Our Doctors in the News

View Archived Newsletters





Thermi RF is now FDA Cleared!

ThermiRF is now FDA cleared for “thermistor‐regulated energy delivery for both micro-surgical and non-invasive aesthetic applications  for dermatological and general surgical applications in soft tissue and nerves” (see press release attached). This is a huge accomplishment for ThermiAesthetics and is actually a more comprehensive clearance than the original SmartLipo approval.

Click here for the official press release.

Print This Post Print This Post

Palm Reading:What Your Hands Really Say About Your Health


Looking at hands for insight about health is no longer solely the domain of sketchy fortune-tellers. Scientists have found correlations with everything from colored rashes and health conditions like diabetes to white nails and liver problems. A health self-assessment is just an arm’s length away.

Spots and Colors
Occasionally systemic diseases can manifest themselves on hands. Orange or yellow-hued xanthomas, or bumps of lipid deposits on the skin, can signal metabolic conditions like elevated lipids, thyroid disease, kidney problems or diabetes.

Still, dermatologist Dr. Lance Barazani of Advanced Dermatology in Commack cautioned to take self-diagnosis with a grain of salt. “No one should be alarmed if they see something on their hands. Most likely, you are seeing just a rash or irritation.”

Orange palms are often a sign of a large amount of carrots, orange squash or other foods with high levels of beta-carotene, rather than anything more alarming.

Most are familiar with brownish sunspots on the tops of hands, but look out for spots that change shape, color or size, or scab and crust over, which may be pre-cancerous growths. Those with a history of eczema should be aware of their personal triggers, but sometimes eczema can be caused by allergies or irritants in the environment. And some people with recurrent hand eczema often have asthma and hay fever. “Hand eczema is very common,” explained Dr. Barazani. “It’s not typically associated with any other issues or food allergies,” which are common misdiagnoses. Avoiding harsh chemicals and cleaners can help keep the irritations down.

Blood blisters are patches of blood pooled under the skin and are caused by friction trauma to the surface. Repetitive movements like the kind in manual labor, exercises that excessively rub palms against equipment (like tennis) or hobbies like drumming can all cause the blisters. Don’t pierce it! Apply ice, clean and dress the area and beware of any that reoccur or don’t seem to heal. Sometimes malignant melanomas can look like a blood blister under the nail.

Shapes on the hands and fingers can also be diagnosed. Lumps, or nodules, under the skin on the knuckles can be a marker for osteoarthritis, gout or rheumatoid arthritis. Reddish-colored bumps on knuckles or fingers can occasionally be a sign of an internal malignancy. And recurrent pink spots and broken capillaries on cuticles is a hallmark of dermatomyositis, a condition that affects connective tissue.

“You should always watch anything that doesn’t go away or keeps coming back,” said Dr. Barazani. Even benign hand nuisances like warts should be treated. In fact, warts are really a sign of infection with a strain of human papillomavirus (HPV) and they are contagious. Use an over-the-counter wart treatment and if that doesn’t work, a dermatologist can freeze them off before they spread.

Nail Nuisances
There are plenty of popular myths about the meaning of marks on nails, like white spots indicating calcium deficiency, but usually changes in the nails have to do with trauma or injury. White spots mean that something has damaged the nail, and as it grows out, it displays that tell-tale whiteness. Even an overly-enthusiastic manicure or an allergic reaction to nail polish can cause this kind of stress to the nail. Extremely white nails can indicate an issue with the liver, but other bodily symptoms would most likely be present.

Cracked cuticles are another bothersome hand nag and are caused by dry and cold weather. Nails prone to cracking should be covered in gloves, moisturized or pampered with cuticle creams to keep the area from being exposed to the dry winter air. Try not to pick at any loose ends and instead trim with a cuticle scissor as necessary. Most likely the environment is the culprit, but sometimes a bad diet can contribute to less-than-stellar skin around the nails. Make sure you are getting enough zinc and essential fatty acids, along with plenty of water to drink.

