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Top Laser Skin Resurfacing Questions Answered by Dermatologist

Adam Wallach, M.D., answers our top questions about laser skin resurfacing. (photo provided by Skin Cancer & Dermatology Institute)
Adam Wallach, M.D., answers our top questions about laser skin resurfacing. (photo provided by Skin Cancer & Dermatology Institute)

Q: What is laser skin resurfacing?

A: Laser skin resurfacing is performed using either an erbium or carbon dioxide laser. Essentially, it is the process of removing some of the epidermis or outer layers of the skin in order to improve its texture and color. Today this procedure is most often performed on the skin using a matrix of tiny dots, also known as fractionation, which provides quicker healing and less risk.

Q: Besides redness in the treated area, what can be expected post-procedure?

A: Some laser procedures, like the treatment of facial blood vessels, produce a noticeable change the moment you leave the office with only a few days of redness.

Other procedures can cause some slight swelling and light crusting, lasting about three to five days.

Q: For best results, how many laser treatments are needed?

A: It depends on how strongly the procedure is performed. If done at a higher power level, a single treatment can result in tremendous change, with a longer downtime. When lower settings are used, there will be less downtime, and the patient will require additional treatments spread out over several months.

Q: Will it hurt and is it safe?

A: Many laser procedures require no anesthesia, but a topical anesthetic cream can be used for those who might be more sensitive. The procedures are very safe when performed by experienced clinicians.

Q: Are there any risks associated with laser treatments? 

A: Laser treatments should be performed by physicians or trained providers with laser experience and knowledge of skin types, including which are appropriate for laser treatments and which are not. Dermatologists have more knowledge in this area than any other specialist. Hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin rarely occur, but are possible side effects.

Q: Who is a prime candidate for laser treatment?

A: Anyone who feels like they would like to refresh or even out either the color or texture of their skin. Light to olive skin tones respond best to laser treatments.

Q: Tell us a little about the Quanta Evo Light™ laser and its benefits.

A: The Quanta Evo Light is a state-of-the art laser with impressive technology. It performs the function of many individual lasers in one. There is no longer a need to have more than one laser at a practice, as this laser provides almost every functionality one might need as a dermatologist! We are incredibly lucky to have this hi-tech device and experienced practitioners right here in Truckee.

About Our Dermatology Provider

In private practice since 1997, Dr. Wallach treats patients at Skin Cancer & Dermatology Institute’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, specializing in medical and cosmetic dermatology, including the use of various lasers, for the last 25 years. He is a strong proponent of patient education in his practice and is a contributing author to the chapter on skin in the upcoming book, The 21st Century Man. Dr. Wallach and his family live in the North Tahoe area. Get to know Dr. Wallach and book an appointment online here.

Skin Cancer & Dermatology Institute

Bringing you patient-centered, world-class dermatological care with ten locations in the Reno-Tahoe area. Skin Cancer & Dermatology Institute specializes in Medical Dermatology, Mohs Skin Cancer Surgery, and Cosmetic Dermatology.

Skiing Knees

Dr. Stone practicing what he preaches. Courtesy the Stone Clinic.
Dr. Stone practicing what he preaches. Courtesy the Stone Clinic.

Nothing loads the front of the knees and the patellar tendons like skiing. When else is your body in a flexed knee position for multiple hours per day, absorbing the forces of moguls, bumps, and landings, combined with twisting, turning, flexing, and extending hundreds of times per hour? If you haven’t trained hard in the off-season, pain awaits.

Good pain is the soreness you feel early in the season. It’s mainly at the patellar tendon and hamstrings, which absorb the load and contract to hold the ski edge on the snow. This is the pain of deconditioning, and it improves with time on the snow. Good pain is the muscular soreness in the quads and calves as the forward-leaning ski boot position loads the muscles with each turn. Good pain responds to a little ice, stretching, warm baths before skiing, and massage afterwards.

Bad pain varies by injury and location. Front of the knee pain—which is often accompanied by grinding and clicking of the kneecap—may indicate damage to the articular cartilage on the undersurface of the patella. If it only hurts when skiing, there are a number of therapies that often work well. These include: 1) A patella sleeve that supports the kneecap, keeps the muscles warm and provides proprioceptive feedback; 2) Patellar stabilizing exercises; 3) Injections of lubricating fluid, which we now combine with growth factors that induce the joint lining to produce more lubrication (we have many patients with arthritic knees who come in for pre-ski season lube jobs); 4) A surgical repair of the damaged cartilage, which can be either a smoothing down of the frayed tissue or a paste grafting to regrow the missing cartilage; and 5) A replacement of the surfaces with a metal and plastic implant called a patellofemoral partial knee replacement.

Bad pain on the inside of the knee—often accompanied by popping or catching, pain with squats, or pain when pushing off on the inside edge of the ski—can have a number of causes. These range from simple overloading (due to the shape of the legs) to the tearing of the meniscus shock absorber, or an injury to the articular cartilage, to frank arthritis on the femoral or tibial surfaces. 

If the pain is getting in the way of your enjoyment of activities, a careful exam, X-ray, and MRI will help define the problem. Fortunately, in the 21st century, there is no reason to live and play with pain. Mild symptoms with little damage can be resolved with lubricating growth factor injections and rehab exercises. The meniscus is repairable and replaceable with donor tissue. Damaged articular cartilage can be repaired with articular cartilage paste grafts, while bone-on-bone arthritis can be relieved with partial knee replacement, an outpatient procedure that can have you back on your skis in three months.

