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What Are Lipomas?

Lipomas (benign fatty growths) Removal Bend, ORWant to know a tumor that you shouldn’t be scared of? Try the underappreciated lipoma. Lipomas are the most common tumor to form beneath your skin. About 1 out of every 1,000 people develops lipomas.

They’re not usually anything more than a soft rubbery bulge on your skin. While lipomas are harmless, occasionally it’s best to remove them.

What is a lipoma?

A lipoma is a collection of fat cells growing in the soft tissue of your body, under the skin but over the muscle. Lipomas don’t develop into cancer because they consist only of fat and sometimes connective tissue.

No one is sure why lipomas develop. They often appear after an injury, and middle-aged people tend to get them more. There also seems to be a genetic factor, as they tend to run in families.

What do they look like?

Lipomas usually appear as small, soft lumps. They’re usually less than 2 inches wide. When pressed on, a lipoma may feel doughy, and they will move easily with finger pressure. They don’t normally hurt, but can if they grow next to nerves or if blood vessels run through them.

Why would I need to remove a lipoma?

Most lipomas are harmless and can be left to their lumpy existence. But if the lipoma becomes tender or painful, acquires infections, becomes inflamed repeatedly, interferes with your movements, becomes enlarged, or has a foul-smelling discharge then you should have Dr. Carter remove it.

How are lipomas removed?

Dr. Carter will usually surgically remove your lipoma. In most cases, this can be done as an outpatient procedure with local anesthetic simply injected around the lipoma. Dr. Carter will then make an incision, remove the fat cells and any connective tissue, and close the incision with a few stitches.

If surgery isn’t an option, steroid injections can shrink the growth, but usually won’t eliminate it.

The lipoma can be aspirated with a needle and a large syringe. This method doesn’t leave a scar but isn’t as effective for larger lipomas.

Do you have a lipoma that you would like have removed? Call Dr. Carter at 541-330-0900 to make your appointment.

Posted in Lipomas (benign fatty growths) | December 30, 2017

Sculptra Is Long Lasting

Dermal Fillers Bend, ORSome people think that if they never went outside that they wouldn’t age. Not so. Not only would you miss out on all the beauty around us here in Bend, but you’d still age. It’s called intrinsic aging, and it involves the yearly decrease of your body’s collagen production. By the time you’re 50, your body produces one third less of this structural skin support protein than when you were 20. Elastin, which keeps the skin supple and elastic, has a similar drop.

That’s why you’re wrinkling, and your skin is sagging. Sun damage and other environmental issues/choices play a role, too, but intrinsic aging is the real culprit.

To fight back against this loss of collagen and elastin, Dr. Carter offers Sculptra, a long-lasting injectable that stimulates the body to produce new collagen to counteract some of the effects of intrinsic aging.

Sculptra is different filler

Most dermal fillers get their name because they “fill” in wrinkles; they push them up. These fillers are injected beneath the wrinkle and push up the skin. Their results are immediate.

Sculptra addresses wrinkles in a different fashion. You’ll see improvement after your injections, as you would with other fillers, but your real improvement will come over time. This is because Sculptra is made from poly-L-lactic acid (PLLA), which works in the dermis layer of the skin to replace lost collagen. Sculptra is known as a bio-activator or “volumizer.” Because it slowly rebuilds collagen, Sculptra gives you subtle results that continue to improve over time. This makes for a natural-looking appearance that gradually improves your skin. It’s not the instant change that you see with other fillers. With Sculptra, your results will come gradually, so no one notices a sudden change. We recommend three injection sessions over a few months for the best results. These results can then last for over two years!

How does Sculptra work?

Sculptra is injected differently. Other fillers are injected at a relatively shallow level, just below the wrinkle that needs to be filled. Dr. Carter injects Sculptra more deeply, into the deep dermal layer of the skin. In the deep dermis, microparticles of PLLA work to rebuild lost collagen and provide structural skin support. As the PLLA is absorbed, a collagen framework is created. This reinforced collagen structure provides a foundation that gradually restores the look of fullness to shallow to deep wrinkles and folds.

