David Vasily, MD is a nationally known board-certified dermatologist with over 25 years experience and medical director of the Aesthetica Cosmetic and Laser Center in Bethlehem, PA. He is a Fellow of the American Academy of Dermatology and of the American Society for Laser Medicine and Surgery.
Scars1: What made you decide to become a dermatologist?
Dr. Vasily: I really decided to become a dermatologist after completing a Dermatology rotation in medical school with Dr. Richard Dobson at the State University of New York at Buffalo. The field was fascinating to me because it includes facets of internal medicine that were of interest to me including Endocrinology and Infectious Disease. It also allowed direct visualization of very rare and fascinating skin diseases and the ability to not only treat them, but see them improve. It is a very visual specialty and this appeals greatly to me, as does the ability to do minor surgical procedures. In addition, the research opportunities in this field seemed enormous to me. As a dermatologist, I continue to treat many medical dermatology problems such as psoriasis, atopic dermatitis, acne, etc.; however, my practice has increasingly focused on dermatologic disorders as they relate to laser including acne, rosacea, psoriasis, etc. In this regard, I have done a considerable amount of clinical research work on the Excimer laser for the treatment of psoriasis.
Scars1: Have new treatment technologies improved results/recovery time?
Dr. Vasily: The new treatment technologies are simply breathtaking. Many of the new Fractional lasers, such as the Fractional 1540 and 2940 laser handpieces from Palomar, have revolutionized skin rejuvenation by improving the safety profile of these procedures and reducing the down time, risk of complications, etc.
Scars1: What methods do you use to treat scars?
Dr. Vasily: Currently we are using the Fractional 1540 handpiece from Palomar as our main treatment for both fresh and older scars. Fresh scars are currently treated at the time of suture removal and two weeks later. Older scars are treated with a series of Fractional 1540 laser and occasionally use of the 2940 laser for volumetrically debulking the scar as well.
Scars1: Can you describe and interesting case?
Dr. Vasily: There are many interesting cases to describe, however, a number of scar revision cases in particular stand out in my mind, because they are some of the most rewarding cases and happiest patients you will ever see in your practice. One case in particular involved fairly disfiguring scars on the face of a Vietnam veteran. These scars had troubled him for many years and were a constant reminder of his severe battle wounds. Laser scar revision has made a significant difference in this patient’s life since he no longer has to see the scars on daily basis. These scars, that were a daily reminder of the battle trauma he sustained, have now been markedly improved.
Scars1: What is the most rewarding part of your job?
Dr. Vasily: As a cosmetic dermatologist, I am simply amazed by the impact we have on patient’s daily lives. When patients look in the mirror and like what they see and feel better about themselves they are better able to cope with the daily stresses of life. There is nothing more rewarding than treating psychologically disabling acne scars in a young woman, or removing disfiguring scars after a motor vehicle accidents, etc. It is the patient’s feedback, and this patient feedback alone that keeps me so motivated and inspired to continue my practice in cosmetic dermatology.
Scars1: At what point should a patient with a scar consider a consultation with a dermatologist? Is there a point where it is too late?
Dr. Vasily: Our ongoing studies and research in this interesting area of cosmetic dermatology indicate that fresh scars, i.e. scars treated immediately after suture removal or after trauma, respond best. However, our studies have clearly shown that even old scars, i.e. scars 20 years older or more, can be substantially improved with laser scar revision.
Scars1: Are there steps people can take to prevent or minimize scarring?
Dr. Vasily: Unfortunately, some patients are scar formers. We now know why these patients are scar formers on a molecular basis, and we are pursuing studies to determine if we can modify the wound-healing response in these patients on the molecular level. However, at present, the only thing the patient can do to minimize postoperative scarring or posttraumatic scarring is good initial surgical wound repair and good postoperative wound care. Attention to these two entities may have a significant impact on eventual appearance of the wound. In addition, early intervention with laser scar revision is critical.
Scars1: Do you have any advice for people whose scars or other skin imperfections make them embarrassed or uncomfortable?
Dr. Vasily: Yes, the patients need to understand that given breakthroughs in recent research with Fractional lasers, it is rare to see a scar that cannot be improved. These patients need to know that there is hope and potential for improving their scars, no matter how disfiguring.
Scars1: Is there anything else you would like to share with visitors to Scars1.com?
Dr. Vasily: Yes, I would like share the fact that this area of research is ongoing and evolving and there are literally breakthroughs on a daily basis in regard to scar revision. This is one of the most exciting times in history for patients with disfiguring scars and I would encourage them strongly to seek consultation with a knowledgeable dermatologist or plastic surgeon for treatment of their scars.