Local Anesthesia Cosmetic Surgery Immersion Course for the Mohs Surgeon

Course Directors:
Greg S. Morganroth, MD
-Fellowship-trained Mohs Surgeon
James O. Barlow, MD
-Fellowship-trained Mohs Surgeon

Location:
California Skin Institute/
Orchard Creek Surgery Center
2420 Samaritan Drive
San Jose, California 95124

Date:
February 10-12, 2012

This intensive live surgery course will provide a strong foundation for the the Mohs surgeon wishing to add local anesthesia cosmetic surgery to their skin surgery practice.

Repetitive exposure of a small group to live surgeries as well as comprehensive education in the consultation, pre-operative, intraoperative, and post-operative phases of surgery will be accomplished through lectures and discussions with surgeons, patient care coordinators, nursing staff, and patients.

Featuring:

• Vertical Vector Face Lift
• Upper blepharoplasty
• Transconjunctival lower blepharoplasty (carbon dioxide laser)
• Extended chin implants
• Fractional and Traditional Laser Resurfacing
• Ultherapy
• Sculptra

Prerequisites:
Attendees must be current fellows or past graduates of a Mohs or Procedural Dermatology fellowship.

Fees:
$7500 includes all meals on-site, hotel (3 nights), and transportation between the hotel and surgery center.

Contact:
DWhang@CAskin.com to register for the meeting.

1. Sunscreen products that offer only UVB protection—and don’t specifically state they protect against both UVA and UVB—don’t provide consumers with adequate protection against sunburn that causes skin cancer and early skin aging. Make sure the product states that it protects against both UVA and UVB. In the future products will be labeled “Broad Spectrum” to indicate they offer protection for both UVA and UVB.

2. To be effective, sunscreen must have an SPF value of 15 or greater.

3. There are no products that truly are “waterproof or “sweat-proof”—in fact, the FDA ruled manufacturers will no longer be able to use these terms in the future (Summer 2012). Instead, products will be rated for the length of their “water resistance” as either 40 or 80 minutes. The advice for consumers is that no matter what the label says, reapply sunscreen after you have been in the water or exercising and at least every two hours otherwise.

4. Products will not be able to claim that they are a “sunblock.” The FDA says that no sunscreen available completely blocks sun exposure. For consumers, this means you should use additional forms of protection when out in the sun, such as hats and clothing that help block sun exposure.

5. Consumers cannot rely on SPF factors higher than “50” to protect them better. According to the FDA, products with an SPF greater than 50 have not been proven to protect skin any longer or better than SPFs with a value of 50.

Dr. Morganroth points out that skin cancers make up nearly half of all cancers diagnosed in the U.S., affecting one in five people over their lifetimes. Sun protection measures should be combined with regular screening by a trained dermatologist at least annually. (If cost is an obstacle, check with local hospitals or the American Academy of Dermatology database for free screening programs. El Camino Hospital’s Cancer Center also offers free screenings every Wednesday afternoon.) If a skin cancer is found, make sure you consider the best options for treatment. Mohs Surgery has been shown to have the highest cure rate.

To learn more about the signs of skin cancer, visit: http://californiaskininstitute.com/2011/05/27/skin-cancer-easy-to-detect-deadly-to-neglect/

The new San Mateo location is:
100 South Ellsworth Ave., Suite 707
San Mateo, CA 94401
Ph: 650-348-1242
Fax: 650-348-0788

When thinking about sun exposure, you might envision yourself on the beach or exercising outdoors. But millions of Americans receive a large portion of their sun exposure when they don’t even realize it – in their cars.

For years, dermatologists have observed that patients in the US often have more sun damage (which can lead to wrinkles, leathering, sagging, brown “age” spots and even skin cancers) on the left side of their faces than on the right. Why? Research increasingly points to ultraviolet A (UVA) radiation penetrating through car windows.

