More Than Skin Deep

In the past, many people who were unhappy with the way their skin looked from a cosmetic standpoint were forced to suffer in silence. In some cases, they didn’t know enough about the options that were available or, if they did, simply couldn’t afford them, since the vast majority are not covered by medical insurance. Some were unable to take the time off from work that was recommended or required for recovery – or worried that the results would not justify the cost, since some interventions were less successful than others.

Today, with the introduction of breakthrough products, innovative techniques, and state-of-the-art technologies that offer great effectiveness, laser and cosmetic dermatology has moved very much into the mainstream. And it is making a huge difference in the lives of patients, improving their physical and emotional well-being without a significant amount of downtime. In 2018, almost 18 million Americans had a cosmetic procedure or intervention, and the numbers continue to grow each year.

The Department of Dermatology at UConn Health has become a leader in this burgeoning field. In addition to providing medical-based care, such as performing Mohs surgery for skin cancer and treating dermatologic diseases, its fellowship-trained, board-certified physicians offer the newest and most effective laser and cosmetic treatments for everything from wrinkles, discoloration, and sagging skin to vein reduction, scar revision, contour sculpting, and permanent hair removal.

Hao Feng, M.D., M.H.S., FAAD – one of two procedural dermatologists in the department along with Maritza Perez, M.D., FAAD – says as faculty members of a university hospital, he and his colleagues use science-based therapies and treatments to give patients the benefits of the latest research and innovation in healthcare. “We have the expertise and the tools to really help people, no matter what the issue,” he says. “They don’t need to travel to New York or Boston. We deliver excellent care that rivals what is offered in the major cities.”

Dr. Perez, who has worked in cosmetic dermatology for more than two decades and has performed and authored countless journal articles about a wide array of dermatological interventions, agrees that when it comes to doing cosmetic procedures, expertise is key. “The compendium – the whole package of how to rejuvenate a face – is not only based on lasers, Botox, or fillers. It’s knowing how to analyze the face and knowing the best way to improve a patient’s look. And that comes with a lot of experience.”

She notes that UConn is very fortunate to have such skilled physicians, not only in Dermatology but in its other departments as well. “It’s important to have the right quality of professionals to take care of your patients,” she says.

Members of UConn’s Dermatology team have an impressive arsenal of tools at their disposal.

Surface-level treatments include wrinkle-fighting serums, cryosurgery to eliminate benign lesions, and painless removal of skin tags. In microdermabrasion, also known as the “lunchtime peel,” crystals and suction are used to exfoliate the top layers of damaged skin, promoting the formation of new, smoother skin with no discomfort or downtime.

Chemical peels – which not only exfoliate skin but stimulate collagen using alpha-hydroxy acids – are great for making wrinkles, fine lines, and pigmentation less visible, improving skin texture, and minimizing the appearance of active acne and scarring.

Lasers can eliminate unwanted blood vessels, fine lines and wrinkles, scars, discoloration like rosacea and brown spots on the face, and sun damage on the neck and chest. Blu-light treatments can remove precancerous lesions. Lasers can also be used to permanently remove hair and tattoos.

Injectables are also popular. For instance, botulinum toxin  (known by the trade name Botox) is not only used to eliminate or reduce wrinkles, but can make hands look younger, reduce excessive underarm sweating, and improve the appearance of the neck when injected along the jawline. It can also promote a better appearance for patients who feel their gums are too prominent when they smile. Fillers, meanwhile, can help to correct facial wrinkles and folds, scarring, skin depressions, and lip lines, as well as correct volume loss in the face and hands. Patients with spider veins in their legs may opt for sclerotherapy, in which a liquid is injected into the veins to make them less visible. Kybella injections are used to eliminate the fat cells that contribute to a double chin.

Minor surgery, small amounts of liposuction in certain areas, and microneedling with radiofrequency are also available.

Dr. Perez says often, the best approach involves not just a single type of treatment but several. “Combination treatments can offer the best outcome, the least amount of downtime, and sometimes the lowest investment,” she says. “For example, for some patients, if you use the right combination of Botox, fillers, and lasers, you can get the improvement of … not a facelift, but almost a facelift. And you can do it in one sitting. When you combine treatments, it’s a beauty, because the improvements are exponential rather than additive.”

