SUZANNE BRUCE, M.D. Q. Even the most perfectly smooth skin is going to have some wrinkles. What kinds of treatments are available to your patients to minimize or eliminate wrinkles? A. While fine lines and wrinkles cannot be permanently eradicated, there are some excellent choices to minimize and to ease that tired older appearance that wrinkles give to the skin. Crow's feet, wrinkles round the eyes, furrows on the forehead, tiny lines around the lips and the mouth – these are the complaints we hear most when it comes to wrinkles. Two of the treatments that we recommend and have found to be successful here at The Center for Cosmetic Dermatology are Botox and collagen injections. Q. Are Botox and collagen injections similar? Do they work the same? Are they effective? A With Botox and collagen, the results of the treatments are similar in that they both work to reduce wrinkles and smooth the skin's appearance. There are other similarities as well: both are administered by injection and both are non-surgical procedures. Neither requires anesthesia and the results are seen quickly. The procedures take only a few minutes and the results can be dramatic. However, Botox and collagen are very different in themselves. Botox is a much-diluted form of botulinum toxin that is injected into wrinkled areas. At the injection site, the muscles are relaxed, resulting in smoothing of facial lines. Botox is an excellent choice around the eyes for frown lines and crow's feet, and on the forehead. However, it can only be used sparingly around the mouth. Relaxing the muscles in the lower part of the face, particularly around the mouth, can temporarily alter a person's expression and smile and affect eating and speaking. While Botox is very effective on the upper part of the face, the lower half is where collagen is the best choice. With this treatment, collagen is injected around the outline of the lips so fine lines are reduced. Vertical lines and smile lines can be treated within minutes. Q. What are the advantages of Botox or collagen injections? A. Advantages are many. These are non-surgical procedures. Side effects are infrequent, and patients can return to their everyday activities immediately. Neither Botox nor collagen injections hamper future cosmetic treatments should a person elect to have other procedures, even plastic surgery, in the future. Q. Are there any cautions about using either procedure? A. A small percentage of people are allergic to collagen, so we perform two skin tests to rule out the possibility. We currently offer these two tests for free. In the case of Botox, bruising can occur at the injection site. Also, if treatment is not administered carefully, patients can experience drooping of the eyelid. At Suzanne Bruce and Associates, our doctors and out Physician Assistant perform the actual Botox and collagen treatments. Q. In April, the FDA approved the use of Botox for cosmetic purposes. What does approval mean for patients? A. FDA approval of Botox may be reassuring for patients who have been reluctant to try it in the past. With the increased media attention coming from the approval, we are seeing more patients seeking Botox treatment. Q. What is the significance of your membership in the Physicians' Network and your designation as a National Training Center for BOTOX® Cosmetic? A. The Physicians' Network is a distinguished national cadre of physicians that patients can contact when they want BOTOX® Cosmetic treatment. As a National Training Center, we have been selected by Allergan, Inc., the maker of Botox, to train other doctors in the proper use of BOTOX® Cosmetic.     Suzanne Bruce, M.D. is a member of the BOTOX® Cosmetic Physicians' Network, and Suzanne Bruce and Associates, P.A. is a BOTOX® Cosmetic National Training Center.     LEIGH ELLEN EUBANKS, M.D.   Q. Dr. Eubanks, lasers are becoming more and more popular for remedying conditions of the skin. Are there different types of treatments that are better for different complaints? How and why? A. It’s very true that in recent years lasers have become one of the most powerful and effective tools in the treatment of cosmetic skin conditions. Using wavelengths that penetrate different layers of the skin, lasers can reduce or eliminate spots and wrinkles, help to correct sun damage, revitalize collagen and stimulate its growth, reduce the damage caused by acne, and correct more problems including uneven skin tone, enlarged pores, and more. Lasers work by emitting an intense beam of light in specific, and different, wavelengths. There are many different types of lasers, each with a different wavelength. Therefore, each laser works on a different target. We can rely on one laser to correct a problem, such as red or brown spots, and another to be more effective on fine lines or wrinkles. Q. What types of problems are best suited for treatment with lasers? A. Here at Suzanne Bruce and Associates, we have been successfully treating a number of skin complaints with the laser and IPL (Intense Pulsed Light) treatments. These include: brown spots, redness and rosacea, broken blood vessels, fine lines, uneven textures, and pore size Again, it is important to note that different laser and IPL treatments are better for some conditions. A consultation with one of our dermatologists knowledgeable about and skilled in the use of laser and IPL can determine which type of treatment is best to remedy a patient’s particular condition. It is also important to remember that a laser or an IPL device is a powerful tool and should only be used by a professional – someone who is thoroughly trained and acquainted with its intricacies as well as the properties of the condition to be treated and the skin of the patient. Q. FotoFacials have been used successfully by dermatologists for many years. For what problem is a FotoFacial™ the best choice? A. FotoFacial uses intense pulsed light and is one of our most popular treatments. The treatment allows us to target sun-damaged areas and treat these areas very effectively. Sun damage is very prominent in this part of the country. Nowadays, we