Frequently Asked Questions

  • Posted by American Skin Institute on November 3, 2014 in

Q. Just a quick basic question. I have bought (and returned) so many products to moisturize and reduce wrinkles on my face, especially around my eyes. I don’t see any difference at all. My grandmother used to rub olive oil (don’t laugh) on her face and it always looked great at 80 years old. Can you recommend something that REALLY makes a difference? I am 40 years old but want to do what I can before thinking about surgery. Thanks for your time. Janet.

A. Many studies have been done that demonstrate that Retin-A™ is an effective cream to improve frown lines around the eyes. The same active ingredient is in Renova™ cream. You will need to see a dermatologist to get a prescription for this. Non prescription creams may be good moisturizers, but none is as effective in reducing fine lines. Sometimes glycolic acid creams can remove dead skin flakes which can accentuate wrinkles. If your lines are deeper or related to smiling or squinting, you may be a candidate for Botox® treatments. Most importantly, use a sunscreen daily to prevent the lines you have from getting deeper.


Q. I’m interested in microdermabrasion, or any other methods to remove stretch marks. Do you specialize in these areas?

A.Our office does perform microdermabrasion. Repeat treatments can sometimes improve stretch marks. Also, newly developed stretch marks have been treated effectively with Retin A™ while others can respond to our Photoderm™ treatments. I recommend making an appointment for a consultation to see which of these treatments is best for you.


Q. Just wondering, will microdermabrasion help reduce the redness or previous scarring.considering that I have very fair skin.and will I be able to see results with just one treatment?

A. Microdermabrasion can help to improve shallow, depressed or minimally elevated scars. Unfortunately, it will not reduce redness. Red scars can often be improved with Photoderm treatments or topical creams. Microdermabrasion works best when performed as a series of treatments. In my experience, one treatment would not produce marked results.


Q. I have been having problems with ingrown hairs in the bikini area. I use waxing in this area and if I do shave, I go with the direction of the hair. I use loofas and my facial person sold me the Peter Thomas Roth body cream to use in that area. All of this may help for future prevention, but what do you do about the ingrown hairs that are already there? They don’t seem to go away on their own. Does a facialist or dermatologist have to remove them? Please advise. Thank you!

A. Ingrown hairs that are already present and visible should be loosened and clipped at the skin surface. Plucking and waxing will temporarily remove the hair but when it grows back it will likely become ingrown again. You may want to consider laser hair removal to your bikini area. Such treatments can permanently destroy unwanted hair follicles and prevent hair regrowth. The effectiveness of these treatments for permanent hair reduction will depend on the color of the hair and the background color of your skin. I recommend a visit to a dermatologist skilled in laser surgery that can further discuss this option with you.


Q. What is your recommended treatment for facial “spider veins?” Also, what are common associated side effects of the procedure used?

A. Facial “spider veins” can be treated with the PhotodermT Intense Pulse Light source, a laser like device, or with sclerotherapy. The type of procedure we chose depends on the size and number of veins you have. Rarely, we still use the hyfercator (commonly known as an electric needle.) but it has a higher chance of causing scarring for larger lesions. Common effects of the procedures include temporary swelling and/or redness. Occasionally, bruising can occur.


Q. Hi, my name is Eric. I’m trying to find a place to get a tattoo removed. The tattoo is on my left hand, middle finger. On the inside of it are three dots. How much would this cost?

A. Most tattoos, especially those with blue, black and red colors, are effectively treated with the Nd- YAG laser. Multiple treatments are the rule and depend on the type and amount of tattoo pigment in your skin. While some tattoos can be removed in 2 treatments, we’ve had to treat others 10-12 times. Of course, if the tattoos are small enough, as might be the case with “dots,” they could also be cut out very easily with minimal scarring. This would be a very rapid approach to the problem. Cost of course, depends upon the size of the area to be treated, but for tattoos measuring about 3″ x 4″, costs are about $225.00-$350.00 per treatment.


Q. I visited your website and wanted to know if you had any procedures to clear up light to mid craters on the side and cheeks area of the face. Please let me know. If you do have such a procedure what will the average price be and do you have any type of payment plans. Need your help. Thank you.