The hand health takeaway lesson is a golden one: Keep a close watch on anything out of the ordinary. Concerns about pain or unusual symptoms should prompt a visit to an internist or primary care physician.

Fascinating Finger Lengths
Recent studies have demonstrated that the length of the ring finger, in comparison to the index finger, is influenced by how much testosterone a baby was exposed to in the womb, which is associated with an increased or decreased risk of certain diseases. The more testosterone in utero, the longer the ring finger. Women with longer index fingers are thought to have received more estrogen in the womb and are more likely to develop breast cancer in their lifetimes. For men, those with longer index fingers were 33 percent less likely to get prostate cancer, according to a 2010 study published in the British Journal of Cancer.

Print This Post Print This Post

Finally, a Real Remedy for Stretch Marks: Dermatology Specialist Joshua Fox, MD, Offers Tips for Understanding the New Laser Treatments for Stretch Marks




stretch-markThey’re hardly a serious disease, but those ugly little ridges that dermatologists call striae distensae (and the rest of us call stretch marks) are a serious concern for many women, especially when summer fashions leave more skin exposed. According to Joshua A. Fox, MD, founder and medical director of NY and NJ-based Advanced Dermatology PC., and a leader in treating stretch marks with lasers “previously, they were all but incurable. Almost 20 years ago we were the first to innovate a laser treatment for stretch marks which generated attention from all the major TV channels including CBS, WABC and CNN. Now, with the arrival of today’s new laser treatments, we have even better solutions for treating stretch marks to offer to our patients.”

Explaining Stretch Marks
Stretch marks are scar-like bands that are formed when the skin is stretched beyond its limits in order to accommodate a sudden increase in body size—because of pregnancy, body building, or weight gain, for example—which creates small tears in the skin. Stretch marks can also occur because of hormonal changes (the kind that come with pregnancy and puberty as well as from external agents like hormone replacement therapy and steroidal drugs). Although they can pop up almost anywhere, stretch marks are most likely to occur in areas where the body stores its extra fat, such as the belly, breasts, hips, and thighs (an exception to this rule would be in body builders, who typically get stretch marks in the skin around the bigger muscles, like the biceps). When they’re newly formed, stretch marks look red and shiny, but after a few months will turn a whitish color and often become slightly indented or depressed. While they do become less noticeable over time, once they’re formed, stretch marks are almost always here to stay.

“Even though stretch marks are visible on the skin’s surface, they’re actually formed in the dermis, which is the skin’s middle layer,” says Dr. Fox. That little detail makes them notoriously tough to treat, as topical agents simply can’t penetrate past the epidermis, or outer layer of the skin. “Up until recently, people didn’t have many options,” Dr. Fox says. Prescription medicines like tretinoin (Retin-A) might help a little with the newer marks, but older marks were essentially impervious to creams. “You could waste your money on creams and lotions, have an operation like a tummy tuck, or just live with them.”

But not anymore. Today, doctors can treat stretch marks—even the old ones—with lasers, and achieve very real major improvements after only a few treatments.

Tips for Understanding Pulsed Dye Laser for Treating Stretch Marks

Dr. Fox was the first to report use of a pulsed dye laser to treat stretch marks, and recently demonstrated success in his own research on more than 300 patients. “Our research, along with other published studies, has shown that the pulsed dye laser can be really effective against stretch marks,” he says. “We found that the laser could improve the discoloration and reduce the size and depth of stretch marks and improve the skin’s elasticity by about 50-65 percent, which is a big improvement.” Other research has confirmed these findings, he adds. For example, one study found that treatments combining the laser with a device that administers radiofrequency waves produced measureable improvements in roughly 90 percent of patients tested.

Other lasers are also helpful in treating stretch marks without downtime. One recent study found significant improvement in the light color of stretch marks with the Excimer Laser. We have also found the Fractionated 1550 Fraxel to be quite helpful in lightening up the scar tissue and making stretch marks appear less. All these lasers require no downtime.

