It's a common problem many battle every day - melasma.  These brown patches usually show up on the forehead, cheeks, upper lip, and chin area.  Women tend to be affected more often than men.  No one knows exactly what causes it, but we do know that there are certain factors that seem to trigger the increase in pigmentation.  Sun exposure and estrogen are the two biggies.  Birth control pills, hormone replacement therapy, and pregnancy (in which case it is called chloasma, or the mask of pregnancy) rev up melanocytes to produce more melanin, which is responsible for pigment in the skin.

Melasma is a difficult condition to treat.  Like many other conditions in dermatology (psoriasis, eczema, acne) there is no cure.  A combination of topical medications and procedures are used to improve it, but results need to be maintained.  The single most important factor is sun exposure.  People with melasma MUST protect their skin from the sun.  Sun avoidance, suncreen, sun protective clothing: the whole nine yards.

The gold standard in topical treatments is the lightening cream hydroquinone.  This can be prescribed by a dermatologist and should be used under their supervision.  A very rare complication of this cream is a condition called ochronosis, which results in darkening of the skin.  Fortunately, this is not common.  There are many other topical treatments available that do not contain hydroquinone.  These are often used as well to treat melasma.  These creams contain lightening ingredients such as azaleic acid, kojic acid, licorice, soy, lignin peroxidase, etc.  One of my favorite non-hydroquinone containing creams is Lytera.  Retinoids can help lighten dark spots as well.  If the treatments are irritating, a topical cortisone is sometimes used. 

In addition to topical treatments, light chemical peels can be performed in the doctor's office.  However, care must be taken to avoid hyperpigmentation (darkening of areas).  Lasers and light treatments, such as intense pulsed light, have been shown to be very effective for brown spots on the face and may improve melasma.

Just as exercise and diet are used to help maintain a healthy weight, strict sun protection and various dermatologist-prescribed treatments can help maintain beautiful skin. 

Hating the lines on your forehead but still hesitating to get Botox? Here's the skinny on one of my favorite beauty treatments.

"I'm afraid I'll look wierd."
With proper technique, a very natural, more youthful result can be achieved. Botox, Dysport, and Xeomin can smooth the "eleven" lines between the eyebrows, which make people appear angry, even when they're not. It can relax lines across the forehead, as well as crow's feet. It can stop wrinkles on the nose (bunny lines), a dimpled chin (golf ball chin), and tight neck bands. A board certified dermatologist with cosmetic experience has the training necessary for beautiful, natural, "non-wierd" results.

"I don't think it's safe."
Botox has been used in millions of patients worldwide for more than 20 years in the treatment of both medical and cosmetic conditions. While there are certain patients that should not have the treatment (those with an allergy to the product, certain neuromuscular conditions, those pregnant or nursing), when used correctly, it is overall a very safe treatment, with serious side effects being extremely rare.

"I don't want to look worse once it wears off."
The effects of Botox last about three months. It works by temporarily stopping the release of a chemical from nerves called acetylcholine which instructs muscles to contract. After a short period of time, the nerves begin releasing the chemical again, and the muscle will contract, just like they did before. Wrinkles will return to what they were before the treatment.

Botox injections are one of the most popular cosmetic procedures performed worldwide. With no cutting or downtime, a little can go a long way.

Today I was fortunate to be a part of the Dove Movement for Self-Esteem, where members of the Women's Dermatologic Society can reach out into the community to educate young girls and teens about skin care and promote positive self esteem.  We met with young women ages 11-18 and had a discussion about what beauty means to them, how they feel when they see images of what "beauty" is in the media, what they would like the images to project instead, and how they feel about themselves. 

In a world where we are constantly bombarded with photoshopped images of perfect, often unattainable and unrealistic ideas and images of beauty, it's so important to reinforce to our young women that real beauty is from within, and is made up of thoughts, actions, voices, and attitudes; not a lipstick color or hairstyle.    We also talked about skin care and living a healthy lifestyle that includes eating foods rich in vitamins and minerals, sleeping enough hours at night, mindfulness, and exercise.  

The program's vision is to "create a world where beauty is a source of confidence, not anxiety."  Look in the mirror.  You are real, and you are beautiful.  Hug your sisters, daughters, mothers, friends.  Let's encourage and empower each other as strong, powerful, healthy females.  That's true beauty!   

A rainbow of light is made of many colors.  Out of ROYGBIV, blue light is by far my favorite.  Blue light is key to photodynamic therapy (PDT): a specialized light treatment that treats actinic keratoses (pre-skin cancers), acne, and rejuvinates the skin.

How does this work?  First, a chemical called levulan is applied to the skin (most commonly the face, but neck, chest, arms, and hands can also be treated) in the office.  This stays on the skin for about an hour.  Then a U-shaped light, specific for blue light is placed so that it shines on the skin for around 16 minutes.  The levulan is activated by this light, and results in destruction of abnormal cells.

Because the levulan is activated by light, sunlight must be avoided for 48-72 hours after treatment.  Redness and some crusting are common after treatment.  Once that subsides, the skin is smoother and often younger appearing. 

Acne may be treated with the blue light alone, as well, but it may not be quite as effective as when levulan is added.  A series of treatments are required.  The acne may worsen initially after the first treatment and then improve.  It's a great option for those who can't tolerate conventional treatments with oral antibiotics, oral contraceptives, and topical medications.

This treatment can also be performed using intense pulsed light (IPL) rather than blue light.  Although an off-label use, it can help "bump up" the improvement seen in fine lines, brown spots, and red spots seen after an IPL treatment.  Multiple treatments are still needed.  

For more information, come in for a consultation with Dr. Bilu Martin at Premier Dermatology, MD.

The secret is out. The fountain of youth is here, and it ain't made of water. It's made of hyaluronic acid, and it's called Juvederm Voluma: an injectable filler from Allergan, the folks who make Botox (for wrinkles), Juvederm (filler) and Latisse (grows/thickens/lengthens lashes).  It is quickly becoming one of my favorite fillers.

Over time, we lose bone and fat in our faces. Think of our skulls as a deflating balloon - depressing, but true. As it shrinks, the skin overlying it begins to sag and drape- leading to hollows under the eyes, sunken-in cheeks, folds around the mouths (the parentheses), folds under our mouth (marionette lines), and a sagging jawline. All of this makes us look tired and older.

It was thought that the answer was just a face lift- pulling the skin tighter. Now we know that without replacing volume, or re-inflating the balloon, that more youthful look just won't be achieved.

Enter Voluma. By restoring volume, cheeks are returned to their rightful place: resting on top of cheekbones, rather than sagging and folding down towards mouths.  The result is a natural, soft, youthful, subtle look for both the upper and lower face.

And the best part? It lasts two years. This is one time where being cheeky is a good thing!