Our Services

 

Clinical & Cosmetic

 

Clinical Dermatology

The medical side of Dermatology.

Acne

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms.  Acne affects most teenagers to some extent.  However, the disease is not restricted to any age group; adults in their 20’s and even well beyond their 40’s can get acne.  While not a life threatening condition, acne can be upsetting and disfiguring.  When severe, acne can lead to serious and permanent scarring.  Even less severe cases can lead to scarring.

 

Treatment

 

Dr Green Dermatology - acneDr. Green uses the newest techniques, medicines, chemical peels, lasers, and light treatments to treat acne and its effects.  The doctor has also developed a skin care line that he tailors for each individual case of acne.

 

If you have moderate acne and are uncomfortable taking antibiotics or are unhappy with your current topical treatment results, BLU-U® blue light therapy – using light without drugs or antibiotics – may be an option that is offered in office.  Another option that speeds up the course of treatment of acne are chemical peels and regular deep cleansing facials.  Ask Dr. Green about these easy and safe treatment options.

Alopecia

Alopecia is the loss of hair. Hair loss can be caused by different reasons, including damage to the hair shaft or follicles. Fungal infections can also cause hair loss.

 

Dr Green Dermatology - alopeciaThere are two main types of alopecia. When the body’s immune system mistakenly attacks hair follicles and causes hair to fall out, it’s called alopecia areata. Hair can fall out in patches all over the body. Androgenetic alopecia, on the other hand, is a kind of hair loss that’s inherited. Hair on the head thins and falls out. In men, this is called male pattern hair loss; in women, it is called female diffuse hair loss.

 

About 60% of people with androgenetic alopecia are men. Hair loss caused by androgenetic alopecia is permanent.

 

Treatment

 

Treatment depends on the type of alopecia you have. With many temporary forms of alopecia, hair will grow back without treatment. For people with alopecia areata, medications as well as cortisone injections may help reduce hair loss. Some men with male pattern hair loss may consider surgery, such as hair transplants, scalp reduction, and strip or flap grafts. Dr Green has created several treatment options including topical application of some products to help retain and potentially regrow one’s loss of hair.

Angiomas

Dr Green Dermatology - AngiomaAngiomas are benign superficial blood vessels.  These tumors can be located anywhere on the body. Some of the different types include spider angiomas, cherry angiomas, and angiokeratomas.  The cause of most types of angiomas are not known. Cherry angiomas and are due to aging and do not have any known significance.  Spider angiomas are more common in childhood and during pregnancy, and a few can appear on anyone.  When present in large numbers, liver damage is always a consideration for the cause. Angiokeratomas are a benign overgrowth of blood vessels and skin cells.

 

Treatment

 

Angiomas do not need to be treated unless they bleed or are troubling to the patient.  Dr. Green treats angiomas primarily with either cautery, laser, or surgical removal.  All three types of treatment have minimal associated discomfort and usually provide a great cosmetic result.  Rarely, angiomas recur after treatment.

Contact Dermatitis

Allergic contact dermatitis is caused by your body’s reaction to something that directly contacts the skin.  Many different substances can cause allergic contact dermatitis, which are called ‘allergens’.  Usually these substances do not cause trouble for most people, and may not even be noticed the first time the person is exposed.  Once the skin becomes sensitive or allergic to the substance, it will produce a rash within hours or as late as a week.

 

Dr Green Dermatology - Contact DermatitisAllergic contact dermatitis is not usually caused by things like acid, alkali, solvent, strong soap or detergent.  These harsh compounds, which can produce a reaction on anyone’s skin, are known as ‘irritants’.  Although some chemicals are both irritants and allergens, allergic contact dermatitis results from brief contact with substances that don’t usually provoke a reaction in most people.
The dermatitis usually shows redness, swelling and water blisters, from tiny to large. The blisters may break, forming crusts and scales.  Untreated, the skin may darken and become leathery and cracked.  Allergic contact dermatitis can be difficult to distinguish from other rashes, especially after it been present for a while.

 

Allergic contact dermatitis is responsible for approximately half of all contact dermatitis cases.  Patients with persistent, unresolved contact dermatitis can suffer for years with a diminished quality of life and increased medical treatment costs.  However, the condition can be effectively treated once an accurate diagnosis is obtained.

 

Treatment

Dr. Green routinely performs patch tests to help patients diagnose the cause of their contact dermatitis.  Patch testing is a safe and quick way to diagnose contact allergies.  A small amount of the suspected allergen is applied to the skin for a fixed time, usually two days.  Items like nickel, rubber, dyes, and poison ivy, poison oak and related plants are fairly common allergens that are determined to be the cause of the rash.   Once the cause is determined, the patient is provided with material informing them of how to avoid the allergen in commonly used products, so the patient will not repeatedly get this rash.

Dysplastic Nevus

dysplastic nevusDysplastic nevus, also referred to as atypical nevus or Clark’s nevus, is an acquired mole that may appear as solitary or multiple lesions. They are significant in that someone with a dysplastic nevus is considered to have an increased lifetime risk for melanoma. Dysplastic nevi are seen in about 4% of the Caucasian population in the United States. Some families have large numbers of dysplastic nevi as well as histories of melanoma. These people must be observed closely because their lifetime risk for Melanoma can be quite high.

 

The most common technique to remembering the signs and symptoms of dysplastic nevus is the acronym ABCDE:

 

  • Asymmetrical skin lesion
  • Border of mole is irregular
  • Color varies from brown, to tan or pink. Cracking, bleeding, and itching can also occur.
  • Diameter of mole is greater than 6mm causing pain and sensitivity
  • Evolution of mole is a sign of malignancy

 

Treatment

 

  • Family members of a patient with a dysplastic nevus should be examined for evidence of the dysplastic nevus syndrome. Such individuals should avoid excessive sun exposure.
  • It is recommended that patients with atypical or dysplastic nevi have their skin examined on an annual basis.

Eczema

Dr Green Eczema TreatmentEczema is a general term encompassing various inflamed skin conditions. One of the most common forms of eczema is atopic dermatitis (or “atopic eczema”). Approximately 10 to 20 percent of the world population is affected by this chronic, relapsing, and very itchy rash at some point during childhood. Fortunately, many children with eczema find that the disease clears and often disappears with age.

 

In general, atopic dermatitis will come and go, often based on external factors. Although its cause is unknown, the condition appears to be an abnormal response of the body’s immune system.  In people with eczema, the inflammatory response to irritating substances overacts, causing itching and scratching.  Eczema is not contagious and, like many diseases, currently cannot be cured. However, for most patients Dr. Green helps manage the condition with several different treatments and avoidance of triggers.

 

Treatment

 

Dr Green Eczema TreatmentDr. Green offers a revolutionary treatment called XTRAC. XTRAC is the only FDA-cleared, clinically proven excimer laser that gets skin clear of psoriasis, atopic dermatitis (Ezcema), as well as vitiligo—and it works fast, with many patients seeing significant improvement and long-lasting remissions. Because XTRAC delivers a highly targeted, therapeutic beam of UVB light only to areas of affected skin, healthy skin surrounding the lesions stays that way. XTRAC clears the symptoms, prolongs the remission and returns skin to a clinically healthy state in record time. All of which means XTRAC delivers consistently predictable results so patients experience less recurrences.