Bad pain on the outside of the knee is similar to the inside, with the same therapies available.

Pain all around the knee—with X-rays that show bone-on-bone arthritis in multiple areas—may be unresponsive to rehabilitation and injections. This issue can be addressed by the reimagined and precise art of knee resurfacing, which is now done with robotic control and the absence of cement. The best implants allow the body to grow into the undersurface of the components, nearly eliminating any concern about loosening due to activities. With these new techniques, the more you ski the better you will do with your knees, and in life.

If you are in pain, solve the problem promptly. Playing forever means enjoying each and every day. We used to issue prescriptions that said, “Must ski powder.”  Now they just say, “Must ski.” But powder is always our preferred way to slide.

Hear the remarkable story from professional ski instructor Angela who saved her skiing career with a double partial knee replacement in one knee. 

Uncommon Tips for Skiing Safety

Winter brings the opportunity for you to slide down nature’s slopes, often without even walking up, bringing bliss to those of you who plan to enjoy it. Photo courtesy of The Stone Clinic.
Winter brings the opportunity for you to slide down nature’s slopes, often without even walking up, bringing bliss to those of you who plan to enjoy it.
Photo courtesy of The Stone Clinic.

Surely you have heard the usual advice: Get strong, stay flexible, don’t take the last run, and ski with a helmet. All fine and good—until you notice that the top skiers on ski teams, along with super fit backcountry skiers, all get hurt too. So, let’s think about some of the less common ski tips and see if they keep you safe this season.

  1. Gear matters. Sharp edges and well-tuned skis grab snow snakes less often and get you out of trouble when you really need that edge. Go to the ski shop now, and tune your gear.
  2. Wide skis are fun in powder, but they increase the injury rate on groomed slopes. The wider the ski, the harder it is to lay them over on their edge, which creates more torque on the knee. No one ski is best. Rent or buy skis for the conditions you are in each day.  
  3. Binding design has only marginally improved, and no unbiased data shows that one binding is better than another. Multi-directional heel release (Howell design) should change this. New bindings, however, have less grit, more accurate calibration, and less interface wear. Get them set to the right release setting for the skier you actually are and not the one you imagine yourself to be.
  4. Helmets have not been shown to reduce neck or significant head injuries, except in some collisions with tree branches or other objects. Clear visibility of your goggles and headgear probably matters even more. For racing, there is no doubt: no helmet, no starts.
  5. Drugs and alcohol are legal in many ski states, but both truly reduce athletic performance. Skiing and boarding half-baked sounds cool to some, but are dangerous to most. Cigarette smoking is just plain idiotic.
  6. Cold feet, cold muscles, and stiff backs lead to an overall reduction in the ability to respond to sudden changes in position. Start the day in a hot shower or hot tub. Stretch there, rather than on a cold floor. If you have poor blood circulation, get boot warmers, or heated socks and gloves. They really work—though they are not durable and don’t survive washing. Upgrade your clothing to the newer materials that are thinner, warmer, and stretchier. Ride the covered lifts. Drink warm fluids. You will be surprised by how much staying warm decreases minor injuries (including those that may lead to major injuries).
  7. Look at the grooming map of the mountain. Surprisingly, not many skiers do. There are far fewer injuries on groomed trails than in rough skiing conditions.
  8. Time your skiing. Ski during the best sun and best snow conditions of the day. Eat lunch when few other people do. The goal is to ski for a long time in life, not a long time in one day.
  9. Take a guide. Most people do not appreciate how many hidden ski trails there are on every mountain. While skiing is already extraordinarily expensive, local hosts and mountain guides are often relatively cheap compared to ski school instructors. The hidden stashes will put huge grins on everyone’s faces.
  10. Fix what’s broken. If your back, shoulder, knee, or other joints are holding you back, get them repaired. The science of joint repair and rehabilitation has advanced so far that almost all joint injuries and arthritic conditions can be repaired well enough to return you to skiing, sometimes within the season.

Winter brings the opportunity for you to slide down nature’s slopes, often without even walking up, bringing bliss to those of you who plan to enjoy it. The operative word is plan. 

Medically authored by 

Kevin R. Stone, MD

Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.

New Laser Skin Resurfacing Technology Available in Truckee

Dr. Adam Wallach (Photo courtesy of Skin Cancer and Dermatology Institute)
Dr. Adam Wallach (Photo courtesy of Skin Cancer and Dermatology Institute)

Dr. Adam Wallach from the Skin Cancer & Dermatology Institute weighs in on laser technology and the new Quanta Evo Light™ laser coming to Truckee.

Q: Tell us a little about how the Quanta Evo Light laser works. 

A: This laser, which possesses impressive current technology, performs many functions that previously could only be achieved by multiple individual lasers. We are incredibly lucky to have this device right here in our small town.

Q: Besides hair reduction, which skin conditions/challenges does it treat?

A: The Quanta Evo Light can be used to treat red blood vessels and sunspots on the face, chest, and arms. It can also be used to perform the Elluminate treatment, a painless and highly effective way to rejuvenate the entire face. It eliminates blood vessels and sunspots while stimulating new collagen all in one laser session. This unique treatment is performed using four sequential laser passes of different wavelengths that each treat a specific target of the skin.

