Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Sunscreens: don’t get burnt!


Although sunscreens are important all year round, they are especially important in the summer months to protect your skin from aging and cancers.

Consumer Reports reviewed 10 well known sunscreens in July 2009 and assessed UVA and UVB protection and their waterproof effectivness and had some interesting findings.  To clear up some definitions:

  • UVA rays are penetrating rays that can cause sunburn, wrinkles, pigmentation disorders and skin cancers.
  • UVB rays cause sunburn and other sink damage and also contribute to skin cancer.  The UVB rays are most responsible for sunburn. 
  • SPF is sun protection factor and measures the UVB sunburn protection on treated skin as compared to skin with no sunscreen.  The way this is calculates is as follows.  Untreated skin normally takes 10 minutes to turn red.  An SPF of 30 lengthens that time to about 300 minutes. 
  • Broad Spectrum implies that the product blocks both UVA and UVB rays (but does not indicate how effective the product is at each).
  • PABA-Free means that the product contains no esters of para-aminobenzoic acid.  Older products with PABA can cause skin reactions, but are rare in products made in the USA.
  • Water Resistant means that the product maintains the stated SPF for 40 minutes in the water.
  • Vary Water Resistant means that the product maintains the stated SPF for 80 minutes in the water.
  • Total Sun block are those with pigments such as zinc oxide that do not allow any sun rays to penetrate.  These are often worn on the nose or lips of sun sensitive individuals.
  • Nanoparticles are particles different chemical or physical characteristics from normal sized particles.  These are often used with zinc oxide or other pigments that totally block the sun rays.  My using nanoparticles, the material looks clearer on the skin. There is some concern about the safety of nanoparticles on human health.  For more info go to www.consumerreportshealth.org and search for nanotechnology.

When shopping for sunscreens, purchase a product labeled “very water resistant” or “waterproof” with an SPF of at least 30 which is plenty for most people.  An SPF of 30 is an easy number to remember and in fact, the FDA is has announced plans to limit SPF numbers at 50.  With this change, sunscreens that provide more than protection than 50 will be labeled 50+.

The highest rated sunscreens by Consumer Reports were:

1. Aveeno Continuous Protection Spray SPF 45. Cost $2.43

2.  Target Sport Continuous Spray SPF 30. Cost $.87

3.  CVS Sunblock with Zinc Oxide for Face, Nose & Ears lotion. SPF 45. Cost $2.33

The Consumer Reports Best Buy were:

1. Walgreen’s Continuous Spray Sport SPF 50. Cost $1.33

2.  Coppertone Water Babies SPF 50 Lotion. Cost $1.14

3.  Target Sport Continuous Spray SPF 30. Cost $.87

You can see that you don’t have to spend a lot to get good sun protection and in fact many people waste money on exotic sounding labels that may provide less protection.  There are some important facts to remember before going into the sun.

  • Apply sunscreen 15-30 minutes before going out in the sun to allow for the absorption and coverage.
  • Apply at least 2-3 table spoons of sunscreen for the average adult.  This is a lot of sunscreen!  Most people apply way too little product.
  • Reapply every 2 hours or after swimming or heavy sweating.  This is very important
  • Wash your clothes after a day at the beach as all of the products can cause stains when left on clothes.
  • Discard sunscreens that are more than 2 years old as they lose potency.  Since there is no expiration date on the bottle, mark the purchase date with a magic marker!
  • Don’t rely solely on sunscreen to prevent aging and cancer.  Protect you skin with clothing, hats and sunglasses.  This is especially important for people with light skin, hair and eye color.
  • Avoid direct sunlight during the hottest times from 10AM-2PM.

There is no doubt that sun exposure accelerates skin aging and the incidence of skin cancer.  Every patient should have a full body mole exam on a yearly basis.  The excessively tanned look is a thing of the past and very few patients are going to avoid the sun completely, so use your head, use moderation and use sunscreen to stay younger longer.

Much sun damage is invisible to the naked eye and Dr. Niamtu offers complimentary skin scanning with the Canfield Reveal Skin Scanner.  You can see in the picture below that in normal light a patient shows little skin damage but with the scanner, there is no doubt about the extent of the damage.  Most patients are shocked to see the degree of sun damage they have.

robscan This image shows a patient in normal light and in the Reveal Skin Scanner.

To keep your skin younger it is important to use Retin-A and some form of bleaching cream.  The Obagi Nu Derm systemis an excellent means of maintaining young and healthy skin.  For patients that desire to reverse sun damage and improve wrinkles and sunspots as well as tighten the skin, Dr. Niamtu offers many treatments including CO2 laser resurfacing, Fraxel Laser, Active FX laser and Deep FX laser as well as Vascular Lasers for spider vein treatment.  Chemical peels are also effective for reversing sun damage and Dr. Niamtu provides numerous types of chemical face peels.



The above image shows a patient before and after CO2 laser skin resurfacing to improve wrinkles,sun damage and sun spots.