The pulsed dye laser administers short bursts (or pulses) of light that specifically target reddish areas in the skin and/or the collagen, and therefore has been used for many years to treat things like enlarged blood vessels, rosacea, and red birthmarks. Moreover, in addition to its ability to treat these conditions, the pulsed dye laser also works to increase both collagen and elastin, two key proteins in the skin responsible for its structure and elasticity.

Dr. Fox notes that new stretch marks can often be significantly or dramatically improved in just one visit, while older marks typically require at least two or three treatments, spaced several weeks apart. Today’s lasers are much easier to handle than earlier models, as they produce much less bruising and almost no pain, just a mild snapping sensation. In addition, pulsed dye laser treatments involve no downtime: Patients can resume all regular activities right away—and get back into those shorts and swimsuits before the summer is out.

Print This Post Print This Post

Tips for Treating Melasma




Melasma is a common skin disorder that affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology. Melasma is often associated with sun exposure but it’s also common in pregnant women, hence the nickname the “mask of pregnancy.” Other common triggers include estrogen supplements and birth control pills. Joshua Fox, MD, a board certified dermatologist and medical director of Advanced Dermatology PC in Roslyn Heights, New York, cautions that patients should consult a dermatologist before trying any at-home remedies for melasma. “Some household remedies and over-the-counter treatments involve scrubbing and/or chemicals that can aggravate the skin and make the condition worse,” he says.

The good news for patients is that technologies are evolving to better treat melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat melasma, especially in severe cases and in cases where it doesn’t respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time,” says Fox. He cautions that patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.

Signs of melasma

Melasma most often affects young women with so called olive or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin and to a lesser extent, the neck and arms.

While melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge, says Fox. “Melasma can rarely fade on its own but most women prefer to treat it because it’s not only unsightly but it also causes some degree of embarrassment,” he says. “Appropriate treatment can significantly improve quality of life and restore self-confidence.”

Tips for treating melasma

Fortunately, there are many treatment options to help manage melasma. “Dermatologists are excited about the FDA’s approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective,” says Fox. These include:

  • The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration. “If a patient is vigilant about sunscreen use and stays out of the sun, the condition can spontaneously improve,” says Fox. “More importantly, it will help prevent further discoloration.”
  • One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as tretinoin, corticosteroids, azelaic acid and kojic acid. Several new products have been developed without HQ to treat the condition.
  • Procedures for melasma include chemical peels, microdermabrasion , Fraxel Dual 1550/1927, Q-switched Nd-YAG and Ruby Lasers.
  • A final option is a combination of several aforementioned therapies. In one recent study researchers in New York found that microdermabrasion and laser treatments used together can be a safe, a non-invasive approach with minimal or no recovery time, and it had long-lasting effects.

Fox reinforces the importance of sun avoidance and sunscreen to help prevent melasma and recommends everyone applies sunscreen 20 minutes prior to going out in the sun. This is particularly important for people aiming to prevent or minimize melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of melasma.

Print This Post Print This Post

The Secret to Healthy, Glowing Skin: Antioxidants


More adult women are getting pimples than ever before, and new research reveals that antioxidants could be an effective, natural treatment.

In seven small trials of antioxidant supplements or lotions, up to 78 percent of acne patients experienced “excellent” or “good” relief after a few weeks of treatment, according to a new paper published in Journal of Drugs in Dermatology. The trials included 458 people.

This new analysis challenges the conventional wisdom that clogged follicles are the main culprits in acne, by presenting emerging evidence that systemic inflammation and oxidative stress play a key role in triggering zits.

Acne Depletes Protective Antioxidant Vitamins

Compared to people with clear, healthy skin, those with acne are hit with a double whammy: they have higher levels of inflammatory markers in their blood, and lower levels of protective antioxidant vitamins—with 31 percent less vitamin E and 52 percent less vitamin A, the paper reports.

In addition, acne sufferers had significantly lower levels of two other antioxidants—vitamin C and beta carotene—and low blood levels of two crucial co-factor minerals that regulate activity of antioxidant enzymes in skin: zinc and selenium.