UV radiation from the sun, associated with about 90 percent of all skin cancers, reaches the earth as longwavelength UVA and shortwave UVB rays. Glass effectively blocks UVB, and windshields are specially treated to block UVA as well, but a car’s side and rear windows allow UVA to penetrate. UV exposure is cumulative, and research has proven that skin exposed to sun shining through window glass, even in the office, can over time lead to significant skin damage. The UV exposure we receive driving a car especially adds up. In a US study by Singer, et al, the researchers found asymmetric photodamage (suninduced skin damage) on the face, with more brown pigment (color) and deeper wrinkles on the left. The more time subjects spent driving a vehicle, the more severe their photodamage on the left side. Reinforcing this research, in countries where the driver’s side is the right side, people tend to develop more sun damage and skin precancers on the right. Certain precancers can turn into squamous cell carcinoma, the second most common form of skin cancer.

Gender Differences

Recently, a study by Butler and Fosko showed that the majority of skin cancers in the US develop on the left side of people’s bodies and faces. This finding is especially pronounced in men, who more consistently spend time driving cars over a lifetime. While younger women have more left-side than right-side skin cancers, at age 50 this trend in them reverses, and rightside skin cancers predominate until age 80. Though we can only speculate, the shift seen around age 50 may indicate that younger women spend more time as car drivers, receiving more exposure on the left side of their bodies, while older women may more often be passengers, thus sustaining more right-side sun damage. However, the number of vehicles per household has nearly doubled in the last 25 years, making it more likely that women today will spend more time as drivers rather than passengers.

Risk of Melanoma

Previous observational studies have shown an increased risk of melanoma in patients receiving large doses of UVA from tanning beds. Butler, et al also found that melanomas in-situ (early, noninvasive melanomas that have not spread from their original tumor sites) were more common on the more UVA-exposed left side of the body. Our observations suggest that UVA exposure over the years may indeed play an important role in the development of this potentially dangerous skin cancer. (Melanoma is linked with intense, intermittent UV exposure; its association with cumulative UV exposure has been unclear.) In the US, the left side of the head, neck, arm and hand receive up to six times the dose of UV radiation as the right side in those sitting on the left side of the car. Convertibles and sunroofs allow even more UV exposure, so extra attention to sun protection must be paid if this type of car is driven.

Protecting Yourself

There are several ways to protect yourself in a car. The first is to apply a broad-spectrum sunscreen with an SPF (sun protection factor) of 15 or higher to your face, arms, neck and hands, about half an hour before you go driving. [The Skin Cancer Foundation recommends using about an ounce over the entire body, including a teaspoonful on the face.] Because UVA passes through the window glass, make sure your sunscreen contains some combination of UVA-shielding ingredients such as zinc oxide, titanium dioxide, stabilized avobenzone, and ecamsule (MexorylTM). Be sure to reapply after two hours, or after sweating heavily.

Protective clothing, such as longsleeved shirts, long pants, UV-blocking sunglasses, and hats with a brim of at least 3 inches all around also help shield against the sun’s radiation. Hats are particularly important for men who have thinning hair and are at risk for developing skin cancer on top of their heads.

Another sun safety strategy in the car is tinting or laminating (applying UV-protective film to) the window glass. Window tinting is regulated in many states, so be sure to check the laws, but clear window film is available throughout the country. One study noted a 93 percent reduction in skin cell death when UV exposure was filtered through UV-absorbing auto glass. Some films, when applied to car windows, can block 99.9 percent of UV rays.

Following all these precautions will help you stay sun-safe both on the road and once you reach your destination.

Dr. Butler is a dermatologist and fellowshiptrained Mohs micrographic surgeon. She is in private practice at the California Skin Institute in San Mateo, CA. Schedule an appointment with Dr. Butler or learn more about her.

Melanoma killed Maureen Reagan, Burgess Meredith and Bob Marley. Clint Eastwood, Sen. John McCain, Regis Philbin and Gov. Jerry Brown are among those publicly known to have been diagnosed and treated for skin cancer in the past decade.

