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Acne
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NYC Acne Treatment Center
NYC Dermatologist Center This service should not be used in place of a visit, call,
consultation with or the advice of your healthcare provider. Communicate promptly with your provider with any
health related questions or concerns. Acne
Acne is a very
common skin problem that shows up as outbreaks of bumps called pimples or zits. These usually appear on the face, neck, back,
chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent scarring. What
Causes Acne? Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the
sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell.
 Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones
produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce
darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to
air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.
Bacteria called
Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect
the sebum. This causes the skin to become swollen, red, and painful.
Infected sebaceous glands may burst, releasing
sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts
may form in the deeper layers of the skin.
What Are the Different Types of Acne? Acne can be categorized by
its severity: - Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal
inflammation (no pustules).
- Moderate acne describes a denser collection of comedones as well as red,
inflamed, pus-filled lesions (pustules).
- Severe acne, also called nodular or cystic acne, describes
widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.
 
Mild acne with comedones on the forehead Moderate acne with pustules Who
Gets Acne? Anyone can get acne, but it appears most often in teenagers, whose surging levels of androgen (a type of
hormone) create larger and more active sebaceous glands. Acne may continue for people in their twenties and thirties, and
even women over forty. Acne also appears more commonly in people whose parents had acne. What Factors Make Acne Worse?
Acne lesions can come and go. These factors can cause acne to flare: - Changing hormone levels in women 2 to
7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills
- Oil from
skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)
- Pressure
from sports helmets or equipment, backpacks, tight collars, or tight uniforms
- Environmental irritants, such as pollution
and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin
What Are The
Treatment Options for Acne? Almost all cases of acne can be effectively treated. Treatment goals are to heal existing
lesions, stop new lesions from forming, and prevent scarring.
Acne treatments aim to control one or more of the
underlying causes of acne. For instance, topical retinoids, such as Differin or Retin A Micro, may help unclog sebaceous glands
and keep pores open. Antibiotics may be used to fight the P. acnes bacteria. Accutane or hormonal agents, such as birth control
pills, may be used to reduce sebum (oil) production.
Before Treatment
After Treatment 
A. Topical medications (applied to the skin) Over the counter - Benzoyl
peroxide—This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills
the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate
the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.
- Sulfur
and salicylic acid—These have some mild ability to break down whiteheads and blackheads.
Prescription
- Topical retinoids (Differin, Retin A Micro, Tazorac, tretinoin)—These are among
the most effective and commonly used acne medications. Topical retinoids are unique in their ability to unclog swollen pores.
They may be used alone for mild acne or combined with other medications for moderate-to-severe acne. They may also be recommended
for long-term use, even after the acne is under control, to keep the skin clear.
- Topical antibiotics—Antibiotics
applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation.
B. Oral medications (taken by mouth) - Oral antibiotics—These medications, which include
tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the
deep layers of the dermis. They are also used for their anti-inflammatory effects.
- Oral contraceptives
(Ortho Tri-Cyclen, Yaz)—For women who experience hormonally triggered acne, birth control pills may be prescribed to
reduce sebum production.
- Anti-androgen drugs—Some drugs used for other medical conditions are
known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.
- Isotretinoin
(Accutane, Sotret)—Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to
other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation.
Most patients take the medicine for 15-to-20-week periods that may be repeated if necessary. Treatment requires monthly office
visits, monthly lab tests, and strict contraception. It is critical that women of child-bearing age do not get pregnant while
taking isotretinoin because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects.
Many of these medications have
side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects
usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away,
tell your doctor. C. Procedures For persistent lesions that are inflamed or unresponsive to medications, some
doctors recommend additional methods, including extraction, light therapy, or corticosteroid injections. How Will
I Choose a Treatment Plan? Your doctor will recommend a treatment based on these factors: - Severity
of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination
of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with an oral retinoid
(Accutane, Sotret).
