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Many patients who are interested in improving age-related changes of the face ask for filler treatments for specific lines such as those that extend from the nose to the angles of the mouth (nasolabial) and/or the marionette lines extending down from the angles of the mouth bordering the sides of the chin. While filler treatment of specific lines may offer some benefit, addressing volume and structural changes seen with aging is more likely to achieve significant improvement.A youthful face typically has full rounded cheeks and tapers toward the chin (visualize a triangle with the apex pointed down). As the face ages, volume loss occurs along with other structural changes with flattened checks and formation of deeper folds and jowls (a triangle with the apex pointing up). Recognition of these anatomical changes, newer injection techniques, and the availability of fillers, such as Juvederm Voluma, Restylane Lyft, Sculptra, and Radiesse gives us better options for facial rejuvenation. Our physicians have expertise in injecting fillers. If you're interested in learning more about treatment options, schedule a consultation with your dermatologist.

In previous blog posts, we've stressed the importance of protecting your skin from the sun's ultraviolet rays to minimize skin cancer risk. The Skin Cancer Foundation recommends monthly self skin exams and annual skin exams by your dermatologist. It's advisable to look for any new or changing growths, growths that appear different or unusual compared to other growths on the body, and irritated or bleeding growths. The following tips can help you prepare for an optimal total body skin exam by your dermatologist:

• Wear clothing and shoes that are easy to remove for a thorough exam.
• Women should avoid foundation make-up and only apply sunscreen prior to an examination. Facial lesions can be hidden under make-up.
• If you wear a removable hairpiece, you should be willing to remove it for the exam. A full exam includes the scalp.

If you have questions, note them in advance to help you remember. Keep in mind, though, if your list is long, you may be asked to make another appointment to cover all of you concerns.

Many of our male patients comment that the cosmetic marketing brochures in our office are almost exclusively directed toward women. While the majority of cosmetic procedures are performed on women and most skincare products are promoted to women, many men are also interested in procedures and products to enhance their appearance. In this regard, the men’s skincare market has grown significantly and is expected to triple in size over the next several years. Maintaining a well-groomed and youthful appearance is important to many men.To achieve a natural, relaxed improvement, it's critical to recognize the differences in men's facial anatomy compared to women. Fortunately, many treatment options are available including Neurotoxins (Botox, Dysport, Xeomin), Fillers (Juvederm, Voluma, Restylane, Radiesse, Sculptra), Intense Pulsed Light, Cryolipolysis (Coolsculpting) and Fractionated Laser Treatments. These procedures can be used alone or in combination. If you have questions or would like to schedule a consultation with one of our physicians to discuss treatment options please call us.

In addition to softening wrinkles, Botox is used to treat a variety of medical conditions including severe spasms in the neck, uncontrolled eyelid spasms, migraine headaches, excess sweating, and urinary incontinence. Several studies indicate that Botox treatments for frown lines between the brow can significantly elevate the mood of individuals suffering from depression. A study released last year, demonstrated that 52 percent of participants who suffered from moderate to severe depression found relief from Botox injections, compared to 15 percent who received a placebo. Plus, nearly a third of the Botox patients went into remission.Two other studies revealed the same and in one, not only did Botox help with depression, but the effects continued even after the cosmetic changes wore off. The exact mechanism of action isn't clear but might involve a feedback theory which states that facial expressions influence mood. It's possible that by relaxing the frown muscles a signal is sent to the brain, improving a person's mood. Botox for depression is currently used off-label and is in clinical trials for FDA approval.

It’s estimated that toenail fungus, aka, onychomycosis, affects 15% of the adult population. While this condition commonly causes cosmetic embarrassment, it may also be associated with pain and secondary bacterial infections. It appears as yellowish thickened nails often with the nail lifted off the underlying nail bed. Onychomycosis is often associated with athlete's foot (tinea pedis), a fungal infection of the toe web spaces and feet. The fungi and yeast that cause these conditions are ubiquitous and commonly contracted when walking barefoot in public places such as gyms, locker rooms, and swimming pool decks. Fungal infections thrive in warm, dark, moist environments. Unfortunately, this is exactly what our feet are exposed to when we wear shoes!Treatment of onychomycosis is directed at minimizing environmental factors by drying feet thoroughly after showers, rotating shoes to allow them to dry, keeping feet open to air by wearing sandals when possible, and avoid walking barefoot in public places. Treatment with oral medication (Lamisil) for moderate to advanced conditions and topical preparations (Jublia, Kerydin) for milder cases can improve and sometimes eradicate this condition.

