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Microneedling in Knoxville, TN: What to Expect and How It Can Improve Your Skin By Dr. Salyards, Refine Dermatology | Knoxville, Tennessee If your skin doesn’t look quite as smooth, firm, or youthful as it once did, you’re not alone. Fine lines, acne scars, enlarged pores, uneven texture, and changes in skin tone are all common concerns as our skin changes over time. One treatment that can address several of these concerns at once is microneedling. This minimally invasive cosmetic treatment uses tiny, sterile needles to create controlled micro-injuries in the skin, stimulating the body’s natural healing process and encouraging new collagen and elastin production. At Refine Dermatology in Knoxville, TN, microneedling is one of our favorite treatments for patients who want to improve their overall skin quality while maintaining natural-looking results. What Is Microneedling? Microneedling is a skin rejuvenation treatment designed to stimulate your skin’s natural repair process. During the procedure, a device containing very fine needles creates tiny punctures in the skin. These controlled micro-injuries are what triggers the skin to produce more collagen and elastin. Collagen helps give skin its firmness, strength, and structure, while elastin helps skin maintain its flexibility. As your body produces more of these proteins, the skin can gradually appear smoother, firmer, and more refreshed. Rather than dramatically changing your appearance, microneedling works with your skin’s natural healing process to improve its overall quality over time. What Does Microneedling Treat? One of the reasons microneedling is such a versatile treatment is that it can address several common skin concerns. Microneedling may help improve the appearance of: Fine lines and wrinkles Acne scars Uneven skin texture Enlarged pores Uneven skin tone Dull-looking skin Loss of firmness It can be a particularly appealing option for people who want gradual, natural-looking improvements without undergoing a more aggressive resurfacing treatment. What Happens During a Microneedling Treatment? At Refine Dermatology, we want your treatment to be as comfortable as possible. Before your procedure, a topical numbing cream is applied to the treatment area and typically sits for approximately 30 minutes. This helps minimize discomfort during the procedure. Once your skin is numb, the microneedling treatment itself generally takes about 20 to 30 minutes. During treatment, you may notice some pressure or a light vibrating sensation. Certain areas, particularly the forehead, can be more sensitive than others, but most patients tolerate the treatment very well. From start to finish, you can generally expect to spend a little over an hour in the office. What Is Microneedling Recovery Like? One of the biggest advantages of microneedling is that it typically involves relatively little downtime compared with more aggressive resurfacing treatments. Immediately after your treatment, your skin may appear red and feel similar to a more intense sunburn. This is a normal part of the skin's healing response. For many patients: Day 1: Skin may be noticeably red and feel warm or sensitive. Day 2: Redness is typically significantly improved. Day 3: Skin often looks much closer to normal. About 1 week: You may begin noticing a healthy, refreshed glow. Although you may see improvements relatively quickly, the deeper benefits of microneedling continue to develop as your skin produces new collagen. When Will You See Microneedling Results? Your skin begins its healing and collagen-building process after treatment, but collagen remodeling takes time. You may notice an initial improvement in your skin's glow and texture within about a week, while more significant changes continue to develop over the following months. How Many Microneedling Treatments Do You Need? While you may notice improvements after a single treatment, a series of treatments is typically recommended for optimal results. A common starting recommendation is three to four microneedling treatments, spaced approximately four to six weeks apart. Your ideal treatment plan will depend on your skin, your concerns, and your goals. During your consultation, your dermatologist can help determine how many treatments may be appropriate for you. Is Microneedling Safe for All Skin Types? Microneedling can be an excellent option for many different skin types and is considered a versatile treatment for skin rejuvenation. However, every patient's skin is different. A consultation with a board-certified dermatologist is an important part of determining whether microneedling is appropriate for you and whether another treatment may better address your specific concerns. At Refine Dermatology, our approach is always personalized. We consider your skin type, concerns, medical history, and desired results when developing a treatment plan. Is Microneedling Right for You? If you're looking to improve your skin's texture, tone, firmness, or overall quality, microneedling may be worth considering. It can be especially appealing if you're looking for a treatment that:  Stimulates your skin's natural collagen production Addresses multiple skin concerns at once Offers natural-looking, gradual improvement Requires relatively little downtime Can be customized to your individual needs The best way to determine whether microneedling is right for you is to meet with a qualified dermatology professional who can evaluate your skin and discuss your goals. Physician-Led Skin Rejuvenation in Knoxville, TN At Refine Dermatology, we believe cosmetic treatments should be approached with the same level of care and expertise as medical dermatology. If you're considering microneedling in Knoxville and want to learn more about whether it's right for you, we'd love to help. Contact Refine Dermatology to schedule a consultation!