Where does Sculptra work best?

Sculptra is effective for:

  • The lines framing your mouth (marionette lines)
  • Hollow areas of the temples, cheeks, chin, and under the eyes
  • Deep folds between the nose and mouth (nasolabial folds), also called smile lines
  • Chin wrinkles

Interested in the long-term effects of Sculptra? Call us at Deschutes, 541-330-0900, to make an appointment.

Posted in Dermal Fillers | December 15, 2017

Botox has some Other Interesting Applications

Botox® Bend, ORSince you may be considering coming to see the team at Deschutes for a Botox session before your holiday party, it may interest you to know some other uses for this world-famous brand.

This all-star of the aesthetic world was first approved for the treatment of wrinkles in 2002, but it was used for the treatment of other medical conditions decades before that. Here are some additional facts about Botox:

The origins or Botox

Clostridium botulinum is the organism from which Botox is derived. It can be found in its inactive form all through the natural environment, including in cultivated soil and forest soil, and in the sediment of lakes, streams, coastal and untreated waters.

Medicinal uses

Botox has been used medicinally for decades. It all started after WW2. Scientists found that the botulinum toxin type A, when injected in very small amounts, could make muscles temporarily stop contracting it was tried in various capacities. It is now used for the following therapeutic applications:

  • Blepharospasm (involuntary eyelid spasms)
  • Idiopathic rotational cervical dystonia (severe neck and shoulder muscle spasms)
  • Chronic migraine headaches
  • Severe primary axillary hyperhidrosis (excessive sweating)
  • Strabismus (crossed eyes)
  • Post-stroke upper limb spasticity
  • Urinary incontinence
  • Overactive bladder
  • Hemifacial spasm


It is also used “off-label” for:


  • Achalasia (esophageal problems creating difficulty swallowing)
  • Sialorrhea (hypersalivation)
  • Allergic rhinitis
  • Hepatopancreatic dysfunction
  • Cerebral palsy
  • Oromandibular dystonia (forceful contraction of the jaw, face, and tongue)
  • Laryngeal dystonia (forceful contraction of the vocal cords)

More about Botox

More than six million Botox treatments are given each year, far and away the most of any cosmetic procedure of any type.

Although Botox is by far the most popular brand, the botulinum toxin is also sold commercially under these other brand names: Vistabel, Dysport, Bocouture, Xeomin, and Myobloc.

Are you interested in saying goodbye to your crow’s feet or the 11s between your eyebrows? Botox is your ticket. Call us at Deschutes, 541-330-0900, to make your appointment.

Posted in Botox | November 30, 2017

It Pays to Get Alphabetical with Skin Cancer

Skin Cancer Bend ORAround here, we’re all out and about year-round. But coming off of the long sunny days of summer, now is a good time to take stock of your skin. At our altitude of 3,623 feet in Bend, we get more than our fair share of ultraviolet rays.

When it comes to knowing about skin cancer and what to look for, it pays to get downright alphabetical, specifically A, B, C, D, and E. Those five letters are an easy way to remember five steps in identifying growths that could be skin cancer.

We all live in sunny Central Oregon for the gorgeous sunny climate, and most of us have at least some knowledge about our skin and sun damage. Gone are the days of slathering baby oil all over our bodies and lying in the sun for hours on end. Gone are the days of the Coppertone little girl and her famous tan line.

Still, the key to beating skin cancer is to keep ever vigilant, to catch it early. Toward that end, Dr. Carter wants her patients to be knowledgeable about the warning signs, so here is some additional information on skin cancer.

Who gets skin cancer?

If you’re one of the people who always seem to need to have lesions frozen or small skin cancers excised, you probably know, and hate, people who never seem to get a thing. Odds are their skin is darker. So, why don’t they have sun issues like you? It all comes down to melanin. Melanin is the pigment in the skin that helps protect it from the sun. Melanin is what is responsible for turning the skin a darker tone (tanning) after receiving sun exposure. This is a protection mechanism.