are so much more aware of the dangers of sun exposure, but truth be told, none – or most of us – weren’t very smart teenagers. We played and bathed in the sun, and we’re all paying for it now in some way, ranging from skin cancer to brown and red sun spots to uneven skin tones. Even as adults, we Texans are outdoor types, enjoying physical activities, such as a round of golf, that put us in the sun for hours at a time. Specifically, FotoFacial has proven to be very effective in the reduction of red and brown spots. We have also used it successfully to help achieve a more even skin tone. A series of five treatments over a period of four or five months is generally recommended for optimum results. Q. What laser treatment do you most often recommended to resolve fine wrinkles, acne, and acne scars? A. In our years of working with lasers, we have found that our non-ablative laser treatments are very effective to help decrease wrinkles, reduce acne scars, and help resolve acne. Additionally, we have found that the laser treatments, such as CoolTouch®, help improve pore size. I have found that this type of laser treatment is excellent for fine lines that can appear around the mouth. A non-ablative laser like CoolTouch uses the light energy to stimulate collagen, which improves wrinkles and scars. However, because the laser is non-ablative, meaning it doesn’t injure or remove any layers of the skin, there is little or no down time needed for recovery. Most patients have redness for about an hour after a treatment. I also recommend the CoolTouch for individuals with acne scars. These patients can realize a 20 to 40 percent improvement – oftentimes even more. And, the improvement is usually permanent. Many of my twenty-something patients have found great relief from their acne scars with CoolTouch. To be effective, a series of five treatments is recommended, and patients who cannot undergo the complete series are advised to consider another treatment. One treatment is administered every three to four weeks. Q. Are there more lasers treatments that you and your colleagues at Suzanne Bruce and Associates recommend for patients? A. Absolutely. In fact, we have found that FotoFirm™ is an ideal treatment to address the components of sun damage, including red capillaries, brown and red spots, redness, rosacea, and other forms of skin damage. FotoFirm is a skin-rejuvenation treatment that utilizes a combination of laser, IPL and radiofrequency energies, giving us the ability to target multiple problems at one time. FotoFirm is generally a series of five treatments, and the recommended time frame is one every three weeks. With a FotoFirm treatment, a patient may experience some redness and swelling, and brown spots will generally get darker before they lighten. Q. There’s a lot of talk about Thermage®. What are its advantages? A. Thermage is a non-ablative treatment that utilizes radiofrequency energy. The treatment is designed to cause immediate collagen contraction, followed by collagen production over a three-to-six month period of time post procedure. Many of our patients have had excellent results with Thermage, including subtle and gradual tightening of the skin. It has been used effectively to sharpen a jaw line, raise eyebrows, and help with sagging under the chin. Thermage offers a patient a non-invasive alternative to tighten loose skin. It is effective on any skin type. Q. Is Thermage® only for facial procedures? A. We have very recently begun using Thermage on different areas of the body to help tighten skin on the stomach and arms. This treatment known as Body by Thermage™ is designed to contract collagen and then cause collagen production, making it an excellent choice for areas that need tightening. It is not, however, a tummy tuck. But, in many cases, such as post pregnancy where there is a surplus of loose skin on the abdomen, we are having good results. A patient sees some improvement after the treatment, and gradually, the tightening continues over a period of a few months. Q. Fraxel® is a laser treatment which is also receiving lots of attention from patients and in the press. Can you give us insight as to this treatment and which conditions it is best for? A. Fraxel is one of the newest laser treatments for skin resurfacing. An ablative laser, it is unique in that it works to remove only about 20 percent of the skin, so recovery is quicker. Fraxel is very effective to improve texture and pore size and eliminate brown spots, dispigmentation, and mottled skin. It is the recommended treatment for the facial lines that are deeper – and it is excellent for older skin that may not respond as well to other laser treatments. It can also be used to give hands a more youthful appearance. It was just recently cleared by the FDA for the treatment of acne scars and surgical scars. With Fraxel, however, there is more downtime than with some of the other laser treatments. There is generally redness and swelling, and subsequent treatments will have peeling, dryness, flaking, and such. Patients find that these conditions resolve as the skin heals. Q. All of these treatments sound very effective. Are there any cautions for individuals who are interested in using one of these procedures to change and improve the appearance of their skin? A. Lasers and IPL and radiofrequency devices are invaluable when it comes to restoring skin to a healthier condition and restoring a younger, fresher-looking appearance. However, I do caution every person considering any of these treatments to know who is going to administer that procedure. It is important not only that the person using the device has an extensive knowledge of the benefits of the procedure and experience with equipment, but also that this person knows how the skin heals and perhaps more importantly, how the skin might be damaged. Lasers are undoubtedly remarkable tools, but it is the doctor’s skill that makes it an effective tool. Lasers are powerful and in the hands of an unqualified person, who perhaps has had only an hour or two of training, the results can be devastating. Here at Suzanne Bruce and Associates, we understand lasers and our other treatment devices. We have been trained and attend subsequent training sessions as techniques and technologies improve. We are constantly consulting internally among our doctors about what works best and adapting our procedures. We understand the physics and the science behind the lasers and IPL and radiofrequency devices. We make our recommendations based on experience and medical knowledge. All our treatments are administered in an aesthetically-pleasing but still medical environment.     