also very affordable compared to a facelift. The other beauty about facial fillers is that there are several to choose from that will naturally reverse the signs of aging and rejuvenate the lips, cheek bones, parentheses wrinkles around the mouth and hallows around the eyes.
Q. My wrinkles are now always visible, even when I am not smiling or frowning. I've heard that laser resurfacing is the best treatment for this but I can't afford to take weeks off to heal. Is there another option?
A. It's a good time to ask because we offer the most current Fraxel™ laser technology available. It works to turn back the clock on aging, improve sun-damaged skin and erase wrinkles, fine lines and brown spots. In fact, the new Fraxel™ SR1500 laser has a 30% deeper treatment effect. This means that each treatment will trigger a greater amount of new collagen production to more effectively rejuvenate your skin. It's performed in our office using primarily topical anesthesia. Each laser resurfacing treatment takes about 60 to 90 minutes, depending on the size of the area(s) being treated. Because the procedure does not "ablate" or remove the outer skin layer, patients can resume routine activities shortly after treatment. Swelling is minimal and generally resolves in about two days. Your skin will be dry and have a pinkish tone for five to seven days as old skin cells are being replaced by new collagen-enriched cells. Our cosmetic consultations are always complimentary, so find out how we can help you look your best.
Too Much Hair!
Laser Hair Removal Is a Safe and Effective Way to Get Rid of Unsightly Hair
April 2008 ~ View print version
Q. Aack, I have too much hair! Like my Mom, coarse hair is appearing on my lip and chin as I age. My daughter, now 20, has developed long, dark hair on her arms, and complains about the shaving rash she gets on her bikini line. Waxing and depilatories are painful and inconvenient and electrolysis is tedious and ineffective. What else is there?
A. Unwanted hair can be a genetic trait, a sign of medical illness, or just normal hair in an unfortunate place. If no correctable cause is identified, we offer permanent hair removal with the Light Sheer Diode laser. It emits visible light wavelengths that are absorbed by the hair follicle, causing it to be heated and destroyed. There is no damage to other parts of the skin, so the procedure is extremely safe and most effective with dark colored hair, such as brown or black. Any body site can be comfortably treated, and with summer just around the corner now is an excellent time to begin.
Q. I like how I look but am starting to notice minor imperfections such as brown spots, fine wrinkles and a more sallow skin tone. Without going overboard, what can I do to maintain and improve my appearance?
A. Most aging changes are due to ultraviolet damage, especially UV-A, so a broad-spectrum sunscreen used daily is critical. You should also protect against oxidative damage to your skin due to pollutants, environmental toxins and sunlight, and we can help with choosing the most effective product for both. Once you protect then you may benefit from mild rejuvenating procedures such as Vitalize peels or Vibradermabrasion, which are gentle while exfoliating, smoothing and brightening your skin with no downtime. Jane Iredale mineral-based makeup provides a natural, even skin tone and also protects against skin irritation and sun damage. And if you decide you want moderate to advanced rejuvenation, we also offer dermal fillers and effective, safe laser technologies. Remember you can find out more about any of these options by scheduling a free cosmetic consultation with one of our medical experts.
Q. What is body contouring and will it help with my sagging jaw line and droopy neck skin?
A. Yes, as people age, they commonly notice sagging skin and prominent fat pads in the jowls, neck, arms, thighs, buttocks and abdomen, which are often resistant to aggressive dieting and exercise. We treat this with one of our specialties called "body contouring." A first step may involve removing extra fat with liposuction. This procedure is done with a tiny canula and small hidden incisions and the post-operation downtime is short. Liposuction alone triggers skin tightening, and this effect is enhanced with a single Thermage treatment done within two months to further tighten and recontour. Thermage involves a device that creates deeply penetrating radiofrequency waves. This energy heats fibrous tissues up to two inches below the skin surface, safely and effectively lifting and tapering loose skin, with or without liposuction. We're excited to offer this new Thermage technology that will also improve the contours of your tummy, thighs and buttocks. Our cosmetic consultations are always complimentary, so find out how we can help you look your best.
Turning Back Time
Simple Procedures Can Turn Back the Clock On Fine Lines, Age Spots and Spider Veins
February 2008 ~ View print version
Q. What are my options for permanently improving the fine wrinkles, spider veins and brown age spots that I don't like on my face?
A. Fine wrinkles, brown age spots and spider veins on the face are easily managed with Fotofacials. This is a comfortable, safe and effective treatment that utilizes visible and near-infrared energy to target and remove these undesirable facial features. With five quick visits to our office your skin will have a more even skin tone, a more youthful appearance and fewer fine wrinkles. We have treated hundreds of patients and published our results in a major medical journal.
Q. When I look in the mirror I see deep lines around my mouth and lips. I've never smoked but have been told these are "smokers' lines." How did this happen and how can I remove these wrinkles?
A. Wrinkles around the lips are due to damage to your skin's collagen bundles. The most common cause is ultraviolet light exposure, whether from sunlight or tanning beds. Smoking also damages your skin, but smoking is not required for these kinds of lines to appear. One popular treatment option is the injection of Restylane and Juvederm. These are dermal fillers that provide long-lasting restoration of lost lip volume, redefine the edges of the lips and fill in the vertical lines that lipstick tends to bleed into. The results are instant and there is no recovery time.
Q. What about the wrinkles around my eyes? These "smile lines" just make me look older. I also don't like the furrow that is always between my eyebrows that makes me look angry and tired. How do I get rid of those?
A. These are "lines of facial expression." They show up due to the repetitive contraction of facial muscles that force the skin to form creases. We use Botox to relax the specific muscles that are pulling the skin into these creases. Botox is extremely safe, and its effect is limited to the muscle that is specifically targeted. Sometimes people are concerned that they will lose their normal facial expressions; when we do Botox it is to return a person's face to its normal appearance. No one will know, except they might ask if you have had a vacation to explain your relaxed, natural and younger looking appearance.
Q. Are these procedures painful? Will I have to hide myself afterwards?
A. We offer a wide variety of procedures to address all the problems that people develop as their faces age. Fotofacials, the dermal fillers and Botox are all part of a group of procedures we offer that have little to no downtime. They are also extremely safe and we make sure to do them in the most comfortable way possible. You should not expect pain to be a problem.