People with fair skin have less melanin so they are less protected. The ultraviolet rays from the sun can alter the genetic material in skin cells, causing them to mutate into cancerous cells. It is estimated that 40 to 50% of people with fair skin (who live to be at least 65 years of age) will develop at least one skin cancer in their lives.

Different cancers

Squamous cell carcinomas and basal cell carcinomas are more common than melanoma and they come from different types of sun exposure. Squamous and basal cell carcinomas are the result of the amount of overall sun exposure. Fair-skinned people who spend a lot of time outdoors will likely develop one of these two skin cancers. Melanoma, the most dangerous type of skin cancer, isn’t thought to come from prolonged sun exposure, but from the intensity. It is believed that melanoma is triggered by the scorching sunburns where the person’s skin blisters and peels afterwards. Research has shown that just one blistering sunburn during childhood doubles a person’s risk for developing melanoma later in life. If you’re over 50, odds are you’ve had countless types of those sunburns because sunscreens were in their infancy when you were a kid.

Know your ABCDEs

These five letters can come in handy when looking for skin cancers on your skin.

  • Asymmetry— If one half of the mole doesn’t match the other half, that’s a concern. Normal moles are symmetrical.
  • Border— If the border or edges of your mole are ragged, blurred, or irregular, that is a reason to call Dr. Carter. Melanoma lesions often have irregular borders.
  • Color— Normal moles are a single shade throughout. If your mole has changed color or if it has different shades of tan, brown, black, blue, white, or red, then it should be checked.
  • Diameter— If a mole is larger than the eraser of a pencil it needs to be checked.
  • Evolving— If a mole evolves by shrinking, growing larger, changing color, itching or bleeding, or other changes it should be checked. Melanoma lesions often grow in size or gain height rapidly.

In a sunny place like Bend, we all need to be aware of the signs of skin cancer. If you’ve been minding your ABCDEs and something has caught your eye, call Dr. Carter and let’s take a look, 541-330-0900.

Posted in Skin Cancer | November 15, 2017

Microneedling Your Way to Better Skin

Cosmetic Dermatology Bend ORIf you’re reading this blog from Dr. Carter and her team at Deschutes, you know that collagen is what we all want. Collagen is the protein in the body that is responsible for providing support and structure to the skin. It makes our skin firm, yet supple. The problem is that as we age our body produces one percent less collagen every year after we turn 20. Bogus. That’s why older skin is more loose, wrinkles easier, and loses volume in areas such as the cheeks.

The goal of many procedures is to kick start our collagen production. Microneedling, also known as percutaneous collagen induction therapy, is one of those non-invasive procedures. Microneedling creates thousands of microscopic micro-injuries in the skin that triggers a wound response from the body. The response? Increased collagen production at the treatment areas.

At Deschutes we use the Rejuvapen microneedling system for treatment of wrinkles and scars.

How does microneedling work?

The concept behind microneedling is to trigger a wound response and increased collagen production. When the skin is injured the body rapidly gets to work repairing it. In addition to the platelets that close the wound off from any more blood loss, the body is also rebuilding the skin by producing new collagen and elastin for the area.

At Deschutes, we use the Rejuvapen system, which has 12 tiny needles located in the tip of the microneedling pen. When used over the target area, the needles produce microscopic holes/channels down into the skin. These heal in just a few hours, but the body perceives them as injuries and elevates collagen and elastin production in the area to compensate.

This has two benefits. First, it stimulates the healing response. Second, these short-lived channels down into the skin are great for the application of topical gels and creams to penetrate below the surface of the skin.

What do we treat with microneedling?

  • Fine lines and deep wrinkles around the eyes, mouth, and forehead
  • Deep lines and crepe-like texture across the face can be firmed
  • Coarse, sun-damaged skin
  • Acne, burn, and surgical scars
  • Stretch marks
  • Overly large pores

We use a topical numbing cream prior to your treatment, so you feel no pain. And there isn’t really any recovery time, just some redness on the treated areas for a day or so.

