Thursday , 19 April 2018
Beauty Tips

Chatting Skin Care with Dr. Justin Piasecki

Dr. Justin Piasecki

On February 15th, I had the pleasure of interviewing prominent skin cancer doctor, Justin Piasecki.  He is the founder of the world re known Skin Cancer Center located near Seattle, which allows patients to have reconstructive surgery following skin cancer removal in the same outpatient setting.

In fact, Dr. Piasecki is the only surgeon in the world certified in MOHs surgery (technique to remove the cancer with the highest possible cure rate) and also double board certified in plastic surgery and facial plastic surgery…which if you’ve ever had a skin cancer scare or known someone who has, this is a BIG deal. That being said, Dr. Piasecki has been a pioneer to this incredible field and maintains a large Canadian patient base as well. Seeing as how skin cancer awareness month is fast approaching (as well as Spring & Summer!) I thought it would be great to chat with Dr. Piasecki in order to gain additional insight into prevention, the controversy about sunscreens, hear his expert skin-saving tips, and answer questions from our readers!

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Dr. Justin Piasecki Interview

Me: Congratulations on being crowned as one of America’s most beautiful doctors! That must have felt good 🙂

Dr. Piasecki: *Laughs Humbly* The show was donating proceeds to Red Cross and so I was honored to do it for the great cause. They actually made a calendar and 100% of sales went to the American Red Cross Disaster Relief Fund–I was happy to be a part of it.

Me:  recently I was reading that you were the only doctor on the planet certified in MOHs surgery (the highest cure rate for the cancer treatment), as well as double board certified in plastic surgery and facial plastic surgery which is the highest possible level of training in facial reconstructive surgery.

Dr. Piasecki:  yes, that’s true, but it is important to know that there are many who are trained in MOHs surgery – these talented doctors are typically dermatology trained followed by a one year fellowship in the removal of skin cancer, along with basic reconstructive techniques.  They are exceptional at what they do and can handle the vast majority of skin cancers and reconstructions requires thereafter.  My extra training just adds a level of security beyond that for those rare cases that are exceptionally complex or particularly cosmetically sensitive.  There are seven of us in the world certified in MOHs and board certified in plastic surgery; of those seven, I’m the only one also double board certified in facial plastic surgery.”

Me: I can’t imagine how hard it must be for any skin cancer patient to not only have parts of their face removed in serious cases but to then have to wait for a second surgery by another doctor. How long on average is that time-lapse?

Dr. Piasecki: Right and many are elderly and have other health problems, and the standard worldwide is to have it cut out by scalpel without the MOHs technique- which leads to a re-currency rate that is 15% which could otherwise be 1% if the MOHs procedure is used.  In many cases the doctor removing it may not have any reconstructive training requiring referral to a trained surgeon for repair. Time lapse could be days or weeks between surgeries. Thus, in my opinion, treatment by a MOHs doctor or with my approach is better. By combining the procedures its only minutes in comparison and it’s a huge convenience for the patient. Currently, the cost of care is a big issue for many States—by combining these procedures millions of dollars per year could be saved. Just in my practice alone 2 1/2 million a year is saved. Not to mention if you don’t combine the surgeries you run in to other problems—particularly, swelling, scar tissue, and wounds begin to heal in some capacity. For the reconstructive surgeon it is then more difficult to discern where the defect starts and ends. Consequently, the quality of precision and re-construction of final results are limited. Whereas, all of these potential difficulties are virtually eliminated in a combined treatment setting.

Me: I’m curious, what is the youngest age you’ve seen skin cancer occur?

Dr. Piasecki: Skin cancer can occur even in children as young as 10 years old—but these are usually rare genetic syndromes. The youngest not in that category are late teens and early 20s and this is usually from cumulative sun exposure (i.e. frequent tanning bed use!). But the most common category I see is 40 plus. The worldwide epidemic is especially in fair skin. It’s a very common problem and most of these types are not life threatening, so medical establishments will look the other way.

“First exposure to tanning beds in youth increases melanoma risk by 75 percent.” –the Skin Cancer Center

Me: That’s true. I for one feel that there isn’t enough awareness regarding skin cancer and what to watch out for?

Dr. Piasecki: There are two common types of skin cancers: basal cell and squamous cell carcinoma–and it’s rare that they’ll be obvious. There will be slight yet gradual changes in the skin or you may even find ares that bleed with minimal trauma. For example, a wound that won’t heal over several weeks to months, or something that’s growing without any other explanation.