Q: How is this laser different to others?

A: As previously mentioned, one laser can accomplish the same results of multiple lasers. It is a state-of-the-art laser that provides almost every functionality one might need as a dermatologist!

Q: What does this laser procedure entail?

A: Firstly, we start with a consultation to discover what you, the patient, wishes to remove or improve. Pretreatment photos and consent are done prior to any procedure and on occasion topical anesthetic is applied to the skin 15-30 minutes before commencing treatment. Patients are most often placed in a reclined position and eye protection is worn by both patient and physician. The laser procedure can take anywhere from 15-45 minutes depending on the treated areas/skin conditions. Once treatment is complete there is often cooling with ice and then an aftercare product is placed on the skin. Finally, the patient is given post procedure instructions and a plan for follow-up is made.

Q: Will it hurt and is it safe?

A: Generally, these procedures do not hurt, although there can be a slight tingling sensation.

Q: How many treatments, on average, are needed to see results? 

A: Some laser procedures, like the treatment of facial blood vessels, produce a noticeable change the moment you leave the office, with only a few days of redness. Sometimes, for example, if one has a very intense problem a second procedure might be needed one to two months later. Other rejuvenating procedures like the Elluminate treatment require two to three treatments spaced four to eight weeks apart to really undo significant aging produced by the sun. Laser hair removal often takes four to eight treatments to effect a lasting change.

About Our Dermatology Providers

In private practice since 1997, Dr. Wallach treats patients at Skin Cancer & Dermatology Institute’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, and specializes in medical and cosmetic dermatology, including the use of various lasers over the last 25 years. He is a strong proponent of patient education in his practice and is the contributing author to the chapter on skin in the upcoming book, “The 21st Century Man.” Dr. Wallach and his family live in the North Tahoe area. Get to know Dr. Wallach and book an appointment online here.

Bringing you patient-centered, world-class dermatological care with nine locations in the Reno-Tahoe area. Skin Cancer & Dermatology Institute specializes in medical dermatology, Mohs skin cancer surgery, and cosmetic dermatology.

Top Skin Care Questions Answered by Local Renowned Board-Certified Dermatologist

Skin Care Awareness Month is fast approaching, a month helping patients understand how to achieve their skin care goals. Adam Wallach, M.D. answers questions about popular cosmetic dermatology treatments and skin care ingredients. 

Q: Some patients are wary of fillers for fear of looking unnatural. What do you recommend for avoiding this? 

A: The key to a natural result is using fillers with a restorative mindset rather than an augmenting one. Find a practitioner whose aim is to create a natural appearance and look in a mirror together to determine what you would like to correct. Start slow, and if you like it, you can do more.

Q: How long do the effects of fillers last?

A: Fillers can last anywhere from as little as six months up to 24 months. That said, there is some variability of duration among patients. Also, facial fillers tend to last longer in some areas than others.

Dr. Adam Wallach (Photo courtesy of Skin Cancer and Dermatology Institute)
Dr. Adam Wallach (Photo courtesy of Skin Cancer and Dermatology Institute)

Q: What does laser therapy treat? Is there downtime after a laser treatment?

A: Lasers can be used to treat many different conditions, including sunspots, facial blood vessels, excess hair, wrinkles, and scars. The downtime depends on the laser used and the strength of the treatment. Some laser procedures target specific problem areas alone, consequently they can have minimal downtime. Other procedures where the entire face is treated often have more wounding due to the affected surface area, but there are lighter versions of these.

Q: How does microdermabrasion work and how many treatments does it typically take to see results?  

A: Microdermabrasion enhances exfoliation by both the mechanical removal of the most superficial skin combined with suction that then removes those skin cells. For the best results, this treatment is performed in a series of 4-6 treatments every 2-4 weeks. 

Q. Talk to us about chemical peels.

A: Chemical peels come in many varieties (salicylic acid, glycol acid, mandelic acid) and multiple strengths, with some of the strongest peels performed only by medical providers. In addition to brightening the surface of the skin, peels help topical creams such as antioxidants, retinoids, and stem cell products to penetrate more efficiently.

Q: Hyaluronic acid is an ingredient often touted with skin care benefits. What is it exactly and how does it work?

A: Hyaluronic acid is a standard dermal component of skin that holds onto water when used topically or in injectables like JUVÉDERM®, which helps plump the skin. Generally, it is incredibly safe and non-irritating as a topical and rarely causes problems as an injectable filler.

Q: Retinol – prescription or over the counter – which is better and why? What skin concerns does retinol help treat? At what age should retinol be incorporated into our skin care routine? 

A: Retinoids are a group of products derived from vitamin A which have been studied for years and whose skin care benefits have been scientifically confirmed. Tretinoin (also known as retinoid acid or Retin A) is the best-studied and best-known product in this group. It has been used for over 20 years for its effectiveness in diminishing fine wrinkling, lessening skin darkening, and generally improving the skin’s tone. Tretinoin is a differentiating factor, which means it normalizes the way cells develop as they are affected by aging or oxidative damage. In theory, tretinoin is returning proper signaling to the skin so that it matures properly. Related molecules to tretinoin are retinaldehyde and retinol that are not quite as potent as tretinoin but still exert their effects with a bit less of the downsides of sun sensitivity and dryness. If you are new to this product category, start with one of these less potent molecules, and you can always transition to tretinoin later as your skin become used to it. Nighttime is the perfect time to use retinoids.

