Understand root cause of a problem before treating it: Dr. Sriram

crop6_240x240_15july14Dr. Snehal Sriram is currently the Cosmetic Dermatology consultant at Nahar Medical Centre, Mumbai. She has over 17 years of experience in the areas of Aesthetic/Cosmetic Dermatology. She has won many academic and research accolades including a gold medal in Mumbai university. Dr Sriram has was heading the medical services for Kaya skin clinics – India and Middle-east.

Her areas of special expertise comprise advanced techniques in cosmetic dermatology including facial sculpting with fillers and botox, acne and acne scar treatments, lasers for different cosmetic treatments, Facial rejuvenation, body shaping and hair growth solutions.

Dr. Sriram answered Sify readers’ queries related to the above in an exclusive chat. Read the transcript below.

Can wrinkles on skin be delayed if not permanently removed? Please give some important tips.Regards.
Ensure healthy lifestyle – diet and exercise – Ensure right skincare regime. Vitamin E is usually effective. – Take skin rejuvenation treatments regularly, this helps keep skin youthful much longer.

Are there any skin treatments for the wrinkles on the neck area?
Depending on the depth of wrinkles. Thread-lifts are good treatments.

Is it true that taking steam or even sweating more helps to achieve a healthy skin type as it washes away the toxins?
If you dont have open pores, you may do this. ensure that you wash with cold water after steaming for 3-7 minutes. do not keep it longer.

It is said that drinking too much water helps to get a glowing skin while some disagree. What is your opinion? How many litres on per day basis is advised by you?
2-3 ltrs a day is good unless you have a medical problem. Anything excess or imbalanced is harmful.

Any remedy for dark circles and eye bags doctor?
Important to understand the root cause and treat it eg. thyroid problems, hormonal abnormalities, nutritional deficiencies like anemia etc. Using vitamin K containing creams along with a brightening cream may help. At times, under eye peel treatments may be necessary.

Jus a general question M’am, how is Cosmetic Dermatologist different from plastic surgeon?
Yes, A cosmetic dermatologist is a dermatologist specialising in cosmetic dermatology, which involves usually non-surgical procedures to enhance your looks. A plastic surgeon is a surgeon who performs surgeries to correct your appearance.

And is there any treatment to get rid of crow’s feet near eyes?
If your skin is not very loose (snap test is usually done to check this), Botox is a good answer for this. Threadlift too works well.

What should I look for in a good and effective anti wrinkle cream?
Three components are most effective – an exfoliating agent – this is usually AHA or PHA. second one is a moisturizer – ceramides or similar ones. third component is nutrient – vitamin E, Vit B5 etc. Also check if the base suits you – it should not be very thick, but adequate for your skin type. If you have sensitive skin, pl do not use OTC products but consult your cos dermatologist

I am 44 yrs female.I want to get rid of some wrinkles on my face. Is an anti wrinkle cream enough or do I need to go for some treatment?
Depends on the depth of wrinkles. Very fine superficial wrinkles may respond to a cream whereas an established wrinkle wont respond that well. I recommend you consult with your cosmetic dermatologist for tailor made plan for you

There are cases where cosmetic procedures tend to go wrong. Please tell us when does a cosmetic treatment tend to go wrong or isn’t succcessful?
There are many reasons why a treatment does not work for you. Usually incorrect patient selection and inadequate discussion on expected results make a treatment unsuccessful. So make sure that you have spent enough time with your cosmetic dermatologist for understanding your concerns and what to expect from the treatment planned.

Should cosmetic treatments be avoided if one is on any kind of medications?
If you are on Isotretinoin, please avoid any exfoliating treatments. Similarly if you take blood thinners, you may need to stop them prior to a surgical or injectable treatments.

What are the risks involved in any kind of cosmetic treatment Doctor?
While you have a valid question, it is difficult to discuss pros and cons of each cosmetic treatment in one answer. Each treatment if done rightly for right patient may work very well, while if not done rightly and without understanding the patient’s needs and skin types, may have adverse effects. Having said that, no medical treatment is free from risks. You need to discuss in details with your cosmetic dermatologist the pros and cons of treatment planned for you. If you have any specific treatment in mind, I will be happy to discuss that.

Please give some tips for nail care.
Ensure that your nail is well hydrated – drink lots of water. moisturize the hands and nails with a hand cream, everytime you wash your hands. – Take antioxidants in your diet – Check your cuticles, dont get aggressive manicures done that may damage the cuticles.

