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Expectations from a dermatologist??

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Hi everyone,

I'm new to the forum--I've found it about a week ago and have been avidly reading everyones posts, soaking up information.

I just have a quick question for everyone:

Does your dermatologist perform all the procedures or does his assistants/nurses do it?

It seems that he gives me a 5 minute inspection whenever I visit him and just pushes the latest and greatest treatments on me. He tells me "it is spectacular, you'll love the results" and "i have so many patients SOO happy with it." Afterwards, he'll immediately try to get me to do whatever miracle treatment he's pushing at the moment and sign me up for the package deals (usually ranging from 3-7 treatments and costing anywhere from 300 to 1500$). The best part? He never has done any of the procedures except for the smooth beam and co2 laser. The acne "extraction" and the dermabrasion, the peels, etc. are all done by the aestheticians he has and they end up creating the schedule and recommending what I do next. I feel confused.....I know they are experts as well but they aren't dermatologists? I worry about their "skills" ?? Extraction by the aesthetician I am comfortable with. Dermabrasion I am not.

The reason I ask: My current dermatologist, Dr. Nissan Pilest, is HIGHLY recommended by my mother's friends. Being in Orange County, CA, these well-to-do moms go to him for all types of age fighting rejuvenating treatments which I'm sure work great. For me, however, I've seen very little benefit in the last 3 yrs of seeing him.

I started wondering: Maybe he's not as great as people say? He has recommended everything to me. I'm now in my late 20s and have had acne since I was 15. It has ranged from moderate to severe to now being rather light. I've tried beta lift chemical peels(4 times), smooth beam (2 times), micro dermabrasion (5 times), CO2 laser, clear light (8 times), and recently Photodynamic therapy (UVA cream + clearlight (3 times)). I've been on BP creams, benzamyacin, benzclin, retin-a, retin-a micro, everything. Medication wise I've tried all types of anti biotics (vectrin, monocyclin, tetracyclin, etc) with temporary success. He is strongly against accutane and recommends that I don't try it because of suicide rates etc.

When I was 16 and the scarring was very minimal, I had a friend take accutane then. His acne was about the same as mine if not worst. A yr later, he's totally acne free and has been since. He's very happy. I was too afraid and my family was so against accutane. Now I have so many scars from light to severe that I am constantly frustrated, antisocial, depressed, self conscious, and self destructive in relationships...........It sux! I am ranting now, I really should stop.

Anyhow, I am now breaking out much less, only occasionally but I REALLY want to get rid of my scars. I read about Dr. Y. and I am really interested but I would like to find another dermatologist for a good 2nd opinion before I go that route. I am in Irvine, CA and would LOVE to hear recommendations of any good dermatologists in the area? I can drive anywhere in S. California. smile.gif I am so tired of my current doc, I feel like he's just trying to push me his quick $300 clearlight + UVA treatments that occupy his staff a total of 10 minutes.

I really want to help with the scars. I obsess about it constantly. It's really frustrating that most treatments aren't covered by my PPO. Yes, acne isn't life threatening, but it causes so much social distress and unhappiness.

I read an earlier post about self confidence issues in relationships and i TOTALLY relate. I (luckily) have been in many relationships with people that could overlook my superficial flaws. One loving girl has even told me she doesn't even notice or see it. The kicker is that I see it, I constantly see it and I constantly feel people see it. I am shy of pictures and I can't stand letting people get too close to me as I fear the scars are MUCH more visible. I am quite self destructive in relationships, I constantly think "wow your a pretty girl, very attractive. What da heck are you doing with me?" Yes, I hear all their rebuttals to my self loathing and I really want to believe them but it's tough. It also doesn't help they all have perfect flawless skin!! It kills me when they tell me how they got a tiny little zit somewhere and pout about it. Blah!

Being Asian doesn't help either! This might be a cultural thing: my family friends or relatives in Asia constantly talk about my acne right in front of me and joke about it to make me feel..better? They have a old saying "good looking guys have big pimples!" And they laugh, it's usually accompanied with laughter etc. Or everyone has recommended "home brew" remedies such as "sleep earlier" and "don't eat oily" and the best one "wash your face more!" Wow it's fun.

Anyhow, I APOLOGISE for the long long post. This is probably the first time I've been fully able to .....talk about it. Thank you for the forum. I will try to contribute and share as much as I can w/everyone =). So far, I've discovered that Cetaphil works 100x better than any other soap I've ever used. So simple, so good!

Just a note: Dr Pilest must be a good doctor, he has lots of clients and really swank facility. I just worry he's not the best for me.


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Dude, we both have almost the same experiences. It's surreal.

But, ask yourself, have you really tried everything? I will be on an intensive liver colon kidney cleansing this September.

Could you tell me more about the Photodynamic therapy? Does it work?

