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Transcript

 

Lee Tetreault:

Hello and welcome to Frequently Asked Questions from the session Cosmetic Dermatology; The Good, The Bad and The Ugly. Today we are joined by Dr. Jonette Keri. Doctor, before we begin, can you provide a few key pointers for our audience from today's session? 

Jonette Keri: 

Of course. What I want people to know about cosmetic dermatology is that patients are asking for cosmetic procedures and they should be educated on which procedure is good for them, as well as which are safe for them. So today, we'll talk about the safety of cosmetic procedures and as well as patient selection.

Lee Tetreault:

Great, doctor. So, let's get into some of these frequently asked questions. First, is botulinum toxin safe? 

Jonette Keri: 

Yes, botulinum toxin is safe. It has to be used by a practitioner who's been trained, for sure, but botulinum toxin has helped us, not only in the cosmetic realm with helping with wrinkles, but it's also helped our patients with pain. It helps with migraines, it helps with neurogenic bladder, it helps people feel better about themselves. And in addition to all of this, it can help with hypohidrosis. It can help with many different things outside of the cosmetic or the dermatologic or the skin realm. So yes, botulinum toxin is safe. It has to be used by an experienced practitioner.

Lee Tetreault:

Should patients take biotin for hair? 

Jonette Keri: 

Biotin is a little tricky now, because the biotin is used in some of the assays for some of our major medical tests, including the thyroid hormones, the parathyroid hormones, and importantly troponin. So you want to make patients aware that the biotin they're taking can interfere with their test. Does it help the hair? We tend to think that biotin helps the hair be a little thicker. For sure, it helps with the nails. As far as it making hair grow, some people would argue yes, some people would argue no. But in fact, biotin can help the hair become thicker. So, my concern with patients who are on biotin is that they don't have their other lab tests being, their lab test being affected by the biotin they're taking. And what do we tell our patients, we tell them to stop their biotin about two days before they go for their lab tests. And if they have an emergency visit to the ER, they let them know they're on biotin. What's probably the most helpful is that every patient keeps a list of their medications that they could turn in in the event of an emergency.

Lee Tetreault:

What creams help for anti-aging? 

Jonette Keri: 

So the classic creams that help for anti-aging are the retinoids. You may know them as tretinoin, tazarotene, adapalene. So the retinoids, derivatives of Vitamin A are the classic anti-agers. But we're also learning that anti-oxidants are good and classic anti-oxidants or Vitamin C, things like Coenzyme Q10, those are agents that are used to help patients not age. But we should think about sunscreen as a cream that will also keep away aging. So sunscreens are also good anti-agers. 

Lee Tetreault:

Should fillers be used in older patients?  

Jonette Keri: 

In the right setting, yes. And in fact, fillers can be very helpful peri-orally for patients that are older who may drool due to denture changes or the way their mouth is aging. So fillers can be definitely used in older patients. Sometimes a patient may not need a filler, they may need a facelift if they want a big cosmetic result. But you can definitely use patient fillers in older patients. You can also use fillers in patients who may have for example HIV disease, who have lipoatrophy of the face. And we and I have treated older patients with HIV disease with fillers to help fill in that lipoatrophy, the sunken in cheek look. So yes, fillers can be used in older patients, they have to, the patient has to be selected appropriately as well as the filler. 

Lee Tetreault:

Do sunscreen matter when we are older? 

Jonette Keri: 

You know, this is a controversy that comes up at the University of Miami, our grand round session all the time. When someone's in their 80s or 90s, do they really need a sunscreen at this point? Well, we don't wanna sunburn for a pain. So to start with, we don't want someone to have a sunburn that causes them pain. As far as how much sun is a lot when you get older, I think patients should always wear sunscreen, but again it is controversial with the older patients. Keep in mind that every ray of sun you get is cumulative. So, they add up. So our 75-year-old might live to be 95. So those extra rays of sun for the older patients, they may add up to something, and skin cancers in older patients over the age of 90 can be associated with a fair amount of morbidity. Sometimes a certain types of skin cancers over the age of 90, we treat much less aggressively. So should older people were sunscreen? I would say if just for the sake of not having a sunburn, yes, and being more comfortable, and remembering that cumulative effect of sun, I would say to keep using them, but I won't end this line of speaking without saying that it is controversial. Sometimes you think at the age 80 or 90, do you really need sunscreen? And that does come up.

Lee Tetreault:

Are chemical peels say for every skin type? 

Jonette Keri

Yes, you can use chemical peels for every skin type. You just have to know which peeling agent to use. Some are safer in our darker pigmented patients. For example, salicylic acid is safe in all skin types. You can use salicylic acid on the darkest skin and you can use it on the lightest skin. So you can use chemical peels on all patients. Now, can you use every agent on all patient? No, you're not going to use a stronger peeling agent, something like trichloroacetic acid, you're not gonna use that on a darkly pigmented patient. So you have to know your patient's skin type and you can tell that usually by looking at them, but sometimes you may ask some questions, and then you pick the peeling agent appropriate for that skin type.

Lee Tetreault:

And lastly doctor, how can hair loss be treated? 

Jonette Keri

Hair loss depends on the type. If you know the type of hair loss, then you treat differently. For example, a woman who's losing hair over the age of 35-40, the term we use is androgenetic hair loss. She may benefit from topical minoxidil, that's a good treatment. And that's also a good treatment for men who have hair loss. If there's a large significant amount of hair loss, minoxidil may not help. There are hair loss conditions, such as alopecia areata. We see this in young kids sometimes where they have a patch of hair loss. Minoxidil have worked the best for that, but topical steroids can work and intralesional steroid. Hair loss can also be from chemotherapeutic agents, and there's not a whole lot we can do with that until the patient gets off the agent. So with hair loss, it can be treated. You have to know the type and then you go from there. Finally, for people who have bad androgenetic hair loss, they can also do things like hair transplants. And I wanna do a shout out to women who have hair loss, if there's bad hair loss in a woman who has androgenetic alopecia, they can get a hair transplant. So it's not just for men.

Lee Tetreault:

This is really useful information, doctor. Thank you so much for your time today.

Jonette Keri

Thank you, Lee.