Technology + Expertise = Healthier Skin

Some of the most advanced lasers and other devices used in cosmetic dermatology are available at UConn Health — with dermatologists who have the expertise to use them. Drs. Maritza Perez and Hao Feng join Carolyn and Chris to explain how they provide the latest available treatment options, not by fitting the device to the patient, but the patient to the device (or other method), safely and effectively resulting in healthier, younger-looking skin.

(Dr. Maritza Perez, Dr. Hao Feng, Carolyn Pennington, Chris DeFrancesco, November 2020)

Transcript

Chris: Cosmetic dermatology continues to make great strides, enabling treatments of conditions that can leave you with healthier, younger-looking skin with minimal discomfort and downtime.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health, and its people, a little better, and hopefully leave you with some health information you’ll find useful.

With Carolyn Pennington I’m Chris DeFrancesco. You may be amazed to hear what dermatologists are capable of using with advances in technology.

Carolyn: And many of the very latest tools and techniques are available at UConn Health, and with that, the expertise to use them in the safest and most efficient manner. Now, here to tell us more about that, are Dr. Maritza Perez and Dr. Hao Feng, both UConn Health dermatologists who provide the latest in cosmetic treatments. Welcome. And thank you for joining us.

Dr. Feng: Thanks for having me.

Dr. Perez: Thanks for having us

Carolyn: Well, cosmetic dermatology may sound superficial, but you don’t have to be just conceited about your looks, right, to, to want to done, and because it is important?

Dr. Feng: Absolutely. So there’s many reasons why patients pursue treatment with us. A lot of times they want to feel better about themselves and be the best version of themselves. And there’s a lot that we can offer to patients these days with minimal downtime. And at UConn Health, we have the expertise to provide the top-notch treatment that patients are looking for.

Dr. Perez: Yes. Let’s not forget that we live in the reality of 2020 going into 2021. And not only we need to look better for ourselves, we need to look better to find a job because a job is important and the looks are important for the job.

Carolyn: Very true.

Chris: What do you find that your patients are asking you most about?

Dr. Perez: Well, the patients have a myriad of all questions when they come to us. And I usually try to guide them to what is really bothering them. And usually what bothers me the most is their necks. But if they don’t talk about their neck, I don’t talk about their neck. But if I start from the top and I say, “Your forehead needed a little enlightening,” and so the wrinkles can disappear with a little chemodenervation, you know, we inactivate your muscles and they go away. And we can do a little bit of the lightening or brightening of your skin with a combination lasers, or we can fill up your cheeks and make you look five years younger. But let’s go back to the neck, and we can lift that neck.

Carolyn: That’s why I wear a lot of scarves.

Dr. Feng: That’s a great way. So a lot of patients come for various things. Some people are bothered by redness. Some people are bothered by the sunspots and the photo damage they’ve accumulated over the decades, whatever it may be. We actually have the technology that can help them.

Sometimes even with one treatment, you can make a nice difference, but we’re here to kind of help the patients and deliver the care that they need.

Carolyn: But isn’t there some art to it too? And I know you both have been doing this a long time. It’s important to go to someone who has the experience, but also has that artistic touch, right, to look at a face and know what that person needs?

Dr. Feng: Yeah, absolutely. I think this comes from experience and it comes from knowledge. And I think it’s really important for patients to know that at UConn Health, we have the expertise and the knowledge to be able to help you achieve the goal that you’re looking for. We have a myriad of devices that will fit your need. So we don’t fit you to a device, we fit a device for what you’re looking for. And we offer not only lasers, energy-based devices, but also injectables that can really work in combination to achieve the best results for you.

Dr. Perez: Not only we offer devices to improve your looks, but we also — remember that there is decades of experience in the hands of the surgeons that are talking to you, and we have been doing this for quite a while. We know how to evaluate the patients, how to realistically guide the expectations of the patients. We manually can do many procedures even without having a tool to do it. So for example, you can do a neck and jaw liposuction and put the fat on the cheeks and voila, a patient looks five years younger. And that needs just very little tools, but very much expertise.

