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Entries by Warren B. Seiler III, MD (5)


What To Do About A Teenager's Acne

acne treatmentsMany teens and young adults suffer from different forms and severities of acne. Unfortunately, the “old school” philosophy of treating acne with topical and oral antibiotics and even Accutane is not always the best or even necessary for the child. Kids are too often diagnosed with “acne” and are prescribed some form of antibiotic or Accutane when simply addressing skin health and cleanliness may be all that is necessary to significantly improve their acne.

Here is what we will address in the consult. We will take a full medical and lifestyle history of the child. This goes beyond the medical part of the history by addressing skin health and daily routine. How does the patient clean his/her skin? Does the patient have any undiagnosed allergies or abnormal

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Sun Exposure & Sunblock: Great Info For Your Patients

Importance of Sunscreen/Sunblock

I reviewed a Special Report insert in the April 2011 The Dermatologist journal that was very informative about the need and use of sun protection. It details the difference in effects of UVA vs UVB rays. I will summarize the main points. It is critical to educate patients about the following information.

UVA and UVB are the rays that are important in skin disease and aging. UVA comprises 96.5% of UV radiation and UVB comprises only 3.5%. (Remember that SPF only tells you how much of the UVB is blocked, although UVB is important in damage to the skin). UVA can penetrate glass and reach the skin’s dermis, while UVB cannot. UV radiation causes DNA damage, immunosuppression, and sunburn.

After UV exposure, melanin (pigment) synthesis is a mechanism to combat UV damage. Melanin blocks UV and scatters UV radiation to prevent damage. This is why darker skinned individuals do not sunburn as easily and do not show as much sun-induced aging and skin disease/cancer. UV-induced immunosuppression is associated with increased risk of skin cancer.

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American Board Of Laser Surgery

I get a lot of questions from laser physicians about the American Board of Laser Surgery. I thought I would leave a short post about the benefits of becoming a diplomat of the ABLS. It is the only recognized specialty board specifically for laser surgery. We have members from many countries because most other countries do not have a laser board. It is like any other board certification with a written and oral exam.  Through the process, the practitioner will gain extensive knowledge about laser procedures, safety, theory, physics, and other information. Feel free to ask me any questions about it! 


Laser/IPL Procedures For Patients With Skin Cancer History

There was a recent posted question on the American Board of Laser Surgery's website about treating a patient who has had basal cell carcinoma (BCC) in the past with a treatment like IPL.

This is obviously a controversial topic for sure!

My protocol (remembering that I am a surgeon) is that anyone with a history of skin cancer must have a full body skin cancer screening in the last six months by their dermatologist prior to me treating them. I must have a letter from that dermatologist stating that there is no active cancer anywhere on the skin and no suspicious lesions that need to be followed. Obviously, if there was a h/o skin cancer on an area I am NOT treating with IPL or laser, I just want a full body check and then we're good. If there is a previous lesion IN the area I am treating, then after dermatology clearance, I have a strong talk with the patient discussing the fact that treatmetns that potentially depigment lesions can mask the warning signs of a potential or growing cancer. They sign separately in consent their understanding and acceptance of risk and wish to proceed with the cosmetic treatment.

This particular question was regarding a simple IPL treatment for a cosmetic concern in a patient that had had h/o BCC in another area. If cleared, you would be fine to treat the cosmetic condition. I did not want anyone reading this to think that I was indicating that the IPL was meant to actually treat the BCC. I do think that it can be preventative of precancers buy removing damaged pigment cells and pigment, but that is obviously an impossible study. Hope that helps!


How Does A Plastic Surgeon Incorporate Lasers Into A Primarily Surgical Practice?

One of the most common questions that other physicians ask me is “how do I incorporate lasers into my surgical practice?”

I am often called by a plastic surgeon, specializing in cosmetic surgery, who wants to know how he or she can begin to use lasers in their practice. It can seem exciting yet daunting to bring in a new procedure because of the level of knowledge and training required to properly treat patients and produce excellent results. And many times, physicians have limited time for further training once a busy practice has been established. In addition, lasers are expensive and most surgeons are not used to having to purchase expensive equipment beyond the initial investment in supplies to start a surgical practice. That being said, the laser procedures can help surgeons offer a much wider range of treatments that will benefit both the patient who has had surgery and the one who is not yet ready for surgery. I tell physicians and patients that laser procedures can be “insurance for your surgical procedure” in many ways. Laser procedures can help add to the result of surgical tightening by treating dyschromia, discoloration, texture, pore size, vascular lesions, and providing overall better skin health and appearance. One can pull the skin tighter with surgery, but the skin often needs surface treatment with laser procedures. Don’t just focus on achieving tighter skin, focus on overall better looking skin also. This may sound like a sales pitch, but you will hear me often say, “don’t put cheap tires on a Rolls Royce!” Surgical results will greatly benefit from maintenance laser procedures and good medical skincare. Finally, a laser procedure can often help a plastic surgeon treat a patient who does not really need surgery yet, so that the patient does not have to be referred elsewhere.

My advice always starts with telling fellow surgeons that

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