About Our Dermatology Providers

In private practice since 1997, Dr. Wallach treats patients at Skin Cancer & Dermatology Institute’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, specializes in medical and cosmetic dermatology, and is well known for treating many types of skin cancer. He is a strong proponent of patient education in his practice and is a contributing author to the upcoming book, The 21st Century Man. Dr. Wallach and his family live in the North Tahoe area. Get to know Dr. Wallach and book an appointment online here.  

A medical expert’s perspective on how to treat crow’s feet

At their earliest stage of development, around the age of 30, crow’s feet happen because of repetitive squinting.  (Photo courtesy of Skin Cancer & Dermatology Institute)
At their earliest stage of development, around the age of 30, crow’s feet happen because of repetitive squinting. (Photo courtesy of Skin Cancer & Dermatology Institute)

How to treat crow’s feet must be one of the most asked cosmetic dermatology questions in our practice. Let’s start with what they are. Crow’s feet are the fine lines and wrinkles that fan out to the side of the lateral corner of your eyes. They are so named because of their likeness to a crow’s foot or footprint. At their earliest stage of development, around the age of 30, they happen because of repetitive squinting. At this stage I like to treat them with the simple use of botulinum toxins (such as BOTOX® Cosmetic, Xeomin®, and Dysport®). Cosmetic neurotoxin injections alone can soften dynamic wrinkles so much so that sometimes they disappear completely — at least while the botulinum toxin is active, which can be for up to three to four months.  

As we age, our crow’s feet become more numerous, deepen, and begin to appear even when we are expressionless. In other words, the wrinkles go from being present only during moments of facial expression to being present even while the face is still or expressionless. In this more evolved stage of crow’s feet, which often starts to happen between the ages of 40 to 50 years old, we may use a small amount of hyaluronic acid (HA) filler in addition to botulinum toxin to help soften the area. You may be more familiar with the brand name forms of these cosmetic injectables such as the collection of fillers from JUVÉDERM®, Restylane® and BELOTERO BALANCE®.

Treating crow’s feet with cosmetic injectables involves little downtime, is an approachable cost point for many, and generally our patients enjoy instant gratification.  

As the depth and number of crow’s feet develop further, dermatologists pivot to other cosmetic tools. Lasers are incredibly popular tools of our trade because of their effectiveness in treating so many dermatological concerns. Ablative lasers like CO2 or erbium, can help to soften the crow’s feet tremendously by smoothing the skin where those lines exist.  With ablative lasers patients will experience 5-10 days of downtime with some redness, slight crusting, and swelling; however, the effect can be dramatic and long lasting, depending on how this procedure is performed. 

For patients who prefer a more gradual approach coupled with less downtime, there are other non-injurious devicessuch as Ultherapy®, Sofwave™, or Fraxel® RESTORE that can help soften crow’s feet. Along with a more gradual effect, these require repetitive treatments to reap benefits.

On a final note, I cannot emphasize enough the importance of avoiding sun damage, not only for helping prevent skin cancer, but for its added benefit of avoiding photo-aging. Remember to limit your sun exposure, wear sunscreen with a sun protection factor (SPF) of at least 30 every day, wear polarized sunglasses and an ultraviolet protection factor (UPF) hat when outdoors.

With the advances in laser technology and the variety of treatments available, there are many options that we can offer our patients depending on their unique situation. To learn more about how to treat crow’s feet, schedule a consultation with one of Skin Cancer & Dermatology Institute’s medical providers or cosmetic specialists.

About Dr. Adam Wallach

Dr. Wallach has been in private practice since 1997 and his specialties include adult and pediatric medical dermatology and cosmetic dermatology. He is especially skilled in the diagnosis and treatment of skin cancers as well as cosmetic injections and laser treatments. He treats patients at Skin Cancer & Dermatology Institute’s Truckee location and lives in North Tahoe with his family. Get to know Dr. Wallach here.

Enjoy an elevated dining experience at Revel Rancharrah

Revel Rancharrah is a vibrant independent living community in Reno that provides best-in-class amenities and services to its residents. Photo Courtesy Revel Rancharrah.
Revel Rancharrah is a vibrant independent living community in Reno that provides best-in-class amenities and services to its residents. Photo Courtesy Revel Rancharrah.

For those looking to enjoy their golden years in style and comfort, Revel Rancharrah in Reno is the premier independent living community for living the good life. Revel Living, their lifestyle culture based on the four pillars of wellness, offers countless opportunities to learn and grow. Whether you are interested in woodworking, yoga, mentoring a student, learning a new language, exploring botanical gardens, or even teaching a class, you will have the opportunity to pursue your interests and passions to live your years to the fullest.

