To sum up:

1. What is my goal as a patient?  What do I want to improve?
2. Will this procedure help?  What other procedures could do the job?
3. What are the risks vs. benefits of the proposed procedure vs other procedures that make this one the procedure of choice?

Intense Pulsed Light or IPL, in the right hands, is pretty ideal for treating brown spots, also known as sun spots or liver spots with very little risk or “downtime.”  So, if you are looking at your face and saying to yourself or my receptionist, “I have a few sun spots on my face,” you should not necessarily be asking for a resurfacing procedure or the fraxl.  While ablating or getting rid of a significant percentage of the surface of your facial skin, will likely get rid of the epidermal lesions, it is also most likely not necessary and a more costly, more invasive, riskier procedure.  However, if you suffer more from blotchy pigmentation as opposed to discrete brown spots, then the resurfacing procedure would likely be superior for you.  On the other hand, IPL can selectively target the hyperpigmented lesions/sun spots/solar lentigos….and have them form a VERY superficial crust that flakes off of the face typically in 7 days, with minimal downtime and minimal risk, again, when performed in the right hands.

I did a 2 year cosmetic fellowship that included intensive training on multiple lasers including an IPL machine.  I published a peer-reviewed article in the journal Dermatology Surgery for a study done in conjunction with Estee Lauder.  I recently did another study for Estee Lauder with my newer IPL machine.

What else is IPL good for besides brown spots?  It is also particularly beneficial for treating blood vessels or telangiectasias on the face – again with little downtime or risk.  However, unlike the treatment of brown spots, treating blood vessels can take more than one treatment and difficult cases can take up to 3 to 5 treatments.

This is where the term “photofacial” came from.  The patient would typically get 3 to 5 treatments spaced 3 to 4 weeks apart.  The average patient would have this procedure done for a fair amount of redness/rosacea/broken blood vessels with or without the brown spots discussed above.  Additional benefits include a decrease in pore size, improvement in skin tone, stimulation of collagen production with a concomitant decrease in fine lines and wrinkles; HOWEVER, these latter benefits are usually much more subtle than the improvement in the redness/blood vessels and resolution of the brown spots, and I do not typically encourage patients to have IPL unless they have the aforementioned brown spots and/or blood vessels/redness .  The MIXTO fractional CO2 system is far superior to IPL and in my opinion, to other resurfacing lasers as well, for stimulating collagen production and decreasing fine lines and wrinkles.

To conclude, if you have brown spots and/or blotchiness, “broken” blood vessels, telangiectasias, capillaries, or rosacea, IPL has a very favorable risk/benefit profile and could be the treatment of choice for you!  For more background information including a history and comparison of “resurfacing” or ablative lasers vs. non-resurfacing ones, please see my upcoming blog on the Mixto laser – the state of the art in fractionated CO2 lasers.

One of the advantages of practicing in Manhattan, the Hamptons, and Aspen, is that whenever an interesting story hits the news, my patient population is bound to know about it.  They are not only savvy, but cover a vast geographic area and often travel to and from my office destinations.  So, if it’s in the news, they are bound to hear about it and sure to inquire about it.

This blog is dedicated to the recent report of botulinum being detected in mice brains after cutaneous injection near the mice’s whiskers.  FIRST, it is important to note that this report is a contradiction to a prior study done by Allergan. SECOND, as the title of this blog suggests, not all botulinum is Botox.  I remember from my high school math classes, that we learned about “logic.”  Basically, if p = q, it does not mean that q = p.  In other words, if Botox is botulinum, it does not mean that botulinum is botox.

To further explain, Botox is a specific version of botulinum toxin, consisting of approximately a 900 kd molecule.  Botox is a specific from of botulinum type A, consisting of light (50kd) and heavy chain (100kd) surrounded by accessory proteins.  These proteins prevent diffusion of the Botox, as does the relatively large size of the Botox.  On the other hand, the recently reported mice story in the news consisted of a botulinum molecule weighing 150 kd, or approximately 1/7^th the size AND lacking the aforementioned surrounding proteins; therefore, it is not that surprising that it would be able to diffuse so much more.  In addition, the mice study utilized a mega dose which was approximately 150 times the dose given to patients, when normalized for body weight. 