M’am please guide me on nail fungus. Why and when does it occur?
When nail barrier is lost due to repeated friction / wetness/ damage, water and microorganisms enter inside. this causes infections – commonly fungal infection. This is seen commonly in people who do wet work like washing clothes, vessels, or even washing hands very frequently.

Are all the cosmetic dermatology related treatments same for both male and females or do they vary?
Cosmetic dermatology treatments should be customised to your skin types for best results. not just based on gender, but also from person to person. Generally men have oilier and thicker skin compared to women, hence the treatments vary.

Is there any cosmetic treatment to get rid of double chin? What is it called?
I find that in most cases of double chin, injection lipolysis works very well. These are tiny fat dissolving injections. one session itself shows good results, but 2-3 sessions maybe needed from case to case. of course there is no substitute for healthy lifestyle to prevent further fat deposits.

Greetings Dr. Snehal. I am a male aged 34yrs. I have an oily skin. I usually travel by Bike to work. What are your suggestions for male skin care which is very oily?
Use a deep pore cleansing face wash 3-4 times a day. Avoid too harsh face wash / soap that dry your skin too much as that may lead to rebound oiliness. Ensure that you clean your face after reaching your destination. Also take vitamin C tablets this helps repair the damage caused by pollution.

I want to know whether pigmentation has a permanent treatment.
There are different types of treatments available for hyperpigmentation depending on the depth of pigmentation and the area involved. This varies from creams, peels, lasers etc.

Can pigmentation of skin be avoided?
Common causes of skin pigmentation are sun-exposure, friction, chemical contact, hormonal fluctuations and post-inflammatory hyperpigmentation. Ensure regular sunscreen usage, avoid any friction or frequent touching/ rubbing the skin. If you have already got hyperpigmentation, please consult your cosmetic dermatologist.

Madam I have very thick (few) hair on both the sides above upper lip. What is the permanent solution to it? Is laser advised?
Laser hair reduction works well for thick hair growth. Usually one needs 6-8 sessions of laser once a month for effective long term results. One needs to check if there is any imbalance between male and female hormones in the body too.

Is acne occurrence at a later age due to hormone imbalance? How to treat this then?
Yes, usually that is the case. Thyroid abnormalities, menstrual abnormalities and other hormonal factors do play a major role. One needs to understand the root cause and correct it. In addition, one needs to treat the acne too, as underlying cause treatment is usually long-term. Treatment for acne depends on the type of acne. for red and pus filled ones, you may need antibacterials – cream and tablets. for blackheads / white heads, you need gels that unblock the oil glands. You will need appropriate skin care routine too based on your skin type. In addition, taking skin peels may help.,

Should make up of any kind be completely avoided if one has acne problem?
Ideally yes, however one may use water based products that won’t clog your oil glands. Ensure the make up is removed as soon as possible.

Does consuming neem juice help to curb acne?
Neem juice alone won’t help. However when combined with a healthy diet (fruits, vegetables, adequate water, avoidance of deep fried and high carb foods) may help.

crop5_240x240_15july14What actually triggers acne? Is this genetic?
Genetic background makes the oil gland large or small. The hormonal fluctuations affect the glands and cause blockage which then leads to acne. Your lifestyle too plays a role.

I am 35yrs female having acne. Is there a permanent treatment to acne?
Adult onset Acne are very common these days. And usually there is a hormonal factor responsible for it. Hence one needs to understand the root cause to give long lasting results.

Is there any treatment to make our lips make pink naturally. I have lips that are on the darker side.
Identify the root causes that may be making your lips look darker and avoid them like chemical contacts, lip make-up, smoking. Use a vitamin E containing lip balm regularly. Avoid the temptation to lick your lips. These tips would work for preventing further darkness. I would recommend you consult a cosmetic dermatologist for appropriate treatments.

What is the right age to go for fillers?
It depends on your face structure and genetic tendencies. Generally for Indian skin types fillers are done between 35-55yrs of age.

Please give some general suggestions that can make us look better and younger.
This starts with healthy lifestyle and diet. Ensure 2 fruits, 2-3 ltrs of water daily. Ensure 30-45 mins of exercise everyday. Also understand your skin needs and use an appropriate skin care regime. Generally antioxidants like vitamin C and vit E serum works as good preventive measures, but they need to be customised to your skin type. Regular exfoliation also works as it stimulates regeneration.

