Scalp Conditions That Can. to Worsen in Winter. Scalp Conditions likely

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1 News, Information and Education from the staff of Associates in Medical and Cosmetic Dermatology winter 2009 edition Economy-Friendly Rejuvenation Americans everywhere are tightening their wallets. Yet, the desire to look (and feel) younger does not go away just because of the economy. So instead of expensive cosmetic surgery procedures (see sidebar on page 4), more and more people are turning to less invasive AND less expensive rejuvenation procedures. The results of a comprehensive consumer and plastic surgeon survey released by the American Society of Plastic Surgeons (ASPS) in November 2008, indicates that cosmetic surgery is down in the U.S. an average of 62%; the figure is even higher in the Northeast part of the country. On the other hand, non-invasive procedures, such as Botox, dermal fillers and laser treatments have risen an average of 73% over the same period. Richard D Amico, MD,ASPS president explains, The results are in. It appears more consumers are choosing the less invasive cosmetic procedures, both to give them a boost and in some cases, to buy time if they need to postpone a more costly invasive surgical procedure because of the economic downturn. or more details about the ASPS survey, see page 2.) Lower Cost, Less Downtime, Non-Invasive Options Cosmetic surgery has the advantage of offering dramatic, almost instant changes in your appearance. However, its downsides are well documented. Any surgery carries risks, among them, long recovery periods, complications from anesthesia, moderate to severe pain during recovery, bruising, scarring, paralysis, even death. Cosmetic dermatology procedures, on the other hand, are far less invasive, require minimal to no downtime, and cost continued on page 2 Heads Up Scalp Conditions That Can Worsen in Winter Many of us diligently rub moisturizing cream on our hands, arms, legs and feet during colder winter months. But we may not take into consideration how harsher temperatures affect another part of our body our scalp. In addition, sometimes troublesome scalp conditions might be too quickly dismissed as mere dry skin or discomfort from hat head. Like all skin conditions, it is important to visit our office so you can be properly diagnosed. Most scalp conditions can be treated, either eliminating the problem completely or at least, reducing the problematic symptoms Scalp Conditions likely to Worsen in Winter Chronic dandruff can be embarrassing and may be exacerbated when the outside temperature is too cold and the inside thermostat too hot. Dandruff is marked by itching with large, white, oily-looking flakes of dead skin dotting the hair and shoulders.while rarely serious, dandruff is most often caused by a yeast-like fungus called malassezia. Having excessive oily skin and hair might make you more prone to dandruff since malassezia continued on page 5

2 Pocketbook-friendly Dermatology, continued from front cover significantly less than surgical alternatives. However, it is very important to be realistic about results and be patient with treatment options that call for multiple sessions to achieve maximum effectiveness. You will not experience the same dramatic effect of a full facelift by using Botox or a ReFirme treatment, explains Dr. Scheiner. However, for those who want impressive results without the cost, downtime and risks of surgery, our cosmetic procedures offer a great alternative. Concerned about the firmness and loss of elasticity in your skin or on your neck? Consider Refirme or a Fraxel laser treatment. Fine lines and wrinkles bothering you? Botox, Artefill and the family of dermal fillers (such as Restylane, Juvedérm, Perlane and Evolence) can offer satisfying results. Uneven skin tone or acne scarring? Chemical peels, Macrodermabrasion, FotoFacialRF and the Fraxel laser treatments can greatly improve your skin s smoothness, tone and coloration. Many of AMCD s cosmetic dermatology procedures can be performed by our highly trained Aestheticians and Physician Assistants, in addition to our doctors. So don t delay! Schedule a cosmetic consultation with a member of our professional team, and find out how you can greatly improve the appearance of your skin without breaking the bank. The ASPS Survey Results In March, and then again in October of 2008, the American Society of Plastic Surgeons (ASPS)* conducted identical economic surveys with women considering cosmetic plastic surgery within the next two years. 59 percent of respondents say the economy has had an impact on their plans for cosmetic plastic surgery, up 9 percent from six months ago. 48 percent of the survey participants are less likely to schedule a consultation appointment now compared to 30 percent six months ago. 27 percent of the survey participants indicated they were considering less expensive options, compared with 20 percent six months ago. ASPS Member Surgeons were polled and asked to compare the first six months of 2008 during the economic slowdown to the first six months of The following percentage of physicians who perform the procedures report: 62 percent report a decrease in overall cosmetic procedures (regions most affected: Northeast and Southeast; region least affected: the Midwest) 73 percent (almost 3 out of 4) report an increased or stable demand for minimally-invasive cosmetic procedures like Botox, chemical peels, and dermal fillers (region with the largest increase: Northeast; region with the smallest increase: the West) *Founded in 1931, The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. 2