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Yeah, I've tried quite a bit of stuff. I feel like my doctors don't really care about the fact that I'm young and not exactly loaded with money to spend on these treatments! I have no savings account because I spend all my stock investments, spare earnings, etc. on trying to improve my skin. Vain? No. I just want to look normal and not worry about zits. I used to even have cystic acne that hurt quite a bit. It sucks because all my siblings have fair skin!

Photodynamic therapy uses aminolevulinic acid with UVA therapy (for acne usually Clear Light). You can read about it here. The technology was, according to my doctor and research I've found, used for attacking cancer cells noninvasively without surgery. They've discovered it works great for attacking oil/sebaceous glands in the skin as well.

If you're not familiar with clear light, it's a treatment where a special light is shined onto the face to kill acne causing bacteria. More information can be found here. I've had clearlight done before and the results were mildly successful. They weren't cheap, about $150 per treatment and I had to do 6 treatments at 1 week intervals.

Photodynamic therapy takes about 3 to 4 treatments spaced at 1 to 2 week intervals. It injures the oil glands on the skin much like accutane does but without the side effects. It has an effective duration for about 6-8 months. Cost is $300/treatment and is completely done by the aesthetician. It takes about 10 minutes for them to put the acid on the face (very light burning, nothing painful) and then 8 minutes of shining the clear light on the face. That part is completely painless and requires even LESS work from the aesthetician. In fact, they leave the room and you follow the voice prompts of a computer that tell you when to rotate your head while it is being "cooked" -- uhr I mean "treated". For 48 hours after the treatment, you can NOT go into the sun at all and I'm serious. You need good sunblock and avoid being in the sun, even driving! First time I did it I didn't take the warnings seriously and my face became bright red and "burnt" feeling. Like a bad sunburn. Subsequent treatments I used a lot of sunblock, used a lot of shade while driving and I was fine. The redness went away in 12 hours.

Right now, I must say that I have stopped breaking out. It has been about 2 months since I finished my last treatment. Breakouts occur infrequently and usually after my own mistakes (not sleeping right, stress, partying late, falling asleep without washing up!!!). It is not as effective as accutane I am sure but it is much safer. It is the best treatment I've had done. I am afraid that I will forever have to cough up $900 every half year to get this done. I know this treatment shouldn't cost this much. I feel there is a serious ethics issue going on here. $900 for acid + light shined on my face for 8 minutes?

I am planning to take pictures of my skin and sending to Dr. Y. for evaluation of possible dermabrasion treatment. I really want to improve my scarring.

But, ask yourself, have you really tried everything? I will be on an intensive liver colon kidney cleansing this September.

Does that work? I believe cleaning the colon should help a little but I don't know...please let me know!

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Hi Zelig,

I feel exactly the same as you. I have had acne for years. I have seen derms and tried everything except tane (I am afraid of more scarring). I hate my scars.

You seem to be dealing with it better than me.

I cannot get into relationships or feel comfortable anywhere.

And, I am still breaking out. So, I have the old indents and ice picks, and new ones.

What really gets me is sitting here watching the pimples come up and scar me.

I don't touch them and I put bp and stuff to help it go away on it, but they still scar me.

I am sorry for letting this out, but when I see someone who feels similar to me I have to tell them I feel that way too.

I am considering going to Dr. Y, but since my acne is not under control, I am afraid to do it. I had one dermabrasion already, but I broke out after, thus new scars, and the old ones are still there.

Have you found a way to prevent scarring? I would be happy to start with that.

I am praying that this breakout I have now will not scar, but they probably will.

I actually thought I was clear on proactiv ( I started 2 months ago), but all of a sudden, 15 pimples. I feel like giving up.

Sorry again. I just had to let that out. I have no friends or anything. I hide behind my hair.

Good luck to you smile.gif

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I've seen very little benefit in the last 3 yrs of seeing him.

If you hired a mechanic to fix your car and you paid him but the car was still broken, would you keep going back to him?

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No, I would not keep seeing a bad mechanic but what if you thought it wasn't the mechanic that was broken but the car? I constantly wonder if it's something wrong with me or the things I'm doing. Supposedly each treatment is "very very effective" but doesn't work for "everyone." It's like one of those hard sale nightmares. "Yes it works but you are a special case."

Liz, I totally feel you. I still have at least one pimple on my face at all times and that just totally SUCKS. I think the best way to not get scars is to have a professional "extract" the pimples for you instead of doing it yourself. The urge to just get rid of it is really strong but highly not recommended (or so my aesthetician says).

Don't apologize about venting! I think maybe we should continue the venting on the other forum though tongue.gif .

What products have you tried to control the breakout other than proactive and bp? Maybe you can try some of the other products that are available. Benzaclin works not bad for me. I use that during the day and retin-a micro at night. I use cetaphil to wash my skin (i love it--it is better than ANYTHING my dermatologist has recommended) and it has made a huge difference.

Good luck I wish you the best as well!

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