“More than 40% of Americans who live to age 65 will have skin cancer at least once.” –the Skin Cancer Center

Me: And would surgery be the only option available if something like this were to develop?

Dr. Piasecki: Most people are scared of having surgery. There are other methods of treating it but there are tradeoffs. The cancerous area can be frozen, burned, radiated, or there is the use of topical creams. However, these are destructive techniques that are often more deforming and with lowered effectiveness (compared to +99.2% with surgery). The healing and experience are far more comfortable and better than other methods. Surgery is something a lot of people want to stay away from but in this case will provide the best results–both health-wise and aesthetically.

Me: I’m sure you must be a huge advocate for skin cancer prevention—what are some of your essential guidelines for someone who loves to spend time in the sun?

Dr. Piasecki: Oh yes, absolutely! Well first, if you enjoy outdoor activities you should not be afraid to—you still have to enjoy life. There is no proof that if you stayed in a dark room you will be prevented from getting skin cancer. Most important thing is early and regular surveillance every year (for caucasians especially), and every month to assess your own skin in the shower. I recommend doing this on your birthday and using that same day every month so you remember. It’s important to just be familiar with your skin.

For daily prevention its important to wear sunscreen and make it a habit. Also, if you are spending a lot of time outdoors its important to re-apply every few hours. Most sunscreens will be deactivated by UV exposure every 2-3 hours. Clothes offer an SPF of about 5. You should ideally be-reapplying to the most sun-exposed areas—i.e. back of hands and face (since taking off your clothes to keep re-applying may not be that practical). I recommend a hat if you will be out for more than a few hours just to provide shade. Aside from those necessary steps its important not to be afraid to live your life.

Oh and avoid tanning beds—actually never go into those. “Sun beds to skin cancer is like cigarettes to lung cancer.” Any exposure to UV radiation is causing damage to your cells. The concept of getting a “pre-tan” before going on vacation is misguided. Its like saying a little bit of poison will save me from more poison later. However, spray tans DO NOT increase the risk of cancer—they are wonderful adjuncts.

“People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma” –the Skin Cancer Center

Me: There has been a lot of controversy over the safety of some sunscreens—for example something that contains vitamin A or its derivatives may actually speed up the cancer that the sunscreen is used to prevent.

Dr. Piasecki: That’s a really great question. This speaks to the big picture of many things we are confronted with in medicine. There is an inherent risk in living. If you drive to the store you are taking a risk. This risk however is pretty low even though the risk is still present. Any time you ingest any food or medication there is some inherent risk to that. Typically these studies are done in mice. There are many substances we use everyday that may all be contributing to this risk. However, the concentration in sunscreens is far too low to cause this. Mice studies don’t apply to humans–if you give mice too much of anything they are likely going to develop some sort of cancer or adverse effect. The risk of sun damage is far worse than any risk from applying sunscreen.

Me: There are also many natural products out on the market that offer high SPF protection and without the carcinogens (like parabens, which are carcinogenic and oxybenzone, which is a hormone disrupting chemical). I am a particular fan of zinc oxide for example. Would you consider these just as useful?

Dr: Piasecki: Oh yes absolutely and I think zinc is great. There are 3 methods to protecting your skin against the sun: sun avoidance (NOT recommended), a chemical sunscreen agent (where the chemical absorbs the UV radiation turning it into heat), or Zinc oxide and titanium which act like a billion tiny mirrors on the surface of the skin deflecting the sun. I actually prefer zinc since it is the most complete, offering both UVA and UVB protection. They even have micronized zinc oxide now which doesn’t give that white appearance (i.e. the lifeguards with the white noses). In general, I recommend an SPF of over 30.

Questions from our readers

We asked our readers yesterday what skin care questions they would love to have you answer. So I’m hoping you’ll let us pick your brain a bit more!

Melody: What’s the #1 proven product for wrinkles?

Dr. Piasecki: Great question! It actually depends—wrinkles are a by-product of two things—loss of elastic tissue and muscle contraction. The way you discern between the two is this: If the wrinkle is present at rest this is a loss of elastic tissue. If it is only present when you smile this is due to contraction of the facial muscles (i.e in this case Botox could be useful).

There is however an effective, basic skin care regimen for wrinkle prevention that includes 4 things: sunscreen, moisturizer, lightening agent (i.e. like hydroquinone), and Vitamin A or retinoic acid. These will improve the appearance of skin and fine lines while diminishing the appearance of wrinkles. The second step would be to engage in injectional procedures like botox and in the lower face (i.e. naso-labial fold)– fillars are useful (Restylane, Juvederm, and Radiesse to name a few). There are also more aggressive methods like chemical peels and laser re-surfacing.