Chris: Dr. Maritza Perez and Dr. Hao Feng, UConn Health dermatologists, joining us here on the UConn Health Pulse. What are some examples of some things that UConn Health has available, that you do at UConn Health, that people might not realize are options for them as far as advances in technology go?

Dr. Perez: Well, manual expertise, we do Botox, or any of the chemodenervation agents, to inactivate muscles to really attenuate wrinkles. We’ll do fillers for cheeks, for hands, for the jawline. I personally do a liposuction, meaning liposuctions of the neck, with a little neck lift, and then I can put the fat in the cheeks, use as a filler. You can also do the fat injections on the hands too, because that’s another part of the body that shows the age without telling us. There’s a myriad of technological availability in dermatology.

Dr. Feng: UConn Health is always trying to being at the forefront of bringing the best devices, and proven devices that are going to provide excellent results for our patients. And that’s something that both Maritza and I feel very strongly about. From a technology perspective, the most common things I see are, number one, people coming in for brown spots, whether that’s just regular sunspots or photo damage and discoloration that have accumulated on their face and neck over the course of decades. And with that we often use a combination of a Fraxel treatment along with a Q switch treatment to really target not only the background brown discoloration, but also any individual dark spots. Another common thing that patients come in for are for redness, whether that’s from rosacea or other broken blood vessels they may have. Again, it could be from rosacea or it could also be a sign of long-term sun damage as well. So we have a pulsed-dye, laser that will specifically target that. We can always use that also to treat vascular conditions such as birthmarks, like port wine birthmarks and hemangiomas. So these lasers have not only indications for cosmetic purposes, but also for medical purposes as well,

Chris: You have to differentiate between which laser is appropriate for which treatment.

Dr. Feng: A hundred percent. You have to be able to pick the right wavelength for each patient. And especially when we think about our skin, different people have different skin colors, and we have to be mindful when we treat a skin color and we have a lot of expertise and we have the right technology to be able to offer that safely and effectively to patients of all colors.

Carolyn: Specifically with lasers, I think in the past, it’s been hard for people with lighter skin, lighter hair to be able to have some of the, like the laser hair removal. And I know you were saying that some of these lasers have improved or they’re different now. What are the latest lasers for all skin types, I guess?

Dr. Perez: Very important question, because we should not treat all skin types with just one tool. We just have to make sure that we educate the patient on what we can do and we cannot do. If you have a lighter patient with dark hair, you select a different laser than if you have a patient with dark skin, dark hair, because that dark skin is going to absorb the energy as well and could be damaged. So having expertise in skin of color as we call it is very important. And I was one of the founders of the Skin of Color Center in New York, at Mount Sinai, many, many years ago, and part of the founders of the Skin of Color Society as well.

Chris: Wow.

Carolyn: That’s great.

Dr. Feng: On top of that, I think it’s just really important for patients and the community to know that both of us are very experienced and understand what can be done and what can cannot be done safely. And we have devices where we play around with the settings to make sure that things are done safely for you. So this one particular device, when used on one setting is safe and effective, but when you use it on another  setting, may be effective, but may not be safe. So this is where the expertise and experience really come in play because we need to make those modifications to fit the individual patient.

Carolyn: And I think your experience also is so important when people come in with a sunspot or with some kind of sun damage and you can more correctly identify it as a potential cancer than I believe some of the cosmetic dermatologists, who are just so focused on superficial, and you both have the experience to really know what is serious and what could be, be potentially dangerous for the patient.

Dr. Feng: Absolutely. Both Dr. Perez and I do Mohs micrographic surgery and we take care of skin cancers on cosmetically and functionally sensitive areas all day long in addition to what we do with the lasers and the cosmetics.