An example of a differing formulation of botulinum soon to hit the US market is called myobloc, which is a specific form of botulinum-type B.  It can have similar effects as Botox but is completely different in structure and potency.  For example, one vial of Botox consists of 100 units, yet one vial of myobloc will consist of 5000 units.  So, a patient will require a much greater number of units of myobloc than of Botox, to get the same result.

Additional facts about Botox are the following:

• Botox was first approved for COSMETIC use in the USA in 2002
• Since then, more than 16 million procedures have been performed for aesthetic/cosmetic purposes
• Prior to 2002, Botox was already being widely used for off-label cosmetic purposes
• Botox has also been approved and used for medical purposes/neurological diseases/spasms for approximately 20 years   
• In one study of 1000 patients, 97% were “definitely satisfied” with their Botox treatment

In conclusion, the study that hit the news was not specifically about Botox!

As background, I would like you to know some of my credentials – in even more detail than appears on the website.  I have always striven to be the best I can be – in anything I have attempted to do.  I graduated high school as Valedictorian and then attended Cornell University where I was named a Cornell National Scholar, the most prestigious award a Freshman can receive.  I graduated with honors and then attended SUNY Health Sciences Center at Syracuse, where I graduated second in my class and was one of only 7 classmates inducted into Alpha Omega Alpha, the medical honor society, as a Junior.  The rest of my education and training is clearly depicted on the website.  It is clear from high school to medical school and from my ability to obtain and excel in positions at Columbia University Internal Medicine, NYU Dermatology, and my Mohs’ surgery and Cosmetic Dermatology fellowship, that I have a passion to be the best in all I do. 

With that history, I will now specifically address the skin care products.  During my 2 year fellowship in Mohs’ skin cancer surgery and cosmetic dermatology, I noted that many patients wanted a “regimen.”  They wanted specific products, and they wanted to know when and how to use them.  That was when I decided to some day have my own skin care line.  This was all coinciding with the tremendous rise in popularity of cosmeceuticals – cosmetic based products with pharmaceutical like properties. 

I  began my practice in the Hamptons in 2002 and had seven custom made products specifically devoted to anti-aging that I sold to my patients and in a couple of salons/retail outlets in the Hamptons.  These products were extremely well-received.  At the time, I was one of the first to have Green tea in my products, and in fact, Green tea was in all 7 of the products.  My desire to be the best led me to continue to research additional ingredients and product ideas.

When I decided to go National, I wanted it to be with something truly revolutionary and unique.  Astaxanthin, an anti-oxidant that gives salmon its pink color and is up to 1000 times more potent than Vitamin E, is that ingredient. The Anti-oxidant Hydrating Cream is THE product.  As you know, this product is currently available.

The next product that has already been formulated and used by my Hamptons’ patients is the new and improved Tighten and Lighten Eye Cream.  I hope to have this available at the National level by January 1, 2008 and will try to provide all purchasers of the Anti-oxidant Hydrating Cream with a sample of the new eye cream.  The new eye cream is an improvement on the one I have sold in my office.  First, it is a cream instead of a gel and as such, is more hydrating.  Second, the technology is new and advanced.  At the right time, I will promote the product and reveal the technology but for now stay tuned!  One hint is that it is NOT Vitamin C and alpha lipoic acid based like my prior eye gel.  Furthermore, the product’s base was just re-formulated in mid September 2007, making it even more cosmetically elegant and hydrating.

I already have plans for our third product launch which I am in the final phases of refining the formulation.  It is also an anti-aging product, and will hopefully be launched within 6-12 months. 

My goal is to become your “go-to” source for your anti-aging skin care needs.  I will do the research and come up with the best products for you.  Similar to the patients in my fellowship, I want you to have a regimen.  I am a firm believer in “a sound mind in a sound body.”  As such, I adhere to a strict physical fitness program.  When it comes to skin care, I draw a similar analogy.  Like any program, skin care takes discipline.  The best chances for success are when you have a routine that you can adhere to and when you see the positive results, you are reinforced to stick to it.  I am confident that with the use of my products, you will see those results and be even more motivated!

Of course, avoidance is best but not always practical. Who wants to give up skiing, golf, tennis….or the beach?! For starters, we all should try to minimize our exposure between the hours of 10 am and 4 pm. Hats, sunglasses, umbrellas, and protective clothing should also be important articles in our defense of the sun. And lastly, sunscreen must be used properly.

