skin

By Stacey Pfeffer

Nestled on a tree-lined section of King Street close to downtown Chappaqua is the office of dermatologist Lydia Evans, M.D.. From the minute you walk into her cozy, yet state-of-the art office, it’s evident that you’ll be given individualized treatment and that she truly takes her time to know her patients’ concerns. Dr. Evans has been practicing both medical and cosmetic dermatology for more than two decades in this location and is passionate about treating families in our area.

Dr. Evans was initially studying both internal medicine and oncology and clearly remembers her rotation through dermatology. Although she fell in love with treating skin conditions, at that point she was already committed to completing her oncology residency. After practicing oncology though for six years, she decided to switch to dermatology.

“Oncology at that point was not what it is today. There are lots of significant strides made forward in the past years but when I was practicing it was not the case. I knew oncology was not the long-term answer for me so that’s why I went back and completed another residency in dermatology and that was clearly the best move I’ve made,” Dr. Evans notes.

Working in the local community for so many years, she’s had the privilege of treating multi-generational families. “I think my longest relationship is with one family, where I see five generations of them, including a very senior grandmother and a relatively new baby. That’s just one of the many things that I love about my job,” remarks Dr. Evans.

As the warmer months approach and sun exposure increases, many patients come in asking about skin cancer prevention. But taking care of your skin “is really a life long proposition,” explains Dr. Evans. “People tend to be very careful with their children about getting their kids to use sunscreen but are not so diligent themselves. A lot of proactive work will save a great deal of aggravation ultimately in terms of skin health such as preventing cancers and the cosmetic aspects.” If patients haven’t been careful about sun protection, visible signs of aging can begin to appear in their early 30s.

Dr. Evans believes that sunscreen should be a daily ritual year-round like flossing your teeth. “Two minutes of prevention equals long-term remarkable benefits,” she notes. She recommends that people look for a sunscreen with both ultraviolet-A (UVA) and ultraviolet-B (UVB) protection. UVA light penetrates glass and UVB light does not but it is the most burning part of light. The intensity of UVA light does not change that much from season to season but driving in your car you are still exposed to it. “Unfortunately exposure to UVA light is associated with cosmetic signs of aging and melanomas,” Dr. Evans said.

In her practice, she recommends that people use an SPF at least in the 30s or 40s. Higher SPFs don’t necessarily protect better, they just protect for a longer period. There is some controversy about the higher SPF numbers because people assume that reapplication isn’t necessary. In reality, sunscreen sometimes gets toweled or perspired off. Dr. Evans suggests that her patients “reapply every 90 minutes, maybe two hours if using a really high SPF.” In addition to sunscreen, Dr. Evans is a proponent of antioxidant serums, which can prevent sun damage in the future. She also recommends that patients have an annual skin check exam to look for moles.

Very often Dr. Evans has patients that come in initially for a skin health exam and then want to find out about other cosmetic procedures to improve their skin’s appearance. Dr. Evans’ practice offers a variety of procedures such as Botox, fillers, Coolsculpting and Ultherapy but her number one rule is patient safety first. “I’m the first guinea pig, so we test everything here personally before it ever is given to a patient. If I’m going to discuss a procedure I want to be able to answer does it work? What’s the recovery like? What’s the downside?” Her office receives many products to sample but Dr. Evans estimates that she only brings in probably one out of eight products that have passed her stringent tests.

Botox and fillers are extremely popular with her patients but are used for different purposes. Botox is used for lines of motion (e.g. crow’s feet, forehead creases) whereas fillers are used to help with lines of rest and help to reshape and recontour the face. “We have a number of different products so treatment can now be very individualized.”

Another procedure that is gaining traction among Dr. Evan’s patients is Coolsculpting for fat reduction. Researchers have now figured out the exact temperature that freezes fat. It can treat a specific site and only takes an hour. About three months post-treatment, patients can expect to lose 25 percent of the fat on a specific area of the body. Besides stubborn belly fat, the company is evolving their technology, so that Coolsculpting can be used under the neck or by the side of the knee where you have smaller pockets of fat that are hard to target with diet and exercise.

Ultherapy is another technology that improves the skin’s appearance. It is based on deep ultrasound that stimulates collagen production deep under the skin and is used for sagging. It’s offered as a single treatment and results on average can last 2.5-3.5 years. “There’s no question it works and you can tell that because I’ve had my machine for five years and I’ve had many people come back for a second treatment and people don’t do that unless it works. It’s fun to see these much less invasive, much less aggressive non-surgical technologies that offer alternatives. You want a change that takes off five to ten years and makes you look more vibrant, more alive. You don’t want people to say, ‘Oh, you got a facelift,’” said Dr. Evans.

One of the main reasons younger patients come to Dr. Evans office is for acne treatment. “Acne is a genetically driven condition that needs persistence. Some people have a relatively minor problem and some carry it in adulthood, so there is almost a spectrum of conditions within acne,” she explains. Dr. Evans believes that treatment should take into account a patient’s lifestyle, convenience and how much the patient is invested in improving. “I may have ten patients come in for acne treatment and there may be eight different treatment regimens because it’s not all the same. It is not formulaic.”

She also considers how the patient’s skin will look in the future and if scarring is present, she will offer more aggressive treatments than for someone with mild acne. Dr. Evans is committed to learning about the newest products in the dermatological field and attends professional meetings regularly to keep abreast of the latest skincare trends. Recently she saw a sunscreen product that is used as a shower gel and bought some samples home to evaluate it. It is supposed be left on for two minutes in the shower but Evans wonders if people will really leave it on for a full two minutes. “It’s a great idea conceptually but you have to think how will this work in practice?”

“It’s an exciting time to be involved in the field and it really pleases me from both the medical and the cosmetic aspect to see such great strides forward. I feel blessed to practice at this juncture because when I compare now what’s available to 25 years ago it’s exponential and I think that’s only going to continue,” concludes Dr. Evans.

Stacey Pfeffer and her husband and three young kids are New Castle residents. With summer on the horizon, she’s hoping her children will be less difficult this year with sunscreen application.