So we’re very keenly aware of things that may look like a cosmetic concern, but that’s actually a medical concern. For example, I had a patient who came in a month ago, worried about two red spots, one on the neck, one on the face, turned out, both were actually basal cell skin cancers. And so we correctly identified and took biopsies and then subsequently treated them with Mohs micrographic surgery rather than treating them randomly with a laser.

Dr. Perez: As we, apart from being most trained surgeons and members of the college of Mohs, and both being trained cosmetic laser experts, we also are dermatologists. We also know how to use a, dermatoscope, a very important tool that is in our hands to differentiate, by magnification and polarization of light, the important conditions that, considered by the patient cosmetic, but might be very medical and very dangerous for their lives.

Carolyn: Is there a better time of year to have some of these spots, these lesions removed?

Dr. Feng: We want to make sure we treat patients safely, and treating tanned skin can pose some risks for some lasers and devices. So generally speaking, fall, winter is a wonderful time to get treatment. You’re also covered up, not going out as much and having less sun exposure. However, that’s not to say that some of these treatments cannot be safely done in the spring and summertime. For example, the pulsed-dye laser, generally speaking, we can do it all year round. But if we’re treating pigmentation and you have tanned skin, generally I will have patients come in at a wintertime when they don’t have a tan, and when they have protected their skin from sunlight, both before treatment and also after treatment.

Chris: One more question for me, as we’re just about out of time with, Dr. Hao Feng and Dr. Maritza Perez from UConn Health dermatology: Could either one of you or both of you give me an example of something that you can treat now with lasers that maybe not too long ago it was a lot more involved and a lot more invasive or intrusive, or just unpleasant for the patient?

Dr. Perez: That brings to mind acne scars. In the past, it used to be that acne scars — acne scars come in different forms: there are ice-pick scars, boxcar scars, there are shallow scars, and that they have a different penetration of the depth of the scar. And in the past it used to be, I’ve been a dermatologist since 1984, it used to be that the only thing that exised was dermabrasion. Then there was only ablative lasers. Now we have nonablative lasers that, without downtime and without too much discomfort, you can improve the acne scars. It might not be in one treatment, but it might be a cumulative treatment.

Dr. Feng: There are so many things that we can do in a minimally invasive to noninvasive manner, especially if someone is coming in wanting to prevent or dial back some of the mild things. We do not hesitate to refer to our surgical colleagues when surgery is in their best interest, but there’s really a lot of things that we can do, such as, again, sagging necks, acne scars, sun damage, texture of the skin, discoloration. There are so many things that we can offer. And like Dr. Perez mentioned, now even for acne scars. We have multiple lasers and devices that can help treat that. We can use fillers. We can use a microneedling with radio frequency device. We’ll have our Fraxel and we have IPL [intense pulsed light] with a 1540 nanometer [wavelength]. Just to give you an idea of just how many options we have to treat a particular type of scar.

Carolyn: Are most of these procedures covered by insurance or no?

Dr. Feng: Most of these, insurances do not cover these procedures. They consider them purely cosmetic, even if there is a medical indication for why they form. For example, you may have broken blood vessels on your face from an autoimmune condition called CREST. However, because insurance companies look at these broken blood vessels as purely cosmetic, they don’t cover it. However, there are conditions which some of the laser treatments are covered. For example, when you have a port wine birthmark, when you have a hemangioma, especially on the head and neck, we always do our best to ensure that we get coverage for our patients because timely treatment is extremely important. There’s also things like a keloid or very thick scars that sometimes insurance decides to cover. Again, this is very much dictated by your insurance policy. And so it may differ between one plan versus another.

Carolyn: So best to come in for a referral and, and you’ll sort it all out.

Dr. Feng: Yes.

Chris: Well, this has been terrific. I want to thank you both for your time, Dr. Maritza Perez and Dr. Hao Feng from UConn Health dermatology. That is our time for today and for Drs. Feng and Perez, and for Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and be sure to tell a friend.