A Growing Specialty

When I graduated from residency 10 years ago, the catch phrase cosmetic dermatology didn’t exist. There were some who used the few lasers available with dermatologic applications and those who performed what many called plastics procedures and hair transplants. But in the last decade, the refinement of techniques and machinery, coupled with the newly described cutaneous uses of injectable materials has allowed dermatologists to answer the many requests of patients wishing to improve their appearance. Sub-subspecialties have developed in topical agent preparations, cutaneous lasers, injectable agents and surgical procedures. History of Growth This year, cosmetic dermatology has taken a giant leap into the limelight. Scores of topical products crowd shelves of the pharmacy, pages of womens’ magazines, and doctors’ waiting rooms. Even our hard-core medical patients are asking what cleanser is the best for wrinkles. One big contributor to the birth of cosmetic dermatology has been topical retinoids. From the study of retinoid effects on the skin, we, as a group, learned more about the skin than many ever believed possible. The research on the retinoids scientifically described how a topical cream can result in enhanced appearance of the skin with little to no damaging side effects. Retinoids helped to introduce alpha-hydroxy acids, beta-hydroxy acids and families of these products that now exist on shelves in many of our offices. Serving Savvy Consumers Our patients are savvy about what’s available in the treatment of skin, but as dermatologists, we’re the front line of professionals who are sought for advice. Patients ask dermatologists who have practiced a lifetime of medical dermatology the same questions that they ask those who practice only cosmetic dermatology. Whether you are a self-proclaimed believer in all that is cosmetically oriented or a non-believer, this issue of Skin & Aging, the 7th Annual Cosmetic Dermatology issue, will give it to you straight. We know our patients all want to look better. But what we know best as dermatologists is that when we answer our patients’ requests for improvement in appearance, we also answer their desire for improved quality of life. When we can remove pigment that is mistaken for dirt on the face of a young woman applying for her first job, or remove facial hair that causes large fluctuant lesions on the face of a salesman, or fill a scar on the face of teenager hoping to be asked out on a date — we are answering the call to improve the life of a patient. While we can feel good about what we are doing for our cosmetic patients, we need to be aware of our limitations in delivering this care. We must address patient expectations, which may be different from our own. We must continue to train, keeping abreast of the latest techniques in our specialty or sub-subspecialty. I like to think that we’re in midst of an exciting time in dermatology that allows patients and physicians to have more impact in improving dermatologic care. Amy McMichael, M.D.