The beauty of practicing dermatology is that you actually can see and feel a patient getting better, says Houston-based dermatologist Dr. Suzanne Bruce. Practicing since 1985, Dr. Bruce is a graduate of Rice University and Baylor College of Medicine, where she also completed her dermatology residency training. As the founder of Suzanne Bruce and Associates, board-certified Dr. Bruce cares for men and women, old and young, and addresses cosmetic and medical skin problems using the latest, cutting-edge technology. In addition to running her own practice, she is a Fellow of the American Academy of Dermatology and a member of the American Society for Dermatologic Surgery, Texas Dermatological Society, and Houston Dermatological Society.
Tell us a little bit about your background. What attracted you to dermatology?
I was attracted to dermatology because of the breadth and depth of the field. My patients are male and female, young and old, healthy and ill. It involves elements of infectious disease, cancer, aging, and immunology. I also like that it is a very visual specialty. You can actually see the improvements as the rash clears or the skin heals after laser treatment.
Maintaining a youthful appearance is more important than ever. What is your advice to a woman in her early 30s to keep her skin in tip-top shape?
Of course the most important advice is to protect your skin from the sun with sunscreen, hats, and clothing. In addition to sunscreen, I recommend using skin rejuvenation products with active ingredients such as vitamin C and retinoids that have been proven to help reduce and prevent aging of the skin.
Can “liquid facelifts” really replace surgery? How can a combination of fillers and muscle relaxing agents take years off a patient’s face?
The so-called “liquid facelifts” can go a long way toward delaying or avoiding a surgical facelift altogether. As we age, we lose volume in the face causing the skin to sag. Our skin gets thinner from loss of collagen. The actions of the underlying muscles of facial expression become more apparent causing more visible frown lines, crow’s feet, and horizontal forehead lines. Botulinum toxin can be used to relax these muscles and soften the lines. Fillers are used to fill out hollow cheeks and temples and smooth lines around the mouth.
What about aging hands? What can be done to make these telltale signs of age look younger?
Brown spots and thinning skin on the hands are telltale signs of aging hands. Resurfacing lasers can be used to remove brown spots and improve the texture of wrinkled skin. Filler can also be used to plump up the hands and camouflage veins.
We hear a lot about skin rejuvenation. What devices help turn back the clock?
There are many devices on the market to help rejuvenate the skin. Intense pulse light devices and lasers can treat red blood vessels and brown spots. Fractionated lasers can improve brown spots, texture, and wrinkles. Skin tightening devices using technologies like focused ultra sound and radio frequency can reduce laxity and improve wrinkles and texture.
Where is dermatology headed? What exciting developments are coming down the pipeline?
There are many exciting things coming down the pipeline in cosmetic dermatology. New longer lasting fillers and wrinkle treatments using a person’s own skin cells are now available. New treatments are available in which antioxidants and other topical agents are applied to the skin immediately after laser resurfacing, allowing active ingredients to penetrate more deeply into the skin. Many companies are developing lasers and light devices that can be used at home for skin rejuvenation and laser hair removal.
Dr. Rosemarie Ingleton is a New York City board-certified dermatologist, who specializes in general and cosmetic dermatology and is a noted authority in treating ethnic skin, adult acne, and dermatologic surgery. She founded Ingleton Dermatology in 1996 and relocated her offices to the trendy Noho section of Manhattan in 2001. She prides herself on creating a relaxed and spa-like environment that encourages patients to openly communicate their concerns, which ultimately leads to successful diagnosis and treatment of skin, hair, and nail disorders.
With all the deals for aesthetic treatments that we see in print and online media, what should a patient ask to make sure the provider is qualified and the product is authentic?
I strongly advise all of my patients to treat a cosmetic treatment like they would any other medical procedure, only more so, because these treatments are elective. You should only seek treatment from a qualified medical specialist and do not skip on doing the research on their credentials. Confirm that the physician is listed on the product manufacturer’s website for the product or procedure you are considering, since it is always a good indication that the physician is purchasing the product directly from the manufacturer. Additionally, do not be afraid to ask about the treatment and confirm what brand of product the physician is going to use on you. You should ask for the brand by name because not all products are the same and should not be used interchangeably. For example, when it comes to treatment with BOTOX® Cosmetic, you might see a deal for “botox,” yet you may end up getting something different when it comes time for you to redeem your treatment. BOTOX® Cosmetic is the brand name and there are no substitutes or generics. It is the only product that has been on the market for 10 years in the United States and as a result, physicians have a great deal of experience with this product. Also, make sure to ask to see the vial of the product to see if it is the real thing—for example, BOTOX® Cosmetic vials will have an Allergan hologram directly on the bottle.
What are some of your favorite devices and how do you use them?