If that doesn’t worry you, consider that skin cancers make up nearly half of all cancers diagnosed in the U.S., according to the American Cancer Society, which has designated May as National Skin Cancer Awareness Month. This year more than 2 million people will be diagnosed with skin cancer, including 115,000 with melanoma, and one person will die from skin cancer every hour. Yet research published in the Journal of the American Academy of Dermatology shows that only 8 percent of U.S. workers had a skin exam in the prior year – even though professional skin exams save lives.

Skin cancer is fairly easily detected and virtually 100 percent curable if caught early, but it can be fatal if left untreated. You can perform a self-screen – more than half of all lesions are discovered by patients – but they aren’t always easy to see. Skin cancers develop on the scalp, between the toes or even on the soles of the feet (60 percent of African American skin cancers are found on the feet). And when individuals, not their physicians, find something, on average they wait three times as long to have it removed, thus increasing the risk of spreading.

What does skin cancer look like?

Skin cancer takes several forms, in part based on the type of cell in which it originates: slightly shiny and transparent or pearly bumps; a raised, pink growth; a red patch of skin; a sore that keeps scabbing over and reopening. It can be any color, shape or size and typically changes over time. Melanoma can develop in a pre-existing or new mole, so anything suspicious should immediately be brought to a doctor’s attention for further study.

If it’s skin cancer, the right treatment will improve the outcome. One surgical option for nonmelanoma skin cancer, Mohs surgery, not only minimizes scarring, but also has the highest cure rate of any treatment.

Instead of excising the cancer and identifying the pathology result days later, Mohs surgery involves removing the area of the recognizable tumor and creating a map on the tissue and patient to ensure correct orientation. The tissue is immediately frozen in the office and examined microscopically to ensure that the entire margin is checked. If the tumor persists, more skin is removed in the exact area of positivity and rechecked until only cancer-free tissue remains. Because the results are available immediately, there is less time to spend worrying. And because the entire tumor has been completely excised, reconstruction can be safely performed the same day – all under local anesthesia.

Studies report that Mohs surgery’s five-year cure rate on new cancers exceeds 99 percent, compared with 88-90 percent for other surgical techniques. Furthermore, it leaves the smallest scar because it removes less healthy tissue.

Ask your doctor if this procedure is appropriate for you and seek treatment by a fellowship-trained Mohs surgeon (see the physician locator available at www.mohscollege.org).

Professional screening critical to early detection, treatment

Even diligent self-screening isn’t adequate. Professionals are more likely to catch early-stage cancers and to find them in hard-to-see areas. If your primary-care doctor isn’t experienced in skin care or your annual physical typically doesn’t include a skin exam, find a board-certified dermatologist and make annual appointments. If cost is an obstacle, check with local hospitals or the American Academy of Dermatology database for free screening programs. El Camino Hospital’s Cancer Center offers free screenings every Wednesday afternoon.

Equally important, minimize your risk. Avoid direct sunlight during the hours of 10 a.m. to 4 p.m. Wear protective clothing made of tightly woven material. Apply and reapply generous amounts of sunscreen with an SPF of 30 or higher, even on cloudy or hazy days. Use lip balm with SPF. Look for sunglasses with strong UV absorption. Wear a wide-brimmed hat that shades your face, neck and ears. All these actions will help reduce your sun exposure. And, take a moment to note where and what your existing moles look like, so you’ll be able to detect changes or notice new ones.

If you’re not worried about skin cancer, you should be. One in five people will get it and some have a higher risk than others (1 in 3 Caucasians). At some recent local screenings, more than 40 percent of participants had a condition warranting further action. If you have fair skin, a family history of skin or other cancers, severe childhood sunburns and/or multiple/atypical moles, you’re at higher risk. Smoking – past or present – adds more risk.

Few conditions are as preventable or curable, but only if everyone develops a healthy level of respect for the risk skin cancer poses. Use this month to jumpstart your detection and prevention efforts.

For more information on types of skin cancer, detection, treatment and prevention, visit www.mohscollege.org or www.aad.org.

Greg S. Morganroth, M.D., a board-certified dermatologist and fellowship-trained skin cancer surgeon, is president and founder of California Skin Institute.