 

Quick Facts

 

  • Effective treatment—symptoms reduced generally in 10-12 treatment sessions
  • Long-lasting relief—typically several months free of symptoms”Simple, painless treatment—sessions are very short
  • Relief without messy creams and daily skin care regimen
  • Covered by most major insurance companies, available by Rx

 

 

What does eczema look and feel like?
Although eczema may look different from person to person, it is usually characterized by dry, red, extremely itchy patches on the skin. Eczema is sometimes referred to as “the itch that rashes,” since the itch, when scratched, results in the appearance of the rash.

 

Eczema can occur on just about any part of the body; however, in infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck. In children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In some people, eczema may “bubble up” and ooze. In others, the condition may appear more scaly, dry, and red. Chronic scratching causes the skin to take on a leathery texture because the skin thickens (lichenification).

 

 

What makes patients with eczema itch?
Many substances have been identified as itch “triggers” in patients with eczema, and triggers are not the same for every person. Many times it is difficult to identify the exact trigger that causes a “flare-up”. For some, it seems that rough or coarse materials coming into contact with the skin causes itchiness. For others, feeling too hot and/or sweating will cause an outbreak. Other people find that certain soaps, detergents, disinfectants, contact with juices from fresh fruits and meats, dust mites, and animal saliva and danders may trigger itching. Upper respiratory infections (caused by viruses) may also be triggers. Stress can also sometimes aggravate an existing flare-up.

 

 

Dr Green Dermatology - EczemaWho gets eczema?
Eczema occurs in both children and adults, but usually appears during infancy. Although there is no known cause for the disease, it often affects people with a family history of allergies

 

 

Moisturizers, Soaps, and Detergents

It is very important that people with Eczema take extra efforts to keep their body moist.  Eczema causes the skin to become drier than normal.  The drier the skin gets, the “itchier it gets” and then the desire to scratch follows perpetuating a very bad “itch scratch” cycle.  Some of Dr. Green’s recommendations are:

 

  • Use a gentle, moisturizing soap (ie. Dove Sensitive skin, Basis, or Cetaphil)
  • Use “Chemical Free” laundry detergent (ie. All Chemical Free)
  • Frequently use moisturizers (ie. TriXera, Cetaphil, or Cerave)

Genital Warts

Genital warts are one of the most common types of sexually transmitted infections. At least half of all sexually active people will become infected with the virus that causes genital warts at some point during their lives.

 

Dr Green Dermatology - Genital WartsAs the name suggests, genital warts affect the moist tissues of the genital area. Genital warts may look like small, flesh-colored bumps or have a cauliflower-like appearance. In many cases, the warts are too small to be visible.

 

Like warts that appear elsewhere on your body, genital warts are caused by the human papillomavirus (HPV). Some strains of genital HPV can cause genital warts, while others can cause cancer. Vaccines can help protect against certain strains of genital HPV

 

Treatment

 

Gardasil Injections:  The future will be here before you know it. And chances are you’ve already started planning it. If those plans don’t include cervical cancer or genital warts, you should know how GARDASIL can help protect against diseases caused by human papillomavirus (HPV).

 

GARDASIL is the only HPV vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, GARDASIL helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, GARDASIL helps protect against 90% of genital warts cases.

 

GARDASIL also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

 

In the future the physicans feel that this vaccine will also be used as treatment for genital warts alongside some common warts.

 

Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments.

 

Imiquimod (Aldara, Zyclara). This cream appears to boost your immune system’s ability to fight genital warts.
Veregen:VEREGEN® is the first botanical drug approved for prescription use in the United States. It is made from the extract of green tea leaves. It’s a powerful natural product that works hard to clear up your warts.

 

It is proven to:

 

Provide complete clearance of warts in most patients (53.6%)

 

Offer a low rate (6.8%) of wart recurrence for patients who achieve complete clearance

 

VEREGEN® is also convenient—it’s available in a 15 gram multidose tube that’s easy to carry and store.

Keratosis Pilaris

Dr Green Dermatology - Keratosis PilarisKeratosis pilaris is a skin condition commonly seen on the upper arms, buttocks and thighs. The skin cells that normally flake off as a fine dust from the skin form plugs in the hair follicles. These appear as small pimples that have a dry ”sandpaper” feeling. They are usually white but sometimes rather red. They usually don’t itch or hurt.
Keratosis pilaris is particularly common in teenagers on the upper arms. It may occur in babies where it tends to be most obvious on the cheeks. It may remain for years but generally gradually disappears usually before age 30. Keratosis pilaris is unsightly but completely harmless. It is usually worse during the winter months or other times of low humidity when skin dries out, and may worsen during pregnancy or after childbirth.

 

Treatment

 

Treatment of keratosis pilaris is not necessary, and unfortunately often is difficult. With persistence, most people can get very satisfactory improvement. Initial treatment should be intensive moisturizing. Dr. Green prefers treatments using creams such as glycolic acid, lactic acid, or even retinol and having their patients re-apply the cream several times daily.

In addition to these treatment options, Dr. Green recommends removing the plugged pores by taking long, hot soaking baths and then exfoliating the areas with a coarse washcloth, stiff brush, scrubbing gloves, or ‘Buf-Puf’ using the specially formulated Lava Scrub.

Lentigos

Dr Green Dermatology - LentigosLentigos, or liver spots, are benign lesions that occur on the sun-exposed areas of the body. The backs of hands and face are common areas to find lentigos. The lesions tend to increase in number with age and sun exposure, making them common among the middle age and older population. These flat lesions usually have discrete borders, are dark in color, and have an irregular shape.

 

These lesions are caused by a marked increase in the number of pigment cells located in the superficial layers of the skin. A biopsy should be considered if a lesion develops a highly irregular border, changes in pigmentation, or changes in the thickness to rule out cancer.

 

Treatment

 

Dr Green Dermatology - LentigosLentigines are usually benign therefore treatment is not necessary. For cosmetic purposes, Dr. Green uses several successful treatments including: hydroquinone preparations (bleaching preparations), Retinols, chemical peels, and lasers. Protective measures should be taken to avoid any excessive sunlight exposure. These include sunscreen with zinc oxide and/or titanium dioxide and protective clothing, such as hats and long sleeves.

Lichen Planus

Lichen Planus (LP) is a common inflammatory disease of the skin and mouth. It affects about one to two percent of the general population.  Skin LP affects men and women equally, but oral LP affects women twice as often as men. LP occurs most frequently in middle-aged adults. The cause of LP is not known. While there are many theories to explain LP, most dermatologists believe it can be classified as an autoimmune disease. This means that white blood cells which usually fight germs begin to attack the normal parts of the skin, mucous membranes, hair, and nails. There are cases of lichen planus-type rashes which occur as allergic reactions to medications for high blood pressure, heart disease, and arthritis. Identifying and stopping the drug helps clear up the condition within a few weeks. Some people with LP can also have hepatitis C, and therefore the physicians will ask for bloodwork.

 

Lichen PlanusLP of the skin is characterized by reddish-purple, flat-topped bumps that may be very itchy. Some may have a white lacy appearance called Wickham’s Striae. They can be anywhere on the body, but seem to favor the inside of the wrists and ankles. The disease can also occur on the lower back, neck, legs, genitals, and in rare cases, the scalp and nails.   While the typical appearance of LP makes the disease somewhat easy to identify, a skin biopsy may be needed to confirm the diagnosis.