Visit http://www.lovethatface.com to find out more about reversing sun damage and keeping healthy skin as well as other cosmetic facial surgery topics.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

July 28, 2009 Posted by | Skin Cancer, Skin care, Sun Damage & Tanning, Suncreens and Sunburn | , , , , | 2 Comments

Lifetime Skin Care


As a busy cosmetic facial surgeon I see thousands of patients a year in consultation for various age related problems.  During the consultation we discuss many things related to facial rejuvenation and one of the questions I ask every single patient is “what do you do for your skin?”  The answers vary from “nothing” to “I use Clinique, or Mary Kay, or Proactive, etc.”  The unfortunate answer is that in reality most women spend hundreds of dollars at the cosmetic counter but don’t utilize a medically based skin program.  Having said that, about 100% of the men I see don’t use any skin care.   Not that there is anything wrong with using the common over the counter skin products, as they do provide some advantage when compared to doing nothing.  The bigger problem is that they do very little when compared to prescription skin care products.  The analogy is similar to Aspirin Vs Percocet.  They are both pain killers, but the prescription strength product does much more.   Same with skin care products.  The products that you can purchase over the counter or over the Internet just are not strong enough to produce significant anti aging effects.  It’s a fact.  Having said this, it is important to understand some of the basics of medically based skin care.  For the remainder of this article, we will focus on prescription skin care products since these are scientifically proven to reverse aging changes in the skin.

Skin aging is a result of many things including heredity, sun damage (actinic damage), wind, etc.  Since our skin is the largest organ on the body, it has to be tough and as all the ravages of life add up, our skin ages, especially in the exposed areas such as the face.  Common skin change includes:

·         Fine Lines and Wrinkles

·         Sun, Age and Liver Spots

·         Uneven Skin Tone

·         Loss of Elasticity and Firmness

·         Loss of Natural Skin Hydration

By using such prescriptions as Retin-A or similar products (Renova or Tazorac) and bleaching agents such as 4% hydroquinone, we can reverse aging changes by the following mechanisms.

·         Increase cellular turnover of abundant, healthy kertincytes, pushing fresh cells to the surface more quickly and promoting old cells to exfoliate faster

·         Suppresses melanocyte (pigment producing cells)production, reversing and preventing hyperpigmentation (brown spots and patches)

·         Promotes even distribution of melanin (skin pigment), eliminating unwanted dark patches and age spots

·         Produces healthy, uniform cells for better skin structure

·         Stimulates fibroblasts to increase collagen and elastin formation, resulting in stronger, more resilient skin

·         Increases natural hydration and necessary nutrients to the epidermis

·         Increases blood vessels and blood flow to the ski

The most common things that patients (and doctors) want to improve through skin care include:

·         Mild to severe sun damage

·         Eliminate sun or age spots and hyperpigmention

·         Fine lines, wrinkles and skin laxity

·         Adult acne

Obagi NuDerm System

In our office we offer numerous levels of lifetime skincare.  Over the past 12 years we have used all he popular major brands of prescription skin care products and over all, we have had the best and most consistent results with the Obagi NuDerm skin care system.  The system is easy to use, can be used on any skin type or color and most important, it works!  No skin care system will work overnight.  Our skin turns over from the bottom layer to the top layer about every 4-6 weeks.  It takes several skin cycles to appreciate the difference so the products must used for about 12 weeks to see the improvement.  Once a patient sees the improvement, they usually continue for life.  Remember, it is “lifetime skin care” The Obagi system consists of a cleanser, toner, bleaching agent, peeling agent, Retin-A and other products.  These creams and lotions are applied twice per day and a sun screen is included.  This skin care system has been very successful in our practice for Caucasian, Asian, Hispanic, and African-American skin types.  It controls age spots, fine lines and wrinkles, promotes skin health and natural color, prevents blackheads and controls most common acne.


Vivite is another popular skin care system made by Allergan and works with glycolic acid instead of hydroquinone.  VIVITÉ® skin care formulations are based on exclusive GLX Technology, a formula matrix that acts as a catalyst for the penetration of glycolic acid bound with natural antioxidants. No other skin care system can offer you this versatile component. VIVITÉ® skin care has GLX Technology throughout the product line in unique formulations that maximize the anti-aging benefits.

The VIVITÉ® skin care routine provides many benefits. GLX Technology has been shown to stimulate the skin’s natural production of hyaluronic acid and collagen. GLX Technology has also been shown to stimulate the production of epidermal growth factor, which is vital to healthy, new skin. The antioxidants protect epidermal cells against destructive free radicals. Vivite is frequently used with Tazorac which is a product similar to Retin-A but is less irritating. 

We frequently begin patients on the Obagi system and if they cannot tolerate it or don’t respond, we change them to Vivite.  In addition, I think it is a good idea to discontinue hydroquinone systems for a while and alternate with glycolic based systems such as Vivite.  It is our pleasure to offer a free skin care consultation to see what is best for you to stay youthful with beautiful skin.  Call us for a free consult.

Although many patients are committed to using multiple potions and lotions several times a day, other patients are not as disciplined.  For these patients we encourage them to at least use Retin-A and hydroquinone.  The Hydroquinone (bleaching agent) is used in the morning and at bedtime and the Retin-A is used only at bedtime.  It is also important to use a sunscreen.


Finally, some patients are very resistant to using multiple products and for our “lazy patients” (like Dr. Niamtu!) we use a single product that is used at bedtime.  Triluma is a prescription cream that contains both Retin-A and Hydroquinone plus an anti inflammatory steroid cream.  The user simply washes his or her face and applies a thin coat of the cream to the entire face before bed.  This is an ideal skin care system for men as they frequently shy away from complicated skin care regimens.

When using Retin-A and hydroquinone the face will frequently become red and itchy.  This means that the products are working.  If the reaction is excessive the amount of the products or the frequency of application is adjusted  to a tolerable lever.  If the patient puts time into simple skin care they can reverse skin aging and prevent further damage.  It works and all men and women should be on some type of medically based skin care to stay looking young and healthy.

For more information about skin care options visit our website www.lovethatface.com or call 804-934-3223 (FACE) for a complimentary consultation.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

May 6, 2008 Posted by | Skin care | , , , | 1 Comment