- Results of previous treatments. Medications may be added in a step-wise fashion,
only if previous treatments are found to be ineffective.
- Degree of scarring. More aggressive therapies
may be started earlier if acne scars have already started developing.
- Gender. Some treatments are
available only for females, such as birth control pills.
Whatever your treatment plan, it is important
that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are
healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important
step to getting acne under control.
How Can I Keep My Acne Under Control? After your acne clears,
your doctor may recommend that you continue therapy with a topical retinoid to keep it under control. It is always a good
idea to maintain good skin care and use skin care products labeled as “non-comedogenic” (do not promote acne)
What About Self Care and Prevention? For ongoing self-care and prevention of acne, follow a few simple guidelines:
- Clean skin gently—Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and
astringents can actually worsen acne.
- Do not pop, squeeze, or pick at acne lesions, as this can promote
inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.
- Limit sun
exposure—Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you
are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).
- Choose
cosmetics with care—As mentioned above, choose non-greasy skin products, and look for words like “non-comedogenic”,
“oil-free”, and “water-based”. Some facial products contain active acne-fighting ingredients, such
as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.
- Be patient with your treatment—Find
out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment
early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins
to improve. You may need to try more than one type of treatment.
Images courtesy of
DermAtlas, © 2001-08 ___________________________________________________________________ This
information is for general educational uses only. It may not apply to you and your specific medical needs. This information
should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.
Communicate promptly with your physician or other health care professional with any health-related questions or concerns.
Be sure to follow specific instructions given to you by your physician or health care professional.
Additional Resources - Medications: Topical
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Dear Friends Care. I
personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I would seek for my own family.
This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians
themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and
service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy,
dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan
that I believe will give them the best results. We also support our patients with a very fine medical staff . Please take
a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts
and Quality Matters. Please allow me to solve your skin problems. After all, at NYC Dermatology , our
philosophy is if you look great you will feel great with gorgeous skin.” Best Regards,
Lip Fillers
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 Full,
sensual lips have long been considered an aesthetic ideal. Lip augmentation with lip implants or dermal fillers plumps up
lips and enhances the look of the entire face. Those who have thin lips can especially benefit from lip enhancement. Recovery
time after a lip augmentation procedure is typically short, making lip enhancement one of the easiest ways to make the face
more visually appealing. http://www.1800blemish.com What is Lip Augmentation? Lip augmentation enlarges the lips through the use of a cosmetic lip filler or lip
implants. Often performed in conjunction with face lift, brow lift, rhinoplasty, and cheek implant or chin implant procedures,
lip augmentation methods enhance lips to create a look desired by both women and men. Candidates for Lip Augmentation
Anyone who desires fuller lips is a good candidate
for lip augmentation. Women who have thinning lips or wrinkles around their lip line due to aging can benefit greatly from
lip enhancement. Find out if you are a candidate for lip augmentation. http://www.dermatologynyc.org Lip Augmentation Cost The cost of a lip augmentation procedure will vary based on certain factors, such as the
doctor who performs it, the type of lip augmentation method, and the geographic location in which the procedure is performed.
Most doctors accept major credit cards, and some will work with patients to devise a payment plan that will allow them to
pay for the procedure over time. Find out more about the factors that will influence the cost of lip augmentation. Lip Implants One lip augmentation method involves the use of lip implants. Lip implants are shaped like a small tube
and filled with synthetic material. A small needle is used to insert the implants into the lips through tiny incisions. One
benefit of this method of lip augmentation is that the results are long-lasting. Unlike injectable lip fillers, the implants
are not absorbed into the body, but remain fixed in place. Learn about the different types of lip implants and the surgical
procedure to place them. Lip Augmentation with Fillers With so many different types of injectable fillers
available for lip enhancement, you are sure to find one that suits your needs. Common types of fillers include fat, collagen,
and Restylane® . The effectivness of each lip filller as well as the duration of each filler’s effects will vary.