Me: Are there other effective {natural} alternatives to hydroquinone?

Dr. Piasecki: Yes actually, studies have shown liquiorice extract and kojic acid to be useful!

Angela: What is the best way to clear up blotchiness and discoloration post breakout?

Dr. Piasecki: Another great question. Pigmentation post break-out is actually the consequence of the inflammation that was present during the breakout (a superficial infection in the pores). A lightening agent like hydroquinone will not help this since the cause for its appearance is from the deposition of iron in the skin and a change in blood vessels. My best advice in this case would be time and to not spend a lot of money on creams. It will get better within 6-9 months you just have to be patient. The best thing to do here is just cover it up if you are heading out and let it heal on its own.

Xina: What are your thoughts on oil-free moisturizers? Are they a good option from some skin types, or do we all need a little oil?

Dr. Piasecki: Amazing questions! The answer is it does depend on your skin. If you have typically oily skin then I would recommend oil free. It also depends on your climate—if you live in a humid climate, then probably oil free as well (and vice versa)–which I know may not be an issue right now in Toronto! 🙂 *Laughs* 

So, skin type and climate make a difference. There are pretty good cleansers with oils. It’s not a one size fits all. Go to your local department store and get samples of a few different moisturizers and try them out before you invest in any particular one. Most companies will make a few different products for logistics but that doesn’t mean it applies to you. Give each product 2 weeks to assess what’s happening with your skin and go from there.

Nicole: What are you tips for managing skin that’s both dry and oily?

Dr. Piasecki: Good question also! Dryness is typically from inflammation and the loss of outer protective oils of the skin. This also creates an environment where bacteria flourishes. The first step is breaking the cycle of inflammation. You should start with changing your cleanser, using lukewarm water which is less irritating, and change the frequency to which you wash your face. Usually dry skin is from trying too hard by washing excessively and too much product use. By decreasing trauma to skin with less frequent face washing and fewer products, you are restoring its natural environment.

If dryness is a big problem and you are only washing your face twice a day, don’t be afraid to skip the morning wash of skin and use lukewarm water at night. Several cleansing oils are available to remove makeup. I’ve seen combinations of castor oil, avocado oil, and olive oil which are great in a very non-traumatic way.

Deanne: What would be the best was to hydrate dry skin during the winter months?

Dr. Piasecki: Good question! Two things that contribute the most in cold climates is dehydration (the excess indoor heating dries the air and people also tend to consume less water). Also, really hot showers are a big culprit (water is actually irritating to the skin). I recommend changing the temperature of your shower to lukewarm, hydrating yourself by drinking more water, and the more frequent use of moisturizer (first thing in morning and even at lunch time as well as the evening). Re-apply!

Me: What do you think about investing in a filter for the shower? I’ve heard that hard water is often a big problem for skin and shower filters are becoming increasingly popular.

Dr. Piasecki: I Wouldn’t recommend going to those lengths if you’re just simply having dry skin. If on the flipside you are having a lot of redness and irritation as well as skin conditions such as eczema and psoriasis—that may very well be helpful.

Michael: What is the best way to get rid of razor bumps on the neck and face for guys with sensitive skin?

Dr. Piasecki: Great questions 🙂 One thing that is different about male skin is that it is thicker. There is also thicker hair formations with the common complications of in-growns. Keeping the skin more moisturized is essentialwhich many men tend to not pay much attention to. If using just a plain soap the skin tries to protect its and create more cells and then it’s not uncommon for hair to get lost beneath the layers of thick skin.

Me: Thank you so much for answering all of our questions! Is there anything else you would like to share with the readers?

Dr. Piasecki: It’s my pleasure! Just that if they would like more information visit our website and feel free to contact us with any questions!

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This concludes my interview with Dr. Justin Piasecki, who was such a delightful and extremely intelligent man to speak with! If you have any further questions don’t hesitate to leave a comment 🙂

About Everything Beautiful

Everything-Beautiful is a holistic beauty, wellness, travel, and lifestyle destination designed for those looking to take charge of their lives naturally! Founded by Erica Grenci, a health and wellness expert and graduating Naturopathic Doctor in 2016, it has been her platform for sharing creative inspiration throughout the health-conscious community.


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