Roughly 75% of women will develop stretch marks during pregnancy. They can appear on the belly, sides, thighs, breasts, arms and buttocks. They can also happen during puberty, or at times of rapid weight gain, as well as from some medications or medical conditions.

Given how common they are, it’s not surprising that in my daily practice as a cosmetic dermatologist, I see a lot of women with stretch marks, and most are looking for a “magic bullet” to get rid of them. So here are my thoughts on stretch marks.

What are stretch marks?

One may think of stretch marks, or striae, as we dermatologists like to call them, as a scar, due to a tear in the dermis, or middle layer, of the skin. This results in loss of some of the proteins that give skin its elasticity, resulting in that classic wrinkly reddish or purplish line. With time, these tend to fade on their own into flesh-colored or white lines.

Can you prevent them?

Before you invest in those yummy smelling tummy-butters, think twice. There are many remedies marketed to eliminate or fade stretch marks, but a large review looking at over 800 women using difference topical preparations including vitamin E, cocoa butter, and alphastria, concluded these creams do not prevent stretch marks.

Can you get rid of them?

Unfortunately, stretch marks are notoriously challenging to treat. Since they are scars, it is impossible to completely cure or eliminate them. That being said, several treatment options exist that can diminish their appearance and have them blend in with the surrounding skin, typically using laser and light devices. In my consultations, I always start off by asking my people what end-result they are looking for with their stretch marks, and try to guide them to a very realistic expectation. I have found in my practice that the earlier you treat the stretch mark the better the result. Treatments are typically quick and comfortable.

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Losing sleep over lost hair?

Hair loss, also called alopecia, is one of the most troubling conditions for women. There’s so much social importance placed on a long and luscious mane.

And alopcia can be really frustrating for your doctor, too.

Unfortunately, because hair loss can go on for a while before your really start to notice it, it can be hard for the doctor to get an accurate history. On top of this, there can often be more than one reason for a woman to lose her hair.

Even when a cause is found, though it can be a relief to have identified the culprit, not all forms of hair loss are reversible. And sometime, particularly when the hair loss is what we call “scarring alopecia,” is doesn’t always grow back.

One important distinction I try to clarify from my patients is whether they’re experiencing hair “shedding” or hair “thinning.”  People who have shedding usually describe many hairs on the pillow, hairs all over their clothes, hairs in their food, hairs on the kitchen counter after preparing a meal…you get the idea.  People who are experiencing thinning describe a wider hair part over time, a smaller ponytail, and hair that just appears “finer.”

When women come to see me with alopecia, it’s really important for me to get a good look at their scalp and hair.

I look for signs of rash or irritation on the scalp, as this can suggest an inflammatory alopecia, which is less common, but needs treatment so that scarring does not occur.  I examine the hair’s overall density (how much hair is there?), relative density (for example, width of the part at different part s of the head), hair shaft abnormalities, and do a “hair pull test” where I see how easily hairs come out.

Often times, I can’t find a reason for the hair loss just from the history and physical exam, so I sometimes need to do blood tests or even a biopsy.

The most common cause of hair loss in women that I see in my clinic is Female Pattern Hair Loss, also called Androgenetic Alopecia. This is progressive, meaning it gets worse over time, and unfortunately, is related to genes and hormones.  The good news is that there are treatment options, including medications you either apply directly to the scalp or take orally, and if that doesn’t work, even hair transplantation!

Hair loss in women is a frustrating and scary problem.

Whether it’s fixable or non-fixable, the first step is an evaluation – call your dermatologist today!

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What’s up with preventative Botox?

Botulinum toxin injection (brand names including Botox®, Dysport®, and Xeomin®…I will just say “Botox®” for simplicity!) is one of the most commonly performed cosmetic procedures today – and I like to refer to it as a “gateway drug.”

Botox® relaxes the muscles into which it’s injected, smoothing wrinkles formed from facial expression.

But what about preventing those wrinkles in the first place?

Short of never smiling/frowning/squinting/concentrating, there’s one true way to go – preventative Botox®!

The concept is simple: relax the muscles so certain facial expressions aren’t physically possible (no forehead scrunching or frowning) and a “set-in” wrinkle will never form.

The most common locations for preventative Botox® are the glabella (frown line area between the eyebrows) and the forehead.

Can people look weird if their facial expressions are limited? Well, yes, but not usually if the Botox® is injected properly.