Leigh Ellen Eubanks, M.D.     KRISTEL POLDER, M.D. Q. Dr. Polder, welcome to Suzanne Bruce and Associates. Your education and your medical experience are an excellent fit for the dermatology practice here at SBA. Please tell us a little about yourself and your background. A. Thank you. A native Texan, I grew up in Wichita Falls. After graduating with honors from Texas A&M University, earning a major in Biomedical Science and a minor in English in December 2000, I began my studies towards my M.D. at The University of Texas Medical School in Houston. I graduated in the spring of 2005. After medical school, I completed a one-year internship in Internal Medicine in Boston at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. I chose Internal Medicine because it is an excellent base from which to enter dermatology. I returned to UT Houston for my three-year residency in dermatology where I rotated between Lyndon B. Johnson General Hospital, Memorial Hermann Hospital and the University of Texas MD Anderson Cancer Center. Training at these three hospitals was a well-rounded experience as I was able to see patients in a variety of situations, some private patients, some who were in the county hospital as well as cancer patients at MD Anderson. In my most recent rotation, I served as the consulting resident at MD Anderson. I consider myself fortunate to have studied and trained in the Texas Medical Center, particularly at the number-one cancer facility in the world. I have enjoyed a one-of-a-kind education and experience. I have been working with Dr. Suzanne Bruce and the staff here since January and, after I am board certified in dermatology in August, I will join the practice as a full-time staff physician. On the personal side, I am married to a physician who is completing his residency in Anesthesiology at Baylor College of Medicine. We were married in 2008 – a few days after Hurricane Ike hit the city. The church had no electricity, which made the event even more memorable. Storms seem to hallmark major events in my life, as I was born during the famous 1979 tornado in my hometown of Wichita Falls, Texas. Q. Was there a storm that brought you and Dr. Bruce together? A. No, actually, it was an airplane! During my residency, on a trip traveling from Boston to Houston, I was seated on the airplane next to Dr. Bruce and her husband Malcolm Waddell, who were traveling home from a reunion at Harvard. Dr. Bruce’s carry-on had the name of a dermatology conference printed on it, and when I saw it, I asked if she was a dermatologist. That started a conversation that continued the entire flight and ultimately ended in my joining her practice. In another small-world coincidence, the physician who served as my mentor in residency was also Dr. Bruce’s mentor in medical school. Even before meeting on the airplane, I was familiar with Dr. Bruce and the excellent reputation of her practice. I remember years ago, when I was a medical student here in Houston, thinking that someday I would like to join a practice as solid as hers. Q. When you began the interview process with Dr. Bruce, why did you believe that this was the right place for you? A. When I was completing my residency, we sought out each other, and Dr. Bruce invited me to come and spend a day shadowing her and her Physician Assistant, April Harrison. This was an excellent insight into the practice, and I was able to learn first-hand about the environment and philosophies here. When I walked in the door, the offices were exactly as I had envisioned: calm and welcoming, yet professional. The overall ebb and flow was ideal. Patients were welcomed by everyone, and the staff was well educated, courteous. The patient was the first concern of every person on the staff. Q. Now that you have been seeing patients on a part-time basis, does your first impression still ring true? A. My first impression has been validated many times over. This practice is patient-oriented, friendly. The other dermatologists are supportive and the staff is number one. Plus, Dr. Bruce is an incredible teacher. While dermatology residency offers a thorough education on the medical side of dermatology, cosmetic procedures are not stressed. It has been such an education to have her at my side during cosmetic procedures and during my training with various companies on all our equipment and indictables. Learning from the best – that’s how I feel.     Kristel Polder, M.D.     APRIL L. HARRISON, MPAS, PA-C Q. April, your education and training have earned you a degree as a Physician Assistant (PA). Please tell us more about this field. A. A physician assistant is a health-care professional who is licensed to practice medicine with physician supervision. That supervision does not mean that the physician has to be in the room with the PA when she sees patients. It means that the supervising doctor oversees the PA’s training and development and ultimately the work that PA does with patients – just like a supervisor in any other business. A PA can conduct physical examinations, diagnose and treat illnesses, order and interpret tests, offer counsel on preventive health care, assist in surgery, and write prescriptions in most states. Here at SBA, I work under the supervision of Dr. Bruce, and provide both medical and cosmetic services. Dr. Bruce and I have a close working relationship. She trained me in all cosmetic procedures; we consult on procedures and technologies; and I treat both my own and some of her patients. Q. The training and education to obtain your certification as