3 Dr. Scheiner among the Top Docs in Main Line Today Each year, the publication, Main Line Today, contacts more than 1,000 doctors and senior hospital staff members in Montgomery, Chester and Delaware counties and asks them to name their top picks in various categories of medicine and surgery. In this year s Top Docs issue (to be published on December 1st), our own Dr. Robin Scheiner is among those singled out for this special honor. I was completely caught off guard, but very pleased to be included on the list, said Dr. Scheiner. The fact that the selection comes from fellow physicians and hospital staff members makes it quite an honor. Main Line Today started its Best of series in 1997, so this year marks its eleventh year. The vast majority of categories that are covered, including restaurants, spas/salons, nightlife, are voted on by readers and editors of Main Line Today. Only the medical and dental categories are based on a jury of peers. Dr. Scheiner will be recognized for her achievement at a special dinner hosted by Main Line Today for all of the physicians mentioned in the Top Docs issue. Congratulations, Dr. Scheiner! Evolence : The latest evolution in collagen fillers AMCD is pleased to introduce Evolence, the latest collagen-based dermal filler to be approved by the Food & Drug Administration (FDA). Collagen fillers have been used to treat fine lines and wrinkles since the early 1980 s. But early collagen-based products required allergy testing before use, and results lasted only 3-6 months. Evolence has been clinically proven to last 6-12 months, and does not require allergy testing before use. How Does Evolence Compare to other Dermal Fillers? Unlike dermal fillers (such as Restylane and Juvéderm) which utilize hyaluronic acid to attract water and create a filling effect, Evolence is an advanced collagen compound that uses natural sugar to more closely mimic the cellular structure of the body s own collagen. Collagen is nature's most fundamental and abundant building block. In fact, collagen makes up 70% to 80% of the skin's dermis, providing structure, strength and support. Collagen depletes naturally over time as we age, leading to a tired or aged appearance. This happens through the formation of new wrinkles and folds, and changes in facial contour and structure.the natural pace of collagen loss can be accelerated by such factors as sun exposure, genetics, hormonal changes and smoking. By replacing lost collagen with an advanced collagen compound, Evolence dermal filler can help enhance and maintain the structure, volume and youthful appearance of your skin. We re excited to offer Evolence as another option for our patients who want to eliminate moderate to deep wrinkles and folds on their face, explained Dr. Hostetler. Some patients are perfectly happy with the hyaluronic acid fillers, such as Juvéderm or Restylane, or the calcium-based filler Radiesse which we also offer. Evolence is now available for those who want a collagen filler that is long-lasting and better tolerated by sensitive skin. The Benefits of Evolence Although Evolence has been used extensively in Europe, Canada and Israel since 2004, it just received its FDA approval in June, 2008, allowing it to now be marketed in the U.S. Its unique benefits include the following: Results last for 6 12 months, so you can minimize the number of repeat treatments over time. Its natural collagen formula reduces potential allergic reactions, so no pre-tests are required before treatment. Visible, natural-looking results can be seen after one visit, with minimal to no downtime. Causes minimal to no swelling or bruising, so you can get right back to daily activities. 3

4 Comparing the Costs of Rejuvenation Options Average Cost of Cosmetic Facial Surgery * Standard Facelift: $8,000 Mid-Facelift: $7,000 Lower Facelift: $7,000 Mini-Facelift: $5,000 Neck Lift performed in conjunction with Standard or Mid-Facelift (an additional $6,000) *includes surgeon fees, hospital/facility fees and anesthesiologist fees Cosmetic Dermatology Options at AMCD Chemical Peels: $100 - $200 Rejuvenates the skin by stimulating cell turnover, creating firmer, smoother, more radiant skin. Botox: $280 - $415 ($815 for three areas) Relaxes the muscles under the skin to reduce the appearance of deep wrinkles on the forehead and around the eyes. Dermal Fillers (including Restylane, Juvéderm, Perlane and Evolence): $310 - $600 per syringe Reduces moderate to deep lines and folds, especially around the mouth. ArteFill: $750 - $1,200 A new permanent injectable wrinkle filler, designed for deep lines and folds. Macrodermabrasion (series of 6 treatments): $975 Particularly effective for fine lines and wrinkles, sun damaged skin, acne and scarring, uneven skin tone and stretch marks. ReFirme (package of 4 treatments/full face): $1,400 - $1,800 Greatly improves skin laxity, sagginess, loss of elasticity and textural irregularities in the face, neck, abdomen, upper arms and knees. Fraxel Laser (package of four treatments/full face): $3,000 Dramatically reduces fine lines and wrinkles, skin discolorations, sun damage and acne scars. Take Advantage of The Holiday Rebate Offer On Restylane and Perlane Here s an added incentive to try either Restylane or Perlane dermal filler: Medicis Aesthetics, the distributors of both products in the U.S., is offering a special holiday rebate for treatments that are received between November 17, 2008 and January 4, During this limited period, you can receive a $50 rebate on a 1-mL syringe or a $100 rebate on two 1-mL syringes of either Restylane or Perlane. Rebate forms can be downloaded from the AMCD website ( or can be picked up at either AMCD office (Springfield or West Grove). This offer does apply during our Special Client Appreciation Days that are scheduled for Dec. 2nd and 3rd, when all Botox and dermal filler treatments are already discounted 20% (see back cover for details). There s no better time for your Restylane or Perlane treatment! 4