For my patients I have no problem fully relaxing the glabellar area (not so noticeable when someone can’t frown), but I tend to take it easy in the forehead. Not being able to raise one’s eyebrows at all = the “plastic” look everyone dreads.

There was a study published in Archives of Facial Plastic Surgery which illustrated the concept of preventative Botox® well. It was done on sets of twins, where one twin received preventative Botox® injections regularly starting at a young age, the other twin did not. The images speak for themselves, no-Botox® twin on the left and Botox® twin on the right.

Now, before you get too excited. There is another school of thought in the Botox® community that preventative injections can eventually result in atrophy of the muscles, or muscle loss, and, unfortunately, a prematurely aged appearance. While atrophy is possible with long-term use of Botox®, as muscles are gradually trained not to move in certain ways, the idea that it will actually cause worse cosmetic results has not been shown.

Personally, I got my first Botox® injection as a dermatology resident, at age 29.

I wanted to stave off the onset of those worry lines. And today, 5 years later, despite the stresses of medical school and residency, I’m still pretty much wrinkle free!

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If doctors’ appointments in general make your heart race, your first visit to a dermatologist can seem particularly intimidating due to the intimacy involved.

Yes, we DO want to look at (nearly) every inch of your skin! But don’t worry, it doesn’t have to be embarrassing, awkward, or uncomfortable in any way.

Here are some tips to prepare for your first skin cancer check.

DOs:
• Expect to undress. You might be surprised by how many patients come in for a “skin exam” only to hesitate to strip. You may be given the option to leave your underwear and/or bra on, and that’s up to you. Just remember, we don’t have x-ray vision, so if it’s covered, we can’t see it!
• Come prepared. Consider coming with a list of “spots” that are worrisome to you. If your list is longer than 4-5 “spots,” we’ll likely skip the detailed verbal history of each area, and start the exam, pausing at each of your sites of concern to tell you what they are.

DON’Ts:
• Don’t get scary ‘cuz you’re hairy. Don’t worry if you didn’t shave your legs or underarms, or if you’re sweaty, or your feet stink. We’ve seen it all! And we don’t mind.
• Don’t stress. We sometimes stop and examine tiny spots with our hand-held magnifiers; it’s not necessarily a cause for concern – we’re good at identifying many benign lesions at first glance. If you’re not sure that we saw on your area of concern, please speak up! But chances are that we saw it, diagnosed it as benign, and we moved on.

Recommendations differ, but I tell my patients to come in for their first “baseline” head to toe skin cancer check before the age of 50. Based on your sun history and what we find at that visit, we’ll tell you how often to come back.

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Dermatologists see myriad of skin issues ranging from cancer to chronic disease to acne to cosmetic treatments.

One of the most common questions we get is, “What is the best anti-aging routine for my skin?”

Here’s my no-frills answer to that one: Everyone’s skin is different, so in order to design the most ideal regimen for your particular skin, you should visit a dermatologist for an individualized plan. BUT, there are some basics that any anti-aging routine should include.

If you do nothing else, following these three recommendations is a great start in your youthful journey:

• SUNSCREEN. You knew that would be #1 on any dermatologist’s list. Sunscreen starting in childhood is ideal, but for most people asking about anti-aging routines, that ship has sailed! Fear not though, it’s never too late to prevent ongoing and future damage. A broad spectrum sunscreen (covering BOTH UVB and UVA rays, not all of them do!) with SPF 30 for daily use, SPF greater than 45 for any time you’ll get  over 30 minutes of sun per day. We will discuss sunscreen specifics another time, just the basics for now!
• RETINOID. Over the counter versions are plentiful, look for “retinol” or “retinaldehyde”. Prescription retinoids are available from your dermatologist, but I typically recommend an over-the-couter cream first, to get used to it. Once your skin is “retinized,” it will tolerate a stronger version with a lot less peeling and redness.
• GLYCOLIC ACID. Usually in the form of a cleanser, toner, or in your moisturizer. Oh, the stinging! So worth it!

So that’s it! Simple as 1-2-3.

Certainly depending on your skin type, pigment, amount of sun damage/pigmentation/wrinkling other beneficial products and procedures can be recommended. I personally like Vitamin C products, various moisturizers and exfoliants, chemical peels, botulinum toxin injections (like BOTOX®), filler injections, and laser depending on your particular concerns.

I recommend making a separate appointment for an anti-aging discussion, as trying to fit it in with your annual skin check can result in an incomplete or rushed plan!

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