Common Skin Conditions: When You Can Treat Them at Home and When It's Time to See a Dermatologist By Dr. Salyards, Refine Dermatology | Knoxville, Tennessee Have you ever noticed a new skin concern and wondered, Can I treat this myself, or is it time to make an appointment with a dermatologist? It's a question many people ask, especially with so much skincare advice available online. While over-the-counter products can certainly be helpful for some concerns, not every skin condition responds to a DIY approach. At Refine Dermatology, one of the most common things we do is help patients identify exactly what's causing their symptoms and create a treatment plan that actually works. Many skin conditions share similar symptoms, which is why getting the correct diagnosis is often the first and most important step. Below, we'll walk through some of the skin conditions we see most often in our Knoxville office, what causes them, and how they're typically treated. Acne Acne is by far one of the most common skin conditions we treat, and it's not just a teenage problem. Many adults continue to struggle with breakouts well into their 20s, 30s, 40s, and beyond. Acne develops due to a combination of factors, including: Excess oil production Clogged pores Acne-causing bacteria Inflammation within the skin Because there are several different causes working together, there's rarely a one-size-fits-all solution. The best treatment depends on both the type of acne and how severe it is. For mild cases, topical medications are often very effective. These may include ingredients such as retinoids, which help prevent clogged pores, or benzoyl peroxide, which targets acne-causing bacteria and reduces inflammation. For more moderate or severe acne, prescription oral medications may be recommended. Some women may also benefit from hormonal treatments if hormones are contributing to their breakouts. One of the biggest misconceptions about acne is that treatments should work overnight. In reality, acne requires consistency. Even the most effective medications often take several weeks to months before significant improvement is noticeable. If you've been trying different products without success, don't assume your acne isn't treatable. More often than not, it simply means you haven't found the right treatment plan yet. Eczema Eczema is another condition we see every day in dermatology. It typically presents as dry, itchy, inflamed, or sensitive skin that can become uncomfortable enough to interfere with daily life. One of the primary issues with eczema is a weakened skin barrier. When your skin barrier isn't functioning properly, moisture escapes more easily and irritants can penetrate the skin more readily, leading to inflammation and itching. Treatment focuses on repairing and protecting the skin barrier while calming inflammation. A few key strategies include: Using fragrance-free moisturizers regularly Choosing products that contain ceramides to help restore the skin barrier Identifying and avoiding personal triggers whenever possible Using prescription topical medications during flare-ups when needed Many people try to simply "push through" eczema, hoping it will improve on its own. Unfortunately, untreated eczema often becomes more difficult to control as inflammation continues. Addressing eczema early can help reduce symptoms faster, minimize flare-ups, and improve overall skin health. Rosacea Rosacea is a chronic inflammatory skin condition that most commonly affects adults. It often begins with facial redness that comes and goes before becoming more persistent over time. Common signs of rosacea include: Persistent redness Facial flushing Visible blood vessels Acne-like bumps on the cheeks, nose, chin, or forehead Because rosacea can sometimes resemble acne, it's easy to mistake one condition for the other. However, the treatments are quite different, which makes an accurate diagnosis especially important. For many patients, topical prescription medications are the foundation of treatment. In more severe cases—or when topical treatments aren't enough—oral medications may also be recommended. Lifestyle changes can also play a major role in controlling rosacea. While triggers vary from person to person, some of the most common include: Heat Alcohol Chocolate Spicy foods Learning your personal triggers and avoiding them when possible can significantly reduce flare-ups and help keep symptoms under control. Seborrheic Dermatitis (Dandruff) When most people think of seborrheic dermatitis, they think of dandruff. While the scalp is certainly the most common area affected, this condition can also appear around the: Nose Eyebrows Ears Beard area Symptoms often include flaking, redness, irritation, and itching. Seborrheic dermatitis is associated with an overgrowth of a naturally occurring yeast that lives on the skin. While it can't usually be eliminated entirely, it can be managed very effectively. Treatment often includes medicated shampoos designed to reduce the yeast and control flaking. Depending on the severity, prescription creams or topical solutions may also be used to calm inflammation and relieve itching. Many patients notice that symptoms improve with treatment but return when they stop using their medications. That's completely normal—seborrheic dermatitis tends to be a chronic condition that requires ongoing management rather than a permanent cure. Benign Skin Growths Not every skin concern is a rash or inflammatory condition. We also frequently evaluate benign (non-cancerous) skin growths, including: Skin tags Warts