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Dermatology

Do you peer in the mirror each morning and play little face games?

Do you find yourself raising your brows, smiling wider, stretching wrinkles, pursing your lips, or lifting the droopy corners that weren’t there last month?

Are you exhausted from trying every TV promise out there to stop your acne and wonder “why me?”

Who doesn’t find something they don’t like about the face in the mirror each morning? It’s human nature to want to look your best. Even royalty and celebrities find themselves sitting across from Dr. Rothfeld seeking the fix for that blemish, that sag or that brown spot.

Dr. Gary Rothfeld , board certified dermatologist at NYC Dematology, having worked alongside several of the world's renowned dermatologists, has shaped a uniquely innovative approach in treating any skin problem you may have. Through cosmetic and medical dermatology, laser surgery and powerful combination treatment options, Dr. Gary Rothfeld quickly and effectively helps you see dramatic improvements in the appearance and health of your skin.

Dr. Gary Rothfeld is well known for his particular expertise is in designing anti-aging, anti-acne, and anti-rosacea treatments with exceptional success and optimum cosmetic elegance. These particular conditions need specialized non-harsh therapies in order to be successful with minimal side effects. Over-treatment or overly aggressive treatment can backfire. Dr.Rothfeld makes sure that doesn’t happen to his patients.

Dr. Rothfelds' main concern is that you receive an individualized skin treatment program that eliminates your problems without unnecessary side effects. This is attained by having one-on-one care with good old fashioned personal attention from Dr.Gary Rothfeld himself."

The most common medical condition that Dr. Rothfeld treats is Acne and Acne Scarring. His comprehensive approach may include photodynamic therapy which will help restore your natural, radiant skin without the signs of acne. This treatment, which can consist of a combination of blue light and laser, significantly diminishes your need for oral medications.

His cutting-edge research in technology initiated his interest and involvement in Laser Dermatology. He has the latest proven lasers to treat acne and acne scarring, broken blood vessles, and rosacea , wrinkles , and loose skin. These laser procedures provide tremendous results with little downtime. All laser procedures are performed personally by Dr. Gary Rothfeld at NYC Dermatology.

As a sought-after expert in the successful use of Botox, he has trained many physicians in how to implement his unique technique in treating their own patients. Many of his patients refer to him as "the Botox artist". Wrinkles in the forehead, between the brows, and around the eyes are painlessly reduced. The results are night & day differences with no downtime or pain.

One particularly exciting use of Botox is the non-surgical Brow Lift. This procedure elevates the brow and can also elevate droopy eyelid skin. He has helped countless patients avoid unnecessary plastic surgery with this procedure.

Another well-appreciated application of Botox Cosmetic is in the treatment for excessive underarm sweating, which has been recently FDA approved. The Botox Cosmetic is non-diluted and prepared in such a way as to be completely painless!

Rejuvenating peels are excellent treatment for the prevention of aging skin and acne. Light Peels and ipl fotofacial offer quick treatments that help improve skin texture and minimize fine lines. Cosmelan treats patchy brown hyperpigmentation.

Your Health is Vital; Start with your Skin. The American Academy of Dermatology recommends yearly skin checks to examine moles and remove unusual ones that are often are high risk.

Botox
Non-surgical treatment that softens wrinkles that have developed over time.
Recovery time is immediate
Duration of Results: 3-4 months

Skin Resurfacing
Removal of the outer layer of the skin using abrasion, chemicals or a laser, resulting in smoother and less wrinkled skin.
Recovery time is one to three weeks.
Duration of Results: Generally permanent.

Collagen Implant
(Different from Collagen and Soft Tissue Augmentation)

An injection of natural protein which puffs up and raises skin tissue to smooth out and make less visible wrinkles and scars.
Recovery time is about three hours.
Duration of Results: Repeated as needed.

Skin Lesions
Skin blemishes, skin cancers, birth marks, scars and other skin growths can be removed or made less visible using various techniques such as hidden incisions or laser treatment.
Recovery time is approximately seven to ten days.
Duration of Results: Generally permanent.