A. Scars on the face can be treated by dermabrasion or laser resurfacing. Both procedures are designed to permanently smooth the surface of the skin. Some deep pitted scars are not very improved with these techniques and must be surgically removed for best results. The cost depends on the size of the area to be treated and which technique is felt to be the most useful. Fees may range between $2000-$3500 and we would determine the fee during your consultation visit.


Q. I would appreciate if you can let me know what does hyaluronic acid do to facial skin. Thank you.

A. Hyaluronic acid is an important component of our skin. It has very important biological functions. When applied topically it acts to hold water in the skin and as a result, it is often present in different moisturizers.


Q. Are you using Botox® injections for the treatment of axillary sweating or can you refer someone who does?

A. Yes, we have used Botox® since 1994, for all the varied indications including hyperhidrosis. Frankly, patients with hyperhidrosis are amongst the most gratified ones we treat. The treatment is very effective and actually lasts longer than the treatment for hyperactive muscles – usually 6 to 9 months. One drawback is the expense. Botox® is expensive and a substantial amount of medicine must be used to treat the areas.


Q. At first I have to apologize for my English. I hope I express myself correctly (I am German). How much would it approximately cost to remove just one wrinkle, that vertical one between the eyebrows? And how long would the results last? Thank you very much for your answer!

A. The crease between the eyebrows is caused by the over use of muscles that pull the eyebrows toward each other; these are called the corrugator muscles. The most common treatment these days is to weaken those muscles by the local injection of a medicine called Botox®. The results last 3 to 6 months. The effects of Botox® are localized so that the nearby muscles are not affected. Patients are typically very satisfied by Botox® treatment.


Q. I’m an African American male with oily skin, with some acne scarring and dark spots. I would like to know what kind of procedures work best for my skin and how good of a result should I expect along with any side effects, such as discoloring.

A. In African Americans and other people of color, it is important to control the underlying acne to prevent the development of additional dark spots (since they are the residual of previous pimples.)


Q. I have been told by my current and past dermatologists to use Cetaphil™ cleanser. I am 36, use glycolic acid products, have normal skin, and wear a lightweight foundation. I do not think Cetaphil™ adequately cleans normal skin of make up and residue, as evidenced by my clogged pores every time I go back to this product. Am I right, and if so, what types of cleansers work best for normal, over 35 skin?

A. Cetaphil™ cleanser is often recommended because it is gentle and non-irritating. However, it is usually not sufficient to remove make-up and does not leave a “squeaky clean” feel to the skin. In general, liquid cleansers are best if you tend to get clogged pores. If your skin can tolerate glycolic products, I would recommend a glycolic cleanser. You can try one in the brand you currently use, or one such as MD Forte™ Glycare Cleansing Gel, which does take off make-up and leaves the skin clean. Be careful around the eyes, as glycolic acid can sting if it gets in your eyes.


Q. I have a friend whose skin on her face (on upper lip) is turning a dark color and gets darker when she goes out in the sun. What can she do about this?

A. There is a skin condition called melasma, one that produces dark discoloration of the upper lip and often the cheeks and forehead, as well. The condition is often produced by the combination of hormonal changes that may occur with birth control pills or pregnancy and sunlight. The most important thing to do is use a sunscreen (at least SPF 15.) We prescribe a prescription strength bleaching cream. Sometimes, chemical peels can help to lighten melasma. They should be followed by constant use of sun protectors such as hats and sunscreens. I recommend a visit to a local dermatologist who can prescribe the best treatment for your friend’s condition.


Q. I am an African-American female, I have adult acne and it leaves scars regardless of what I do. I am totally unhappy with the results of medicines like Melanex™, which takes forever. I am interested in Microdermabrasion for the removal of acne scarring. Please let me know what the results are.