a physician assistant runs parallel to that of a physician. Do you see and handle the same type of dermatological patients as a physician? A. Yes, my patients are exactly the same. I am licensed to practice medicine, and the only medical limitation a physician assistant has is that I cannot perform unsupervised major surgery. As part of my PA degree, I studied pharmacology at UTMB and am licensed by the state to prescribe medications. Q. Do you belong to professional associations? A. Yes, I am a member of the Society of Dermatology Physician Assistants, the Texas Academy of Physician Assistants, and the American Academy of Physician Assistants. Q. Tell us your experience since you started here at Suzanne Bruce and Associates in mid-2005. A. For the first few months, I shadowed Dr. Bruce, expanding my knowledge of dermatology and my skills, learning from her. Whatever procedure or treatment that she recommended, I watched and learned from her, adding what I knew from my past experience at MD Anderson. As I learned, I began to administer the procedures and see patients just as Dr. Bruce does. Now, I see patients for everything from consultations to treatments. I also work in The Center for Clinical Research as a sub-investigator on various clinical trials. Q. What types of patients do you see in your practice at SBA? A. I treat patients with the same types of concerns that the physicians do. Here are some examples of patients whom I have helped over just the past few weeks: • One of my appointments was with a woman who was concerned about brown spots, broken capillaries, age spots and a red, ruddy complexion. From an earlier consultation, she had decided on a series of FotoFacial™ treatments to correct the problems. She came in an hour before her appointment with me, and a medical assistant applied a numbing cream. Then, I administered her first FotoFacial on her face, neck and chest. She will return for more treatments over the coming months. • With her son’s wedding coming soon, a patient decided it was time for BOTOX® Cosmetic injections to lessen the wrinkles between her eyebrows and on her forehead and to soften her crow’s feet. I administered the treatment to the problem areas. • Thermage®, an excellent solution for loose skin, was the answer for a patient who wanted a rejuvenated look for a college reunion. I used Thermage to tighten the skin on her lower jaw along the jowl line, on her face and under her chin. • Another individual came in for the fifth and final treatment in a FotoFirm™ series. This procedure uses intense pulsed light and a collagen-building laser to reduce freckles, rosacea, large pores and wrinkles. She will be returning in the next six to twelve months for a maintenance treatment. • I have seen several patients who are using Restylane®, a dermal filler, to soften prominent nasolabial folds (the diagonal line between the nose and corner of the mouth) and reduce marionette lines (the vertical lines at the corners of the mouth). After the area to be treated has been numbed by one of our medical assistants, I administer the Restylane via tiny injections. • One individual came to me recently to discuss a remedy for freckles, brown spots and crow’s feet – and an overall rejuvenation for her skin that was showing the effects of aging. She was very knowledgeable and had read about treatment possibilities in our newsletter, The Skinny. I determined Fraxel® would be the best option for her. Fraxel is a laser we use to resurface the skin. I answered her questions, and we discussed possible side effects. She then made an appointment to start a Fraxel treatment series. • I am treating another patient for loss of volume in her face. She originally came in concerned about sunken cheeks, nasolabial folds and marionette lines. I recommended Sculptra™, a synthetic, injectable filler that we use to treat wrinkles and contour irregularities. It can last up to two years. Sculptra requires two or three sessions every three to four weeks. I will be seeing her for her final treatment soon. • I was recently treating a patient with sclerotherapy for her leg veins, and I noticed a suspicious mole on her leg. As SBA is a medically-based dermatology practice, we were able to further investigate the mole and determine its pathology. Q. You also mentioned The Center for Clinical Research. What is your capacity in this department of Suzanne Bruce and Associates? A. I am active in different studies at The Center for Clinical Research, and I see patients there almost daily, following their progress and determining the usefulness of different drugs. For instance, I am sub-investigator now on an acne study that is trying out combinations of different drugs and in a psoriasis study to determine a new drug’s effectiveness. Q. It sounds like you have enjoyed all aspects of your practice since joining SBA. How would you sum up your experience so far? A. very day is interesting and exciting. I really enjoy seeing and treating patients and getting to know the new patients and understand their concerns. I am challenged to stay on the edge of the latest developments in dermatology and administer the best treatments possible. I am honored to work with the top cosmetic dermatologist in Houston. Q. Life is not all work and no play. Tell us a little about your life outside the office. A. I am married, and my husband is an executive with Methodist Hospital. We just welcomed a daughter into the family; she was born in February 2005. She’s beautiful, but with blue eyes and red hair, I’m already applying sunscreen. Every time we go out for a walk, on it goes. She’ll grow up knowing the importance of protection from the sun, and it will be second nature for her to wear sunscreen.     