Scar Revision
Surgery to make scars less visible using various techniques such as Z-plasty or W-plasty.
Recovery time is variable
Duration of Results: Generally permanent

Acne
Acne is the term for plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), that occur on the face, neck, chest, back, shoulders and even the upper arms. Most teenagers have some acne. However, adults in their 20's, even into their 40's or older, can get acne. Acne often clears up after several years even without treatment, but you need not wait to outgrow it. Untreated acne can leave scars, which can be treated by your dermatologist as well.While not a life threatening condition, acne can be upsetting and disfiguring. Acne can also lead to serious and permanent scarring.

Mole Removal
The majority of moles and other blemishes are benign (not-cancer). They will never be a threat to the health of the person who has them. Spots or blemishes that warrant medical concern are those that do something out of the ordinary-those that act differently from other existing moles. This includes any spot that changes in size, shape or color, or one that bleeds, itches, becomes painful, or first appears when a person is past twenty.

Occasionally, a mole may become a cancerous growth. Therefore, it's best to get medical advice from Dr. Gary Rothfeld, Board Certified Dermatologist at NYC Dermatology if you notice a mole that does not follow the normal pattern. Dr. Rothfeld may be able to assure you that the mole is harmless. To accomplish this, he may study a sample of it under a microscope for an accurate diagnosis.
He would then remove the mole, or part of it, so that thin sections from the mole can be cut and examined under a microscope. This is a simple and harmless procedure. If the growth was only partially removed and it is found to be cancerous, then the entire lesion and an extra margin of safety will need to be removed.

A person may wish to get rid of moles that are in areas of trauma, where clothing can irritate them, or simply because they are unattractive. The most common methods of removal include numbing the spot and then shaving the mole off, or for some moles, cutting out the entire lesion and stitching the area closed.
Most procedures used to remove moles take only a short time and can be performed in our office. Sometimes a mole will recur after it is removed. If a removed mole does begin to reappear, the patient should return to see Dr.Gary Rothfeld.

Rashes, Eczema & Psoriasis
Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back. In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Our Board Certified Dermatologist Dr. Gary Rothfeld can help even the most severe cases.

Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.
People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.

Freckles & Age Spots
These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available. Dr. Rothfeld at NYC Dermatology board certified dermatologist treats many cases every week.

Seborrheic Keratoses
These brown or black raised spots or wart-like growths look like they were stuck on the skin surface. They are not cancerous and are very common in older people. If annoying, they can be easily removed by a dermatologist.

Cherry Angiomas
These are harmless, small, bright red raised bumps created by dilated blood vessels. They occur in more than 85 percent of middle-aged and elderly people, usually on the trunk. Electrocautery, laser surgery, or other surgical therapies remove these spots.

Wart Removal
There are several different lasers used for the treatment of warts. Laser therapy is used to destroy some types of warts. Lasers are more expensive and require the injection of a local anesthesia to numb the area treated.

Another treatment is to inject each wart with an anti-cancer drug called bleomycin. The injections may be painful and can have other side effects. Immunotherapy, which attempts to use the body's own rejection system is another method of treatment. Several methods of immunotherapy are being used. With one method the patient is made allergic to a certain chemical which is then painted on the wart. A mild allergic reaction occurs around the treated warts, and may result in the disappearance of the warts.

Warts may also be injected with interferon, a treatment to boost the immune reaction and cause rejection of the wart. There are some wart remedies available without a prescription. However, you might mistake another kind of skin growth for a wart, and end up treating something more serious as though it were a wart. If you have any questions about either the diagnosis or the best way to treat a wart, you should seek your dermatologist's advice.

Birthmarks
Many babies have what are called "birthmarks" when they're born. In some cases they may appear within the first few weeks of life. They can be brown, tan, blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. They can be flat or raised, pink, red or bluish discolorations.

The exact causes of birthmarks are unknown. Most vascular birthmarks are not inherited, nor are they caused by anything that happens to the mother during pregnancy.

There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified. The most common types of vascular birthmarks are macular stains, hemangiomas, and port wine stains. There are also many rare types of vascular birthmarks.