From the Ritz to Reno

Beyond the incredible activities and atmosphere at Revel Rancharrah, the dining options have been elevated to the next level with the addition of Chef Luis Urquilla. After working at the Four Seasons and then the Ritz Carlton in Santa Barbara for the past six years, Chef Luis was thrilled to join Revel Rancharrah and  bring his exquisite gourmet culinary creations to their restaurants. “We snatched Luis from the Ritz Carlton when the hotels were closed during COVID-19, and we are lucky to have him,” said Linard Timatyos, Dining Services Director with Unidine Services, Revel Rancharrah’s dining services partner.  “Luis is an incredible chef and has done phenomenal things since he began here last October. The residents love him and what he brings to the table. Now that we have him, he’s not going anywhere.”

The entree from the St. Patrick’s Day event. Photo Courtesy Revel Rancharrah.
The entree from the St. Patrick’s Day event. Photo Courtesy Revel Rancharrah.

Having trained and worked at two five-star restaurants, Chef Luis focuses not only on fresh flavors, but also colorful presentations that are works of art to view and taste. Each month, Chef Luis and Timatyos host a meeting for the residents to gather their feedback on the food and discuss what they would like to see on the menu for the next month. The chef then creates a menu for a month’s worth of lunches and dinners for both restaurants at Revel Rancharrah: The Social Club, a pub offering both classic and craft cocktails along with a casual dining and shared plate menu; and Ovation, the modern American restaurant that rivals the upscale restaurants that can be found in Reno and surrounding areas. Both restaurants offer made-from-scratch, seasonal menus cooked to order with exceptional service. With 99% of the residents now fully vaccinated against COVID-19, seats at both restaurants are highly sought after by residents and their guests. 

Special Events to Please the Palate

In addition to the incredible meals served daily at Ovation, once a month, a Chef’s Table event is offered for residents, which allows Chef Luis to stretch his culinary muscles and get creative with both flavors and presentations. Each  Chef’s Table event features a new, creative fine dining menu designed by Luis, with wine pairings for  each course. The April event included lamb loin with chimichurri, a mahi-mahi appetizer, butternut squash mousse with a berry orange citrus beurre blanc sauce, chocolate pistachio mousse with a raspberry sorbet, and more. Chef Luis is thrilled to be able to offer these experiences for the residents, and they enjoy watching the chef create his dishes in Ovation’s open kitchen. “Coming from the hotel restaurant industry, this is a new experience for me,” said Chef Luis. “I’m very happy and enjoy working with everyone here.”

A sample entree from a Chef’s Table event. Photo Courtesy Revel Rancharrah.
A sample entree from a Chef’s Table event. Photo Courtesy Revel Rancharrah.

Revel Rancharrah also hosts barbecues with outdoor patio seating for the residents during summertime holiday weekends.. These include everything you could want in a summer barbecue, including baby back ribs, chicken, hamburgers, corn on the cob, coleslaw, potato salad, and all the traditional barbecue trimmings. Revel residents also enjoy weekly “Wine Down Wednesdays” in The Social Club, which include wine tastings and shareable appetizer plates. Live music is often included to add to the festive atmosphere.

Both Timatyos and Chef Luis are relatively new to senior living, but they enjoy the atmosphere and relationships with the residents. They love  finding new ways to wow them with exceptional food and service. “I’ve worked with other chefs before, but we’ve brought something new to senior living. It’s a true fine dining experience, and we make sure that we also provide impeccable service,” Timatyos said. “This is the new way of senior living, and we continue to add to this concept. We are even developing an app that can let residents know when we introduce a new menu item or have a wine tasting planned. The residents rave about the quality of food and service we provide, and we are proud of the experience we offer.”  

To learn more about Revel Rancharrah, call 775-242-6752 or visit revelrancharrah.com.

Tourists excited, anxious about 2021 summertime travel

Most travelers would like large outdoor events to resume, but with safety adjustments and size limitations. Photo source from RRC Associates, IDA Survey, May 2021
Most travelers would like large outdoor events to resume, but with safety adjustments and size limitations. Photo source from RRC Associates, IDA Survey, May 2021

Many Americans are looking forward to traveling again this summer, with several new research studies pointing to a high level of interest in hitting the road. Upwards of 90% of American travelers already have at least one leisure trip planned for this summer, with an average of three leisure trips overall, according to research from Destination Analysts

While many people are starting to feel generally safe doing certain travel-related activities, some visitors remain hesitant. For example, a recent national survey from RRC Associates shows that Americans are looking forward to outdoor events/farmers markets and indoor retail shopping, while some indoor facilities, like gyms/rec centers and bars/night clubs, are still viewed with caution. 

Having a sense of how your visitors feel about these issues will allow local businesses and chambers to provide the right communication, safety guidance and level of service this summer. 

Survey suggests anticipation is high among vaccinated travelers

The RRC Associates traveler study compiled responses from over 4,000 active Americans who travel, shop, dine, and attend events. The vast majority of survey respondents is planning to take an overnight leisure trip this summer, a strong sign of the pent-up demand that has been talked about. 

As well, 84% have received one or more COVID-19 vaccine shots, far greater than the roughly 50% of all Americans who have had at least one dose. The higher vaccination level among travelers is clearly contributing to the increased interest in getting back to visiting favorite destinations once again this summer. 

Encouragingly, survey respondents are feeling significantly more safe than they were three months ago doing a variety of travel-related activities, like dining, shopping, attending festivals/events, staying in hotels and watching spectator sports. This is good news for business owners and mountain town officials, signaling that visitors are anticipating spending money at local businesses and generating local sales and lodging tax dollars. 