April L. Harrison, PA-C     CHRISTINA AHRENS, ARNP Q. Christina, as a nurse practitioner (NP), you have completed graduate school as well as become nationally board certified. Please tell us about your education. A. Patients often ask ‘what is a nurse practitioner,’ so let me address that question first. In the medical field, an NP is a registered nurse (RN) who has completed advanced training, usually a master’s degree, in the diagnosis and management of common and complex medical conditions. After receiving an undergraduate degree in nursing, a registered nurse may enter into an NP program, which varies in length from one to two years. After NP training is completed, the candidate must take a specialty board exam to become certified. In general, nurse practitioners provide a broad range of health-care services, including prescribing medications, treating illnesses and administering physical exams. A nurse practitioner can provide most of the same care as a physician and maintains close working relationships with physicians. Q. Where did you complete your education to become an NP? A. I obtained my undergraduate degree, a Bachelor of Science, from the University of North Florida in the spring of 2005. I then attended the University of Florida in Gainesville, where I completed the educational requirements and received a Master’s of Science in Nursing in the fall of 2006. After graduating with honors from both programs, I received national board certification as a Family Nurse Practitioner. The Family Nurse Practitioner encompasses all specialties and all ages, but for the last semester for my master’s degree, I trained with a dermatologist, Dr. Alison Moon, in Jacksonville Beach. I then joined her and worked in her practice for over two years until I relocated to Houston in June. Q. What attracted you to dermatology? A. I enjoy that it is a visual field and appreciate the wide variety of conditions that are treated as well as the challenges that come with that. I also enjoy treating all age groups. It is a very rewarding field, one that allows you to really make a difference for each patient. Q. What brings you to Houston? A. I am recently engaged and my fiancé, a physician, will be completing a fellowship in plastic surgery at Methodist Hospital, so we are both relocating here to Houston. Q. Your background sounds like an excellent fit for Suzanne Bruce and Associates. How did you discover this practice? A. My finding Dr. Suzanne Bruce and her practice here in Houston is a wonderful coincidence. Dr. Moon, the physician I worked with in Jacksonville Beach, actually trained in cosmetic dermatology procedures with Dr. Bruce, before she opened her own practice. And, Dr. Moon grew up in Houston and knew Dr. Bruce because they both attended the same church. Dr. Moon spoke very highly of Dr. Bruce and when I gave notice that I was moving to Texas, she made the introduction and recommended me. I was very fortunate to make the connection. Q. What did you like about Suzanne Bruce and Associates? A. The very first thing I noticed – and appreciated – is that this practice puts the patient first. Everyone is focused on providing the best care for patients in all phases of the practice, including medical, cosmetic and research. There is also an excellent camaraderie, a good collaboration among the doctors, the support staff, everyone. It’s a family-type practice, and I truly believe that the best medical care stems from this philosophy. Q. Will you be involved in all phases of medical care at Suzanne Bruce and Associates? A. Yes. Most of my experience thus far has been in the medical arena, but I am very interested in learning more about cosmetic dermatology procedures. I am also excited about the research aspect of the practice. Dermatology is a constantly evolving field, and it’s extremely important to continue learning. Dr. Bruce stresses continuing education and learning in the practice. She and all the professionals at Suzanne Bruce and Associates are curious; always open to ideas to be able to offer the best choice, the best treatment for patients. I think this is going to be a very stimulating opportunity for me in all areas. Q. What about hobbies and interests outside of dermatology? A. Running and traveling are my two favorite activities. And, of course, planning the wedding. My fiancé and I will be getting married in two years, so we have time to plan everything.   Christina Ahrens, ARNP     JASMINE LEUNG, RN, BSN Q. Ms. Leung, your years of experience as a nurse have been in several different areas of medicine. What has stimulated your interest and brought you to the field of dermatology? A. During my years as an RN, I have been privileged to work in many different fields of medicine, from oncology to critical care to dialysis and more. In my experiences, I have been involved with patients and with clinical trials which have piqued my interest in many different directions. When I was helping conduct a study at the University Of Texas Dermatology Clinic, I was involved with a clinical trial study on skin rejuvenation. I was fascinated. An additional conference on skin care furthered my interest and my knowledge, and when Dr. Bruce approached me about this unique position, I realized that it was an ideal way to put my knowledge to further use. Q. Describe your position here and how what you do adds such a unique dimension to this practice? A. My title is Clinical Associate for Cosmetic Services. As such, I see patients and I make recommendations to help them reach their skin-care goals. What makes this unique is that I am able to offer the patient an overall perspective. I know the capabilities, and the limitations, of today's skin-care products. I know when a physician should be consulted. In effect, I blend the medical treatments with skin-care regimes. Q. Skin-care products are available at most every drugstore. Are those offered at a dermatologist's office really any different from the rest? A. Absolutely. All our skin-care products are highly effective, and what's more they have been scientifically proven and dermatologically tested. There are many products sold in stores that are excellent. Ours just take the processes further, offering more intense, more specialized care. And, the fact that we oversee their administration and recommend a specific regime adds to the effectiveness. Q. Describe what you and a patient would discuss during a first visit. A. Our first discussion is centered