Other harmless skin lesions Many of these growths can be treated easily in the office with minor procedures if they're bothersome, uncomfortable, or cosmetically concerning. Other lesions may not require treatment at all. If they're truly benign and aren't changing or causing symptoms, monitoring them may be the best approach. The important thing is getting an accurate diagnosis. While many skin growths are completely harmless, it's not always possible to distinguish benign lesions from skin cancer without a professional evaluation. When Should You See a Dermatologist? With so many over-the-counter products available today, it's understandable that many people try to manage skin concerns on their own first. In some cases, that's perfectly reasonable. However, there are times when it's worth scheduling an appointment with a dermatologist. Consider seeking professional evaluation if: Your symptoms aren't improving after trying over-the-counter treatments. Your condition continues to worsen. Your symptoms are painful, severe, or affecting your quality of life. You're unsure exactly what you're treating. You've noticed a new or changing skin growth. One of the biggest advantages of seeing a board-certified dermatologist is getting the correct diagnosis from the beginning. Many skin conditions can look surprisingly similar, but require very different treatments. Treating the wrong condition can delay improvement and sometimes even make symptoms worse. Personalized Care Makes a Difference The good news is that most common skin conditions are highly manageable with the right diagnosis and treatment plan. Whether you're dealing with stubborn acne, chronic eczema, rosacea, dandruff, or another skin concern, you don't have to figure it out alone. At Refine Dermatology, we take a personalized, physician-led approach to caring for every patient. Rather than relying on trial and error, we work with you to understand your skin, identify the underlying cause of your symptoms, and develop a treatment plan tailored to your needs.  If you've been struggling with a skin condition that's not improving—or you're simply looking for answers—we're here to help. The sooner you receive the right diagnosis, the sooner you can get your skin feeling healthier and more comfortable.

Why Your Skincare Routine Isn't Working (And What Actually Matters) By Dr. Salyards, Refine Dermatology | Knoxville, Tennessee Have you ever looked at your bathroom counter full of skincare products and wondered why your skin still isn't giving you the results you expected? It's one of the most common conversations I have with patients. Many people assume that if their skin isn't improving, they simply need more products, more steps, or the latest trend they've seen online. But in reality, healthy skin isn't about doing more—it's about using the right products consistently. As a board-certified dermatologist and founder of Refine Dermatology in Knoxville, Tennessee, my approach to skincare has always been centered around evidence-based medicine and personalized care. Every patient's skin is different, but there are a few fundamental principles that apply to almost everyone. Understanding the basics can help you build a skincare routine that actually works! Why Quality Matters More Than Quantity One of the biggest misconceptions in skincare is that expensive routines with dozens of products automatically produce better results. The truth is that an effective skincare routine doesn't need to be complicated. What matters most is using products that are formulated to create meaningful changes within the skin. This is one reason why I often recommend medical-grade skincare products. Unlike many over-the-counter products, medical-grade skincare is designed to penetrate the skin more effectively and deliver active ingredients at concentrations that have been studied and shown to make a difference. These products often utilize higher-quality ingredients, more sophisticated delivery systems, and formulations supported by clinical research. That doesn't mean every product on a drugstore shelf is ineffective. However, when patients tell me they've been using skincare consistently but haven't seen the improvements they expected, one of the first things we evaluate is whether they're using products that can truly impact the health and function of their skin. Over time, the right products don't just improve the appearance of your skin, they help create healthier, stronger skin from within. Why Vitamin C Matters If I could recommend one category of product for nearly everyone to use in the morning, it would be an antioxidant serum, particularly one containing vitamin C. Every day, our skin is exposed to factors that contribute to aging and skin damage. Ultraviolet light, pollution, environmental toxins, and even our body's normal metabolic processes generate unstable molecules called free radicals. These free radicals damage collagen and accelerate many of the visible signs of aging. This is where vitamin C becomes so valuable. Vitamin C acts as an antioxidant, helping to neutralize free radicals before they can cause significant damage to the skin. In other words, it helps protect your skin throughout the day while also supporting long-term skin health. But the benefits don't stop there. Vitamin C can also: Brighten uneven skin tone Reduce the appearance of pigmentation Support collagen production Improve overall skin radiance Enhance your skin's natural defense systems One of the reasons I love antioxidant therapy is that it's both preventative and corrective. You're