 

LP of the skin usually causes few problems and needs no treatment. If there is severe itiching there is help. Many cases of LP go away within two years. As it heals, LP often leaves a dark brown discoloration on the skin. Like the bumps themselves, these stains may eventually fade with time without treatment. About one out of five people will have a second attack of LP.

 

Treatment of Lichen Planus of the Skin and mouth

 

There is no known cure for LP but treatment is often effective in relieving itching and in improving the appearance of the rash until it goes away. Since every case of LP is different, no one treatment is perfect. The two most common treatments include the use of topical corticosteroid creams, ointments, or other anti-inflammatory drugs, and antihistamines taken by mouth. More severe cases of LP may require stronger medications such as cortisone taken internally or a specific form of ultraviolet light treatment called PUVA.

 

There is no known cure for oral LP although there are many treatments that eliminate the pain of sores. When the disease causes no pain or burning, treatment may not be needed. More severe forms of LP – those with pain, burning, redness, blisters, sores, and ulcers – can be treated with a variety of medications, both applied to the sores (topical) and taken by mouth (oral). As with any disease of the lining of the mouth, LP can lead to poor dental hygiene and gum disease. Careful daily oral hygiene is very important. Schedule regular visits to the dentist for examinations and cleanings at least twice a year.

Melasma

Dr Green Dermatology - MelasmaMelasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.  It is also referred to as the “mask of pregnancy”.

 

It is not a harmful disease, but can severely affect a person’s cosmetic appearance.

 

Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.  The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves.  It may also develop in persons taking oral contraceptives, hormone replacement therapy, or excessive sun exposure.

 

Treatment

 

Sunscreens are essential in the prevention of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 30 or higher should be selected. In addition, physical sunblock lotions and creams such as zinc oxide and titanium oxide, may be used to block ultraviolet radiation and visible light. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of ultraviolet rays is received while walking down the street, driving in cars, and sitting next to windows.  Which is why Dr. Green will recommend some form of sunblock to protect your melasma from worsening or even returning.

 

Melasma may slowly fade after delivery, or it may remain for many years, or even a lifetime.  Similarly if melasma develops after starting birth control pills, it may improve after discontinuing them.  Darkening will most likely reoccur with subsequent pregnancies or reintroduction of oral contraceptives.

 

Typically, Dr Green treats Melasma with hydroquinone (a bleaching cream) and kojic acid that he formulates and can be administered while continuing the birth control pills.  Dr Green also like to add a bleaching cream in conjuction with glycolic acid, and a retinol to maximize the effects.  The topical depigmenting process is slow, therefore Dr. Green also offers quicker techniques to help reduce the melasma, such as chemical peels, microdermabrasion, and laser treatments.

Molluscum Contagiosum

Molluscum ContagiosumMolluscum is a common viral infection that affects the skin.  They are similar to warts, but are caused by a different virus.   It primarily affects three groups: young children, sexually active adults, and immuno-compromised individuals (such as those with HIV infection).  Molluscum is most easily transmitted by direct skin-to-skin contact. Molluscum may be spread between children in swimming pools. The lesions of molluscum are usually small, flesh-colored or pink, domed-shaped growths.  They may appear shiny and have a small indentation in the center.  In young children the lesions are usually generalized on the face, trunk, and extremities. In adults the lesions are sexually transmitted and favor the lower abdomen, upper thighs and groin in both men and women.

 

Treatment

 

Dr Green Dermatology - Molluscum ContagiosumA treatment course is determined based on each individual case.  In young children, spontaneous resolution is certain, but can sometimes take two years or longer.   Due to the frequency of molluscum spreading and its contagious nature, Dr. Green usually recommends treatment. Molluscum are treated in the same ways that warts are treated.  They can be frozen with liquid nitrogen, treated with topical acids, scraped off with a small instrument (curette), cauterized, and even treated daily with a home application of Glycolic cream or lotion, as well as a Retinol, or even a topical immune modifier.

 

Often if there are many growths, multiple treatment sessions may be needed every three to six weeks until the growths are gone.

Pityriasis Rosea

Dr Green Dermatology - Pityriasis RoseaPityriasis Rosea is a rash that can occur at any age but it is most common in the ages of 15 to 40 years of age.  The rash can last anywhere from several weeks to several months, and usually disappears spontaneously.  The rash often begins as a large pink scaly patch on the chest or the back.  This patch has been called the “herald” or “”mother” patch.  Within a week or two, more pink patches, sometimes hundreds of them, appear on the body affecting the trunk and sparing sun-exposed areas.  The patches are oval and often form a pattern over the back that resembles the outline of a Christmas tree.  Some patients will experience some itching, especially when they become overheated.

 

The cause of this rash is unknown.  It is not caused by a fungus (ringworm) nor a bacteria.  It is also not due to an allergy.  It is not contagious.  Many doctors believe that it is caused by a virus.

 

Treatment

 

In most cases therapy is not required as many patients are asymptomatic. However, Dr. Green will prescribe medications to decrease the associated itch as well as help speed up the time of resolution of this rash.  Usually there are no permanent marks as a result of this rash

Psoriasis

Psoriasis is a chronic, autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious.

 

Dr Green Dermatology - PsoriasisThere are five types of psoriasis. The most common form, plaque psoriasis, appears as raised, red patches covered with a silvery white buildup of dead skin cells. Psoriasis can occur on any part of the body and is associated with other serious health conditions, such as diabetes, heart disease and depression.

 

Psoriasis is the most common autoimmune disease in the U.S. As many as 7.5 million Americans have psoriasis.  Currently there is no cure for Psoriasis, however there are many different types of treatment.

 

Treatment

 

Because of the complexity and commonness of this disease there are many different types of treatment, depending on an individual basis.  Topical medications and moisturizers applied directly to the skin may improve its condition.  Controlled delivery of artificial ultraviolet light, are used in treating psoriasis, such as Xtrac Laser (Phototherapy).  Another form of treatment is the Xtrac Laser (Phototherapy), which uses ultraviolet light to stimulate the pigment cells to produce Melanin (pigment) again. XTRAC is the only FDA-cleared, clinically proven excimer laser that gets skin clear of psoriasis—and it works fast, with many patients seeing significant improvement and long-lasting remissions. Because XTRAC delivers a highly targeted, therapeutic beam of UVB light only to areas of the skin affected by psoriasis, healthy skin surrounding the lesions stays that way. XTRAC clears the symptoms, prolongs the remission and returns skin to a clinically healthy state in record time. All of which means XTRAC delivers consistently predictable results so patients experience more good days of living than bad.

 

Quick Facts

 

  • Effective treatment—symptoms reduced generally in 10-12 treatment sessions
  • Long-lasting relief—typically several months free of symptoms. Simple, painless treatment—sessions are very short
  • Relief without messy creams and daily skin care regimen
  • Covered by most major insurance companies, available by Rx

 

For more severe forms of psoriasis, Dr Green sometimes prescribes medicines that are given by injection, such as Humira, Stelara or Enbrel.  Dr Green also now prescribes a new oral medication called Otezla to provide a long lasting and safe way to deal with chronic psoriasis that is extensive and life changing.  Combining various topical, light, and systemic treatments often permits lower doses of each and can result in increased effectiveness

Rosacea

Dr Green Dermatology - RosaceaIs a common skin disorder that is characterized by a persistent redness on the face, with the cheeks and nose most frequently effected.  It is often referred to as “adult acne”.  The cause of rosacea is unknown, but is thought to be due to an abnormal response of blood vessels to thermal stimuli, hot drinks, emotional stress, spicy foods, and particularly chronic sun exposure and damage; thus producing vasodilation of blood vessels (flushing) and inflammation. Additional skin findings include the appearance of small blood vessels, flushing, and red papules and pustules.

 

Treatment

 

The treatment of Rosacea consists of sunscreens and the avoidance of specific triggers for all patients.  Dr. Green is a renowned speaker on the subject of Rosacea, highly trained in the use of some of the newest of treatment options and medications to provide relief of this chronic condition.  Dr. Green also recommends a combination of treatments tailored to individual patients ranging from Green Tea cleansers, prescription topical and oral medications, to laser treatments.  An improvement in both the signs and symptoms of Rosacea are almost certain in our practice.

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin condition affecting millions of Americans. It shows up as reddish, flaky patches of skin. Common areas affected include the scalp, eyebrows, eyelids, nasolabial creases, lips, ears, armpits, umbilical area, and groin. Itching may be severe. It can be unsightly, itchy and, since it is often on the face, may cause embarrassment. It is not contagious, but usually a chronic condition.

 

Dr Green Dermatology - Seborrheic DermatitisIn adults seborrheic dermatitis usually affects the scalp, eyebrows, ear canals, sides of the nose, and behind the ears. It sometimes affects the armpits, chest and in the groin area. Most people with it complain of dandruff, especially on the back and sides of the scalp (bad dandruff is usually seborrheic dermatitis).
Stress, fatigue, weather extremes, oily skin and infrequent shampooing or skin cleaning make it worse. Severe medical illnesses, including AIDS, Parkinson’s disease, head injury, and stroke are associated with seborrheic dermatitis. However, the vast majority of people with seborrheic dermatitis have no associated conditions.
Seborrheic dermatitis may start in infancy as cradle cap. It affects the scalp as thick, crusty, yellow scales. Children usually outgrow it by age 3 and do not normally get seborrheic dermatitis. Cradle cap is not contagious, it is not caused by poor hygiene, it is not an allergy, and it is not dangerous. Cradle cap usually does not itch, but it may. If excessive scratching occurs, it can cause additional inflammation, mild infections or bleeding.

 

Treatment

 

Many treatments exist to quickly improve the condition, ranging from medicated shampoos, Green Tea Cleansers, to the use of selenium sulfides, cortisone, antifungals, and a few other topical medications.  A person may need to try several shampoos to find the one that works best, and then rotate between several medicated and non-medicated shampoos to maintain effectiveness. It’s important to massage the shampoo and or cleansers onto the scalp and other affected areas and leave it in place for a few minutes before rinsing thoroughly. Other shampoo ingredients that are sometime helpful are salicylic acid, coal tar, and sulfur.  The quicker one seeks treatment, the quicker Dr. Green can help alleviate the condition.

Seborrheic Keratosis

Seborrheic KeratosisAlthough seborrheic keratoses are often confused with warts, they are actually quite different.  Seborrheic keratoses are non-cancerous growths of the skin that are very common.   There may be just one growth or multiple.  They can be tan to light brown, but vary in color and at times can be black.  They also vary in size from very small to larger than a half-dollar.

 

We do not know what causes seborrheic keratoses.  However, almost everybody will eventually develop at least a few of these growths.  These lesions have been referred to as “barnacles of old age”.  These become more common and more numerous with advancing age.  Many doctors believe that there is also a genetic predisposition with the development of these lesions.

 

Treatment

 

Dr Green Dermatology - Seborrheic KereatosisSeborrheic keratoses do not need to be treated due to the fact that they are not dangerous.  However, the removal of these lesions for cosmetic reasons is oftentimes rewarding and elegant.  They are removed using a type of procedure called electrosurgery, in which a type of laser burns off the seborrheic keratosis sometimes followed by an instrument known as a curette for removal.  This procedure is associated with minimal pain and maximal results.

Shingles (Herpes Zoster)

Shingles (Herpes Zoster)Shingles, also known as herpes zoster, comes from the same virus that causes chicken pox.  Therefore anyone who’s had chicken pox can develop this eruption later in life. After having chicken pox, the virus remains in a dormant state in certain nerve cells of the body and then reactivates, causing zoster. About 20 percent of the population is affected at some time during their lives.

 

What prompts the virus to “awaken” and cause problems in normal, healthy people is not clear. Most physicians believe there is a temporary weakness in the body’s ability to fight off disease. This allows the virus to move along the nerve fibers toward the skin. The fact that the disease occurs more often in people older than age 50 (although children can get it, too) supports this since the immune response is believed to be weaker in older people. Trauma or possibly stress may also trigger a zoster attack.

 

People whose ability to ward off disease is weakened are more prone to develop zoster. They are also more likely to have a serious form of it. This includes some people with cancer, such as leukemia or lymphoma, or who have undergone chemotherapy or radiation therapy for cancer. People who have had organ transplants and are taking drugs to ward off transplant rejection may also be more susceptible, as well as those with diseases that affect the immune system, such as AIDS. The majority of people who develop zoster, however, are otherwise healthy.

 

Scarring usually does not occur. However in persons who have more severe infections, such as those with weakened immune systems, elderly persons, or those with blisters become infected may have some scarring.  About 20 percent of those people who have had chicken pox will get zoster. Most people get zoster only once.

 

 

What are the signs of an outbreak?

 

Early signs of a shingles outbreak are often vague, and can easily be mistaken for other illnesses. The first sign of an attack can be an isolated pain, burning sensation, “tingling” sensation, numbness in a major nerve in or under the skin, or even a “shooting” pain around the trunk or down the arm or leg. Mild flu-like symptoms, such as headache, fever and upset stomach, may also occur.

 

At this point, these symptoms can be confused with other illnesses, such as an ulcer, ruptured disc, pneumonia, appendicitis, or even a heart attack. However as the outbreak progresses, the symptoms become clear and the diagnosis is made more definite.

 

Dr Green Dermatology - ShinglesLesions (rash) appear on the skin from one to 14 days later, usually in a band on one side of the body or back, or clustered on one side of the face. The number of lesions varies from person to person. These lesions become fluid-filled blisters in two to four days. They continue appearing for several more days, and then turn from clear to cloudy in appearance as white blood cells attack the virus.

 

Eventually all the blisters crust, scab and heal, most often within a few weeks. Vision and hearing problems are less common, but equally serious, and can occur whenever shingles appears on the face. If this happens, one should see a doctor immediately. If shingles affects the eye, it can cause temporary or permanent blindness through infection of the cornea or retina.
Is zoster contagious?

 

The virus that causes zoster can be passed on to others, but they will develop chicken pox, not zoster and only if they have not had chicken pox. Zoster is much less contagious than chicken pox.  Persons with zoster can only transmit the virus if blisters are broken and someone who never has had chicken pox or who already is ill is close by.  Pregnant women, newborns, or those who already are ill or immunosuppressed, such as cancer patients, are at the highest risk. Because of the risk of contagion for these people, these patients with zoster are rarely hospitalized unless absolutely necessary.  In pregnancy, Zoster can potentially cause major problems to the newborn baby.

 

 

What about treatment?
In most people with zoster, the condition clears on its own in a few weeks and seldom recurs. Treatment is helpful however because it can speed up the recovery time. Treatment consists of pain relievers as well as cool compresses to help dry the blisters.  Dr. Green prescribes several highly effective medications for zoster.

 

Probably the most common problem of herpes zoster is post-herpetic neuralgia. The associated pain, numbness, itching, and tingling can last for months or even years. It is more common in older people. Seeking treatment quickly can help alleviate the condition and decrease the potential risk for post-herpetic neuralgia.

 

 

Vaccination against Herpes Zoster

 

A vaccine has been newly approved by the U.S. Food and Drug Administration (FDA) for persons aged 60 years and older who have never had zoster. In one study, this immunization decreased the incidence of shingles by more than 50 percent. This vaccine has not been studied in persons with a history of shingles, and it should not be given to people who have decreased immunity (e.g., HIV, active cancer, taking drugs that decrease the immune response, etc.

 

The vaccination is offered in the offices, just ask the doctor if you are an ideal candidate.

Skin Cancer - Actinic Keratosis

Dr Green Dermatology - Skin Cancer - Actinic KeratosisActinic Keratosis are considered the earliest stage in the development of skin cancer, hence the name “Pre-cancer”.  They are small, scaly spots most commonly found on the face, ears, neck, lower arms, and back of the hands in fair-skinned patients who had a significant amount of sun exposure.

 

Treatment

 

Dr. Green uses many different treatment options and tailor it to each and every case.  Cryotherapy (Freezing) is usually the most common treatment that Dr. Green uses, as well as photodynamic therapy, topical chemotherapeutic agents, chemical peeling, dermabrasion, laser surgery, and even curettage.

Skin Cancer - Basal Cell Carcinoma

Dr Green Dermatology - Skin Cancer- Basal Cell CarcinomaBasal Cell Carcinoma is the most common type of skin cancer and appears frequently on sun-exposed surfaces on the head, neck, and hands.  However, it can occur on any body part.    It usually occurs in fair-skinned people.  Basal cell carcinomas are slow growing skin cancers, yet are considered tissue destructive.  This means that if the cancer goes untreated, it will begin to bleed, crust over, heal, and repeat this cycle.  It is very rare that this type of cancer metastasizes (spreads to other parts of the body), it can extend beneath the skin to the bone, nerves, and cause a considerable amount of localized damage.

 

Treatment

 

Dr. Green uses many different treatment options and tailors it to each and every case depending on the depth of the cancer, the location, and sometimes based on the patient’s needs.  Some of the more common dermatologic surgical treatment options that Dr. Green performs as well as recommends include surgical excision, electrodessication and curettage (also known as ED&C), which involves alternately scraping and burning the tumor with low levels or electricity, and SRT-100 (superficial radiation therapy) a new non- invasive procedure which uses targeted low levels of radiation to cause destruction of the cancers DNA, allowing for faster healing times and minimal or no scarring.

Skin Cancer - Melanoma

Dr Green Dermatology - Skin Cancer - MelanomaMelanoma can develop from a mole, which can be a risk factor for melanoma, but most moles do not become melanoma. However, melanoma is the most serious type of skin cancer due to its tendency to spread, or metastasize, to lymph nodes and other areas of the body, as compared to the other types of skin cancer (Basal and Squamous Cell Carcinoma).

 

When melanoma spreads, it can spread to almost any other organ in the body but most commonly spreads to the liver, lungs, bones, and brain.

 

Symptoms of melanoma and other skin cancers vary from person to person. It is important to note that not all skin cancers and melanomas fall into these categories, so just use this list as a guideline:

 

  • A change on the skin. This could be a new spot, or a change in color, shape or size of a current spot.
  • A sore that doesn’t heal.
  • A spot or sore that becomes painful, itchy, tender or bleeds.
  • A spot or lump that looks shiny, waxy, smooth or pale.
  • A firm red lump that bleeds or appears ulcerated or crusty.
  • A flat, red spot that is rough, dry or scaly.

 

 

If a melanoma is suspected, a skin biopsy will be performed. For this, Dr. Green will remove a sample of skin tissue and send it to a dermatopathologist to be looked at under a microscope. If the biopsy shows melanoma, the dermatopathologist will measure the thickness of the melanoma to find out how advanced the cancer is.

 

Treatment

 

The best treatment for you depends on your stage of cancer and your age, overall health and personal preferences. The most important factor in determining both the treatment and prognosis is the depth of the tumor.  Quite simply, how far below the top skin layers does the melanoma go?

 

 

Treating early-stage melanomas

Treatment for early-stage melanomas usually includes surgery to remove the melanoma.  Usually, the physician will remove the cancer as well as a small border of normal skin and a layer of tissue beneath the skin. For people with early-stage melanomas, this may be the only treatment needed.  However, for late-stage, thicker, or even invasive and aggressive melanomas, the doctors will work with surgical oncologists and plastic surgeons to increase the cure rate of these melanomas.

 

 

Treating Late Stage Melanoma

 

Ipilimumab was approved by the FDA in March 2011 to treat patients with late-stage melanoma that has spread or cannot be removed by surgery. Yervoy acts more like a vaccine in that it stimulates the patient’s own immune system to fight the melanoma. Although it is not highly effective, the vaccine shows promise for the most advanced cases.

 

ZELBORAF is a prescription medicine used to treat melanoma that has spread to other parts of the body or cannot be removed by surgery, and that has a certain type of abnormal BRAF gene.  This new medication also shows promise as it attacks certain types of melanomas.  The person is first tested for the Braf gene and a treatment plan is used depending on the presence of that gene

 

  • Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be given intravenously, in pill form or both so that it travels throughout your body. Or chemotherapy can be given in a vein in your arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don’t affect other parts of your body.
  • Radiation therapy. This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells. It’s sometimes used to help relieve symptoms of melanoma that has spread to another organ. Fatigue is a common side effect of radiation therapy, but your energy usually returns once the treatment is complete.

Skin Cancer - Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common skin cancer.  It too is more commonly found on fair-skinned people.  Like Basal Cell Carcinomas,  Squamous Cell Carcinomas are directly caused by sun damage and appear on sun damaged skin (ears, face, lips, mouth, hands, arms, legs, as well as anywhere on the body).  Squamous Cell Carcinomas can develop into large masses and become invasive.  Unlike Basal Cell Carcinomas, this form of cancer can metastasize (spread to other parts of the body).  Therefore it is important to not allow the cancer to go untreated.

 

Treatment

 

Like with BCC, many treatment options exist for SCC and Dr. Green tailors it to each and every case depending on the depth of the cancer, the location, and sometimes based on the patient’s needs.  Some of the more common dermatologic surgical treatment options that the physician will perform as well as recommend include surgical excision, electrodessication and curettage (also known as ED&C) which involves alternately scraping and burning the tumor with low levels or electricity, and SRT-100 (superficial radiation therapy) a new non- invasive procedure which uses targeted low levels of radiation to cause destruction of the cancers DNA, allowing for faster healing times and minimal or no scarring.

 

Skin Cancer - Treatment Specializations

Cryosurgery using Liquid Nitrogen

 

Cryotherapy, also known as cryosurgery, is a commonly used in-office procedure for the treatment of a variety of benign and malignant lesions. In one report, cryotherapy was the second most common in-office procedure after skin excision. The mechanism of destruction in cryotherapy is necrosis, which results from the freezing and thawing of cells. Cryotherapy can be employed to destroy a variety of benign skin growths, such as warts, pre-cancerous lesions (such as actinic keratosis), and malignant lesions (such as Basal Cell and Squamous Cell Carcinomas). The goal of cryotherapy is to freeze and destroy targeted skin growths while preserving the surrounding skin from injury.

 

 

Electrodessication and Curettage (ED&C)

 

Electrodessication and curettage is a combination skin cancer treatment that involves scraping the abnormal cells with a curette and then “burning” or cauterizing the area with an electric current or liquid nitrogen to seal the blood vessels and remove all remaining cancer cells. This process may be repeated several times to ensure complete removal.

 

Curettage may be performed alone or in conjunction with other treatments. When performed together, electrodessication and curettage are most effective for primary lesions and are sometimes used for recurrent lesions as well.

 

 

Surgical Excision

 

Excision refers to the removal of a lesion by cutting through the skin down to the underlying fat and in most cases repairing the wound with sutures (stitches). Many types of lesions are removed by excision, including moles, cysts, lipomas, and skin cancers. When repaired, excisional wounds are usually sutured in a straight line, oriented to follow the normal wrinkle lines of the skin. Most wounds are closed with a layer of dissolving stitches below the skin in addition to a layer of surface sutures, which are removed one to two weeks after surgery. Depending on the location and size of the wound, it is often recommended that patients use a non-stretch skin colored tape to support the incisions for two weeks or more following suture removal, until the wounds have sufficient strength to minimize risk of a spread scar. Excisional wounds mature below the surface of the skin for approximately six months following surgery, by which time they have usually reached their final appearance.

 

Dr. Green always has two goals in mind while treating you and your skin cancer.  First, he wants to remove the cancerous tissue.  Second, he wants to leave you with the most cosmetic appearing surgical site as possible.

 

 

Topical Chemotherapy Agents

 

The topical chemotherapeutic agent most widely used for cutaneous tumors is 5-fluorouracil (5-FU) which interferes with DNA synthesis in actively dividing cells causing tumor death.  Some of the common used topical prescription medications in this category are: Carac Cream, Effudex cream, Aldara, and Zyclara.  Patients self-treat by applying the topical cream for several weeks, resulting in increasing erythema and superficial erosions at affected sites. These sites typically heal without scarring once the desired inflammatory end point is reached. Some patients can experience pruritus (itching) and irritation, and, therefore, require close follow-up during the course of treatment to monitor response to the medication.

 

Although topical 5-FU has been used to treat precancerous actinic keratosis lesions, which may progress to Squamous Cell Carcinoma, its usefulness in treating invasive Squamous Cell Carcinoma is hindered by the inadequate depth of penetration of the topical medication into the dermis.  Topical 5-FU application has been limited to treating superficial Basal Cell Carcinoma or Squamous Cell Carcinoma, because of the potential for persistent, deeper-invasive tumors to remain following treatment, and even then its use is rare.

Tinea Versicolor

Dr Green Dermatology - Tinea VersicolorTinea versicolor is a very common skin condition, especially in warm tropical climates, in which there is an overgrowth of the skin surface with yeast. This overgrowth results in uneven skin color or spots on the trunk and upper arms, that may be scaly to the touch.  Essentially the yeast (fungus) grows slowly and prevents the skin from normal tanning.  As the unaffected skin tans in the sun, the pale spots, which are affected by the yeast, become more noticeable, especially on darker skin.  Some patients may experience mild inflammation and itching, while others report no symptoms.

 

Treatment

 

The treatment of  this condition is often simple, including with antifungal medications – topical creams, shampoos, and even oral pills depending on the severity

Urticaria (Hives)

Hives are raised, often itchy, red welts on the surface of the skin. They are usually an allergic reaction to food or medicine. Substances that can trigger hives include medications, shellfish, eggs, nuts, fish, milk, pollen, animal dander and insect bites. Symptoms include itching and swelling of the surface of the skin into red- or skin-colored welts (called wheals) with clearly defined edges. The welts may enlarge, spread, and join together to form larger areas of flat, raised skin. They can also change shape, disappear, and reappear within minutes or hours. The welts tend to start suddenly and resolve quickly. When you press the center of a red welt, it turns white.

 

Dr Green Dermatology - Uticaria (Hives)Hives are very common with 10-20 percent of the population having at least one episode in their lifetime. Hives can sometimes occur in deeper tissues of the eyes, mouth, hands or genitals. These areas mat develop a swelling that is frightening in appearance, but usually goes away in less than 24 hours. This swelling is called angioedema.
In many cases, a single attack of hives is due to an infection or virus and these go away within a few days to a few weeks. Some people get repeated attacks that occur as an allergic reaction to a variety of things (foods, most commonly nuts, chocolate, fish, tomatoes, eggs, fresh berries and milk, insect stings, and medications). In this case, they usually break out within a few hours of the exposure. Usually, the patients figure out the cause by themselves, and they never bother coming to a doctor.

 

Occasionally, a person will continue to have hives for many years. These hives, called chronic urticaria, can be one of the most frustrating problems dermatologists see in their patients. This is defined as hives lasting longer than 6 weeks. Patients like this come in miserable and worried with this problem, often having seen multiple specialists. Neither the patient nor the doctor can determine the cause of the hives. Patients will often say, “It has got to be something causing these hives.” The truth is hard to accept for some patients.
Treatment

 

Treatment may not be needed if the hives are mild. They may disappear on their own. To reduce itching and swelling, the physicians recommend: Avoid hot baths or showers. Avoid irritating the area with tight-fitting clothing. Apply calamine lotion. Take antihistamines – The most well tolerated initial treatment is the non-sedating antihistamine Claritin. Zyrtec is similar but may sometimes cause sedation. If that doesn’t eliminate the hives, a sedating-type of antihistamine (hydroxyzine, cyproheptadine or doxepin) is added at night.  A short course of oral cortisone can often help  to clear the hives completely if above measures are ineffective.

 

In the overwhelming majority of cases of chronic hives (95%)  the cause is considered “idiopathic” (a medical term that means there is no discernible cause). Because of those 5% of cases with a cause, it is worthwhile for to determine if any underlying disease is present (e.g. thyroid problems, liver problems, skin diseases, sinusitis) or if there is an allergic cause (i.e. a reaction to a drug, insect, food, etc.). This can be accomplished by a good history and physical, a few blood and urine tests, a skin biopsy, and at times Patch Testing (see contact Dermatitis). Some patients with chronic hives and elevated anti-thyroid antibodies in the blood improve when given thyroid supplement even if the thyroid function is normal.

Vitiligo

Vitiligo is a skin condition whose exact cause is unknown. In Vitiligo, patches of skin lose their pigmentation.  This disease affects an estimated 1% of the world’s population. It affects individuals of all ethnic origins and both sexes, but is much more easily noticed on darker skin as areas that fail to tan.

 

Treatment

 

Dr Green Dermatology - VitiligoPrescription steroid creams are the safest and simplest initial treatment, especially for recently diagnosed or spreading Vitiligo. They are usually applied twice daily, and results require three to six months.  Another form of treatment Dr. Green will use is the Xtrac Laser (Phototherapy), which uses ultraviolet light to stimulate the pigment cells to produce Melanin (pigment) again. XTRAC is the only FDA-cleared, clinically proven excimer laser that gets skin clear of psoriasis—and it works fast, with many patients seeing significant improvement and long-lasting remissions. Because XTRAC delivers a highly targeted, therapeutic beam of UVB light only to areas of the skin affected by psoriasis, healthy skin surrounding the lesions stays that way. XTRAC clears the symptoms, prolongs the remission and returns skin to a clinically healthy state in record time. All of which means XTRAC delivers consistently predictable results so patients experience more good days of living than bad.

 

Quick Facts

 

  • Effective treatment—symptoms reduced generally in 10-12 treatment sessions
  • Long-lasting relief—typically several months free of symptoms. Simple, painless treatment—sessions are very short
  • Relief without messy creams and daily skin care regimen
  • Covered by most major insurance companies, available by Rx

Warts

Dr Green Dermatology - WartsWarts are a benign skin growth caused by a viral infection in the top layer of the skin. The viruses that cause these warts are called Human Papilloma Virus (HPV). Warts are usually skin-colored and feel rough to the touch. They can also present as dark colored, flat and smooth. Warts are passed from person to person usually by direct contact, and sometimes indirectly. They occur more easily if the skin has a small cut. Patients with a weakened immune system are more prone to a wart virus infection. Warts can disappear without treatment over several months to years, especially in children. However, they are bothersome and painful.  In adults, warts do not disappear as easily without treatment.

 

Treatment

 

Dr Green Dermatology - WartsThere are variety of treatments, depending on the age of the patient and the type of wart.  Cryotherapy (freezing) is the treatment of choice. It requires repeat treatments in one to three week intervals.  At home a topical application of Glycolic acid, salicylic acid, retinols, or even a topical immunomodulator daily is also strongly encouraged by Dr. Green.  Sometimes if there is an isolated lesion the doctor can remove the wart.

Xerosis

Dr Green Dermatology - XerosisXerosis is a medical term for dry skin. When it results in skin that is scaly and itchy, the condition is called pruritus. This occurs when natural moisture is drawn out of the skin.

 

The skin needs moisture to protect itself. The best way to relieve dry skin is to use a moisturizer. Too much water can cause the skin to dry out. Habitually showering or bathing more than once a day should be avoided to prevent dry skin.

 

Environmental factors such as excessive sun exposure and pollutants in the air can damage the skin. Dry skin is often a problem in cooler climates, especially during winter months when home heating systems are used regularly. This unhumidified heat is dry and draws moisture from the skin. Outdoors, cold winter air causes the body to protect itself by drawing blood away from the skin. When this occurs, the skin is not well nourished and xerosis can result.

 

Treatment

 

Dr. Green’s goal of therapy is to reverse fissuring and scaling and add moisture to the skin. Because water provides skin with its flexibility, moisturizing the outer layer of the skin is most important. Emollients are creams that can be applied to the affected area to prevent water from evaporating from the skin’s surface. Emollients also smooth over the scaly edges that can flake off and cause intense itching. Emollients should be applied after bathing and frequently throughout the day.

 

Cosmetic Dermatology

Helping you improve your skin’s appearance.

Botox

BotoxBOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate-to-severe frown lines between the brows and give patients a “more relaxed” look that lasts for several months.

 

BOTOX® Cosmetic is administered by Dr. Green as a simple, painless and nonsurgical treatment that is injected directly into the muscles between the brows.

 

Dr. Green most often will use Botox on forehead lines, crow’s feet (lines around the eye) and frown lines between the brows.

 

Receiving a Botox treatment takes only a few minutes and usually no anesthesia is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to fourteen days to take full effect and it is best to avoid alcohol at least one week prior to treatment to decrease the risk of bruising.

 

Temporary bruising is the most common side effect of Botox, which can resolve in 24-48 hours.

Dysport

dysportIn addition to offering Botox® treatments, Dr. Green offers Dysport®. Dysport® was approved by the FDA in June of 2009 as another botulinum-A treatment proven to reduce wrinkles and fine lines on the face

 

 

 

 

 

 

Fraxel Laser

Most of us wish we could slow down the effects aging has on our looks – and maybe even get a few years back in the process. Fraxel® is proven laser technology that can help reverse the visible effects of aging, naturally helping you look as young as you feel. With Fraxel, change isn’t drastic or scary – it’s you, just younger.

 

Fraxel is effective on:

  • Fine lines and wrinkles – like crow’s feet and brow lines
  • Surface scarring – erasing effects of acne and other scarring
  • Pigmentation – minimizing the appearance of age spots
  • Sun damage – helping heal dangerous skin damage
  • Actinic Keratosis (AK) – a common pre-cancerous skin condition

 

Fraxel is a laser used by physicians to treat damaged and aging skin by harmlessly penetrating the outer layer of skin, but only resurfacing 15-20% of the skin during each session so multiple treatments are needed, often 3-5. This method protects the skin from enduring too much damage at once and eliminates much of the downtime associated with CO2 or erbium laser resurfacing treatment.

 

Before treatment, your skin will be cleansed thoroughly and a topical anesthetic may also be applied to provide more comfort during the procedure.  The device is used to pass a laser  over the skin and you may feel a slight pinch or warming sensation with the pulse, but patients rank this as minimally painful.

 

After treatment, you should expect a sunburn-like redness which disappears in a few days. Within 24 hours, new epidermal skin will develop and your skin will have a bronze appearance which can last from three days up to two weeks depending on what level of treatment you have received. As the new epidermal tissue replaces the damaged tissue, your skin will flake off. Typically patients find they can go back to work soon after treatment or the next day, and you may apply make-up or shave soon after treatment.

 

To protect your new skin, be sure to wear SPF 30 or higher sunscreen and apply twice a day. You must avoid the sun as much as possible and take extra care to protect your skin from more damage.

IPL

Photorejuvenation (IPL- Intense Pulsed Light) laser treatments are most commonly used for:

 

  • Lightening and removing “sun spots”, “age spots”,  and brown blotches on the face, neck, chest, hands and other areas of the body
  • Lightening and reducing redness, rosacea, dilated blood vessels and “broken” blood vessels on the face, neck and chest
  • Helping to control flushing
  • It also has a lesser effect of improving skin texture through collagen stimulation and improves pore size minimally by temporarily reducing oiliness

 

Photorejuvenation, almost always consists of a series of 3-5 treatments, usually one every two to four weeks. The benefits of photorejuvenation treatments are achieved with little discomfort and minimal risk.

 

The laser/IPL device emits a range of lightwaves that are then tuned and targeted at hemoglobin (the red blood cells in the blood vessels) or melanin (the brown pigment in freckles and age spots). The light beam passes through the skin and is absorbed by either hemoglobin or melanin resulting in damage to the vessel wall or fragmenting of melanin pigment. These tiny vessels and the melanin pigment are then absorbed by the body, rendering them less visible.

 

After your first treatment, you can expect to see some redness, darkening of brown spots, and light swelling. These symptoms will resolve in several hours to one week. Makeup can be immediately applied, if desired. After the treatment, your skin will feel smoother and have a more even tone. A gradual decrease in overall redness, flushing, age spots, and fine lines will be more visible after each treatment.

 

The main side effects are mild, temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister (like a sunburn blister).  There are rare other side effects which your laser center will review with you in your consent form.

Juvederm

JuvedermJUVÉDERM® XC is the smooth gel filler that Dr. Green uses to instantly smooth away wrinkles around your mouth and nose. With just one treatment, you’ll get smooth and natural-looking results that last up to a year.

 

JUVÉDERM® XC is manufactured using HYLACROSS technology, creating a smooth-consistency gel. It is infused with lidocaine to improve comfort during treatment. With JUVÉDERM® XC you get the smooth results you expect, with the improved comfort you want.

 

Everyone will notice, but no one will know.

 

It is also used as a lip augmentation agent, and to fill in hollow places and scars on the face. However, all hyaluronic acid facial filler products are eventually absorbed by the body, usually within six to nine months.  Juvéderm is also used by Dr. Green to plump lips, which also lose fat and internal shape with normal aging.

Kybella

Kybella (deoxycholic acid- a naturally- occurring molecule in the body that aids in the breakdown and absorbtion of dietary fat) injection is the first and only FDA-approved injectable treatment that is used in adults to improve the appearance and profile of moderate to severe fat below the chin (submental fat), sometimes referred to, “double chin.”

 

When injected into the fat beneath your chin, KYBELLA® causes the destruction of fat cells. Once destroyed, those cells cannot store or accumulate fat.

 

Dr. Green will design a treatment plan tailored to help you improve your chin profile. During your treatment sessions, Dr. Green injects KYBELLA® into the fat under your chin using multiple injections. Patients will experience visible results in 2 to 4 treatment sessions. Up to 6 treatment sessions may be administered spaced no less than one month apart.

Bellafill

What is Bellafill used for?

Bellafill is used to smooth moderate to severe facial folds and wrinkles from the nose to the corners of the mouth (nasolabial folds). Bellafill is meant to be a permanent wrinkle solution. It has been found to be a safe dermal filler that restores volume and fullness to the skin. It is also used to correct acne scars on the cheeks in those over 21 years of age.

 

How does Bellafill work?

Bellafill is injected into the skin with an ultrafine needle. Bellafill plumps the skin to smooth away wrinkles and folds. Bellafill is composed of nonabsorbable microsphere collagen which acts to provide support for a longer-lasting wrinkle correction. Most patients see results within one or two treatments. Allergy pre-testing is required.

 

How long does Bellafill last?

Bellafill is a non-resorbable dermal filler, unlike many other dermal fillers that are absorbed and require reinjections over certain fixed amounts of times. Results with Bellafill are semi-permanent.

Voluma

JUVÉDERM VOLUMA® XC adds volume to correct age-related volume loss in the cheeks to help create a more youthful appearance.

Wrinkles and lines aren’t the only signs of aging. Over time, the cheeks flatten, and the skin may begin to sag. This is caused by a natural loss of volume in the cheek area, or what the experts call age-related midface volume loss. JUVÉDERM VOLUMA® XC is designed to add volume beneath the skin’s surface to lift and contour the cheek area.

Laser Hair Removal

If efforts to remove unwanted hair leave you with bumps, nicks, burns, or the hassles of repeated shaving, tweezing, or waxing, laser hair removal may be an option worth considering.

 

Laser hair removal is a technique that uses beams of highly concentrated light penetrate the hair follicles. The light is absorbed by pigment in the hair follicles and destroys the hair within the follicle. Laser hair removal is among the most commonly performed cosmetic procedures in the U.S

 

Lasers are useful for removing unwanted hair from the face, leg, arm, underarm, and bikini line, as well as other areas where unsightly hair is a problem.  The average amount of treatments to have for each location is 6 treatments.

 

If you are planning on undergoing laser hair removal, you should limit plucking, waxing, and electrolysis for six weeks before treatment. That’s because the laser targets the hairs’ roots, which are temporarily removed by waxing or plucking. You should also avoid sun exposure for six weeks before and after treatment. Sun exposure decreases the effectiveness of laser hair removal and increases the risk of complications following treatment

 

After treatment, the treated area of your skin will look and feel much like it is sunburned for a day or two. Cool compresses and moisturizers may help. Unless you experience blistering, you will be able to wear makeup the following day.

 

Over the next month, the treated hair will fall out. Wearing sunscreen for the following month will help prevent temporary changes in the color of the treated skin.

Radiesse

RadiesseCollagen is what gives volume, flexibility and strength to healthy, young skin. As a part of the aging process, your own natural collagen breaks down, diminishing facial volume and elasticity. This loss of elasticity and volume results in wrinkles, facial lines and skin laxity – all of which rob your skin of its youthful, fresh appearance.

 

Ideal wrinkle reduction is achieved by replenishing your skin’s lost volume. Upon injection, RADIESSE® Volumizing Filler immediately provides the volume and lift needed to diminish the signs of aging because of the calcium-based microspheres and gel that comprise the product. But what’s unique about RADIESSE Volumizing Filler is that it acts as a scaffold under the skin, providing structure and stimulating your own natural collagen to grow.1 This process continues for several months, which extends the initial effect of RADIESSE Volumizing Filler. Best of all, the natural results are clinically proven to last a year or more in many patients, which is why Dr. Green chooses RADIESSE Volumizing Filler to achieve long-lasting facial rejuvenation.

 

Radiesse can be used on the face as well as rejuvenating your hands.  Dr. Green is a board certified dermatologists who trains other physicians on how to use Radiesse on patients for facial rejuvenation and facial contouring.

Restylane & Restylane Silk

restylaneRestylane is most commonly used for lip enhancement (volume and contouring). It is used to diminish wrinkles and aging lines of the face such as the nasolabial folds (nose to mouth lines), melomental folds (sad mouth corners), “crow’s feet” and forehead wrinkles (frown lines). It may also be used for filling aging-related facial hollows and “orbital troughs” (under and around the eyes), as well as for cheek volume and contouring of the chin, forehead and nose.

 

Restylane can also be used to revitalize the skin by increasing skin elasticity structure, without the goal of adding volume, for example in the face, hands and décolletage.

 

Duration depends on factors like the individual’s skin type, lifestyle and age. After the initial treatment, follow-up sessions are normally recommended around every 6 to 12 months depending on the individual and the treatment. A treatment of the lips lasts less than 6 months.

 

Treatments have a recovery time of 2 to 3 days.

 

 

perlaneRestylane Silk is the “sister” product of the dermal filler Restylane. They’re manufactured and marketed by the same company, Galderma. They also contain the same biocompatible hyaluronic acid, a naturally occurring sugar that binds with water to enhance your skin’s fullness and elasticity.

 

The difference between the two fillers is in the size of the hyaluronic particles. Those in Restylane Silk are slightly larger. For that reason, Restylane Silk tends to be used for deeper, larger facial wrinkles and creases.

 

Restylane Silk is especially effective at improving the large nasolabial folds between the nose and the mouth and the “worry” lines that can become an unwelcomed permanent fixture on the forehead. The filler is also used to enhance the volume and size of lips.

 

Restylane Silk is injected under the skin with an ultrafine needle. To minimize any discomfort, we may recommend (or you can request) a topical anesthetic, which will numb your skin. The entire procedure usually takes less than half an hour.

 

Following the injection, some swelling and redness may occur as well as some associated pain. This typically doesn’t last longer than a week. A rare side effect is the appearance of red bumps around the injection site. Should any side effects persist, call our office.

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