on expectations. I am always honest as to what goals can be reached and which are unattainable. When a patient approaches me with unrealistic goals, I always stop and tell them I cannot help. I know our products, and I know what the results will be. For instance, a patient who is in a hurry and wants results overnight is not a good candidate. However, someone who is willing to work with the regime and take the necessary steps can be successful. And she, or he, is usually delighted with the results. Q. How do you assess a patient's treatments? A. Generally, a patient has a specific problem he or she wants to correct. For instance, if someone is troubled by acne scars, a Derma Peel or Obagi Peel may be an option. Fine wrinkles or pigmentation may require a more aggressive treatment. I may bring in a physician for a consultation or to administer a treatment, such as Botox for reduction of forehead wrinkles. Every treatment, every recommendation, every patient is different. Of course, if I see what I determine might be a serious problem, such as a skin cancer, any of our physicians is available to make a diagnosis. That's the beauty of being at Suzanne Bruce and Associates, we have the best of both worlds.   Jasmine Leung, RN   MARIA ANTESODA, RN and MARCELA RAMIREZ, RN, BSN Q. Have you seen many changes or advances in cosmetic dermatology procedures in recent years – particularly in permanent hair reduction? Maria: In all phases of treatment here at The Center, we are always seeking the most effective procedures. Dr. Bruce is always searching and researching to find the best and the latest for her patients and our clients. But, it’s not just new for new’s sake. When new equipment is mentioned in one of her journals or at a meeting, Dr. Bruce investigates. When new applications are discovered, she goes to conferences – or sends us. It is her dedication to excellence that inspires all of us to provide the utmost in care for everyone who comes to us. And it is her insistence on knowing all we can that drives us to perform at our best. She sets the standard and expects us all to follow her lead. Marcela: Our new permanent hair reduction laser is just one example of the level of commitment here at The Center for Cosmetic Dermatology. In October 2005, we added the Cutera® CoolGlide Vantage laser. However, we didn’t just randomly select the Cutera. Over the summer months, we brought in five or six different types of lasers. We worked with each of the different machines, trying the equipment out and evaluating each machine’s benefits. We questioned the consultants, and we went to seminars. After careful deliberation, we decided on the Cutera. Q. What is unique about the Cutera and what are its benefits? Maria: The Cutera is a versatile laser. As a hair-removal system, it offers permanent hair reduction. Because of its longer wavelength, it is particularly suited for patients with darker skin types. Marcela: It’s a nice complement to the EpiLight, which uses intense pulsed light (IPL) for hair removal and is particularly effective on clients with lighter skin. Q. Does the Cutera work on all skin types? Marcela: Yes, it can be used on all skin types. However because it is an Nd:YAG laser rather than an IPL device, the Cutera is ideal for individuals with darker or tanned skin. The long-pulse Nd:YAG laser beam bypasses the melanin layer and goes directly to the hair follicle. We have used it successfully on our African American, Asian, Indian and Middle Eastern patients and our tanned patients. Before, we had to be very careful with our Epilight settings when treating these patients and treat at lower energy levels, which usually translated into more treatment sessions to achieve the desired results. Now, we can provide effective results in fewer treatments more safely. The risk of superficial burns is greatly lessened, virtually eliminated. Q. Is permanent hair reduction possible for blond or light hair? Maria: Because it contains very little pigment, blond or light hair is difficult to treat effectively with any laser or IPL system. We can get some reduction with the Aurora, which uses a combination of IPL and radio frequency energy, but it takes many treatments to achieve any meaningful results. Q. Where can the Cutera laser be used? Marcela: Both the Cutera and the EpiLight can be used anywhere on the body where there is hair, except around the eyes. We treat legs, bikini area, underarms, stomach, back, chest, arms and face. For women, the bikini, underarm and face are the most frequently-treated areas. For men, the back, neck and beard are the most common treatment sites. Q. What percentage of your patients are men? Maria: Most of our patients are women, about 80 percent. But more and more men are realizing the benefits of permanent hair reduction. With men, ingrown hairs and infected follicles can produce unsightly bumps and blemishes – particularly on the neck. Using the Cutera, these blemishes are pretty much eliminated. Marcela: And now that we have the Cutera for darker skin, African American men and women can be treated very successfully. African-Americans, men in particular, often suffer with razor rash, and these treatments can eliminate many of the problems related to shaving. Q. Many places – spas and beauty salons – advertise hair removal treatments. Are these the same treatments you offer here at The Center? Maria: It’s hard to guess what other establishments might offer in the way of hair reduction, but as RNs with years of experience, Marcela and I both know how to administer these treatments to achieve the best results for our patients. Hair removal is not a guessing game. I have heard stories of technicians reading guidelines and guessing about the level of intensity – that’s not how we operate. Hair removal requires precise calculation. The procedure is important and must be performed safely. It should not be treated lightly as simply a beauty decision. We are both licensed and certified on our hair removal equipment. Marcela: And, because we are medical professionals – and supported by Dr. Bruce and her team of