A personalized approach

No matter what type of result a patient hopes to achieve, the guidance provided by UConn’s dermatology team is invaluable. “There’s a dizzying amount of information on the internet, including a lot of advertising,” says Dr. Feng. “It’s very difficult for the consumer to navigate all of that, and to know if any of it really works. A big part of my job – and what I love doing for a patient – is to provide them with the correct information. To say, ‘This is what we can realistically do for you,’ and help guide them through the process.”

UConn’s dermatologists take into account not only the potential effectiveness of a treatment but its suitability to the individual patient and their situation. “We want to understand what kind of results patients are seeking, and what kind of downtime they can have,” says Dr. Feng. “Then we consider what kind of potential harm there may be. For example, if you have dark skin, your skin is going to be more prone to side effects and complications than someone who has Caucasian skin. As a team, we really want our patients have an excellent experience. We’ll never recommend things that will not work or is not right for them.”

Right procedures, right provider

One thing many patients may not be aware of is that it’s critically important not only to select the right products or procedures, but the right provider. Dr. Feng explains that while various cosmetic treatments can have marvelous results, they can also be dangerous in the hands of a provider who is inadequately trained to use them safely or does not know how to deal with complications when they occur.

“I’ve seen multiple patients who’ve gotten procedures done and suffered long-term consequences. One example is a young college student who was bothered by excess, unwanted hair on her arms and had a treatment that resulted in very visible burns and scars. We had to do a lot of work to help correct that,” he recalls. He also knows of patients who had filler accidentally injected into a blood vessel, causing serious complications. “Unfortunately, the injector did not recognize this serious complication and the patient never received time-sensitive treatment that could have prevented her facial scars.”

“Our goal is to never have a patient be in that position in the first place,” he says.

“I really urge consumers to look at the training and the expertise of anyone that they’re considering getting cosmetic and laser energy-based treatment from. You want someone who really knows what they’re doing, who can take care of you from the beginning to attain your goals, and who has the right devices and options that fit your needs – not just what’s convenient for the person who’s treating you. And I think that’s something that makes UConn stand out compared to other places in the area, and really in the entire state.”

At UConn, he notes, a complication is “a very rare event, but it can happen. However, we are trained to recognize and reverse any side effects very quickly, with no negative results. You really have to know what you’re doing, to minimize complications and use these products safely.”

Because UConn’s dermatologists are also expert in treating medical issues, they are able to identify and treat potentially life-threatening skin lesions, like melanoma.

Finding a concerning skin lesion during a cosmetic consultation is not uncommon, Dr. Perez says. Since joining UConn from private practice 18 months ago, “I’ve removed five melanomas in a given week, so we’re saving lives here on an everyday basis. But on top of that, we’re improving the appearance of people who may be feeling self-conscious or depressed about the way they look.”

When it comes to offering medical care, Dr. Perez takes a lot of satisfaction in helping people, regardless of their situation. She says one of the reasons that she shifted from private practice to UConn Health is because she wants to give back to the community. “We take care of all patients, regardless of their insurance status.”

You might say that both physicians bring to their positions something of a world view.

Dr. Perez was born and raised in San Juan, Puerto Rico. She went to college at 15, finishing a bachelor’s degree in biology with a minor in chemistry in just three years, and finished medical school at 23. After completing a fellowship in immunology and marrying a fellow physician, she spent several years in research at Yale before completing another fellowship, this time in dermatology, and subsequently went into private practice. Her twin daughters are also in medicine.

Dr. Feng, who was born in China, emigrated to the U.S. with his family at the age of 10 and lived in Florida and California before earning his medical degree at Yale, followed by a year-long internship at Yale New Haven Hospital. After completing his dermatologic residency at NYU, he stayed in Manhattan for a fellowship in surgery, laser surgery, and cosmetic dermatology, returning to Connecticut in 2019.

Both are delighted to be at UConn. “I always wanted to have a career where I can not only provide excellent patient care, but also really teach and help mentor the next generation of physicians to be top-notch dermatologists,” says Dr. Feng. “Also, being at an academic center, you’re surrounded by so many brilliant people, both those with a lot of experience and really great young minds. We’re building and creating something here that’s really exciting to me.”

Drs. Perez and Feng discuss advanced cosmetic dermatology treatment options on the November episode of the UConn Health Pulse podcast. Hear it at https://h.uconn.edu/derm-podcast.

Carol Latter is the editor of Seasons Magazines and lives in Simsbury.
Photography courtesy of UConn Health