Suzanne Bruce and Associates

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.

MIRIAM L. HANSON, M.D.

Q. As a medical student, what interested you about the field of dermatology?
A. During my second year at Baylor College of Medicine, we began to do rotations and research in several different disciplines. I did a dermatology rotation early on, and enjoyed doing the procedures and learning about dermatology. At that point, I started researching my options and realized that dermatology might be an excellent specialty for me. I did enjoy many other fields, but I just felt dermatology was the best fit for me.

Q. During your internship and residencies, how did you pursue your studies in dermatology?
A. After graduating from Baylor, I started the four years of internship and residency. For dermatology, students are required to complete one year of internal medicine and three years in dermatology.

As my studies continued, I found that dermatology provided an excellent combination of surgery, cosmetic procedures and medical dermatology. Also, coming from UT Southwestern, where the school has an emphasis on research, I found that I was particularly drawn to the clinical trial side of dermatology. And, that’s actually one of the reasons I like the practice that Dr. Bruce has established, with The Center for Skin Research.

Q. You grew up in Austin and completed your studies in Dallas? How did you know about Suzanne Bruce and Associates?
A. I had heard about Dr. Bruce when I was at Baylor. She used to teach at the medical school, and I knew of her reputation. This past year, when I began to consider my path after my residency, I started looking at different practices. I saw a posting for Suzanne Bruce and Associates and answered it.

Q. What about the practice did you think would make it a good fit?
A. First of all, I really like the diversity of Suzanne Bruce and Associates. I like the cosmetic aspect and the medical side. Plus, as I mentioned, due to my training at UT Southwestern, the clinical trial component is of particular interest. It has been an easy transition for me.

I am also very appreciative of the practice’s focus on the patient. The doctors and medical staff are very aware of all aspects – providing the ultimate in care, both medically and cosmetically, while maintaining a high level of professionalism.
On several visits, I took the opportunity not only to visit with the doctors, but also to talk with the staff. On every occasion, including the Saturday United Way Women’s Initiative Program hosted by SBA, the staff was professional, and happy, an aspect which I believe is extremely important in the overall scheme of things.

Many on the staff have been with Dr. Bruce for a long time, some since the beginning. That says quite a lot about the quality of the care and the importance of maintaining excellence. As well, the patients were pleased with the care they were receiving.

Finally, Dr. Bruce herself was a major factor in my decision to join the practice. She is such a warm, caring person. Easy to work with and friendly. Also, though I have completed my work as a resident, she has worked with residents in the past, and I sense that she continues to maintain her role as a mentor and teacher. The doctors and medical staff are all very involved in continuing training, which was another key factor in my decision and very important in the ever-changing field of dermatology.

Q. You mention the field of dermatology as changing, can you comment further on that?
A. As with every field of medicine, innovations and discoveries continue to change in dermatology. Medically speaking, there are new drugs to treat psoriasis, lupus and other conditions that were formerly difficult to treat. Of course, one of the biggest changes is the advent of cosmetic dermatology procedures, which are growing exponentially. When it comes to cosmetic treatments, it is so important for individuals to rely on professionals who are medically trained. The medical professional that a person chooses for skin care needs to be someone who has done a lot of procedures and stays up-to-date. There can be complications, and the doctor or medical professional needs to know how to handle the situation. Procedures are user dependent, and a person will always get better results from someone who has undergone extensive and on-going training.

During my visits for training and my first month of practice at Suzanne Bruce and Associates, I have been impressed with the emphasis on providing excellent patient care in medical and cosmetic dermatology. Among the doctors and medical staff, there is an enthusiasm and commitment to stay at the forefront of dermatology. It is encouraging to see such a focus on learning, training and delivering the best possible results.

Miriam L. Hanson, 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

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

SUZANNE BRUCE, M.D. and MEGAN PASCHALL

Q. Dr. Bruce, The Spa adds another dimension to your dermatological practice at Suzanne Bruce and Associates. What is the reasoning behind adding these services?

