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Health // Doctor in the House
Rasa Fournier

Treatments For Facial Sun Damage

Dr. Kevin Mott
Cosmetic dermatologist and skin surgeon at Cosmeskin/Hawaii Skin Cancer Center

Where did you receive your schooling/training?

I went to medical school at the University of Iowa, then I entered the Navy and was stationed in Hawaii in 1987. I served my Navy time, and then I specialized in dermatology and dermatology surgery fellowship training at the University of Missouri. I moved back to Hawaii and started my practice 13 years ago.

What services do you offer?

I have my practice subdivided because I have two distinct services. The Hawaii Skin Cancer part of the practice specializes in specialty treatment of skin cancers, especially difficult ones on the face. We do a procedure called Mohs micrographic surgery that has the highest cure of any skin cancer treatment. We use it on critical areas like noses, eyelids, ears, lips – anywhere on the face – to cure skin cancer and do reconstruction with the least amount of tissue loss possible. That aspect of the practice is from sun damage causing skin cancers.

The other half of the practice, Cosmeskin, is more rejuvenative, for treating premature aging changes from the sun that don’t cause skin cancer but cause the skin to look older in appearance and in terms of lines, wrinkles, saggy skin, spots. We do lasers for skin rejuvenation, hair removal, wrinkle fillers, Botox, leg veins, skin tightening, cosmetic surgery, liposuction, and eyelid, face and neck lifts. It’s a full-service skin center, so any procedure that is done on the skin, we perform.

With tissue loss, do you take from another part of the body?

When we treat cancer, by definition there’s skin missing, so we have to decide what is the best way to replace what’s missing. When we’re reconstructing skin on the face in particular, we rearrange the skin area that’s next door that has a little extra, and that procedure is called “flap surgery.” We use nearby skin, because that skin has the best color and texture match. Everyone thinks we borrow skin from the backside, but then it would always look like the backside. The face has the most amazing healing properties. It’s amazing how much skin you can actually lose to skin cancer and still repair without it being noticeable. We can replace half a nose or a whole nasal tip, or rebuild cartilage that we borrow from the ear. We restore appearance.

Is most of the facial reconstruction because of sun damage, or are there other causes, too?

The top 10 reasons for getting skin cancer, all 10 of them, are related to sun exposure. Every time your skin gets enough UV light or sunlight to generate a tan or a little pink sunburn, you’ve mutated DNA – every time you get that UV light, which targets our cells, it physically melts your DNA and our skin tries to repair as much of it as it can. Some of that damage stays hidden for the majority of our lifetimes, but as we get older, as our immune surveillance ability decreases, and as we get more sun exposure, that promotes that damage. A cell will turn cancerous at some point and start to grow. The incidence of skin cancer is almost nil in places that don’t get sun exposure on our body – on our bottoms and so forth. I can’t remember the last time I treated a skin cancer there. Our faces are exposed to the environment every day, so they have the most cumulative UV exposure and that’s why the majority of the skin cancers we treat are on the face.

What is the latest in cosmetic treatment?

We have two new procedures that we implemented this year. One is called Liposonix. It’s an FDA-approved treatment for noninvasive fat removal. We use a technique called high intensity focus ultrasound, where the sound waves are focused to a thin pinpoint. They’re very powerful at that point, and they’re transmitted to a certain depth underneath the skin. They vibrate the entire zone of fat cells gently to death. Then your body breaks them down and you actually lose that zone of fat. It’s somewhat akin to noninvasive liposuction. When I do liposuction, I’m actually sucking out fat in little tunnels underneath the skin, so the fat decreases and the skin gets lower to the surface. With Liposonix, we remove that same zone non-invasively, so no down time. In one hour, with one treatment, patients usually lose about two inches off their waistline – that’s one size off your waistline. It’s a pretty powerful treatment. Not too long ago we didn’t think something like this was possible, but it’s done without any needles or surgery, with just ultrasound technology.

The newest procedure we’re offering has a catchy name, it’s called the Vampire Facelift. It was just on Dr. Oz. With skin rejuvenation, a lot of us have this appeal to all the creams, lotions and potions you see on informercials or that celebrities endorse. They have some benefit, but it’s usually not a profound benefit, because they’re cosmeceuticals. If they had any kind of significant impact, they would actually be a drug and have to be regulated. They’re moisturizers and in most cases, with very nice-sounding ingredients.

In my experience, the best way to rejuvenate skin is to use a controlled wound, because when you repair a wound, you invite in all kinds of healing responses, stem cells, new blood vessels, new collagen. One of the main features of wound healing has to do with our platelets. Platelets initiate the entire wound-healing cascade, including making new collagen, blood vessels and inviting in stem cells. There’s a new technique where you actually draw out blood and isolate the platelet layer and inject that into the skin. You generate wound-healing responses without making a wound. That’s called platelet-rich plasma (PRP). It got its startup in sports medicine and orthopedics for joint problems and tendons. Well, somebody thought it would be a great idea to tighten the skin, and, by gosh, it works. You inject it into the skin and you get the same wound-healing response – you generate new collagen throughout your skin, and new blood vessels. The skin gets a nice glow to it. This is an injectable procedure using your own material. You’re using your own blood, but just the platelet layer with the platelet-rich plasma. You’re actually getting a form of stem cell therapy, too, because the platelets initiate a healing cascade that draws in your own stem cells, so you don’t have to go get them grown someplace or isolate them someplace else, you just draw in your own material. We’re the first place in Hawaii or the Pacific offering PRP skin rejuvenation.

Any tips or preventative measures you can recommend for skin care?

There’s a plethora of skin-care products. All these products and claims are very confusing, even to dermatologists. The bottom line is the No. 1 anti-aging skin treatment is still sun protection – using a program of sunscreen, clothing and doing things off peak hours. If you protect your skin from the sun, you’re going to age less, you’re going to have less work to do and maybe less need for some of these procedures.

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