A. Microdermabrasion is useful for mild acne scarring. Deeply depressed scars and ice pick scars will not really be helped. It sounds as if you have active acne and the most important issue at this point is, in my opinion, to control the acne. In this way at least you won’t be developing new scars and discoloration. Repeat microdermabrasions and light peels would be useful for improving any discoloration and superficial marks. I’d suggest an evaluation to discuss medications to control your acne.


Q. I am interested in getting erbium laser resurfacing. I have some acne scars that I really would like to get rid of. I have read about erbium laser resurfacing that is an excellent procedure for darker skin tone like me. Do the doctors at Mid Valley perform this specific laser treatment? If so, how much does it cost? I would like to know some ideas then I can come in for consultation.

A. The erbium laser typically is used to produce superficial resurfacing. Often this depth of treatment is not satisfactory for acne scarring. C02 laser resurfacing and dermabrasion remains the most useful technique for acne scars. Its true skin pigmentation can be affected by the treatment, but this doesn’t happen in all cases. We have treated Asians, Hispanics and Blacks for acne scarring in the past. Sometimes a small test treatment can help to predict the likelihood of discoloration.


Q. I’m really confused if “keloids” can still be removed. I have searched the net but I got contrasting answers. So, I hope you can give me clear information about this. Thanks.

A. You may be getting different responses to your question because keloids on different parts of the body respond differently to treatment. In some instances keloids can realistically be improved but not removed. In some cases, for example on the earlobe, it might be practical to attempt to surgically remove the keloid. On the other hand, keloids on the torso and extremities will usually return when surgically removed. For this reason, non-surgical approaches are usually used on these areas. These include cortisone injections and special dressings.

Q. I’m inquiring about mole removal. It is something I would like to remove and wonder if there are any side effects, and how much for the removal?

A. Moles can indeed be removed to improve one’s cosmetic appearance. There are a variety of techniques that are typically used. However, dermatologists are all aware that melanoma, a form of skin cancer, can develop from pre-existing moles. Therefore, before any removal is considered, a thorough skin exam must be performed. The cost of removal depends on the number of lesions to be removed and the method by which they will be removed.


Q. I have flat warts on my hands and feet. I was wondering if laser surgery would be effective?

A. In general, because of cost and possible scarring, laser surgery is not considered the first choice of treatment for flat warts. Initially, liquid nitrogen, salicylic acid and trichloroacetic acid and even Retin A™ cream are likely to be used.


Q. I have a few questions. First, I have been to the doctor for what they say are “keratoses”. I am 27 years old and used to tan but have stopped. I have what looks like white or flesh colored bumps, or little crusty spots, on my legs and feet, arms and hands. It has been a while since I’ve been tanning and they are still appearing. My doctor says not to worry, but I am young and don’t like the way these things look. What can I do? And is it no big deal? I also have veins on the side of my nose that are dark. Why? With in the last 2 years my skin is going to crap. I do smoke. Can that play a part in my complexion? Thanks, Amy

A. Keratoses are superficial growths of skin. The type you describe sound like the benign, harmless type, since your doctor said not to worry about them. They can be easily removed, either by freezing or burning them off, usually with minimal discomfort. Since some keratoses are pre-cancerous, it’s important to accurately identify the benign and malignant types. A dermatologist is expert at this. While smoking may not cause skin cancers or other growths, it’s one of the worst things you can do to your skin. It can play a role in the development of veins and wrinkles on the face. Veins can also be caused by an inherited tendency for them to occur. I suggest you follow up with your dermatologist to get treatment for these problems.


Q. My husband has 2 large sebaceous cysts: one, which is about an inch across, in the center of his chest; and another about ¾ of an inch in diameter on the left side of his back. Is there any reason for concern?

A. Generally, sebaceous cysts are not dangerous. However, they can enlarge, or become inflamed or infected. For these reasons, I recommend that cysts be removed surgically. I recommend a visit to a local dermatologist who can advise the best course of action for your husband’s cysts.


Q. My previous diagnosis (scalp) was tinea capitis, a fungus infection. Therefore, I took extreme anti-contagion/re-infection measures: e.g. daily laundering of bedding, boiling combs and super cleaning the shower after use. Now my condition has been diagnosed as alopecia areata. Do I need to continue these burdensome efforts?