Dr. Bruce: As a dermatologist, when it comes to skin care, I am always looking for scientifically proven treatments that offer real benefit to our patients. At the same time, many of our patients have told us over the years how much they love their facials, asking us why we don’t offer them here. So I sat down with Megan, who has been with SBA for two years and is a licensed esthetician, and we developed a unique set of facials that would offer our clients the pampering they would get at a spa along with the benefits of real skin therapies they would expect from us. We wanted to provide our clients with the best of both worlds.
Megan: Generally, a facial is given to provide relaxation – a time to relax and enjoy. But now, here at The Spa, we have combined medically-effective treatments, such as microdermabrasion and GentleWaves®, with the relaxation of a facial. Our facials have a scientific basis and provide a more therapeutic approach to skin care, yet the atmosphere is tranquil and peaceful. Individuals enjoy a respite from the stress of the day and feel pampered; yet the facial is good for the skin, leaving it glowing and healthy looking.

Q. Megan, what is your experience?

Megan: I am a licensed esthetician, which means I have met the requirements set by the State and am qualified to administer beautifying, cleansing and exfoliating treatments for the skin. Before coming to SBA, I worked in a more traditional spa-type setting, offering facials, skin analysis and other treatments to clients, but I came here because of all the advances that a dermatological practice like ours could offer our clients. I have been working side-by-side with Dr. Bruce and the other dermatologists at The Center for Cosmetic Dermatology since early in 2004. My knowledge of the skin and the various medical and cosmetic skin-care treatments available has been greatly enhanced during this time. I am thrilled to have this opportunity to use my esthetic skills and the knowledge I’ve gained at SBA to provide our clients with unique services at The Spa.

Q. What types of services are available at The Spa?

Dr. Bruce: Most of our offerings are facials with a medical orientation. Each one provides a bit more aggressive treatment than might be offered in a non-medical based spa. All our facials feature microdermabrasion that exfoliates the top layer of dead skin cells, helps with brown spots and minimizes pores. For acne and skin rejuvenation, we offer a combined microdermabrasion and Levulan® and blue light treatment. This treatment requires a medical consultation before it can be administered.
Megan: In addition, we offer skin-care consultations to help our patients in setting up a home skin-care regimen and one-on-one makeup lessons to introduce our clients to our popular glo™minerals makeup that contains a broad-spectrum UV sun block and has added antioxidants. Finally, to complement The Center’s hair removal treatments, we provide professional waxing services, including brow, underarms, bikini and more.

Q. The addition of microdermabrasion would enhance the efficacy of a facial. Are there other benefits to treatments at The Spa as well?

Dr. Bruce: Another factor that I think is important in facials is the consideration of an individual’s personal skin-care regimen. If someone is on a medically-prescribed regimen, it is very important to coordinate all treatments, even a relaxing facial. For instance, Tazorac, Accutane, topical and oral medicines might make a person’s skin more sensitive. Megan is very familiar with dermatological drugs and their effects and can advise an individual as to what treatment, what facial, might be most effective. It is part of our process in The Spa to inquire about a person’s skin care before any treatment is started. And I would recommend to anyone who is going to have a facial, here or anywhere, to mention prescriptions and over-the-counter products they are using before having any type of facial.
Megan: In my years of working with Dr. Bruce and the other dermatologists at our clinic, I have learned not only about the benefits of drugs that might be prescribed, but also about the potential side effects of everything from oral antibiotics to topical vitamin A treatments. Before I administer a facial, I talk with my client and discover what his or her skin-care routine is. This way, I know what to recommend – and can avoid the use of a treatment that might be too harsh or damaging to his or her skin.

Q. Are the dermatologists involved with clients at The Spa?

Megan: My staff and I administer the treatments personally – the facials, the microdermabrasion, the GentleWaves® treatment, the waxing. One of our treatments does require a consultation from a dermatologist before it can be administered, but the others can be done based on our experience and the knowledge of the individual’s skin-care history. However, if there is ever an occasion when a question arises or if I see something that I think needs medical attention, a doctor, nurse, or physician assistant is available right then. If there’s any question, I can take advantage of another level of skin-care expertise. It’s an ideal situation.

Suzanne Bruce, M.D.

Megan Paschall

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