Why Expertise Is Important

A recent study published in JAMA Dermatology provided cold, hard evidence to what most board certified dermatologists had suspected for a long time:  PAs (aka Physician Assistants) perform more biopsies and miss more skin cancers, including the deadliest form of skin cancer melanoma.   JAMA Dermatology  reported that “compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists.”

What does this mean for you as a patient?  Monetarily, it means that you are paying more for unnecessary biopsies of benign lesions.  Psychologically, it means you are being put through unnecessary procedures and being left with scars that may not have been necessary.  Medically, it means skin cancers and deadly melanomas are being missed at a greater frequency despite these additional biopsies; perhaps because the wrong growths are being sampled.

Board Certified Dermatologist undergo years of training.  My recent blog post details our expertise and the American Academy of Dermatology released a great web page with information detailing the difference between a Physician Assistant, Nurse Practitioner and a Dermatologist.  

When discussing the dangers of bargain cosmetic treatments, which are becoming increasingly common with memberships, med spas, and Groupons, a friend opened my eyes to an important point.  She commented, "everyone knows they are more risky, but what they don't realize is they can actually be more expensive."  I had explained to hear that an expert injector can do more with less.  One syringe of filler in my hands placed properly goes much further than two or three syringes in the hands of an injector that misplaces the product.  Botox or Dysport that has been over-diluted or inappropriately placed can require additional units to achieve the same result.  Increased risks aside, you are likely to spend more money for a less cosmetically appealing outcome with a non-expert injector.  You really do get what you pay for in life.  Same goes for your medical care.  This study helps back what we already know:  all providers are not created equal.  We undergo very different training.  Medical doctors are not "providers," we are doctors and lumping us as "providers" only aims to confuse patients.  

This study is so important because it highlights not only the cosmetic side of dermatology, which can get more airplay, but the medical side.  With all medical professionals wearing long white coats and being lumped together as "providers," I think it is very important for patients to know the difference and to know hard evidence shows that there is a very real financial, psychological and medical difference in who is taking care of you.   

Dangers of Cheap Laser and Bargain Botox

A remarkably successful, intelligent friend of mine passed along marketing material from one of the many subscriptions-based, "accessible," med spas that are popping up in test markets like NYC and LA.  She is not the first friend of mine to ask me about these med spas offering quickie beauty treatments marketed in an approachable, no side-effect, rebranded way.  

These med spas refer to laser treatments as "laser facials" making them seem less invasive and as risky as a facial with your aesthetician.  They offer a menu that packages injectables like Botox, Dysport, Restylane and Juvederm into catchy, well-branded services.  While their marketing and branding is very effective, it discounts the risks associated with these cosmetic procedures.  

Laser treatments are not facials.  The right laser set to the appropriate settings can help with fine lines, brown spots, wrinkles, pore size and overall skin texture and tone, which is fabulous, but they can also cause burns, scars, worsening of skin discoloration and even blindness.  The wrong laser or too conservative of a setting on a laser can also be a waste of money and even less efficacious than a facial.  In my practice, I perform procedures with proven results with settings that give a real change in the skin.

Additionally, filler treatments are amazing at restoring volume and creating a sexy lip pout, but they are also not without their risks.  Fillers most commonly can cause bruising and swelling, but blindness and skin necrosis are also real, potential risks.

Beyond risks, an injectors skill level also plays an important role in "getting what you paid for."  I have transformed a face with 2 well-placed syringes of filler, while other injectors on a face with similar needs can place 6-8 syringes in the wrong place and at inappropriate depths  and provide little improvement at a remarkably increased cost and risk to the patient.

Some of these med spas suggest that they "specialize" in aesthetic treatments and do not waste time with skin checks and skin cancer.  Some imply that since this is all they do that they are somehow more expert and skilled at lasers and injectables.  I would wholeheartedly disagree.  I would strongly argue these are added bonuses and should be requirements for those performing these procedures.  Performing laser on a sun spot that is in reality a melanoma is dangerous.  The additional skills at diagnosing and treating skin cancer and deep understanding of anatomy are essential for protecting our patient's safety and allows an effective, cost-efficient treatment plan to be formulated.  Not all brown spots are created equal and knowing what the spot is and what lasers or treatments will improve the spot saves a patient time and money.  Knowing danger zones in addition to the anatomy of the volume loss allows for expert placement getting you the best results with the least amount of syringes.  

In the hands of a well-trained board-certified dermatologist or plastic surgeon you are more likely to get a patient-centric, cost effective treatment plan where potential risks are lessened.  Most importantly, in instances when complications do occur, albeit rarely in the hands of an expert, a board-certified dermatologist or plastic surgeon can manage these side effects.  Please inquire about your cosmetic provider's credentials to ensure you are getting your treatments from an expert.  

 

What Does FAAD mean?

FAAD stands for "Fellow of the American Academy of Dermatology." 

If you are seeing a dermatologist you should look for FAAD after their name, much like you would look for any professional credential like MD or PhD.  This abbreviation is an indicator that your dermatologist has a license to practice medicine, passed an examination administered by the governing board of dermatology, the American Board of Dermatology, and is therefore "board-certified."

To remain board-certified, dermatologists must also repeat an examination administered by the American Board of Dermatology every 10 years to ensure they have remained up-to-date on advances in the field of dermatology.  

With the explosion of medical spas and mid-level providers particularly in the field of dermatology and cosmetics, many patients and consumers do not know who to trust or the difference in their healthcare provider's credentials.  No longer does a long white coat signify MD (medical doctor), instead it has come to represent all healthcare providers and aestheticians in medical and non-medical settings.  Patients and consumers must inquire specifically about their medical provider's credentials to ensure their safety and protect themselves from those without the proper training in dermatology specific diagnosis, treatments and procedures.  