To listen, simply select play below to listen to the interview:

More of The Joanie Greggains Show can be heard here!

Dr. Butler is a board-certified dermatologist and fellowship-trained Mohs surgeon who practices the full range of medical and surgical dermatology with a special interest in skin cancer evaluation and treatment, Mohs surgery, facial reconstruction, and cosmetic dermatology including Botox, Dysport, wrinkle fillers, lasers, and leg vein sclerotherapy.

Schedule your appointment at 415.831.5600 or schedule online!

Now, our practice is among a few in the region to offer the clinically proven and FDA cleared Ultherapy® procedure for lifting and toning loose, lax skin—without surgery! At California Skin Institute, patients may now experience ultrasound treatments designed to strengthen your skin from the inside out, in a completely non-invasive way.

After just one to two treatments, with no downtime, your skin will gradually reflect a more refreshed, uplifting appearance. FAQ’s may be found after the before-and-after images.

What is a summary of Ultherapy?

Ultherapy is a non-surgical ultrasound treatment for lifting and toning the skin. One to two treatments will naturally rejuvenate and strengthen the collagen within the skin. The goal is to achieve a more open look to the eyes, a more defined jawline, or a sleeker neck. Ultherapy is 30-60 minute treatment without any downtime. The results occur gradually over 2-3 months.

How is Ultherapy different from other cosmetic procedures?

Ultherapy is the only non-surgical cosmetic procedure that uses ultrasound to specifically target the foundational layer of facial tissue that doctors address in surgery. The use of ultrasound also enables CSI Practitioners to actually see the layers of skin being treated, allowing the energy to be delivered precisely to where it will be most productive.

Is it safe?

Ultrasound energy has a proven track record, with use in medical imaging for over 50 years. In addition, the procedure has been cleared by the FDA after demonstrating safety in clinical studies, and tens of thousands of treatments have been performed worldwide without any significant adverse events.

Who is a good candidate for Ultherapy?

There is a broad range of people who can benefit from Ultherapy, but typically those in their thirties and older are candidates. While Ultherapy is not a replacement for surgery, it may be a viable option for those people who want some lifting, in order to look more refreshed and toned but are not ready for surgery yet (mentally, financially, or logistically).  There are also younger candidates in their twenties who want to “stay ahead of the game” as well as those looking to prolong the effect of previous surgeries.

What about treating anatomical regions other than the face?

Currently, Ultherapy is a face and neck treatment. However, the company is conducting a number of clinical studies with physicians around the world to investigate the use of Ultherapy for treating other anatomical regions.

Can men have it done?

Absolutely! Men and women globally are receiving Ultherapy.

Does it hurt?

While comfort thresholds vary from patient to patient, it is noted that there is some discomfort while the energy is being delivered, which is temporary and a signal that the collagen-building process has been initiated. We take measures to make the experience as pleasant as possible and patients often share with us they leave CSI comfortable and happy given the benefits of Ultherapy to come. If you are still concerned about discomfort and pain, California Skin Institute is one of the only practices offering IV sedation to maximize the comfort of the treatment. If choosing IV sedation, additional charges will apply to cover the operating room and anesthesiologist’s fees.

How many treatments does it take?

The majority of patients only need one treatment, while those with a fair amount of laxity may need more than one treatment. Annual touch-up treatments can assist in slowing down the rate of skin aging.

How long does it last?

Patients treated with Ultherapy still have fresh young collagen after a year’s time following the procedure, however skin will continue to age. Yearly touch-up treatments are available to assist in keeping pace with the aging process.

What does collagen do?

Collagen is a natural protein that gives skin its youthfulness by keeping it firmed and toned. As we age, collagen loses its strength and its ability to stand up to the effects of gravity that pull the skin downward. Ultherapy jump starts a repair process that strengthens your existing collagen and produces fresh, new collagen.

Are there any side effects?