Rosacea
Rosacea, (rose-AY-sha) is a common skin disease that causes redness and swelling on the face. Often referred to as "adult acne," rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. It also may involve the ears, chest and back. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

When it first develops, rosacea may come and go on its own. When the skin doesn't return to its normal color and when other symptoms, such as pimples and enlarged blood vessels, become visible, it's best to seek advice from a dermatologist. The condition rarely reverses itself and may last for years. It can become worse without treatment.

Many people with rosacea are unfamiliar with it and do not recognize it in its early stages. Identifying the disease is the first step to controlling it. Self-diagnosis and treatment are not recommended, as some over-the-counter skin applications may make the problem worse.

Dr. Gary Rothfeld, board certified dermatologist in Manhattan, New York often recommends a combination of treatments tailored to the individual patient. Together, these treatments can stop the progress of rosacea and sometimes reverse it. Gels and creams may be prescribed by a dermatologist. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months. Oral antibiotics tend to produce faster results than topical medications.

Cortisone creams may reduce the redness of rosacea. However, they should not be used for longer than two weeks and strong preparations should be avoided. It is best to use these creams only under the direction of Dr. Rothfeld.
The persistent redness may be treated with a small electric needle or by laser surgery to close off the dilated blood vessels. Cosmetics may offer an alternative to the more specific treatment. Green tinted makeup may mask the redness.

Sclerotherapy of Leg Veins
The injection method, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930's and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. In any one treatment session a number of vessels can be injected.

The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. our dermatologist will choose a solution that is best for your particular case.

Occasionally larger varicose veins are underneath or associated with the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy, intravascular laser, or radiofrequency, followed by compression. After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

Scar & Keloid Treatments
Several techniques can minimize a scar. Most of these are done routinely in the dermatologist's office. Only severe scars, such as burns over a large part of the body may require general anesthesia or a hospital stay.

Surgical scar revision can improve the way scars look by changing the size, depth, or color. However, no scar can ever be completely erased; and no magic technique will return the scar to its normal uninjured appearance. Surgical scar revision typically results in a less obvious mark. Because each scar is different, each will require a different approach.

The most important step in the treatment of scars is careful consultation between the patient and the dermatologic surgeon Dr. Gary Rothfeld - finding out what bothers a patient most about a scar and deciding upon the best treatment.
Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter. A technique of irregular or staggered incision lines, rather than straight-line incisions, to form a broken-line scar that is much more difficult to recognize may be used. Sometimes, a scar's direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into a hairline, or a natural junction (for instance, where the nose meets the cheek). Best results are obtained when the scar is removed and wound edges are brought together without tension or movement (pull) on the skin.

Skin Cancer
(MOHS Micrographic Surgery)
MOHS micrographic surgery is a highly specialized procedure for the removal of skin cancer. It was originally developed in the 1930’s by Dr. Frederic MOHS and has been refined since, gaining substantial application only in the past decade. Although this procedure is very precise, its major drawback is that it is very time consuming and requires specialized training, personnel and equipment. Consequently, only a few major medical centers can provide this type of therapy.

There are three surgical steps to MOHS micrographic surgery:

By examining the edges and underside of the tissue, the physician can trace out and exactly locate any additional areas of cancer remaining. Before the tissue is examined, it is marked with colored dyes to distinguish top from bottom and right from left, and a detailed map of the excised tissue is made. By doing this, we can pinpoint the exact location of any remaining tumor during the microscopic examination. If more cancer is present, the procedure is repeated. We remove only the area of remaining cancer.

Using microscopic examination, the MOHS surgeon pinpoints areas involved with cancer and selectively removes only those areas. This way, we trace the skin cancer out to its “roots”. This results in preserving as much normal tissue as possible with the highest chance for a cure. Other forms of therapy have only a 50% to 70% chance for success in curing skin cancers that have previously been unsuccessfully treated.

Using the MOHS micrographic surgery techniques, the percentage of success is very high, often 97% to 99% even when other forms of treatment have failed. With this technique, an excellent chance of a cure is achieved. However, no one can guarantee a 100% chance of a cure.

MOHS micrographic surgery gives patients the highest chance for a cure of even complicated skin cancers with preservation of the maximum amount of normal tissue. This method is highly specialized, and not all medical centers in the United States are equipped with the personnel and training to offer this treatment.

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