Interested in microneedling? Call us at 541-330-0900.

Posted in Facial Rejuvenation | October 30, 2017

Microblading Isn’t for Our Bike Trails

Microblading Bend, ORAround here pretty much everyone uses the bike trails, many with inline skates, aka Rollerblades. You may think that the term microblading is all about those rolling wheels.

Alas, you’d get that question wrong on Jeopardy!

Microblading is a form of semi-permanent make-up used to create fuller, more defined eyebrows.

What is microblading?

Not everyone can have eyebrows like Leonid Brezhnev, one of the last rulers of the USSR (look him up!). But many of us have eyebrows that are beyond wimpy. Microblading is a form of tattooing where the pigment is implanted within the skin using a manual, handheld tool instead of a tattooing mechanical pen.

How is microblading done?

We have a microblading pro at Deschutes, Tara McKenna. Tara draws delicate, individual hair-like strokes that mimic the existing hairs in the patient’s brows. Tara’s skills and technique create a very natural, pleasing look. This is night and day better when compared with traditional permanent make-up that often makes for eyebrows that look gray and artificial.

Would microblading be a good thing for me?

Microblading is great for convenience and simplicity. You can benefit if:

  • You want the convenience of perfect brows every day without any effort.
  • You’ve lost much of your eyebrow hair density due to aging, genetics, illness, or overplucking or waxing.
  • Your vision has decreased, making it difficult to apply make-up to your eyebrows.

How long does it take?

Microblading requires two appointments. The first appointment lasts between 60 and 90 minutes, the second between 30 and 60 minutes.

How long will it take for my results to show?

Immediately after your microblading session, the pigment will be very sharp and dark, and you’ll think it is way too strong. Not to worry. This is simply because the pigment is still very high in the skin. It settles in, and the pigment softens. This takes around one month. At that point, you return for your second appointment, and Tara makes any adjustments or touch-ups that you want.

How long does it last?

Microblading doesn’t place the ink as deeply as a tattoo, so the results are not permanent. Your results will usually last from one to two years, and then a touch-up session will probably be needed.

Want to say goodbye to your wimpy eyebrows? Call us at Deschutes, 541-330-0900, and ask about microblading.

Posted in Microblading | October 15, 2017

Actinic Keratoses — Previews of Coming Attractions

Precancers and Sun Damage Treatment Bend, ORWe’re past the height of summer movie madness at the Regal Old Mill Theaters. Sometimes this summer there were so many previews, they could last 20 minutes. But when it comes to your skin — which is our reason d’etre at Deschutes — there’s a preview of something to come, as well. They are called actinic keratoses, and they are a preview of squamous cell carcinoma or basil cell carcinoma skin cancer.

Dr. Carter is an expert at spotting these precancerous skin lesions and treating them. This prevents them from developing into skin cancer.

What is an actinic keratosis?

Actinic keratoses are the result of long-term sun exposure. Sun exposure isn’t an individual event type of thing. Over the years, your amount of exposure accumulates and can eventually develop into both squamous cell and basil cell carcinomas.

An actinic keratosis is a rough, scaly patch growing on the skin. They look a bit like a dry patch, but with a definition. You’ll find them on areas that receive the most sun exposure. They can be different dimensions. Their color will range from light to dark, from pink to red. They can be flat or raised.

Who gets them?

More than 58 million Americans are diagnosed with actinic keratoses every year. They are more likely to develop in those with fair complexions, and in those with gray, green, or blue eyes. Darker-colored races, such as African-Americans, Samoans, Asians, and Hispanics, are less likely to develop these lesions.

How do we treat them?

The key with these lesions is to get rid of them before they develop into squamous or basil cell carcinomas. Some people don’t see any reason to remove these types of skin cancer, which isn’t usually life threatening, unlike melanoma. But if you let them grow, they can spread, and their removal can then be very disfiguring, especially in the face.

