1. Skin and Aging Marlene Mash M.D & Debra Hrobak PA-C
Montgomery Women’s Health Fair October 22, 2009

2. Structure Of The Skin Three Layers Epidermis Dermis Subcutaneous Layer
Dermis contains collagen, elastin and other skin support fibers that are damaged by UV radiation and causes photoaging

3. Functions of the Skin Many important functions: Prevent Infection
Maintain a barrier
Repair Injury
Provide Circulation
Communication
Provide Nutrition
Regulate Temperature
Convey Beauty and Physical Attractiveness

4. Photoaging---what is it??
Photoaging refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiation.

5. UV Radiation Two Types of Rays We are Worried About: UVB UVA
Responsible for Sunburn
Usually exposed from 10am-4pm April-October
Cannot penetrate glass
UVA
95% of the UV radiation reaching the earth
Can penetrate deeper into the skin

6. What Happens? Skin Cancers Dark Spots Broken Blood Vessels Wrinkles
Leathery loose skin

7. Skin Cancer More than half of all new cancers are skin cancers
More than 1 million new cases of basal cell carcinoma and squamous cell carcinoma occur annually
Melanoma will be diagnosed in 62,190 persons this year alone!
10,710 people will die from skin cancer this year!

8. Types of Skin Cancers Actinic Keratosis Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma

9. Actinic Keratosis Pre-cancerous Lesion
Scaly, non-healing red spot on skin
Commonly found on the face, lips, ears, neck, scalp, forearms, and backs of hands
Have the potential to develop into Squamous Cell Carcinoma
1 in 6 people will develop AK in lifetime

10. Basal Cell Carcinoma Most common form of skin cancer
Sun exposed areas of the body
Open sore, reddish patch, growth with elevated border and central indentation, bump or nodule

11. Squamous Cell Carcinoma
Major type of skin cancer
May penetrate and destroy underlying tissues and metatasize to other organs
Sun exposed areas may also develop from burns, scars, exposure to chemicals or radiation, and immunosupression
Warty, elevated growths with central depression, or scaly patches

12. Melanoma Skin cancer of melanocytes or pigment cells
May affect anyone of any age and can occur anywhere on the body
Increased risk in fair skin, light hair color and eye color, those with personal or family history
May spread to other organs of the body
Essential to treat this skin cancer early
4% of all skin cancers but 74% of all skin cancer deaths
Will affect 62,000 Americans annually and causes 8,500 deaths per year!!!!

13. Detecting Skin Cancer One half does not match the other half
The edges are notched or ragged
Varied shades of tan, black, and brown
Can always add an E letter for evolving. Need to look for things that are new or have had a change in size, shape, shade of color or developed new symptoms such as bleeding, itching or tenderness
Greater than 6 mm in size

14. Detecting Skin Cancer Self examinations every two months
Yearly visits to the dermatologist for a full body exam
Regular visits for new or changing skin lesions

15. Photoaging Signs Skin Cancers Dark Spots Broken Blood Vessels
Leathery Loose Skin
Wrinkles

16. Dark Spots, Broken Blood Vessels, Loose Skin
Common signs of photoaging
Common complaints in the dermatologist office
Seen on the face, neck, arms, and hands
Several Treatments offered:
Topical Bleaching Creams with Retinoic Acid
Lasers---used to treat dark spots as well as broken blood vessels
Skin tightening lasers
Microdermabrasions and chemical peels

17. Before and After

18. Wrinkling Common sign of photoaging and index of photodamage
Multiple Causes:
Breakdown of collagen and elastin in the dermis from sun exposure
Loss of fat under the skin as we age
Sebaceous glands in the skin produce less oil as we age
Chronic muscle use
Free radicals and hormones

19. Treating Wrinkling Moisturizer Retinoic Acid Daily Sunscreen Botox
Cosmetic Fillers
Face Lift

20. Botox and Dysport Botulinum Toxin Type A Injected under the skin
Causes muscle relaxation and softening of wrinkles
Very effective and safe to use
Possible side effects: bruising, headache, drooping of eyelids

21. Before and After Photos

22. Cosmetic Fillers
Dermal fillers are substances injected at varying depths within the skin and soft tissues to fill facial imperfections such as wrinkles, creases and concave scars, as well as to enhance the fullness, or volume and shape of facial tissue
Two Types:
Temporary dermal fillers include two categories: collagen and hyaluronic acid fillers
Semi-permanent and permanent dermal fillers are those used to correct deeper facial creases and in larger volume restoration. These fillers generally include microsphere particles suspended into a liquid or gel formulation or compounds that do not readily absorb, injected deep within the soft tissue for more long-lasting and large volume correction.

23. FDA Approved Fillers Cosmoderm and Cosmoplast Restylane Sculptra
ArteFill
Radiesse
Juvederm
Elevess
Perlane
Prevelle Silk
Evolence

24. How Do You Choose? Cosmetic Consult Treatments will chosen based on:
Area to be treated
Depth of wrinkling
Patients desire for permanence
Patients budget

25. Before and After Photos

27. Expected Side Effects Swelling Bruising at injection sites Redness
Ulcerations of skin
Cold sores
Most injections tolerated well
Ice after injections
Avoid aspirin, ibuprofen, blood thinners, vitamin E prior, ginko boloba, St. Johns wart two weeks prior
Arnica Montana

29. Marlene Mash M.D Board certified dermatologist
Expert in cosmetic procedures as well as general and surgical dermatology
Offers general dermatology services as well as:
Cosmetic injectables
Upper and lower eyelid blephroplasty
Liposuction
Advanced treatments for hyperhidrosis (excessive sweating)
Various laser procedures

30. Support Staff Two Physician Assistants
Maria Fudala PA-C
Debra Hrobak PA-C
Experienced in general dermatology, dermatologic surgery, as well as cosmetic services
Licensed Aestheticians
Medical Assistants
Reception Staff

31. Our Office Located in plymouth meeting Convenient location
Evening and Saturday hours

32. Questions???