dermatologists – we know the importance of continuing education and investigation. We both spend time throughout the year at seminars and conferences to keep up with the latest techniques and settings. Dr. Bruce herself is intent on knowing the very latest applications and having the most effective technology. Q. As registered nurses, both of you are professionals in the medical field. How long have you been with The Center for Cosmetic Dermatology? Maria: I have been here since 2000. Before joining The Center, I worked for a spa that offered laser hair removal. I have ten years of experience in the field. In fact, I worked with the first FDA-approved hair removal laser. Marcela: I also started with Dr. Bruce’s practice in 2000 after graduating from Texas A & M with a bachelor of science in health. I received my bachelor of science in nursing (BSN) from the University of Texas Health Science Center in 2003 and have been seeing my own patients ever since. Maria: We both work closely with the doctors here, offering cosmetic procedures, including permanent hair reduction, for men and women. Q. Have you been able to help individuals who suffer with too much hair? Maria: Yes, in most instances, the changes are outstanding. We have women who have come in with excessive facial hair. They are shy and withdrawn because of their appearance. Yet, with just a few treatments, the difference is remarkable and the results life-changing. It is such a joy to have them look at me straight on, not worrying about having too much hair on their faces. We can point to many success stories. Q. Is permanent hair reduction a long process? Marcela: The recommended, most effective method for permanent hair reduction is a series of at least four treatments, each spaced at least six weeks apart. Some salons or spas tell their clients to come in sooner, but that’s really a waste of money. Spacing treatments closer than six weeks doesn’t allow enough time for the hair to grow. Maria: The treatment is simple, lasting from 20 minutes to an hour, depending on the area treated. We generally recommend that an individual use an anesthetic cream, which can be applied at home before the patient arrives or we can do it here in our office. During treatment, the Cutera laser or the EpiLight IPL wand is skimmed over the surface of the skin, which has been coated with a gel. There is a sensation, more intense with the Cutera, depending on the area. After the first treatment, hair reduction begins in about seven to 21 days. For three weeks after that, there is no hair growth. Basically, the first treatment results in about a 15 percent reduction, which some people say they can see and others cannot. Marcela: The second treatment is six to eight weeks after the first one and the third, six to eight weeks after that. The change after the third treatment is often dramatic, but that, of course, depends on the patient as well. Maria: The permanent hair reduction treatments are definitely effective. Our many satisfied patients refer their family and friends. We also get many referrals from other doctors. Maria Antesoda, RN Marcela Ramirez, RN SANDRA M. NERO, CRC Q. Sandy, tell us about The Center for Skin Research. A. The Center for Skin Research, which was started in March 2000, was a component that Dr. Bruce always wanted to incorporate into her practice. When she was a member of the faculty at Baylor College of Medicine, she was the head of dermatological research for the university and wanted to pursue this area in her own practice. During her years at Baylor, I was a clinical research coordinator, and it was there that I met Dr. Bruce. When she started The Center for Skin Research, I left Baylor and joined her here as the first full-time research coordinator. Q. Who is involved in The Center for Skin Research? A. The Center for Skin Research has grown quickly, and now there are several of us who work here. Jasmine Leung and I are full-time coordinators, while Kristy Madia and Sue Shannon have recently joined us as full-time coordinator assistants. Dr. Bruce is the lead doctor and principal investigator. April Harrison, PA-C serves as a co-investigator. Dr. Eubanks is involved in various trials as needed. Both coordinators were involved with research before joining The Center. Jasmine worked in research at the University of Texas Heath Science Center Houston. Q. What are the benefits of having a research component? A. As we conduct research, we are continually at the forefront of medications that are being used for dermatology. We can learn first hand what works best. For instance, now Tazorac™ is a well-known drug, but before it was used on a widespread basis, we were involved in its testing. We also conducted a study for a topical gel that may be approved to treat basal cell carcinoma. The drug irritates the area that is affected, and when the area heals, the basal cell cancer is gone. And, there’s no scar, no surgery. It’s a remarkable new development in basal cell treatment. Q. What kinds of checks and balances do you have? A. First of all, there’s an internal pride at Suzanne Bruce and Associates that sets our standards to the very highest levels. With our backgrounds in research, we adhere to stringent criteria so that we can truly judge a medication and can offer meaningful data. Furthermore, FDA approves the studies, and the Institutional Review Board (Ethics Board) checks to be certain that all trials are conducted correctly and are not harmful to the patients. We have established a reputation for excellence here at The Center. Pharmaceutical companies seek us out. Q. How do you find participants for the studies? A. There are a variety of ways we find patients for our studies. Our website is an excellent source of information. Individuals who are interested can read about the current studies and can e-mail or call us to be considered. We also recruit patients from both our Medical and Cosmetic Center, and we often advertise in the newspaper or on the radio. Q. Is there a cost involved? A. No, the studies are free to patients, and usually there is a stipend given