  • Cryotherapy — This is the most common treatment for actinic keratoses. If you’ve ever been to our offices, you’ve probably been introduced to the liquid nitrogen bottle. Dr. Carter sprays the lesion with this extremely cold gas. The lesion turns red, swells, may blister, and then peels off.
  • Topical creams and gels — Various topical applications can also remove actinic keratoses. One cream, 5-flurouracil, is applied to the skin for two to three weeks at home. It causes inflammation on the growth, which then peels off. Picato gel is only used for two to three days, causes a sunburn-type irritation, and makes the lesion peel away. Solareze gel is also effective.
  • Photodynamic therapy — In photodynamic therapy, we apply a topical drug called Levulan to the skin. A blue light then activates the chemical in the drug, which kills abnormal skin cells.
  • Topical immunotherapy — Over the past decade, a new approach for these lesions and even in situ skin cancers is to trigger the patient’s immune system to attack the abnormal pre-cancerous or cancerous cells. There are two prescription creams, Aldara and Zyclara, which are applied to the lesions daily. They trigger an immune response where the patient’s white blood cells attack and remove the abnormal cells.

If you have rough, scaly lesions on your skin, see the team at Deschutes. Dr. Carter will get rid of these growths before they become something more serious.

Posted in Medical Dermatology, Skin Cancer | September 30, 2017

Platelet-Rich Plasma

Nonsurgical Facial Rejuvenation Bend, ORPlatelets, no they’re not some Bizarro World entry into the paper plate market. Platelets, for those of you who were passing notes in biology class instead of studying, are the critical element in the blood responsible for wound repair. More specifically, platelets allow the blood to clot. They’re also powerful little growth facilitators, another part of their wound-healing prowess.

Here’s an idea. Let’s say we take some blood and concentrate those platelets and then inject it back into your skin and let the platelets go to work.

Yeah, we do that every day at Deschutes Dermatology. It’s called platelet-rich plasma, and we use it to rejuvenate facial skin.

What is platelet-rich plasma?

If you take a blood sample and remove all the white and red blood cells, what you’re left with is plasma and blood platelets, but in a much higher concentration than when the blood cells are in there. Platelet-rich plasma (PRP) has been used for years to speed the healing of joints, tendons, and muscle tissue in professional athletes. Now it can “heal” problems such as sun damage, acne scars and stretch marks, and the decreasing volume that is a part of normal aging.

How is a PRP treatment done?

At Deschutes, we start the PRP process by taking a small amount of blood from you, about the same amount used for a typical lab test. That blood is then placed in a centrifuge that spins at a high rate and separates the different components of the blood. Red and white blood cells are divided from the platelets and the plasma (the clear fluid that makes blood liquid). This plasma now contains a higher than a normal number of platelets (four times higher) and is called platelet-rich plasma.

Dr. Carter then reinjects the PRP back into areas of the patient’s face that need rejuvenation. Once injected the PRP stimulates the growth of new collagen, revitalizes skin tissue, and smoothes and firms the skin. That’s where PRP injections are different than dermal fillers. Dermal fillers simply fill lines and folds. PRP fuels skin rejuvenation. You can think of PRP as a natural filler that is rebuilding rather than simply filling.

What happens after my session and when will I see results?

The entire PRP session takes only around 15 minutes and is relatively painless. There isn’t any recovery time, but there can be some slight redness and swelling at the treatment sites. This passes very quickly.

Results begin to show themselves in three to four weeks as new collagen is added to the treatment areas, and these results continue to build for months.

Interested in putting your platelets to work improving your facial skin? Call Dr. Carter at 541-330-0900 and ask about platelet-rich plasma.

Posted in Facial Rejuvenation | September 15, 2017

E is for Eczema

Eczema Treatment Bend, OROK, so that doesn’t make sense — eczema has an X sound to start it — but no matter how you spell or say it, eczema is annoying. If it makes you any more comfortable, you’re in good company; over 30 million Americans have some form of eczema. But the itching, scaly skin doesn’t have to be a way of life. Dr. Carter can treat your eczema.