ABOUT INSIGHTS COLLECTIVE

Insights Collective; a Tourism Economy Think Tank and Resource Center – is a collaboration of destination travel industry experts who are collaborating and working, together with mountain resort communities and their stakeholders, to understand, plan, and navigate through the emerging tourism marketplace.

www.TheInsightsCollective.com  /  info@theinsightscollective.com

Some spin-off benefits pandemic-prompted outdoor dining

The popularity of newly-created outdoor dining spaces, sometimes on sidewalks, parking spaces, or other public rights-of-way, is perhaps an unintended consequence of the pandemic. And, indeed, many would like to see these outdoor dining spaces remain permanent. According to the survey, 57 percent support keeping these alternative outdoor eating locations. 

“One of the benefits to come out of the pandemic is this kind of innovation, which in many cases might have taken local government years to enable via permitting. It’s a benefit to the destination, residents and visitors,” commented Carl Ribaudo of Insights Collective. 

However, a clear delineation remains between comfort with outdoor and certain indoor settings. People are very likely to want to dine at restaurants with outdoor seating, attend outdoor events, such as festivals, farmers markets and concerts. Intent to patronize retail stores, both small boutiques and large, big-box stores, is also high. 

But visitors remain noticeably more cautious with other indoor businesses like gyms/rec centers, movie theaters, indoor spectator sports and bars/night clubs. These results show that visitor sentiment remains mixed and that certain businesses will likely have to continue to navigate the challenges of perceptions of safety.

Guests favor size limits, precautions for large events

Regarding special events and outdoor festivals, while people are ready for events to resume, they tend to want some limits on the size of the events and some safety protocols in place. With such precautions in place, 79% say they would attend an outdoor concert or arts festival this summer. On the other hand, without any precautions, 66% are unlikely to attend such outdoor events. 

“The feedback is clear — event attendees do not want to be in a crowded space,” said Brian London of Insights Collective. “Less is more, in that fewer attendees and less crowding will lead to higher satisfaction.” The takeaway is that interest in outdoor events is high, but some level of limitation needs to be in place for attendees to want to partake. 

When it comes to vaccines and masks, this controversial issue appears to be less divisive among the survey respondents. The majority of travelers feel that having proof of vaccination should be required to board a commercial airline (59%), but a significant minority is opposed to a “vaccine passport” or other requirements (22%). 

Outdoor Dining Graph: Outdoor dining has been very popular during the pandemic, and travelers support keeping those options in the future.
Outdoor Dining Graph: Outdoor dining has been very popular during the pandemic, and travelers support keeping those options in the future.

Turning vaccine requirements into a positive message

These results show that businesses will have to tread carefully in terms of how they approach encouraging or requiring customers or staff to show proof of vaccination. Spinning the issue positively, such as providing an incentive or coupon for vaccinations (like Krispy Kreme did last month), might be the best approach. 

“VIP seating sections, designated floors on hotels (and) lift lines reserved for those who are vaccinated are examples of rewarding those who are compliant,” noted Ralf Garrison of Insights Collective. 

Sentiment about travel and whether or not visitors feel safe doing certain things can evolve quickly, as local and national health guidance changes and people re-adjust to participating in activities they used to do. Indeed, the CDC revised its guidance about masks for vaccinated people just the other day. 

Nevertheless, individual visitors are likely to have different attitudes about masks, distancing, sanitization, and other policies. Irrespective of local nuances, this summer generally looks like it will be busy, with visitation levels to mountain destinations likely to be quite strong and a return to a summer somewhat more like we are all used to. 

Welcome to the Neighborhood

The percentage of stays that are unpaid, which correlates closely to owner usage, has remained up over historical norms since the pandemic began in March 2020.  Source: Inntopia Business Intelligence
The percentage of stays that are unpaid, which correlates closely to owner usage, has remained up over historical norms since the pandemic began in March 2020. Source: Inntopia Business Intelligence
INSIGHTS FROM TAHOE

While real estate did gangbusters in 2020, Tahoe Prosperity Center CEO Heidi Hill Drum doesn’t think this is a sign that the demographics of full-time residents is changing.

“I actually don’t think we’re seeing an evolutionary change – yet. It is easy to use anecdotal information (seems like there are lots of new people moving to Tahoe to work in a Zoom town) and assume it is significant,” Hill Drum said “And while we should welcome our new remote-worker residents, we don’t yet know if they will stay once their offices open back up again. And, for every new resident, many are also leaving the area.”

The year-round population has seen a drop. In the year 2000, the Tahoe Basin saw its highest year-round population count at 60,295. By 2018, it dropped to 52,979 and in 2019, it dropped to below 50,000 for the first year ever. 

“We have plenty of room to grow our year-round population, yet we aren’t,” Hill Drum said. “Even if the realtors are to be believed (which they are of course – lots of homes are selling!) we’re still not likely to have experienced an increase of 10,000 people in one year. Ideally, for our economy, we would increase our year-round population and especially in the 25-44 year old age range of young professionals and families.”

Mountain towns have always been a place to which one can escape the noise, pollution and daily grind of the concrete jungle, and conversely have been magnets that attract folks with peace and quiet, clean air, relaxation and panoramic vistas.

