"Aging is a chronic relapsing skin disease. And that's why dermatologists are so good at nonsurgical rejuvenation," Dr. Lupo points out.
It's often impossible to cure conditions such as acne and psoriasis forever, she notes. "If I've got a patient who has severe acne, I put them on Accutane (isotretinoin, Roche). And I still make sure they're on Tazorac (tazarotene, Allergan), Altreno (tretinoin, Ortho Dermatologics) or something to maintain their improvement. Left to its own devices, the human body does not do too well."
Antiaging treatments require similar attention and persistence. Patients must stay on top of everything from exercise and sunscreen use to skin care, injectables and laser resurfacing, she says: "It's hard work to look good." Other vital elements of the journey include setting patient expectations and providing realistic timelines.
Refer out when appropriate.
Dr. Lupo refers approximately 20% of her prospective patients to plastic surgeons because she does not perform surgery. "I wish some of the plastic surgeons in town would send me people with acne before passing them off to their aestheticians who really don't understand acne," she says.
Balance sensitivity with strength.
"I can be pretty overwhelming," says Dr. Lupo. So at the end of each consultation, she pauses and asks if she's said too much. "But the greatest mistake I see in doctors is not being decisive and confident. If you're not confident that you can do a good job, go back and get some more training so you can. If you're going to do it at all, do it well."