Why see a Board-Certified Dermatologist for a Cosmetic Procedure?

The popularity of cosmetic procedures has exploded over the past few years. An annual survey by the American Society for Dermatologic Surgery shows that 70% of dermatology patients are considering a cosmetic medical procedure.  Given the increasing popularity of cosmetic procedures, dermatologists urge patients to investigate carefully the training that their medical provider has received before any cosmetic dermatologic procedure. 

Board-certified dermatologist have completed 4 years of undergraduate education, 4 years of medical school, and 4 years of residency.  During their 4 years of residency 1 year is spent doing internal medicine, surgery, pediatrics or OB/GYN.  Dr. Caren Campbell completed 4 years of undergrad at Ohio State and Colgate, 4 years at Jefferson Medical College, 1 year of internal medicine at Albert Einstein and 3 years of dermatology specific training at University of Louisville. 

During Dr. Campbell's 3 years of dermatology specific training many days, weeks and hours were dedicated to learning anatomy for surgical and cosmetic procedures.  A large reason to have an excellent understanding of anatomy is to know what can go wrong with medical and cosmetic procedures in order to prevent them from happening.  Knowing danger zones is essential not only for the removal of skin lesions, but also for cosmetic injections, such as neuromodulators (e.g. Botox, Dysport, Xeomin) and fillers (e.g. Juvederm, Restylane, Radiesse, amongst others). 

Dermatologists have led the research to develop and put into practice most every cosmetic skin and laser procedure.  Dermatologists are specifically trained and rigorously tested in their knowledge of facial anatomy and muscle innervation, proper uses of the variety of neuromodulators and fillers, the dangers and complications of these procedures, and the proper diagnosis and management of complications when they do occur, albeit rarely in experts’ hands.  

In addition to injections, dermatologists are the most knowledgeable medical experts in ways to keep your skin looking its best.  Our best beauty tip is to limit sun exposure.  Wear sun protective clothing and regularly use broad-spectrum sunscreens with Sun Protective Factor (SPF) of 30 or higher. Protecting your skin from the sun is by far your best way to prevent skin aging and skin cancer. Sun exposure that has happened in our pasts leaves behind fine lines and wrinkles, brown, red, and scaly spots which can be successfully treated. Dr. Caren Campbell offers laser treatments, chemical peels, surgeries, prescription, and over-the-counter products  to help improve and maintain the overall appearance of your skin.

What is a Dermatologist?

Dermatologists are a unique group of physicians who are specifically trained to be your “go-to” experts in all issues pertaining to your skin, hair, and nails.  Dermatologists are the experts in treating acne, aging skin, rashes, nail changes, hair loss, and any skin lesion, particularly bleeding or changing spots of any color, shape or size.

Dermatologists are the most skilled physicians in the diagnosis and treatment of skin cancer.  For example, if a patient is concerned about a bleeding or changing skin lesion they should see a dermatologist.  A dermatologist has years of training to recognize patterns and clues that make a spot concerning for skin cancer.  If we are concerned about a particular lesion, we can take a sample of the lesion, called a biopsy.  A biopsy is then sent to our dermatopathologist who gives us greater details about skin lesions at a microscopic level.  These details allow us to diagnose the spot and decide whether the lesion needs additional treatment.

If additional treatments are needed, the good news is that most skin cancers are curable. Dermatologists are uniquely trained to know and perform the best treatment options for skin cancers and other skin lesions.  Such treatments can include various surgical techniques to remove most any spot.  A large portion of our 3 years of dermatology training includes the mastery of skin-specific surgery.  We are experts in removing skin cancers and benign skin lesions, placing stitches, and making the best scars.  We then follow patients to ensure the spot does not return and no new worrisome spots arise. 

Through our training as skin surgeons, dermatologists learn detailed anatomy underneath the skin, particularly where blood vessels, nerves, and muscles are located.  We recognize possible “danger zones” for certain procedures. Knowing these danger zones is essential not only for the removal of skin lesions, but also for cosmetic injections, such as neuromodulators (e.g. Botox, Dysport, Xeomin) and fillers (e.g. Juvederm, Restylane, Radiesse, amongst others). 

The popularity of cosmetic procedures has exploded over the past few years. An annual survey by the American Society for Dermatologic Surgery shows that half of our patients are considering a cosmetic medical procedure.  Given the increasing popularity of cosmetic procedures, dermatologists urge patients to investigate carefully the training that their medical provider has received before any cosmetic dermatologic procedure. Dermatologists have led the research to develop and put into practice most every cosmetic skin and laser procedure.  Dermatologists are specifically trained and rigorously tested in their knowledge of facial anatomy and muscle innervation, proper uses of the variety of neuromodulators and fillers, the dangers and complications of these procedures, and the proper diagnosis and management of complications when they do occur, albeit rarely in experts’ hands.  

In addition to injections, dermatologists are the most knowledgeable medical experts in ways to keep your skin looking its best.  Our best beauty tip is to limit sun exposure.  Wear sun protective clothing and regularly use broad-spectrum sunscreens with Sun Protective Factor (SPF) of 30 or higher. Protecting your skin from the sun is by far your best way to prevent skin aging and skin cancer. Sun exposure that has happened in our pasts leaves behind fine lines and wrinkles, brown, red, and scaly spots which can be successfully treated. Dr. Caren Campbell offers laser treatments, chemical peels, surgeries, prescription, and over-the-counter products  to help improve and maintain the overall appearance of your skin.