This combination of escape and attraction is what makes mountain communities desirable places to live, either as a primary or secondary home. Long-term residents know this: unless they’re among those lucky enough to spend their entire lives in our communities, they’ve sought the escape, found the attraction, and made the move. But it’s not a move everyone can manage, and so the rise of the “treehouse,” the second home in the mountains to which to escape. 

Chief among roadblocks to full-time mountain residency is employment. Most people find their career in the city, and in many cases that same work for the same money isn’t available in smaller communities. Queue a pandemic, and with it a literal shift in how the world works.

Suddenly there’s a new phenomenon in rural America, coined elsewhere as “in-migration” – the escape of new residents and second homeowners from their urban domiciles to the attraction of the mountains. What began almost immediately after the pandemic declaration as a significant increase in second home occupancy has evolved into the full-on migration of second homeowners and wholly new residents to resort towns. The Insights Collective is working to understand the up- and downside consequences of these changes.

Changes in Rental Inventory

  • The upside: Tired or declining inventory is getting a facelift, raising the overall standard of inventory in the town and putting renovation dollars into the pockets of local suppliers and contractors. That increase in quality also increases the potential rental revenue or resale value of the unit at a future date, essentially “banking” revenue for the community.

At the same time, mountain towns across the West are reporting an aggregate increase of 4.8 percent in taxable retail sales during the past 10 months, despite lower occupancy and shut-downs. While not likely entirely attributable to new residents, there is a strong correlation between the two.

  • The downside: A majority of second homes in mountain communities are part of the traditional leisure rental pool, either through property management companies, online markets like Airbnb or both. Second homeowner use over the past year contributed to a 5.5 percent decline in available units in western mountain resorts this past winter versus 2018/19.

While it doesn’t sound consequential, that amounts to slightly more than 188,000 room nights. Each of which can potentially generate an average of $399 per night based on DestiMetrics’ data, for a potential loss of $75 million in revenue and the corresponding lodging taxes.

ABOUT INSIGHTS COLLECTIVE

Insights Collective; a Tourism Economy Think Tank and Resource Center – is a collaboration of destination travel industry experts who are collaborating and working, together with mountain resort communities and their stakeholders, to understand, plan, and navigate through the emerging tourism marketplace.

www.TheInsightsCollective.com  /  info@theinsightscollective.com

Workforce Housing

  • The upside: Workforce housing is a long-standing issue that public and private sectors have been challenged to address holistically. New and increased urgency is a strong catalyst to compel both sectors to find solutions. Says Chris Romer, CEO of the Vail Valley Partnership, “Second homeowners and new residents bring significant benefits to our community. It is incumbent on the private and public sector to increase our housing stock dedicated to the local workforce.”
  • The downside: New residents purchasing properties or units in mountain communities are further exacerbating pressure on available and affordable workforce housing, a significant pre-pandemic condition across the industry. This drives the workforce to the outer edges of the community or, worse yet, to other communities altogether, creating challenges servicing the needs of both the tourist- and resident-based local economies.

Real Estate Transactions

  • The upside: Real estate inventory in mountain towns is consistently selling as quickly as it’s listed, often over both market value and asking price. This generates new-found home equity for non-selling residents, and sellers are able to capitalize financially on the high demand. The resulting significant increases in real estate transfer taxes can be a mitigating factor to town budgets, perhaps even partially funding workforce housing solutions.
  • The downside: What was barely affordable housing in many communities is quickly moving out of the reach of all but the most affluent of buyers, adding to the aforementioned workforce housing issue. That’s potentially creating a localized valuation bubble and putting new homeowners and the long-term financial health of the community at risk, if so.

Changing the Business Curve

  • The upside: Communities have long sought a leveling of the peaks and valleys of weekend/midweek visitation, and the pandemic (to a degree through in-migration) has partially accomplished that.

Says Dave Belin, director of consulting services at RRC Associates and an Insights Collective member, “New residents were taking advantage of flexible work schedules to ski and recreate midweek. This incremental demand is anticipated to continue this summer on trails and in outdoor dining.” These patterns of leveled visitation are also reflected in the Inntopia / DestiMetrics occupancy data.

  • The downside: While there is potential for midweek overcrowding resulting in a loss of ‘down days’ in the community, it’s frankly difficult to identify a downside to a smoother, more consistent business cycle.

Today we’ve only scratched the surface of in-migration. Issues such as physical infrastructure, parking, broadband capacity, political orientation, schooling and public health and safety are just some of the many not addressed that the Insights Collective sees as manifesting across the industry in the months to come. As destination resort populations evolve, leaders and constituents have an opportunity to embrace and exploit the upside, mitigate the downside and meet the pre-existing and new challenges head-on.

Drs. Hibler and Wallach Talk Skin Cancer – An Insightful Q&A with Medical Dermatology Providers

Get to Know Our Dermatology Experts

Dr. Hibler calls North Lake Tahoe home and sees patients at the practice’s Incline Village location. Specializing in medical, pediatric, surgical, and cosmetic dermatology, his approach as an osteopathic physician focuses on treating the whole person. 

In private practice since 1997, Dr. Wallach treats patients at the practice’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, specializes in medical and cosmetic dermatology, and is well known for treating many types of skin cancer. Dr. Wallach and his family live in the North Tahoe area.

J. Hibler. D.O.
J. Hibler. D.O.

J. Hibler, D.O.

Q: What types of skin cancer are there?