5 Winter Scalp, continued from front cover feeds on the oils in your scalp. In simple cases, we might suggest starting with daily cleansing with a gentle shampoo to reduce oil and cell build-up, says Dr. Boucher. In more severe cases, we might prescribe a steroid lotion and recommend some lifestyle changes that can help as well. Seborrheic dermatitis can also cause dandruff-like symptoms. Your scalp may be greasy looking with flaky white or yellow scales. Sensitivity to new hair-care products or dyes can cause similar symptoms. This condition may look like psoriasis, a condition which we usually think of on knees, elbows and trunk but which also affects the scalp. Your dermatologist or Physician Assistant will be able to tell the difference. Scalp psoriasis is very common and can become more prevalent or severe during the dry winter months. Psoriasis is caused when skin cells grow too quickly and create red lesions covered with scales. It can be very mild or severe enough to cause thick, crusty plaques to cover the entire scalp which then causes temporary or even permanent hair loss. Treatments may include over-the-counter tar shampoo products or heavier strength prescription medications. Other treatments like salicylic acid or even ultraviolet (UV) light may be considered. Scalp/Hair Conditions, Any Time of the Year Hair thinning or loss, known as alopecia, is a common frustrating and embarrassing scalp complaint any time of the year. On a normal scalp, people lose between 100 and 150 hairs per day. The typical life cycle of a human hair is between one and seven years depending on an individual s genetic make-up and the location of the hair on the body. Once growth ceases, the hair follicle rests for approximately 2-3 months. After that point, the hair is shed and the next growth cycle begins. If you think you re losing an unusually large amount of hair this winter, you should schedule an appointment since there are various treatments which can be considered depending upon a patient s age, health history and the amount of loss. We ll want to know the patient s diet, medications, present and past medical conditions and any family history of alopecia to help determine what s really at hand, says Dr. Boucher. For instance, sometimes patients exhibit hair loss a few weeks or months after severe physical or emotional stress. Painful sores, blisters, or bumps that develop on the scalp may be caused by an infection of the hair shafts called follicultis, from allergic skin reactions or viral infections. Cysts can appear on the scalp just like they do on ears, face, the back and other body areas, usually caused by plugged ducts at the site of the hair shaft. Problems can develop if the cyst becomes infected. Lastly, don t overlook the possibility of ringworm, another infection that can affect the scalp with the same circular red patches you d find on other parts of the body. Many people will experience hair or scalp problems this winter which - while upsetting and sometimes embarrassing - are not normally caused by serious medical conditions. Your highly-trained dermatologist or Physician Assistant is there to determine what s at the root of your winter scalp complaint. The Life Cycle of a Human Hair An average human is born with 100,000 to 150,000 hair follicles which continue to produce hair throughout his/her lifetime. Each hair acts independently, going through the same life cycle but at different times. In other words, at any given point, some of your hair is growing (in fact, the majority), some is in a resting phase and some is falling out A Hair is Born Cells at the base of a hair follicle create a new hair, fueled by keratin and protein secreted from sebaceous glands. The process occurs simultaneous with the hair resting phase. The Growth Stage (85-90% of your hair) The hair grows slowly (.3 cm per day or 1/4 to 1/2 per month) upward from the hair follicle. This phase can last from 1 7 years, depending on the individual s genetic make-up. On average, 90% of your hair is in an active growth stage. The Resting Phase (1-2% of your hair) During this period, the hair stops growing and remains dormant for approximately 2-3 months. This is the shortest period in the hair s life cycle. The Shedding Stage (10 14% of your hair) During this final stage, the dormant hair is slowly pushed out by the new hair that has been growing in the base of the hair follicle. On average, we shed 100 to 150 hairs a day

6 There s Still Time to take advantage of 20% discounts on Botox and Dermal Fillers on our Special Client Appreciation Days: December 2nd & 3rd That s right! As you re making your list of what you need to do to be Holiday Ready, don t forget about preparing your face as well. This year, AMCD is doing their part to make sure that you re looking your best for those holiday parties. We ve set aside two full days - December 2nd and 3rd - and are offering our valued clients 20% off on any Botox or dermal filler treatments (including Juvéderm, Restylane, Perlane and Evolence). If you haven t made your appointment yet call our office today. Space is limited! Another way to save on Botox AMCD is pleased to offer our valued patients the BOTOX Cosmetic Benefits Card Program. The program offers a $25 reward toward the cost of your next BOTOX treatment at AMCD (appointment must be within three to six months of the prior one). In addition, participants will receive exciting Botox Cosmetic giveaways, magazine subscriptions, treatment reminders, special offers, and news from BOTOX. For more information on how to register, visit Get Skin Savvy in form and take advantage of our online specials for products and services. Sign up online at Healthplex Pavilion II 100 West Sproul Road, Suite 120 Springfield, PA Jennersville Regional Medical Building 1011 West Baltimore Pike, Suite 205 West Grove, PA