Not long ago, we saw a 31-year-old Colombian female whom, 9 years earlier in Colombia, had received cosmetic injections of an unknown filler substance into the buttocks and lower extremities. When she’d had the substance injected, the procedure had been performed in an office setting by a person she believed to be an esthetician. She received at least five injections during her first and only session.
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Memorial Day weekend in South Florida was hot! Unfortunately, I wasn’t where all of the action was in South Beach. I was actually invited to speak at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery in Boca Raton. I spoke about hyperhidrosis.
Hyperhidrosis is excess sweating and is common on the hands, underarms, feet and even in the groin. It almost always gets worse in the summer so I thought it would be a good time to shed some light on this condition and treatment options. If you suffer from hyperhidrosis, you are not alone. Around 2.8% of people have hyperhidrosis. It tends to run in families and can start in childhood. Most people grow out of it but for some it can persist into 30’s and 40’s. Antiperspirants that contain aluminum chloride are the best first line treatments. HydrosalPro is an excellent new product from Canada that has worked well on many of my patients. Antiperspirants with aluminum chloride are actually used at night so that they can penetrate better and clog the sweat ducts. Usually they are applied nightly for 4-7 nights and then as needed.
If topical antiperspirants don’t work, Botox injections are another excellent option. Some insurance companies cover the procedure and Botox typically stops sweating for 3- 6 months. For severe cases, there are also two surgical procedures to treat hyperhidrosis. One involves liposuction of the sweat glands in the underarms and is a permanent safe solution. The other procedure is called sympathectomy and is a more significant surgery that cuts the nerve that causes sweating of the hands. Although this procedure is very effective, up to 30% of people get sweating in other locations so there are significant risks involved.
For anyone with hyperhidrosis, I always recommend the website sweathelp.org. It has tons of detailed information on all of treatments I discussed today. If you have hyperhidrosis, don’t get discouraged this summer. There are many treatment options available…you just have to find the one that works best for you.
People with multi-hued skin tones (tan/olive/brown skin) have a higher risk of scarring after surgery. There are a few things you can do to prevent this unwanted side effect. First and foremost, it is important to understand your risk of scarring. If you have had surgery in the past without any problems, it is less likely that you will develop a bad scar or keloid. Unfortunately, some people who have no history of scarring after surgery can still develop a keloid or hypertrophic (thick) scar. This is because not all skin on the body is the same. For example, facial skin tends to heal better than skin on the body.
The areas that have the highest risk of scarring are those with a lot of tension. The chest, shoulders, and back are typically the worst locations for scars for that reason. If you know you have a personal or family history of bad scars, plan to see a dermatologist within 3-4 weeks of surgery. Preventative treatment options include steroid injections, steroid tape, and silicone sheets. Also it is imperative to wear sunblock on new scars to prevent hyperpigmentation or darkening of the scar. If you do develop a thick scar, dark scar, or keloid, there are treatment options. Bleaching creams can help with dark scars and some lasers can be used in lighter skin types to help with red scars. It can also be helpful to see a dermatologist before your surgery so that you have a treatment plan in place ahead of time. Surgical scars can be significantly minimized with an organized approach to scar prevention so plan ahead!
Scars are a big challenge in my practice. Every patients always asks, “Isn’t there a laser that can remove this scar?” Well we do have effective treatments for scars but very rarely can we make them go away completely. First of all, it is important to know that they are many different types of scars. I treat a lot of keloids which are thick raised scars. These often occur on the earlobes after piercings or anywhere on the body after surgery. Keloids can be injected with cortisone to help shrink and flatten them. The injections work well to make keloids flat but they do not make keloids go away completely. Once flat, keloids can be either red or darker than the surrounding skin. In lighter skin, lasers can sometimes be used to improve redness. In darker skin, we can use fade creams to lighten the scar.
If a scar is already flat, like a scar from a burn or a simple cut, there are a few treatment options that have been proven to work. Sunscreen, of course, is key to prevent hyperpigmentation or darkening of the scar. As mentioned earlier, lasers can be used for redness and fade creams for dark discoloration. Silicone gel sheets are thin clear sheets of silicone that have proven to improve the appearance of slightly raised scars. Cordran tape is a prescription clear tape that conatins a steroid that can also help with scars. There are no topical creams that have been proven to work for scars so don’t waste your money on these over the counter products.
If you have a bad scar, don’t forget that there are excellent coverage makeups that can hide scars. Cover FX and Dermablend are two options that provide excellent coverage. The good news is that scars are a big area of research in dermatology and new treatments are on the way. I will keep you posted!