protecting your skin from future damage while simultaneously improving its current appearance. Think of vitamin C as an investment in your skin's future. The Gold Standard for Anti-Aging: Retinoids While antioxidants are the cornerstone of a morning routine, retinoids remain the gold standard treatment for nighttime skincare. Retinoids are vitamin A derivatives that have been extensively studied for decades. In dermatology, they remain one of the most effective ingredients available for improving the health and appearance of the skin. Retinoids work by increasing cellular turnover and stimulating collagen production. This process helps address many of the most common skin concerns we see, including:  Fine lines and wrinkles Acne Hyperpigmentation Uneven skin texture Sun damage Loss of skin firmness If a patient asks me to choose just one product category that truly changes the skin over time, retinoids are almost always my answer. Of course, not all retinoids are created equal, and not every patient will tolerate the same strength or formulation. That's why selecting the right retinoid—and introducing it properly—is so important. When used correctly, retinoids can create remarkable improvements in skin health and appearance over time. The key word here is time. Retinoids are not overnight solutions. They require consistency and patience, but the long-term results are often worth the investment. When Should You Start Using These Products? One of the questions I hear most often is: "Am I too young—or too old—to start using products like vitamin C and retinoids?" The answer is usually neither. For antioxidants like vitamin C, I often recommend starting in your 20s. This is when prevention becomes especially important. Protecting your skin from oxidative damage early on can help preserve collagen and minimize future signs of aging. Retinoids can also be introduced in your 20s, particularly for patients dealing with acne. However, many people choose to start retinoids during this decade simply to support long-term skin health and aging prevention. That said, there is no "perfect" age to start. I've helped patients in their 30s, 40s, 50s, and beyond incorporate these ingredients into their skincare routines with excellent results. The most important factor isn't your age—it's choosing products that align with your skin type, concerns, and goals. Skincare should never be one-size-fits-all. How We Choose the Products We Carry at Refine Dermatology At Refine Dermatology, we're very intentional about the products we recommend and carry in our office. We don't believe in offering dozens of brands simply for the sake of variety. Instead, we focus on products that are supported by clinical evidence and that consistently deliver results for our patients. One of our primary skincare lines is SkinBetter Science. I appreciate this line because its formulations are supported by strong clinical data and tend to be very well tolerated, even by patients with sensitive skin. We also carry Colorescience, which has become one of my favorite sunscreen brands. Sunscreen is truly non-negotiable when it comes to skin health and anti-aging. Colorescience products are mineral-based and include ingredients such as iron oxides, which provide additional protection against visible light and blue light exposure. In addition, we developed our own skincare line, Refine Skin, to provide patients with products that are simple, effective, and more affordable. We wanted to create options that allow patients to achieve excellent results without feeling overwhelmed by cost or complexity. For patients looking for more advanced treatment options, we also offer Plated Skin Science. These products utilize exosome technology, which supports skin repair and collagen production at a deeper level. I often recommend these products for patients who want to maximize their results or who are combining skincare with in-office procedures. At the end of the day, our philosophy is simple: we don't carry everything. We carry what works. Building a Simple, Effective Skincare Routine One of the most reassuring things I tell patients is that a good skincare routine doesn't have to be complicated. In fact, the most effective routines are often surprisingly simple. A foundational morning routine typically includes: A gentle cleanser A vitamin C or antioxidant serum A moisturizer A broad-spectrum sunscreen In the evening, your routine might look like: A gentle cleanser A retinoid or targeted treatment A moisturizer That's it. From there, additional products can be incorporated based on your individual concerns, whether that's pigmentation, acne, rosacea, sensitivity, or aging. But before adding more products, it's important to establish a strong foundation. Better Products, Used Consistently If there's one takeaway I hope patients remember, it's this: You don't necessarily need more skincare products. You need better products—and you need to use them consistently. Healthy, beautiful skin doesn't come from chasing every trend or trying every new product that appears on social media. It comes from understanding what your skin needs, choosing evidence-based products, and committing to a routine that supports your long-term goals. At Refine Dermatology, we help patients build personalized, physician-led skincare routines every day. Whether you're just getting started or looking to refine your current regimen, our goal is to help you find a routine that actually works for your skin. Because when it comes to skincare, the right approach can make all the difference.