The lip augmentation procedure is quite simple, lasting only a few minutes and having a low incidence of lip sensitivity.
Learn more about the different types of lip fillers. Lip Augmentation with Fat Transfer Lip augmentation
with fat transfer is a revolutionary method for improving the volume of the lips.With this form of cosmetic lip surgery, the
doctor carefully prepares fat liposuctioned from one area of the body for injection into the lips. Since the tissue used in
this method comes from your own body, it is less likely to be rejected by your body, and the result is supple, natural-looking
lips. Learn more about lip augmentation with fat transfer. Lip Augmentation Recovery The extent of your
recovery will depend largely on which lip augmentation method you choose. For lip fillers, only a topical anesthetic to numb
the injection site is typically required, and recovery consists of mild discomfort for one to two days. The healing period
for lip implants and fat transfer is longer and may involve several weeks of recovery. Lean more about the recovery process
following lip augmentation. Risks and Benefits of Lip Augmentation Very few patients experience significant
complications with lip enhancement, but like all surgical procedures, risks do exist. Bleeding, infection, and swelling are
a possibility with any surgery. Side effects more closely associated with lip augmentation include lumping, scarring, numbness,
cold sores, and asymmetrical lips. The benefits of a lip augmentation procedure include fuller, shapelier lips,
and a more vivacious, youthful appearance. Many patients experience long-lasting results that look completely natural. http://www.nycdermatologist.com
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The NYC
Dermatology Center of Skin of Color addresses the unique needs of
patients with pigmented skin, hair and nails.
The
focus of NYC Dermatology is to diagnose and treat skin problems of African-American, Hispanic, Indian
and Asian patients. Dr. Gary Rothfeld a board certified dermatologist at NYC Dermatology is devoted to the
dermatology needs of patients of skin of color, which he provides unparalleled treatments, cosmetic interventions
and diagnoses
 Specifics of colored skin
Our Dermatologist Dr. Rothfeld explains:
Ethnic
skin contains the same amount of melanocytes
as Caucasoid skin, (melanocytes are cells located in the bottom of the skin's epidermis), but it contains different amounts
of melanosomes, which produce melanin, what gives skin its color. They exist in far greater amounts in colored
skin, they're bigger and they exist all over the epidermis. This is what gives ethnic skin a more intense
colour.
Specifics
Collagen fibres
and fibroblasts are denser and more compact in the dermis, which means that aging occurs much later in colored
skin. The most common skin complaint in colored women is acne, according to ethnic skin specialist Dr. Rothfeld. Acne is the most
common problem, not because ethnic skin is more prone to it but because it causes more damage to colored skin than it does to Caucasoid
skin. After spots, ethnic skin is prone to pigmentation and patches."
Dos
and don'ts
Ethnic skin is better adapted to the sun: it sweats and hydrates itself
naturally, a bit like internal air conditioning! However, when exposed to a cold, dry climate, this mechanism
becomes less effective and the skin loses its protective hydrolipidic film and its natural radiance, often
becoming dull and grey-ish.
Dr.Rothfeld a board certified dermatologist at
NYC Dermatology says: There are certain products that aren't recommended for ethnic skin. I don't think regular exfoliation
is ideal, though once in a while it can do your skin
good as long as you use a gentle exfoliator. Peeling masks/wraps are generally okay, but you should never use just
any old product on your skin. It's important to see a dermatologist to find out what's right for you. Laser treatment
doesn't always work on ethnic skin and can even cause permanent depigmentation, so you need to be careful. |
BOTOX®, Botulinum
A Exotoxin About BOTOX® BOTOX® is a highly purified naturally occurring protein complex that has
been used for over twenty years, in adults, children and even infants for the treatment of a variety of conditions caused
by muscle spasm, including spasm of the vocal cords. The cosmetic use of BOTOX® is a direct outgrowth of these previous
uses.
| | | BOTOX® is effective in improving the appearance
of a gingival smile by relaxing the muscles that cause excess gums to show. |
Benefits - Treats upper facial lines, wrinkles, hyperhidrosis (excessive sweating), and some headaches
- Can be used in the lower face and neck for treatment of the "downward smile" and neck
bands
- Can be used to shape the eyebrows
- One of the safest and most effective treatments for smoothing these lines and wrinkles
- Treats some thickened
lower eyelids and enlarged jaw muscles
- Over time the shallower lines will frequently
repair themselves
Alternatives to BOTOX® Question & Answers about BOTOX® How does it work?