There may be slight redness for a few hours following the treatment, and it’s not uncommon to have slight swelling, tingling or tenderness to the touch for a few weeks, but these are typically mild and are temporary in nature. There may be other post-procedural effects such as bruising and small areas of numbness however these are less common and, again, temporary.

Is treating the lower face and upper neck off-label since the FDA indication is specifically for a brow lift?

The treatment reviewed by the FDA was a full face and upper neck treatment; the indication given was specifically for the brow, undoubtedly because there were validated methodologies for measuring the 2 dimensional “lift” effect on the brow. In the FDA clinical study, 9 out of 10 patients had significant lifting of the brow (great for any non-invasive energy based device) and results were seen elsewhere on the face and neck as well.

How much does it cost?

An Ultherapy treatment costs between $1500 and $3500 depending on the extent of treatment. IV sedation is available in the Mountain View and San Jose/Los Gatos for an additional cost of $1000-1500 (estimated) depending on the extent of treatment.

To schedule your Ultherapy consultation appointment, call Kathy Aronson, R.N. at (650) 969-5600 ext. 224 or e-mail kathya@CAskin.com

California Skin Institute has been a center for excellence in body sculpting with tumescent liposuction since 1996 for patients with
localized areas of fat resistant to diet and exercise.  Tumescent or local anesthesia liposuction remains the definitive method for fat removal both in safety and efficacy.  Despite its great safety record at CSI, tumescent liposuction is still considered a surgical procedure with a day or more of reduction of normal activity.

Many of our patients have been waiting for a non-surgical alternative due to a fear of surgery.  As Innovations in non-surgical fat removal have evolved over the past few years, California Skin Institute has been cautious in adopting these technologies until there is FDA-approval and a clinical track record with early

adopter physicians.  One of the newest and most promising techniques is Cryolipolysis™ technology via the Coolsculpting procedure which received FDA-approval for non-invasive reduction fat in September 2010.  Cryolipolysis™ cools the targeted fat tissue to break down the fat cells for easy removal without damage to surrounding skin and muscle.  The natural repair mechanisms of the body remove the freeze injured cells over a period of months.  The results are noticeable and natural looking with a 20% reduction of the fat tissue after a single treatment.  Multiple treatments create an additive reduction in the localized fat deposits.

Read more about the PinPointe FootLaser at:
http://pinpointefootlaser.com/in-the-news/press-releases/pinpointe-footlaser-receives-fda-clearance

Dr. Butler is a board-certified dermatologist and fellowship-trained Mohs surgeon who practices the full range of medical and surgical dermatology with a special interest in skin cancer evaluation and treatment, Mohs surgery, facial reconstruction, and cosmetic dermatology including Botox, Dysport, wrinkle fillers, lasers, and leg vein sclerotherapy.

Schedule your appointment at 650.342.5200 or schedule online!

This second edition publication is scheduled for release on April 23, 2010.

Get party-ready with these quick fixes for face and body.

With the stresses of a flailing economy and the holidays just around the corner, you may have awakened to notice those folds between your brows deepening, or your once plump cheeks giving way to gravity.

If you’re looking for that quick beauty pick-me-up that’s a step above the traditional spa facial – but short of going under the knife – you could be the perfect candidate for one of the many non-surgical treatments available at your local dermatologist’s office or nearby medi-spa.

Commonly referred to as “lunchtime treatments,” the vast array of facial rejuvenation and body adjustments, which require little to no downtime, have recently grown in popularity because of their effectiveness, availability and significantly lower cost as compared with invasive surgical procedures says Dr. Greg Morganroth, a dermtologic surgeon and founder of the Bay Area-based California Skin Institute….

» View the Full Article (PDF)

» View the new location

The California Skin Institute is Northern California’s largest and most comprehensive dermatology, laser and cosmetic surgery practice with offices in Mountain View, San Jose/Los Gatos, Saratoga, Los Altos, San Mateo and San Francisco.

CSI specializes in the recognition, prevention and management of all types of skin cancer. Our patients benefit from our nationally recognized expertise in Mohs Surgery and Facial Reconstruction as one of the largest Mohs practices in Northern California.