A. Alopecia areata is not contagious. Since you do not have a communicable condition, you do not need to continue the anti-infection measures. The cause of alopecia areata is unknown. The usual treatments include topical cortisone creams and occasional local cortisone injections. Typically, alopecia areata persists for only a limited amount of time before resolving. Dermatologists would be your best source of advice.


Q. I have an irritated area on my right hand. My middle finger and ring finger developed tiny blisters that are filled with clear fluid. The two fingers show a little edema and itch. The blisters will break causing crusting. Cultures are negative. Biopsy done on tissues show perivascular chronic dermal inflammation. I am a nurse and work at a dialysis facility. I am wondering if this sensitivity could be from the ethylene oxide found in the packaging of the sterile products we use.

A. The signs and symptoms you describe could be due to allergic contact dermatitis. One way to test for this would be to do appropriate patch testing. Hand eczemas due to frequent exposure to soap and water or a fungus infection could also produce similar rash and biopsy findings. I recommend a follow-up appointment with a dermatologist who can tell you if a patch test is appropriate for you.


Q. Hello. My dermatologist has me on Doxycycline™ (100 mg). I’ve been on it for a little over a year; I went off of it for about 4 months, and the problems returned. I would like to know if there is an herbal antibiotic instead that I can take. Thank you.

A. While health food stores may tout a number of herbal remedies for acne, I am personally unaware of any scientific critical evaluation that has proven them to be of benefit. Acne is a time-limited but often extended condition that sometimes requires long-term treatment. Fortunately, we have many years of experience with the medicines commonly used and know these to be extremely safe for the vast majority of patients. If you have concerns, I would strongly suggest that you review them with your dermatologist.


Q. How should I take care of the skin on my breasts? Should I keep them dry with powder or moisturized with a lotion? I have large breasts that sweat and chafe. How should I handle red bumps?

A. Typically, the skin of the breast is treated in the same manner as the skin on the rest of the body. Large breasts may cause rashes in the folds under the breasts. “Red bumps” if associated with a rash could be a sign of infection. It may be necessary to use prescription medication to control the chafing that you described.


Q. I have some light colored moles on my face one on my nose and two on my cheek. I want to know how easy is it to get rid of them without any scarring? I am 31 years of age with good skin. What is the best procedure for removal of these pests?

A. Moles that are clinically benign are often removed for cosmetic purposes. In these instances, it is important for the dermatologist to select a method that will minimize the risk of scarring. The method most commonly used is referred to as “shave” or “horizontal” excision in which the elevated portion of the mole is removed resulting in a flat surface. No sutures are required and healing takes about 5 to 7 days. I hope this information is useful to you.


Q. Hello, I am interested in learning more about the removal of moles from my body and face. I must have about twenty on my back, five on my chest and two on my face. I would really like to rid myself of them all, and need to know first how you go about paying for the procedure. Do I pay personally or does insurance cover it? So, how do you determine the cost? I guess that is my first major concern, if I can afford to do it then I would especially consider going through with the procedure. Thank you for your time.

A. Moles that are suspicious are often removed for biopsy purposes. Usually insurance coverage is applicable for such procedures. Removal of a mole for purely cosmetic purposes is not covered by insurance programs. Usually the technique used for such removal is called “horizontal” excision because the elevated growth is sliced off at the surface of the skin to minimize the risk of scarring. The cost of this type of procedure is based upon the number of lesions to be removed. The cost must take into account not only removal but also the routine pathology exam of the lesion removed.


Q. In July I lost 10 lbs which threw me into telogen effluvium. My hairs shed through Sept. and Oct. and since then shedding has seemed to be pretty much back to normal. I was wanting to know when I can expect to start seeing regrowth? I have lost 40 to 50% of my hair so needless to say this has been very upsetting. Thank you very much for you time.

