Maintaining Youthful Skin
February 23, 2011
By Dr. Deborah Yang
Dr. Deborah Yang
Dermatologist and cosmetic dermatologist at Kaiser Permanente
Where did you receive your schooling and training?
After graduating from Moanalua High School and then Rice University, I went to medical school at Baylor College of Medicine in Houston, where I also did my residency and fellowship training. I completed my residency in dermatology and my fellowship in procedural dermatology, which encompasses skin cancer surgery as well as lasers and cosmetic dermatology.
How long have you been practicing?
About a year and a half.
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What are the most common procedures you do?
I do skin cancer surgery, specifically Mohs surgery, and cosmetic dermatology.
Is cosmetic dermatology mostly facial?
In general, people focus on their face, but if you actually look at the neck, chest and back of the hands, you can tell someone’s age more because sunscreen isn’t typically put on these areas. If you look at the left side of a patient’s face, you can always tell there’s been more sun damage because people drive with the sun facing them on the left side, so we typically have our skin cancer and our deeper wrinkles here.
We can put fillers in the backs of the hands. It’s very satisfying both for the patient and the doctor because the results are pretty instant. All of a sudden a patient’s hands look 10 years younger. Laser treatment does a great job on brown spots and blood vessels on the chest, as well.
What do you mean by “fillers”?
We fill in the smile lines extending from the nose toward the lip, or to bring up the corners of the lip, for example, because a lot of times as women age the corners of their lip start to droop so it looks like they’re frowning even though they’re not unhappy.
There are also other types of fillers, which can be used in deeper layers to add volume, because a lot of people start to lose the fat in their cheeks and that ages them, as well. Sometimes the lines are deeper on one side, and that’s because patients are sleeping on one side. If they can sleep on their backs it usually helps. Then at least gravity isn’t working harder on one side.
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What is laser surgery and what is it used for?
Laser stands for “Light Amplification by Stimulated Emission of Radiation.” It’s noninvasive and is a concentrated wavelength that targets blood vessels, pigment or water. The Palomar laser that we use has a lot of different treatment options. It can treat brown spots and red blood vessels that people develop on their face as they get older due to sun damage. Laser can be used for permanent hair reduction, to improve the appearance of scars, to treat acne scars and scars from surgeries and injuries. It is also pretty good for spider veins.
Laser treatment should always be done by someone who’s been trained in laser surgery. There are very few problems with laser treatment when performed by a trained professional, but if problems do arise the complications can be bad, so you want someone who’s had the proper training.
Can you talk more about cancer treatment?
I treat the more difficult skin cancers such as skin cancer that’s in areas where there’s not enough skin to be able to close a significant hole, so on the face - like the nose. Or skin cancers that have previously had surgery and come back. We do Mohs surgery, a specialized technique in which small amounts of tissue are removed and then examined under the microscope while the patient is waiting. Once the skin cancer is completely removed, the closure is done usually on the same day.
Usually, patients are referred to me by another dermatologist because they’ve already had a biopsy and we know that it’s a skin cancer. I take a small amount of normal tissue around the affected area, instead of the large amount of tissue that would normally have to be taken during an excision where you’re not able to look at the pathology. We freeze the skin then cut small, horizontal layers. Once we see the margins around the edge and the bottom are clear, we know that all of the cancer is out.
Then I can close the area knowing that I’m moving healthy tissue into the remaining hole. The great thing about Mohs surgery and dermatologic surgery is the patients are awake, so you can have them animate and move their face, and you can put the scar within the lines that they already naturally have.
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What are some of the latest advancements in the field?
We have the nonablative fractional resurfacing, which is really great because it’s the laser that treats scars as well as fine lines and wrinkles. In the past, patients would take weeks to recover from the redness. This new technology allows patients to get the procedure done and go to work the same day. It takes multiple treatments, and it does-n’t necessarily have as dramatic of an effect, but it does improve scars and wrinkles that we couldn’t do before without causing a lot of down time.
What age and gender demographic do you mostly see?
Skin cancer is more prevalent in men than women. In Hawaii, the average age of the skin cancer patients I treat seems to be younger - even as early as 40s and 50s - than what I saw on the Mainland because people are out in the sun so much here. Most of the time it’s older men and women, and usually in lighter skin - people who have seen a lot of sun throughout the years and have not had much protection. In terms of cosmetic dermatology, I see all ages, more women, but there also have been more and more men who come in.
Any final thoughts?
Make sure you’re wearing your sunscreen regularly because that’s the closest thing we have to the fountain of youth. It’s the most important thing you can do for your skin before deciding on cosmetic treatments.