Should the selection of sunscreen vary with seasons? Should we go for a higher SPF for summers?
Yes. For summers in city use SPF 30+ is good enough. Whereas in winters and monsoons SPF 15+ is adequate. More important is UVA protection for Indian skin types as UVA is responsible for tanning and pigmentation.

Which is the best sunscreen to use?
Opt for an SPF of 30 plus for regular use. Ensure UVA protection of atleast +++. Increase the protection when you go on holidays to 50+ SPF. Ensure sunscreen is applied 3 hourly.

Is facial rejuvenation different from normal facials?
Yes. Usually facial rejuvenation is performed under guidance of cosmetic dermatologist using medical technologies. Hence it gives rise to healthier skin and longer lasting effects.

I want to try facials available now days for men. How many times in a month should I try this?
If you do not have sensitive skin you may opt for it once a month. If you do have some skin concerns or some sensitivity/allergies please visit your dermatologist before taking any facials.

Doctor I am a male aged 28yrs. I have 2-3 dark patches on face. Not very big but I want to get rid of them. Please advice something.
Dark patches on the face can happen because of many reasons like hormone changes, sun damage, frictional pigmentation, etc. To take care of the dark patches one needs to prevent further damage and repair existing damage. Ensure that you apply sunscreen everyday and avoid touching your face. To repair existing damage one may opt for skin peels or laser treatments if need be. I would recommend you consult a cosmetic dermatologist.

Is botox suggested for all skin types? Thanks.
Botox as suggested earlier is done to relax muscles causing expression lines, hence the deciding factors are muscle mass and skin laxity. Would recommend you consult your cosmetic dermatologist for a detailed consultation.

How much does a botox treatment usually cost?
Depends on the area involved and the muscle mass. May vary from Rs.6000-30,000.

Is the botox treatment completely safe?
Botox treatment is very safe if done by an experienced cosmetic dermatologist. Also its completely reversible and there is no lasting effect on the body.

How often in a year does one need to go for botox and fillers?
Typically, botox needs to be done twice a year, sometimes 3 times a year (if one has very strong muscles). Fillers are of different types – volumising fillers may last for 1 to 1 and a half years.

Hi Doctor, I am 54 yrs female. Please guide me on botox and fillers. I want to go for it.
Botox works by relaxing the muscles that cause expression lines. Hence it is most appropriate for forehead lines, frown lines and lines around the eyes. For grooves, folds and sagging, one needs to use fillers. I recommend you visit a cosmetic dermatologist who can examine you and suggest the best treatment for you. These treatments are very safe when done by an experienced doctor.

Do moles tend to grow back once removed?
Depends on the depth of removal. There may be a 15-20 % chance of regrowth.

I have two moles on my back. Is it safe to remove them?
It is difficult to answer without examining you. However generally mole removal is a safe procedure if done by an experienced dermatologist.

Should all moles be treated?
Not necessarily. Moles need to be treated only for two reasons – either for cosmetic purposes one opts for mole removal or if your dermatologist is suspecting some growth in it, she may ask for a biopsy.

Madam when are moles considered to be examined?
If you see any mole growing rapidly, or having asymmetric borders, immediately consult your dermatologist.

I am a woman aged 37yrs. Can I go for a skin enhancement treatment? What should I keep in mind before going for it?
Please understand your skin and its needs first. Go to a cosmetic dermatologist who will do a detailed consultation and assess your requirements. Then opt for appropriate treatments. Generally, peels and aqua treatments are safer for most types of skin. Then one may opt for treatments like laser photofacials or microneedling for good collagen growth to prevent fine lines and wrinkles.

Are all cosmetic treatments available today safe doctor? What are your views on them?
While you have a valid question, it is difficult to discuss pros and cons of each cosmetic treatment in one answer. Each treatment if done rightly for right patient may work very well, while if not done rightly and without understanding the patient’s needs and skin types, may have adverse effects. If you have any specific treatment in mind, I will be happy to discuss that.

What are the treatments available to get rid of acne?
Treatment for acne depends on the type of acne. for red and pus filled ones, you may need antibacterials – cream and tablets. for blackheads / white heads, you need gels that unblock the oil glands. For very severe acne, one needs to assess the root cause and treat it appropriately. You will need appropriate skin care routine too.

Hello Dr.Sriram, Can you please suggest something to maintain glow and freshness on skin for normal skin?
For glow and freshness, please use a vitamin C serum at night, also a cream with extract of curcurmin at night helps. There is no substitute for healthy lifestyle esp diet with fruits and 2-3 ltrs of water and regular exercise.