A. You are correct to associate your hair loss with the rapid weight loss. This is one of a number of conditions associated with telogen effluvium. Some of the others include acute illnesses, operations and childbirth. The hair shedding begins about 3 months after the initiating event and regrowth begins at just about the same time. Since scalp hair grows at a rate of about 1/3 millimeter per day, one can calculate that it takes about a month for 1 centimeter of hair growth. This is an average so your growth may be faster but as you can see it can take many months before your hair density returns to normal.


Q. I’m really confused if “keloids” can still be removed. I have searched the net but I got contrasting answers. So, I hope you can give me clear information about this. Thanks.

A. You may be getting different responses to your question because keloids on different parts of the body respond differently to treatment. In some instances keloids can realistically be improved but not removed. In some cases, for example on the earlobe, it might be practical to attempt to surgically remove the keloid. On the other hand, keloids on the torso and extremities will usually return when surgically removed. For this reason, non-surgical approaches are usually used on these areas. These include cortisone injections and special dressings.


Q. I am 41 years old. I still have acne. I’m getting scarring. I tried Accutane™, couldn’t stay on it because it drove my cholesterol up. Any suggestions?

A. Accutane™ is one of the most effective treatments used for chronic and severe acne, but increasing cholesterol levels is one of the possible side effects. This apparently happens in individuals susceptible to elevated cholesterol. However, this is not an absolute reason to discontinue the medication unless the cholesterol reaches very high levels. You didn’t mention if you were male or female but for men, hormonal therapy is not appropriate but your dermatologist should be able to review other alternatives. In women who are unable to use Accutane™, hormonal therapy has been used successfully. If appropriate, you should consider this approach.


Q. I have a lot of breakouts on my chin. I’ve done a lot of glycolic peels, BPO 10%, salicylic acid. I am a licensed esthetician, so I’ve tried everything. Please help me. I can’t take anything like Accutane™ or Retin-A™ because I am trying to get pregnant.

A. There are many reasons for acne not to respond to the typical topical agents, such as those you have tried. A thorough medical history and exam would be necessary to evaluate those other possibilities. However, there are a number of prescription strength topical agents that might be appropriate for you to consider. These include a number of different topical antibiotics not harmful to pregnant females. In addition, the technique of microdermabrasion would probably enhance the effect of any topical agents you might be using. This procedure removes the dead layer of cells on the surface of the epidermis that might increase the number of new blackheads and whiteheads that develop. I hope this information is useful. Thanks for your inquiry.


Q. My daughter has an allergy to sunblock, are there any alternatives out there?

A. Thank you for your question. There are many varieties of sunblock available and as in the case of your daughter, many people find they are sensitive or allergic to one or more of the components. Many times it is a matter of trial and error to find the sunscreen/sunblock that does not cause irritation. As a rule, those blocks using titanium dioxide or zinc oxide as an active ingredient tend to be associated with the smallest likelihood of sensitivity. I hope this helps.


Q. I’ve read that skin cancer is on the rise. I want to check myself out for any funny looking spots, but frankly, I’m confused about the different types of skin cancer and what I should exactly be looking for.

A. You’re right. Skin cancer is on the rise. In fact basal cell carcinoma is the most common of all cancers. While that may sound ominous, it’s reassuring to know that basal cell carcinoma is also one of the least dangerous of all cancers and that only in the most unusual of circumstances does anyone ever die of this condition. On the other hand, malignant melanoma will affect about 30,000 Americans this year, and will cause 7,000 deaths. So checking yourself, or seeing your dermatologist for an exam is an intelligent thing to do. Any non-healing sore or any enlarging or otherwise changing growth should be evaluated for the possibility of skin cancer. Basal cell carcinoma and squamous cell carcinoma, the third type of skin cancer, usually occur on the most sun exposed parts of the body, the face, neck, hands and arms. While sunlight also causes melanoma, it’s the intense sunburns that are probably responsible and if you think about it, our worst sunburns occur on the covered areas of our body – the back and legs. Indeed, in men, the back is the most common area for melanoma, while in women it’s the back of the legs. For melanoma, look for a pigmented mole that may show a change in shape, color, or size. When melanoma is discovered early, its almost 100% curable. Sadly, some people disregard the warning signs until it’s too late.

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