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Dr. Jeremy B. Green

Dr. Jeremy B. Green: Erasing Scars on all Skin Tones


August 02, 2012

Jeremy B. Green, MD, is an Assistant professor of Dermatology and Cutaneous Surgery at the University of Miami Department of Dermatology. After graduating with honors from the Northwestern University Feinberg School of Medicine and the University of Miami Miller School of Medicine, he trained and served as Chief Resident at the University of Miami Department of Dermatology. In addition, he completed advanced fellowship training in laser and cosmetic surgery at SkinCare Physicians in Boston, Massachusetts, with clinical faculty from Harvard and Yale University Departments of Dermatology.

He’s published numerous articles in journals such as Dermatologic SurgeryCosmetic Dermatology, the Journal of Investigative Dermatology, and Dermatology Times, and has lectured both nationally and internationally on laser and light-based treatments.

Dr. Green chose to become a dermatologist because of the impact dermatology had on his own life. “As a teenager, I had very horrible acne,” he explains. “It was quite severe. I required Accutane treatment for two cycles. This had a tremendous psychological impact on me and really showed me the influence that a physician can have on a patient’s life.”

One patient stands out to him because of his own experiences. “Many parents are hesitant to start their children on Accutane, but it’s the best treatment we have for severe acne. Unfortunately, when patients aren’t started at an appropriate time, permanent scarring can result. One particular patient I recall had a very strained relationship with his parents because he blamed them for his severe acne scars. I can sympathize having suffered through severe acne as a teenager. After a series of five fractional laser treatments, I see a complete turnaround in him as a person: he holds his head high, he is exercising and has put on weight, he’s interacting with his parents in a more positive fashion. So it’s really gratifying for to me to see how laser treatments can have an affect on a young person’s self-esteem and quality of life.”

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Dr. Green’s Advice
  • Patients can wait 6 months for nature to take its course with wound healing, or laser scar treatments can begin as soon as a couple of weeks after surgery/trauma
     
  • Consult a doctor with both laser and traditional surgery experience
     
  • Choose a doctor who uses Skintel or other devices to scientifically measure melanin in skin
     
  • Have realistic expectations—it takes several sessions to make a difference and they may not completely erase the scar
  • Dr. Green typically tells his patients that it takes six months for a scar to finish healing, but that it’s never too early to consult laser surgery experts. According to him, “After six months, the wound is finished healing and what they have is as good as they’re going to get naturally. However, some studies have shown that laser treatments can improve the appearance of scars when initiated only a couple of weeks after surgery or trauma.”

    Patients can benefit from consulting someone with both surgical revision and laser surgery. Dr. Green explains that often, doctors will favor what they have more experience with, so traditional surgeons will favor surgical revision and laser surgeons will favor laser surgery. “By talking to people with experience in both, you can get a better idea of which treatment will work best for you.”

    For patients with darker skin tones, it’s essential to choose a physician with an understanding of how different skin tones are treated. According to Dr. Green, Our studies have shown that it is safe to use fractional lasers in people with dark skin; however, in order to reduce the risk of any post procedure pigment change, it’s important to decrease the density of the laser treatment.”

    Emerging technology is improving treatment of darker skin tones. New devices allow doctors to measure the amount of melanin or pigment in the patients’ skin. “This is an important breakthrough,” explains Dr. Green, “because previously laser surgeons would assess people’s skin based on hair, eye color, skin tone, and their response to ultraviolent light—if they burned easily, or tanned and never burned. These were questions we asked, so our assessment of skin tone has always been very subjective. Revolutionary devices like Skintel give a melanin index, which provides an objective scale, and takes the guesswork out of assessing a patient's skin type.”

    Before this technology, incorrect assessment of skin tone led to injuries. “Most of the laser-induced burns and scars we see in our clinic are due to a clinician incorrectly assessing a person’s skin. For example, for a patient with a lot of pigment in their skin, lasers for hair removal targeting pigment in the hair itself can also be absorbed by pigment in the skin, causing the patient to get burned.”

    In the next ten years, technology will continue to advance. Dr. Green believes the next step in laser technology is for fractional technology, dividing lasers into hundreds and thousands of beams, to be applied to other lasers. “Right now there are only a few wavelengths of light that are used with fractional laser technology, but it may also be applied to other wavelengths. There are great new technologies, and they’ll continue to be refined.” 

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