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By Dr. Jill Salyards, Owner & Founder of Refine Dermatology in Knoxville, Tennessee Skin cancer is the most common cancer in the United States, affecting millions of people each year. While that statistic can sound alarming, there is encouraging news: when detected early, skin cancer is one of the most treatable cancers. Early diagnosis and appropriate treatment play a critical role in protecting not only your skin but your overall health. At Refine Dermatology in Knoxville, Tennessee, we believe patient education is a powerful tool. Understanding what skin cancer looks like, the different types, and the treatment options available can help you feel more informed and empowered about your skin health. Why Skin Cancer Awareness Matters Your skin is your body’s largest organ, and it’s exposed to environmental factors—especially ultraviolet (UV) radiation—every single day. Over time, sun exposure can damage skin cells, leading to abnormal growth and, eventually, skin cancer. Routine skin checks, both at home and with a board-certified dermatologist, are essential for catching skin cancer early. Many skin cancers begin subtly, often appearing as small changes that are easy to overlook. Basal Cell Carcinoma: The Most Common Skin Cancer What Is Basal Cell Carcinoma? Basal cell carcinoma (BCC) is the most common type of skin cancer. It arises from the basal cells in the lower layer of the epidermis and typically develops in sun-exposed areas such as the face, neck, ears, and scalp. Although basal cell carcinoma rarely spreads to other parts of the body, it can continue to grow locally. If left untreated, it can cause significant tissue damage and, in some cases, affect nearby structures. What Does Basal Cell Carcinoma Look Like? Basal cell carcinoma can appear in several ways, including: ● A pearly or shiny bump ● A pink or flesh-colored patch that slowly enlarges ● A sore that doesn’t heal or repeatedly scabs over ● A small indentation with raised edges Treatment Options for Basal Cell Carcinoma Treatment depends on the size, depth, and location of the cancer. Common treatment options include: ● Surgical Excision: The cancer is removed along with a margin of healthy skin to ensure complete removal. ● Mohs Surgery: Mohs is a specialized, tissue-sparing technique often used for high-risk areas such as the nose, eyelids, ears, and lips. The cancer is removed layer by layer and examined under a microscope in real time, preserving as much healthy skin as possible. ● ED&C (Electrodesiccation and Curettage): For certain superficial basal cell carcinomas, the lesion is carefully scraped and cauterized. ● Topical Medications: In select cases, topical treatments such as imiquimod may be appropriate. Squamous Cell Carcinoma What Is Squamous Cell Carcinoma? Squamous cell carcinoma (SCC) is the second most common type of skin cancer. It develops from squamous cells, which make up the outer layer of the skin. While many squamous cell carcinomas are treatable, SCC carries a higher risk of spreading than basal cell carcinoma, especially when tumors are larger or located in high-risk areas. What Does Squamous Cell Carcinoma Look Like? Squamous cell carcinoma may appear as: ● Scaly or rough patches ● Crusted or wart-like bumps ● Tender or painful lesions ● Areas that bleed easily or don’t heal High-risk locations include the ears, lips, scalp, and hands. Treatment Options for Squamous Cell Carcinoma Treatment varies based on the tumor’s characteristics: ● Surgical Excision: Often the first-line treatment, especially for well-defined tumors. ● Mohs Surgery: Recommended for high-risk tumors, recurrent lesions, or cancers in cosmetically sensitive areas. ● ED&C or Topical Therapies: May be appropriate for early or superficial squamous cell carcinomas. ● Radiation Therapy or Systemic Treatment: In more advanced cases, treatment may involve radiation or collaboration with oncology specialists. Melanoma: The Most Serious Type of Skin Cancer What Is Melanoma? Melanoma is the most serious form of skin cancer because it can spread quickly to other parts of the body. It develops from melanocytes, the cells responsible for pigment in the skin. Early detection is absolutely critical for melanoma, as treatment outcomes are significantly better when caught early. What Does Melanoma Look Like? Melanoma often appears as a new or changing mole. Dermatologists commonly use the ABCDE rule to identify warning signs: ● A – Asymmetry: One half doesn’t match the other ● B – Border: Irregular, scalloped, or poorly defined edges ● C – Color: Multiple colors or uneven pigmentation ● D – Diameter: Larger than a pencil eraser (though smaller melanomas exist) ● E – Evolving: Changes in size, shape, or color Any mole or spot that looks different from others or changes over time should be evaluated. