Perhaps the most rewarding part of my job is seeing a teenager who has no self-confidence go from putting his head into his T-shirt to hide his face to looking you in the eye and smiling with confidence (after) we help him with his acne," says Dr. Mary Lupo, a clinical professor of dermatology at Tulane Medical School who has a private practice in Lakeview. "I can't tell you how gratifying it is to help people feel good about themselves."
It's a common refrain among the city's dermatologists, who have an arsenal of cosmeceuticals and nonsurgical techniques to treat skin conditions and smooth away signs of aging and other imperfections.
Acne is a familiar complaint among patients of all ages and often can be easily treated with medication. "(The cause) is a combination of hormones and genetics," says Dr. Nicole Rogers, a dermatologist at Old Metairie Dermatology. "Treatments can involve oral or topical antibiotics, retinoids that help us shrink and tighten pores to help reduce outbreaks or (the medication) Accutane for treating severe acne."
Doctors can lessen acne scars by using dermal fillers — mostly collagen injected under the skin — to lift pockets of depressed skin and lasers to smooth the skin. "For scarring, there are a number of options," Rogers says. "Sometimes even if people have old acne scarring, they can benefit from using Accutane. There are definitely options for people."
It's a busy time of year for Dr. Sharon Meyer at Uptown Dermatology and Aesthetics. As winter turns to spring, people want to rejuvenate their skin in preparation for warm-weather activities.
"Spring is a time when people want to look better and they're looking to look good in a swimsuit," she says. Adults seek treatments to smooth lines and wrinkles and make their skin glow, she says.
"I really think once you get past a certain age, even 35, it really does help if you're willing to do the botulinum toxins (Botox and Dysport) and fillers. If you wait too long and the lines are at rest — if they are really deep while you're not making a facial motion — it is really hard (to erase them). You might have to add a filler also. If they continue their Botox/Dysport, (the lines) gradually diminish."
Lupo uses a combination of protocols on her skin-rejuvenation patients, including collagen fillers, light chemical peels to smooth the skin and topical creams such as Retin-A and alpha hydroxy acids. Retin-A enhances collagen production and helps the skin's natural exfoliation process. Alpha hydroxy acids smooth the skin and get rid of fine lines, similar to microdermabrasion, and are useful on thick or sun-damaged skin.
"My forte, and what I teach, is the combining of injectables and lasers in skin care," she says. "I think the most important thing, first and foremost, is (the skin) needs to be in good shape." To that end, Lupo emphasizes using sunscreen to protect against harmful UV rays and discourages the use of bleaches to lighten skin. "I prefer not to concentrate on wrinkle therapy if the overall canvas is not in good shape," she says.
Lupo employs intensed pulse light (IPL) treatments, which leave the surface of the skin undamaged, as well as laser resurfacing to improve fine lines, large pores and other imperfections. She also uses chemical peels, microdermabrasion to exfoliate and smooth the skin and Lumixyl, a synthetic peptide cream, to lighten spots and add overall brightness.
"Once your skin color and texture looks better, the next step is to treat the lines and wrinkles and sagging," Lupo says. "Probably Juvederm (an injectable gel made of hyaluronic acid that hydrates and builds volume) is the big workhorse because it's soft and great in lips. Radiesse (a filler that promotes collagen production and creates volume) is better for men and those with thick skin. Sculptra (an injectable implant that contains microparticles of poly-L-lactic acid) is for very tired or thin faces and those with a loss of facial fat — those who are sick, have eating disorders, have lost weight. It helps areas of atrophy and gauntness. You actually look like you've gained weight without gaining weight."
All three doctors tout the use of retinoids (vitamin A derivatives) to help reverse visible signs of aging, including wrinkles and age spots, promote healthy cell growth and shrink the size of pores. They also advocate the daily use of sunscreen, especially on the face, and avoiding overexposure to UV rays.
"You should never purposely tan," Meyer warns. "When I'm at the beach I'm either on the balcony reading a book or on the beach under an umbrella." In addition to sunscreen, she recommends protective clothing lines such as Sun Precautions, which sells apparel with an SPF of 30 or more. "You have to protect your skin and use appropriate sunscreen," she says. "I like the ones with high zinc oxide. They tend to block the damaging rays better."
People shouldn't let a fear of the sun limit their activities, however. "The main thing is you have to live and enjoy life," says Meyer, who grew up in Pensacola, Fla., was a lifeguard and now plays on a tennis league. "You just have to be smart and adjust. I take the summer off from tennis, or we play early in the morning instead of from 10 a.m. to noon."
Although it is important to moisturize your face and use a sunscreen, Meyer says some people overdo it. "One mistake New Orleanians make is they overhydrate, then they break out. You don't want to use a heavy sunscreen when it is hot and humid." Different types of skin need different sunscreens, she says, and some even come with a tint so it can be worn like makeup. "Some people think wearing a sunscreen every day (is a hassle)," she says, "but when you find one of these cosmetically elegant ones, you want to put it on."
Other recommendations from Meyer, Lupo and Rogers include using topical antioxidants, glycolic and lactic acid products (under supervision of a dermatologist), wearing a wide-brimmed hat in the sun and not smoking tobacco. And, Lupo adds, "Never get on a tanning bed."
Dermatology is not all about aesthetics. These doctors are also a main defense in the detection and treatment of skin cancers. Anyone who has suffered serious sunburns or has a family history of skin cancer should be examined from head to toe for irregular moles and other odd-looking spots to make sure they are not malignant. For people over 40 years old, that could mean an annual checkup if they have certain risk factors, Meyer says. Others can go less often, but the frequency and personal risk factors should be discussed with a doctor.
Lupo also treats spider and varicose veins with sclerotherapy and a new injectable product, Asclera (polidocanol), recently approved by the FDA. "It's painless," she says of Asclera. "You don't get the burning and stinging that you do with saline (used in traditional sclerotherapy), and you don't get the pigmentation (that sometimes results)."
Rogers' specialty is treating hair loss in men and women, including hair transplantation. Although balding is generally considered a male condition, Rogers says it happens to females as well.
"Up to 40 percent of women can be affected by hair loss at some time in their lives," she says. "It can be devastating. People are anxious to find answers — to find out what is going on with them."
For men, she says, hair loss often is inherited and can be traced through their family. Hair loss in women can be inherited, but generally a doctor must consider other variables such as medications, hormones and iron and vitamin D levels. "Sometimes we have to play detective in terms of figuring out why people have hair loss," Rogers says. "If it is inherited, we have medical and surgical options." Monoxidil (used in Rogaine) can help retain and thicken hair, and antiandrogen therapies stimulate hair regrowth in women. If started early enough, the oral medication Propecia can help men from losing their hair, she says. Hair transplants involve taking hairs from one part of the scalp and surgically implanting them in a balding area.
A large number of patients who visit dermatologists are simply seeking prettier, younger-looking skin. When it comes to erasing the signs of aging with fillers, Botox and Dysport, Lupo says practice makes perfect. "I think the key is to go to someone who injects a lot because ... the more you do something, the better you are at it. It's like colors on a palette to an artist. I think all the fillers are wonderful, it's just a matter of matching the right filler to the right patient."
Dermatologists can give patients great tools and treatments to make them look dramatically better, but it can take some time. "People always want the next miracle," she says. "Just like getting in shape isn't an instantaneous thing and is a lifetime commitment, the same thing is true for your face. But no matter how old you are, it's never too late to start taking care of your skin."