Proper use of sunscreen starts with the proper cream itself. Inherent in the selection process is knowledge of the proper ingredients. Zinc oxide and titanium dioxide formulations typically block out the whole Ultraviolet A and B spectrums. Zinc oxide was the original white thick paste we used to see lifeguards wear on their noses. There are products with zinc oxide and/or titanium oxide that have become more cosmetically elegant, BUT it can still be difficult to find ones that do not leave at least somewhat of a white film on your skin. 

Consequently, there was a market for chemical sunscreens as opposed to the zinc oxide and titanium dioxide based physical blockers. In the past, it was thought that Ultraviolet B rays were more important and therefore, sunscreens originally typically blocked out the UV-B rays only – with ingredients such as oxybenzone. We then realized that Ultraviolet A rays were just as important if not more important causes of skin cancer and photo-aging. Therefore, in the late 1990’s, sunscreens in the USA evolved to include an ingredient known as Parsol 1789, or avobenzone. So, alas we had UV-A and UV-B protection by combining multiple chemicals and did not require the previously mentioned zinc or titanium based formulations.

But, not so fast, and some of you may be aware that there have been products available overseas with certain ingredients that have been touted to still be superior to those available here in the states. One product that you may be familiar with is Anti-helios, and an ingredient you may have heard of is mexoryl.

If we finally had a chemical UV-A blocker in the form of Parsol 1789, why or how could overseas’ products be better? What we then realized was that when it came to blocking out the UV-A rays, the Parsol 1789 was not very photo-stable; meaning that after approximately 20 minutes of sun exposure, it broke down and was not that effective. While frequent re-application of sunscreen is very important, having to do so every 20 minutes is unrealistic and too inconvenient.

The products overseas contained ingredients such as the mexoryl which was more photo-stable and provided superior UV-A protection. Finally, within the past year or two, in the USA we have cross-linked the UV-A blockers in a manner to provide the same stability as the overseas sunscreen products have. One of the ingredients to look for is called helioplex and Neutrogena, in particular, has several different SPF’s available that contain this ingredient.

So, the choice is to use one of the physical based blockers containing zinc oxide or titanium dioxide or one of the newer based chemical blockers that contain helioplex or something that specifically states that it is cross-linking the UV-A blocker, for the required added photo-stability.

Lastly, patients often ask what number SPF they should use. First of all, SPF only refers to the UV-B protection. If you are going to be outside for extended periods of time, playing a sport, or at the beach…you should use at least a 45 AND do frequent re-applications, especially after sweating or water exposure. If you are just going about your daily errands or commuting to work and are primarily indoors, but getting incidental minimal sun exposure, you should still use a moisturizer or product that contains at least a SPF of 15. 

One anecdote I like to leave patients with is that we all need to keep in mind when the companies come up with their SPF rating, it is all done under exact laboratory conditions. The average person does not put on enough sunscreen and studies have shown that when one puts on a SPF 15, they are actually getting about a SPF 4. For this reason, the higher SPF one applies, the extra margin of protection you will have. 

When will Dr. Kenneth Mark Skin Care have a sunscreen?

We have been doing some research in developing a sunscreen, but again, we want all of our products to be the absolute best. At this time, we feel that the commercially available ones described above are quite good, but we have plans to make ours the best! 

As an aside, it should be noted that vitamin D synthesis also requires adequate dietary calcium intake.  The Minimal Erythema Dose, or MED is the amount of ultraviolet radiation, specifically UV-B for vitamin D metabolism that will cause redness of the skin.  Even if only 6% of the skin’s surface were exposed to only 1 MED, the body would be able to produce the equivalent of 600-1000 IU of vitamin D. 

How does this translate to real life practices?  The good news is that we do not need to experience redness or a sunburn to have adequate vitamin D metabolism.  Sub-erythemal sun exposure of the hands, face, and arms a mere 2-3 times per week is more than adequate.  90-95% of people obtain their vitamin D requirement from casual sun exposure.  This is often enough, even for people who live in climates where they can only make vitamin D in the spring, summer, and fall.   The reason is that vitamin D is fat-soluble and can therefore be stored in the fat and released when needed. 

Should we be concerned that strict sun avoidance and sunscreen use will cause vitamin D deficiency?  The answer is NO!  If the above statistics are not proof enough, most people do not ALWAYS use sunscreen before going outdoors, nor do they use the proper amount.  So again, incidental sun exposure in the spring, summer, and fall is more than adequate. 

Kenneth Mark, M.D.
Kenneth Mark Skincare, Inc.