It has long been observed that when a patient has a stroke that paralyzes
one-half of their face, they lose the wrinkles on that same side of their face. For the treatment of wrinkles, a very dilute
solution of BOTOX® is injected just under the skin into the overactive muscles producing the wrinkles. This blocks the
impulses from the nerves to those muscles and produces a temporary muscle weakening, allowing the skin to regenerate and eliminate
the lines. When the muscles are kept under the influence of BOTOX®,
they become shrunken (atrophic) and the BOTOX® effect starts to become more long lasting. The first BOTOX® treatment
may last two to four months, but if the next treatment is given before the BOTOX® effect has significantly worn off, the
second treatment will often last three to five months. With the third treatment, if given before the effects of the previous
treatment have worn off, the effect tends to become even longer lasting. We've had patients come in saying "I had
BOTOX® given a year ago, somewhere else, and it didn't work." A statement like this reflects a misunderstanding
of the use of BOTOX®. We tell patients that to get optimal results they need to think of BOTOX® as a series of treatments,
not just a one time or short term therapy. 
Frowning before BOTOX® | 
Frowning after BOTOX® | BOTOX® is used primarily to correct lines
on the upper one-half of the face, particularly the frown lines, the forehead lines, and the crow's feet. These lines
can add years to your appearance and can project a false impression of anger, concern or depression. BOTOX® can also be
used to improve fine and deeper lines in the upper lip, the "downward smile" (the downward drooping of the corners
of the mouth that occurs with aging), to improve the "gingival smile" (excessive gum show on smiling) and the creases
and folds in the neck. BOTOX® has also been used to decrease the roll of muscle just below the lower lid margin and accentuated
by smiling in some individuals. BOTOX® can also be helpful treating webbing of the neck and the transverse neck creases.
Unfortunately BOTOX® cannot be used to correct lines that are not caused by muscle contraction, but in some of these instances
Restylane and other fillers may be of help. At times fillers and Botox are administered at the same time. BOTOX®
acts to improve the line or crease by weakening the muscle that folds the skin. It is this repeated folding and unfolding
that causes the crease. When the muscle activity stops the fold rapidly becomes less prominent because the skin tends to flatten
out in the absence of muscle activity. However, the line in the skin remains initially. Fillers fill the fold, elevating it,
but that does not stop the muscle activity. Sometimes BOTOX® and fillers will be used together in a single location, to
produce more rapid initial improvement. Are there people who should not use BOTOX®? People
who are pregnant, breast feeding, have rare neurological disorders, or who are allergic to albumin should not be treated
with BOTOX®. 
Frowning before BOTOX® | 
Frowning after BOTOX® | What results can you expect from BOTOX®?
Within two to fourteen days, you should begin to see decreased movement
of the muscles injected. Over the next one to two weeks, you should see a further reduction and possibly a complete absence
of movement of the treated muscles. We will frequently see patients back after two to three weeks to evaluate the effectiveness
of the treatment. If there is still some muscle movement we may inject additional BOTOX®. As the treated facial muscles
remain weakened, the skin gradually remodels itself and the lines are first reduced and then frequently eliminated. The effect
of BOTOX® generally lasts about three months, although thick, strong muscles may need to be treated more frequently initially.