A: There are several different types of skin cancer, but the two main categories are: 1) malignant melanoma and 2) non-melanoma. The second category is divided into basal cell carcinoma and squamous cell carcinoma. Basal and squamous cell carcinoma are much more common than melanoma, but typically not as dangerous as melanoma. Melanoma can grow on any area of the body, even where sunlight does not reach, which is why we are so keen to encourage our patients to not only perform monthly self-exams, but also get full skin exams at least once per year with a dermatology provider. For those with a family history of skin cancer or who have been treated for skin cancer before, full skin exams should happen more frequently.

Q: Is skin cancer hereditary? 

A: Some very rare types of skin cancer are hereditary, and there is a genetic component to some melanoma types of skin cancers. Talk to your dermatologist about your family’s history of skin cancer as it is an important factor.

Q: Are there common places that skin cancer is found in men or in women?

A: Most skin cancers are found on sun-exposed areas. In men it is often the chest or back areas and in women the legs are most frequently affected. But it is important to know that melanoma, the most dangerous form of skin cancer, can be found anywhere, including unusual and non-sun exposed areas which makes thorough full skin exams so critical.

Q: What should we know about practicing sun safety during the winter months?

A: Living in the Sierras and surrounding desert areas such as Reno, Carson, and the central California valley, brings a unique dimension to our daily sunscreen usage. Both altitude and the amount of sun days in these areas make sunscreen an integral part of our daily routines in every season, including winter. Sun exposure and the damage it causes is cumulative, so getting into the practice of wearing sunscreen year-round is highly recommended.

Q: Is light therapy safe to use? Can it increase the risk of skin cancer? 

A: The light therapy prescribed by dermatologists to treat certain conditions is a specific wavelength of light that is beneficial to the skin and it acts as an overall anti-inflammatory. Natural sunlight contains the whole spectrum of light which includes the good and bad wavelengths, so only small 20–30-minute doses of natural sunlight without protection is okay.

Adam Wallach, M.D.
Adam Wallach, M.D.

Adam Wallach, M.D.

Q: What should I be looking for to help detect skin cancer? 

A: The most important starting point is knowing the existing spots on your skin. If you are over the age of 40, the moles you have should be unchanging, although you may acquire or have changeable spots like sunspots or liver spots or keratoses as you age. The trick for all age groups is to identify spots that look different than your usual crowd of spots. Put another way, look for the ugly duckling or lone wolf on your body. Not infrequently, cancers may bleed, and on occasion a mole that is becoming malignant will itch. Here is where I emphasize the importance of getting to know your spots through regular self-exams. Check your entire body at least once per month and have a family member help check those hard-to-reach spots or use a mirror.

Q: What are the most unusual places that you have detected skin cancer on a patient? 

A: Skin cancer can occur in almost any area of the body, including those areas where the sun does not reach. I have detected skin cancer on the eyelid, between the toes, on genitalia, within the nose, and under the fingernail.

Q: What is Mohs micrographic surgery? 

A: First developed in the 1930s by Dr. Frederic E. Mohs, this type of dermatologic procedure is considered the gold standard for skin cancer surgery. It differs from standard dermatologic surgery in that the tissue is examined histologically at the time of removal.  If there is still cancer remaining, successive stages of skin are removed until the histology is clear. This technique is used principally for large or recurrent cancers, cancers located in difficult locations like the nose, eyelids, and ears, and for cancers with aggressive pathology. It is an out-patient surgery that can be relatively quick, or take all day, based on how complicated and how large the cancer is. Your dermatologist will prepare you with their expert tips on how to prepare for the day of surgery.

Q:  If I have scars from skin cancer treatment, are there ways to diminish their appearance? 

A: The most common scars that result from skin cancer removal are the white lines one sees where the excision occurred. Fractionated carbon dioxide lasers do a great job at blurring these white scars. The other common scarring that one sees around excision sites is the secondary development of blood vessels or telangiectasias. These vessels most often are triggered because of the healing process, but they often give an exaggerated redness to the surgical area. Pulse dye and KTP lasers, which we use at Skin Cancer & Dermatology Institute, do a great job at removing these post-surgical excessive vessels.

Q: Tell us your three favorite sunscreens and why? 

A: My favorite sunscreens are from EltaMD®. My daily use sunscreen is EltaMD UV Clear SPF 46. It is super lightweight and a favorite among my patients with normal to oily skin. This is also the only tinted sunscreen I have found that almost all men like and which blends upon application without any unusual trace of color. For outdoor sports, I use EltaMD UV Sport SPF 50 which is an amazing water-resistant sunscreen that does not feel tacky like most sport-type sunscreens. Remember to reapply sunscreen liberally and frequently. Finally, I love EltaMD UV Lip Balm SPF 36 for lip protection. Do not forget that every part of our skin needs protection, including the lips.

Learn more about skin cancer, schedule a full skin exam, and get to know Skin Cancer & Dermatology Institute’s medical providers online.

About Skin Cancer & Dermatology Institute

Your Reno-Tahoe area experts combine market-leading skin and patient care with the most advanced technology and lasers. With nine convenient locations, Skin Cancer & Dermatology Institute has been treating caring for our community for more than 20 years.

Skin Cancer & Dermatology Institute