What is eczema?

Eczema is known by atopic dermatitis or atopic eczema for doctor types. If you’ve heard of the common term, eczema, it could be from a dandruff shampoo commercial or something like that. It’s a chronic condition characterized by red, itchy, dry skin that is due to inflammation.

It’s common for babies and young children, showing up on the face. In most children, eczema is a passing condition.

In adults, eczema has much in common with allergies, although the exact triggers of eczema are still somewhat of a mystery. Eczema can develop anywhere on the body but is common on the shins, behind the knees, and on the arms.

No matter what the actual cause, the body reaction that causes eczema is due to abnormal function of the immune system. Also, activities that can cause the skin to be more sensitive, dry, or irritated, and or any defects in the skin barrier can lead to an outbreak of eczema.

What are the symptoms?

Eczema shows itself as patches of chronically dry, itchy, thick skin that appear on the hands, neck, face, and leg area. The skin may appear red or brownish-grey. The affected areas may have small bumps that leak fluid when scratched. The irritation and itching are usually worse at night.

How we treat eczema

Mild cases of eczema (people don’t even realize they have it sometimes) can often be managed with over-the-counter anti-inflammatory creams. But when those don’t work, or when your rashes become crusty or develop blisters, then it’s time to see Dr. Carter.

These are the array of prescription medications and other treatments she may use to get a handle on your eczema:

  • Hydrocortisone
  • Antibiotics
  • Antihistamines
  • Corticosteroids
  • Ultraviolet light therapy
  • Immunosuppressants
  • Prescription-strength moisturizers

You don’t need to live with the itchiness and embarrassment of eczema. See us at Deschutes. Call 541-330-0900 to make an appointment.

Posted in Eczema | August 30, 2017

Leave the Double Chin to Jobba the Hut

Kybella Treatment Bend, ORJust about all of us have some degree of a double chin after we hit out 45th birthday or thereabouts. It’s a combination of our skin and tissue becoming looser and the development of fat cells.

But you don’t have to feel like you look like Jobba the Hut. You can stop in and see Dr. Carter and have her treat your double chin with Kybella. Before you know it, you’ll have a profile that looks more like yours at 25 rather than 45 or 50.

What is Kybella?

Kybella is the only FDA-approved injectable treatment to improve the appearance of double chins by destroying the fat cells helping your skin to sag. Clinically, a double chin is called submental fullness (a much more pleasant term!). Studies have shown that over two-thirds of people are bothered by their double chins. And those people say their sagging chins bug them just as much as wrinkles and other signs of aging.

How does Kybella work its magic?

Kybella’s secret is quite simple. It is made, basically, of deoxycholic acid. Deoxycholic acid occurs naturally in the human body. Its job is to help with the breakdown and absorption of dietary fat. The key is that deoxycholic acid doesn’t know the difference between dietary fat (the ingested kind) and the fat living a comfortable life under your chin. To it, fat is fat and must be destroyed.

So, when Dr. Carter injects Kybella into various locations under your chin, the deoxycholic acid finds the fat and destroys it. The fat is then broken down and flushed from the body through the lymphatic system. In addition to getting rid of the fat, Kybella also destroys the fat storage ability in the area. So, not only is the fat gone but so is the body’s capacity to store fat in the future.

How long do results last?

We said destroy, and we mean it. Kybella doesn’t need ongoing future sessions — the fat is gone permanently. You decide on the number of injection sessions you want to get to your goals, and once you’re there, you’re done. Obviously, your chin muscles and tissue will continue to slacken somewhat with age, but the fat that has been most of the problem is gone for good.

How many sessions will I need?

The FDA has set the maximum number of treatment sessions at six, but how many you decide to have is up to you. Some people find they like their new profile at just two to four sessions. How many you end up having is up to you.

Interested in getting rid of your chinny chin? Call Dr. Carter at 541-330-0900 and let’s talk about Kybella.

Posted in Kybella | August 15, 2017

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