A recent evaluation of data of Swedish Men who used erectile dysfunction (ED) medications such as sildenafil (Viagra, Pfizer Inc), vardenafil (Levitra, Bayer HealthCare Pharmaceuticals), and tadalafil (Cialis, Eli Lilly and Company) found a significantly increased risk of developing melanoma and basal cell carcinoma, the most common form of skin cancer, compared to an aged-matched control group. Married men and those with higher educational levels and incomes were also at significantly increased risk for melanoma. Interestingly, the risk was highest among men who filled only a single prescription for one of the medications. If a causal relationship between the medications and melanoma existed, men who filled the most prescriptions would be expected to have the highest risk. It’s most likely that the same types of men who are at risk for melanoma (i.e. a lifestyle with increased sun exposure) also happen to take ED medications.Another large study that looked at the dietary patterns of more than 100,000 Americans discovered that those who consumed citrus—specifically whole grapefruit or orange juice—daily had a 36% higher risk of developing melanoma. It is theorized that the increased risk might be due to the presence of furocoumarins in citrus which are known to make the skin more sensitive to sunlight. The American Society of Clinical Oncology called the findings "intriguing" but said that it's too early to make any changes to dietary recommendations. The results have also been criticized due to various issues with the study design.The best ways to prevent the development of skin cancer are sun avoidance and sun protection measures including the use of broad-spectrum sunscreens with a minimal SPF of 30, hats, and protective clothing.Referrences: JAMA. 2015;313(24):2449-2455. doi:10.1001/jama.2015.6604. Citrus Consumption and Risk of Cutaneous Malignant Melanoma JCO published online on June 29, 2015; DOI:10.1200/JCO.2014.57.4111.

Summer officially arrives later this month accompanied by longer days and increased ultraviolet exposure.For those who spend a lot of time indoors and/or have a history of skin cancer, several oral supplements might be worth considering.Polypodium Leucotomos (PL) is a fern extract that has been shown to have photo-protective activity. It is marketed as Heliocare and Fernblock and can be taken orally in the morning and prior to extended sun exposure. Vitamin C is also known to have photo-protective qualities. Rather than supplements, a diet rich in multicolored fruits and vegetables is advised. Finally, Australian researchers recently released a study abstract revealing that Nicotinamide, a form of vitamin B3, significantly reduced the incidence of non-melanoma skin cancers among people who have had a previous basal cell carcinoma or squamous cell carcinoma. This double blind, placebo controlled study found that those who took 500 mg of Nicotinamide twice daily reduced their risk of developing another skin cancer by 23%. Supplements should only be considered adjunctive measures, not substitutes for a complete sun protection regimen including:

• Minimize direct sun exposure between the hours of 10 am and 4 pm
• Apply a broad spectrum sun screen with at least SPF 30 and reapply every few hours of exposure. To ensure adequate coverage, an average adult should apply a shot glass full of product to cover all exposed areas.
• Wear sun protective clothing. Several online companies (Coolibar, Sun Precautions) sell SPF rated hats and clothing.
• Wear a broad rimmed hat.
• Protect your eyes with UV protected sun glasses

The importance of early detection of skin cancer cannot be over-emphasized. This is particularly critical with melanoma, the most serious skin cancer. In this regard, regular skin exams by your dermatologist are beneficial. The frequency of evaluations is generally determined by personal and family history of skin cancer, history of irregular (atypical) moles, skin type, amount of sun exposure and history of sunburns. Monthly self skin exams can also pick up early signs of skin cancer. Our patient's often comment that they have difficulty recognizing the particular features of skin cancer (see www.skincancer.org for photos and descriptions of melanoma and the more common and generally less serious non-melanoma skin cancers.) Here are a few simple tips:

1. Regarding moles: If a skin lesion is new or changing, it should be evaluated by your dermatologist.
2. Any mole that looks significantly different from your other moles should be evaluated by your dermatologist. This is commonly referred to as the "ugly duckling sign" or "funny looking mole sign."
3. Any skin lesion with bleeding, crusting, scaling, or irritation that doesn’t heal within a couple of weeks should beevaluated by your dermatologist.

"Hey Doc- My Vitamin D level is low. Should I get a little sun exposure?" This is a question we are often asked and the short answer is "No"!Vitamin D is essentially for bone health and other metabolic functions and deficiency is associated with impaired bone formation. The sun’s utraviolet rays (UV) interact with the skin to produce vitamin D.Unfortunately, there is strong evidence that UV exposure from the sun or tanning devices is associated with an increased risk of developing skin cancer. In addition, there is no scientifically proven safe threshold level for UV exposure that generates optimal vitamin D production without increased skin cancer risk. Fortunately, an adequate amount of vitamin D can be obtained from a healthy diet that includes foods naturally rich in vitamin D; such as fatty fish including salmon, tuna, and mackerel, cheese, and egg yolks; foods/beverages fortified with vitamin D, for example certain daily products, breakfast cereals, and orange juices; and/or vitamin D supplements. To protect against skin cancer, sun avoidance including the regular and proper use of a broad-spectrum sunscreen, is advised.Adopted from www.aad.org