In my dermatology practice, I am very excited about the great results I have seen on my patients derived from using the Fraxel® 1927 laser to remove both skin discoloration and sun damage. It is a fractional laser treatment, which means that there is much less down time than with previous devices that do the same thing. My patients who receive this treatment are back to looking good after only 5 days. Also, I have been impressed by the results of the Lyra 1064 laser for removing excessive hair and razor bumps/ingrown hairs in my patients of all skin colors. Most recently, I have added the Liposonix® device to my practice. This device uses high intensity ultrasound energy to destroy fat cells. It delivers awesome results in patients who just have pockets of fat that will not go away despite regular exercise. We also have the Pelleve Wrinkle Reduction system for skin tightening and fine lines.
What’s the best way to minimize or eliminate acne scars?
The best way to minimize or eliminate acne scars depends on the type of acne scars you have. Very superficial scars can be adequately “polished” down with either medical grade microdermabrasion or with medical-grade chemical peels. Deeper scars need to be examined by a dermatologist to assess whether a laser resurfacing procedure, or a dermal skin filler (like JUVÉDERM®) ,or punch grafting (a surgical procedure) would give you the best results.
What are the most common cosmetic treatments that your patients request?
The most common cosmetic procedures requested in my practice by my patients are BOTOX® Cosmetic injections, chemical peels, and skin fillers. Laser hair removal remains a very popular request from my patients, as well.
Do you have basic recommendations for first time dermatology patients?
All of my first time dermatology patients are especially encouraged to be vocal with me about their own skincare concerns and why they are coming to see me. I approach each of my patients with a customized, easy-to-follow skincare plan. I would tell any first time dermatology patient to never hesitate to ask their physician what products they use on themselves. While everyone’s skin is different and has different needs, you will be able to take an up-close and personal look at the physician and find out what works and be sure to ask why they recommend those specific products or procedures.
Board-certified dermatologist Dr. Annie Chiu believes that healthy skin should be attainable by everyone. At The Derm Institute, her South Redondo Beach, Calif, facility, she focuses on both cosmetic and medical dermatology. She specializes in facial rejuvenation, using fillers and neuromodulators such as BOTOX, along with lasers, peels, and a personalized skincare program, as well as medical dermatology including a multidisciplinary approach to acne and skin cancer treatment. With the right combination of minor procedures and good skincare, Dr. Chiu believes that the doctor-patient partnership can have a real impact on how patients feel about themselves.
What are the most common myths about acne-prone skin and its treatment?
A lot of people believe that washing their face frequently and avoiding moisturizers all together will control oily or acne-prone skin. However, the result of over-washing (more than twice a day) or not using any moisturizers at all is that the skin becomes superficially dry, which causes the oil glands to produce even more oil. This can become a vicious cycle. I always recommend washing your face twice a day and to use an oil-free moisturizer if your are prone to acne.
Is Botox® only for the frown lines? What else can you do with it?
Although Botox is FDA approved for the frown lines between the eyebrows, dermatologists commonly use it for forehead lines, crow’s feet, and neck bands. Some lesser known ways of using Botox include utilizing the product to lift the corners of the mouth, lessen a gummy smile, or lift the tip of the nose. With careful expert use of the product, we can address a lot of problem areas with Botox alone, or in combination with fillers. I specialize in artistic and subtle methods of facial rejuvenation with advanced techniques involving the use of fillers, neuromodulators such as Botox, along with lasers, peels, and a personalized skincare program.
What is the “trapped-on-a-desert-island” skincare product you cannot do without?
I’m such a beauty junkie that I don’t know if I could choose! But if it’s a desert island, for sure a broad-spectrum sunscreen: I love La-Roche Posay’s Ultralight Sunscreen Fluid. For a little anti-aging activity, I would sneak in a topical retinoid if I can have a second product.
Another wonderful all-in-one anti-aging product is SkinMedica’s TNS Essential Serum. There are some great clinical studies behind it that show it can improve fine lines and the overall texture of the skin.
Why is the specialty of dermatology fulfilling for you?
I love making people feel more confident and radiant. The interaction with patients and the vast number of procedural advancements in the field is unparalleled. I take a very personalized and artistic approach to skin rejuvenation. With the right combination of minor procedures and good skincare, we can have a real impact on how our patients feel about themselves—with minimal downtime. It is incredibly gratifying to see the tangible results of patients not only looking, but feeling wonderful as well.
How can our readers tell if their cosmetic practitioner is qualified to perform a procedure or give an injection?
Feel free to ask questions of your cosmetic practitioner. Where were they educated, what is their experience? Ask for before and after photos of actual patients of the person treating you. Make sure they have an overall plan and that their aesthetic style is consistent with yours.
Just because a skincare product is expensive, does that mean it is effective?
It is a little secret that a lot of companies spend more on marketing and packaging than the actual product. So no, price is not always indicative of how well a product works. Everyone’s skin is unique, so having a discussion with your dermatologist to come up with a personalized regimen is very important. Look for products with well-designed clinical trial evidence of its efficacy. I’m tempted by beautiful packaging too, but stop to look at the ingredients, and if they are too complex to understand, always ask your dermatologist.