to participants to cover their time and travel. When required, any lab work is generally included as well. Q. What is the length of time for the studies? A. Time frames vary, but most clinical trials last from four weeks to a year with some running up to 18 months. Each criterion is different, and so every trial has a different time frame. Q. Describe the care a patient would receive if he or she were participating in a trial at The Center for Skin Research. A. Patients receive exactly the same care they would if they were a patient at either The Center for Medical Dermatology or The Center for Cosmetic Dermatology. We cater to our patients and offer the same nurturing environment that is found in all divisions of the practice. I should also mention that patients in our trials are treated with confidentiality. Q. After a trial is concluded, what happens to the information? A. The sponsoring drug companies review all the data that we have collected. Then, combined with information gathered from other research sites around the country, they evaluate the effectiveness of a drug and determine whether it would be beneficial. If the answer is yes, they approach the FDA for approval. Sandra M. Nero, CRC MARIA URIBE MARTINEZ Q. Maria, you have been with Suzanne Bruce and Associates for four years. Tell us a little about yourself. A. I was born in Mexico, but my parents moved to Texas when I was just 12 months old. Because of my heritage, I am bi-lingual, speaking both Spanish and English. I earned my Texas Medical Assistant certification here in Houston, and I am currently pursuing my national certification. Before joining Dr. Bruce’s practice, I was employed by an ophthalmologist here in the city. The doctor’s primary concern was, of course, eyes, but he also did laser skin-resurfacing procedures. I was able to assist, so that’s how I became interested in dermatology. The more I learned, the more I wanted to know and be involved with skin care. Actually I came here on a personal office visit, then applied for a position and have been working here ever since. Before assuming my new position as a patient-care coordinator, I was a medical assistant helping the doctors treat patients on both our medical and cosmetic sides of the practice. The knowledge that I have gained over these four years has prepared me to be a patient-care coordinator and be responsive to patients’ needs and concerns. Q. Why is Suzanne Bruce and Associates such a good professional environment? A. The environment here is dynamic, energetic. Everyone – the doctors, the nurses, the patient-care coordinators, the staff – works very hard, providing patients with the utmost in care and the very latest procedures. I enjoy the day because there is always something new to learn. The practice is always ahead of the game, seeking answers, reading, investigating. “Did you hear about this treatment? Did you read about this procedure? How does that work?” – that’s what it’s like here, questioning, confirming. Everyone loves the pace and the attitude. It’s a very stimulating practice. I’m happy – proud – to be a part of Suzanne Bruce and Associates. Q. What do you think makes Suzanne Bruce and Associates different from other dermatological practices? A. I truly believe that the fact that all the doctors and the staff are women makes a difference. To the one, they are thorough. Nothing is too small to be considered. If a patient has a question, someone will take the time to find the answer. From a medical perspective, the dermatologists are thorough and exact. From a cosmetic aspect, the doctors understand that while the answers are based in sound medical discipline, the results are cosmetic. Appearances are important. Plus, the research component keeps us aware of what’s new. With research, our doctors accumulate data first hand. They use the knowledge and experience gained from our research when treating our medical and cosmetic patients. Consider my position, for instance. When I meet with new patients in The Center for Cosmetic Dermatology, we visit and discuss the issues and options. And, I use the VISIA system to analyze the patient’s skin from a technical standpoint. The VISIA procedure, which by the way is complimentary with an office visit, analyzes the skin and gives the dermatologist a picture to determine the good and the bad. We get a picture of sunspots, wrinkles, sun damage, evenness of tone, pore size and bacteria level. It’s all there for the doctor. The patient and I discuss the VISIA results and then, when the doctor comes, the patient already has background knowledge – about his or her skin and about the options. The doctor-patient interaction can now take a more focused direction. Q. VelaSmooth has been attracting a lot of attention for treating cellulite. What have the results been? A. We have been offering VelaSmooth™ here in The Center for Cosmetic Dermatology for a while and the results have been encouraging. Patients have lost inches; skin that was once lumpy has a smoother texture. It is an exciting new option for treating cellulite on the abdomen, thighs and buttocks. As I mentioned earlier, we are fortunate because The Center is one of the test sites for VelaSmooth, so we are able to offer the treatments prior to FDA approval. The treatment is not painful. It doesn’t require topical anesthetic. If fact, it feels somewhat like a warm massage. VelaSmooth takes about 30 to 45 minutes per treatment, and generally, a patient will need ten treatments initially with follow-ups recommended once a month for six months. Q. What else is new? A. Prevage™ is a new skin-care product that we cannot keep in stock. The anti-aging cream contains idebenone, an antioxidant that is proving to be the most potent and effective antioxidant yet. Prevage offers improved appearance of fine lines and little wrinkles. Plus skin is smoother and less dry – and it looks more even. It’s remarkable. Our patients love this new product. We also recently added glo™ minerals, a line of mineral-based makeup, and it is proving to be very popular with our patients. Maria Uribe Martinez