These findings suggest that adults with acne are under far more oxidative stress than those with healthy skin, says lead study author Witney Bowe, MD, a dermatologist with Advanced Dermatology in New York and a Clinical Assistant Professor of Dermatology at SUNY Downstate Medical Center.

The War Within Your Skin

“Classically, we were taught in medical school that follicles get plugged, leading to colonization with bacteria that then caused inflammation,” says Dr. Bowe. “This view was accepted as dogma until more sophisticated molecular studies turned it upside-down.”

The new research indications that systemic inflammation actually precedes bacterial colonization. “A rise in inflammatory markers, such as interleukin-1, is actually one of the first events in the pimple-causing process,” adds Dr. Bowe.

As I reported recently, many scientists theorize that low-grade systemic inflammation may be the root cause of most or even all chronic diseases. In fact, it’s been linked to a wide range of disorders, from heart attacks and stroke to type 2 diabetes, lung disorders, neurological conditions, and even cancer.

This fiery process is the body’s natural response to injuries and infections. Most of the time, it’s protective, by sending immune system defenders to attack invading pathogens. However, chronic inflammation is like being shot by friendly fire, since the relentless immune system assault turns into a war within the body that harms instead of heals.

“Now there’s emerging evidence that inflammation and oxidative stress are early players in causing acne, which has focused us on using antioxidants as a treatment,” says Dr. Bowe.

What is Oxidative Stress?

When a freshly cut apple turns brown, a copper penny turns green, or a wrought iron railing gets rusty, the culprit is oxidation, a reaction between oxygen molecules and substances they touch.  As you may remember from high school chemistry, oxidation is the process of removing electrons from a molecule or atom.

One byproduct of normal metabolism—as well as smoking and other unhealthy habits—is formation of free radicals, highly unstable atoms or molecules that are missing one of their electrons. To achieve stability, they steal an electron from nearby molecules, leading to a domino-like chain reaction, in which the attacked molecules become free radicals and then rob their neighbors, resulting in oxidative stress, explains Dr. Bowe.

However, the body also has antioxidant defenses to protect against free radical damage, including physical barriers to cage free radicals, enzymes to neutralize dangerously reactive forms of oxygen, and antioxidants in our diet that donate electrons and defuse free radical chain reactions.

Antioxidants for Beautiful, Glowing Skin

Although there are no large, randomized clinical trials of antioxidants as an acne therapy yet, all seven of the small, recent studies Dr. Bowe and colleagues analyzed found striking improvements in acne after just a few weeks of treatment.

If you’re prone to pimples, the studies the team analyzed suggest that the following oral or topical therapies could be helpful. Dr. Bowe also recommends consuming antioxidant-rich foods, such as fruits, vegetables, and green tea.

Discuss the treatments below with your dermatologist or healthcare provider to make sure they are appropriate for you:

  • Antioxidant supplements. In one of the studies, nearly 79 percent of people with mild-to-moderate acne who took a supplement containing zinc, vitamin C, mix carotenoids, vitamin E and chromium three times a day for 12 weeks had 80 to 100 percent improvement.  In another study, taking a supplement with zinc, copper, folic acid, and nicotinamide for four weeks resulted in 79 percent of patients reporting moderately-to-much-better skin appearance, and 55 percent reporting a moderate (25 to 50 percent) reduction in zits or a substantial (more than 50 percent) reduction.
  • Zinc. In another study, taking 30mg of zinc gluconate daily for two months effectively reduced the number of pimples in people who initially had 15 or more acne pustules. Zinc was also effective in reducing antibiotic resistance in acne-inducing bacteria in lab tests. 
  • Sodium ascorbyl phosphate (SAP, a vitamin C precursor). Four of the studies evaluated the effects of 5 percent SAP lotion, with improvements ranging from “statistically significant improvement” to nearly 79 percent of participants experiencing “excellent/good efficacy.” All of these studies were randomized controlled clinical trials, deemed “level 1 evidence” (the highest scientific rating).
Print This Post Print This Post