With repeated treatments, as the muscles become weaker, the effect of BOTOX® may last longer. This depends on keeping
the muscles inactive. If the effect of the BOTOX® is allowed to wear off, the muscles regain their strength, the folds
and creases redevelop and the muscles do not shrink in size. The BOTOX® effect lasts on average three to six months, although
on occasion it may be longer or shorter. For best long term results the BOTOX® must be re-injected as it begins to wear
off. It is essential to keep the muscles in a weakened state so that the lines do not reform. 
Before BOTOX® | 
After BOTOX® | What about safety and side effects? Dermatologists
and ophthalmologists have been using BOTOX® since 1980. It has an excellent record of efficacy and safety and was first
used in infants to correct overactive eye muscles. Although there have been recent news articles about the safety of BOTOX®,
problems have occurred only in children with cerebral palsey who were receiving large doses BOTOX® into their neck muscles
to treat spasticity (hyperactivity of the muscles). It is our belief that BOTOX® is exceptionally safe and effective and
can help prevent you from projecting emotions that you're not feeling. We had one woman patient who said that much of
the communication in her marriage involved her husband repeatedly asking her "Why are you angry?" Despite her repeated
denials, it took BOTOX® therapy for them to be able to move on to other topics of conversation. BOTOX® does not affect
the nerves transmitting sensation, so there is no numbness associated with BOTOX® administration. There
have been no long-term side effects, allergic reactions or health hazards related to cosmetic BOTOX® use thus far. Some
patients have been getting BOTOX® treatments for more than 10 years, with no problems. Side effects may include nausea,
headache or mild flu like symptoms, usually with doses above those used for cosmetic purposes. If you should stop BOTOX®
treatments, your appearance will gradually revert to the appearance you would have had if you had never been treated with
BOTOX®. How long will it take to recover? One of the many advantages
of BOTOX® is that there is no down time. Although occasional bruising may occur, the treatment produces no other immediately
noticeable effect and you may immediately apply make-up and go about your usual activities. No local anesthetic or sedative
is required, so you will be able to continue with all of your usual activities immediately after your treatment. You will
even be able to drive yourself home after a treatment. BOTOX® treatments take only a few minutes. Does
it hurt? BOTOX® treatments are short and gentle. Because of
the extra care and equipment we use, every patient who has received BOTOX® elsewhere has confirmed that our California
BOTOX® injections are significantly less painful than any of their previous BOTOX® treatments. A minimal amount of
discomfort may be experienced when the needle is inserted and a few drops of BOTOX® are injected into the muscles which
need relaxation. The discomfort lasts only a few seconds, and new patients very frequently exclaim that the pain was much
less than they had anticipated. What should I do after my BOTOX®
treatment? You should exercise the treated muscles for two hours following your BOTOX® treatment.
This will allow the best possible uptake of BOTOX® by the treated muscles during normal facial movements. Do not rub or
touch the areas that were treated with BOTOX® for two hours following your procedure. Rubbing and pressing the injected
areas could spread BOTOX® out of the treated muscles and into non-targeted muscles. If your BOTOX® moves out of the
muscles it is injected into, there could be less effect on those muscles, and unwanted temporary relaxation of nearby facial
muscles. After two hours, there are no restrictions. Who performs
the treatments? Dr. Rothfeld will personally administer your BOTOX® How
many units of BOTOX® will my treatment require? Typical treatments
are as follows: - Glabellar lines (between and just above the eyebrows):
20-40 units
- Upper forehead lines: 15-30 units
- Crow's
feet (wrinkles and squint lines radiating outwards from the outer corners of the eyes): 10-20 units
- Anterior
neck (to reduce jowls, and to reduce vertical and horizontal lines on the anterior
neck): 30-40 units
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Open 7 Days A Week — Se Habla Español
NYC Dermatology - Manhattan Dermatology - Skin Institute of
New York - Skin Cancer Doctor- NYC Cosmetic Dermatology- Cosmetic Dermatological Surgery - New York City -
Board Certified Dermatologist
Manhattan Office
Dr. Gary Rothfeld
NYC Dermatology
- Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
212.644.9494
1.800.BLEMISH
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