Board certified dermatologist, Dr. Lori Brightman, specializes in Mohs micrographic surgery, dermatologic surgery, cosmetic dermatology, and laser surgery. She received her medical degree from Boston University Medical School, where she was elected to Alpha Omega Alpha, the national medical honors society. Thereafter, she completed her residency training at Boston University/Tufts New England Medical Center combined program and continued her training in Skin Oncology at Boston University as well as Mohs micrographic surgery and procedural dermatology at the Laser & Skin Surgery Center of New York. Today, Dr. Brightman practices in New York City and is a member of the dermatological team at the Laser & Skin Surgery Center of New York. She is a member of the American Academy of Dermatology, American Society for Lasers in Medicine & Surgery, American Society for Dermatologic Surgery, and the American Medical Association.
Dr. Brightman regularly lectures nationally and publishes widely about advances in cutaneous oncology, laser surgery and cosmetic dermatology. Her current research involves the use of laser and light devices in the treatment of medical and cosmetic conditions. Her service to the community includes lectures and skin cancer screenings for many community based programs as well as major corporations. Here she answers questions about hyperpigmentation as well as treatments for cellulite.
What’s new in the world of hyperpigmentation treatment?
Topically, more natural products are some of what’s new (and old) in the world of hyperpigmentation treatment, such as soy proteins, kojic acid, licorice extract, grape seed extract and hydroquinone. A newcomer to the topical world of treating pigmentation is a fungal derivative known as lignin peroxidase, such as found in Elure (www.elureskin.com).
There also are laser and light devices, which are effective in treating skin pigmentation issues.
Your dermatologist can help you determine which treatment or combination of treatments would best suit your needs.
How has the treatment of hyperpigmentation evolved in the last few years?
Until recently, topical treatments focused on preventing more melanin from being formed. Hydroquinone and products with hydroquinone, to date, have been considered to be the most effective topical treatments. Other agents also have been used in the treatment of hyperpigmentation, and examples of these include retinoids, topical steroids, azelaic acid, kojic acid, and soy. Recently, these latter alternative agents and therapies are being employed and explored more and more. Oral agents are also being explored and include pycnogenol, a French pine bark extract, as well as grape seed extract.
More recently, a different approach to reducing pigment has been explored with lignin peroxidase, which is used in Elure. It functions by breaking down already existing pigment in the skin.
Who is a candidate for topical treatments?
While most patients may be good candidates for topical treatments, when determining if a topical therapy is right for you, it is important to consider not only the potential benefits, but the risks as well. The most commonly reported adverse reaction to most of the above products, including hydroquinone, is irritation, burning, and pruritus, or itchiness. Patients also should be warned that too frequent application as well as using too high of a concentration of hydroquinone can result in further darkening of the involved area. This is a condition known as exogenous ochronosis. Retinoids may also result in dry, red, and scaly skin. Those who regularly apply topical steroids can develop red bumps and pustules, skin atrophy with telangiectasias, or even an allergic contact dermatitis.
How do you decide when to use lasers vs. topicals in treating hyperpigmentation?
As above, the choice of treatment is often guided by the patient, their goals and appearance of the condition along with any prior failed therapies.
Hyperpigmentation is due to increased melanin content, the dark pigment produced by melanocytes, or pigment producing cells found in the skin. Depending on the location and depth of the cells and pigment one may choose to treat with lasers rather than topicals. However, topical therapy with hydroquinone along with adequate sun protection is often the first line treatment for many dermatologists.
What are the best lasers for treating hyperpigmenation? How quick are the outcomes?
Q-switched lasers are often used to reduce pigment in the skin, including Q-switched Alexandrite, Ruby, and Nd:Yag lasers. There also are now fractional non-ablative and sublative lasers that have proven to be effective in reduction of dyspigmentation. The best treatment is dependent upon the skin type of the patient as well as the depth of the pigment in the skin.
Can you use lasers in the summer time?
First and foremost all patients of all skin types should follow safe sun practices, including regular application of sunscreen of SPF 30 or higher and wearing sun-protective clothing and broad-rimmed hats. With that said, depending on the condition to be treated and type of device to be used, lasers can be used in the summer time.
Summer is a popular time for showing more flesh. How do you treat cellulite? What kinds of results can patients expect to see from VelaShape?
Cellulite is the bulging of fat cells into the top layers of your skin, resulting in a dimpling of the skin. This affects 85-90% of post-pubertal women. There are now many devices available in the treatment of cellulite employing different modalities, with some targeting collagen, others targeting fat reduction, and those claiming to address both. These treatments include and are not limited to application of radiofrequency, infrared, ultrasound, laser and light, and cold.
Depending on the body part treated, patients who undergo treatment with VelaShape can expect to see modest reduction in the overall circumference and volume of a treatment area, as well as an improved clinical appearance.
Who is a candidate for VelaShape?
Good candidates are healthy individuals without excessive skin laxity, who are interested in circumference reduction.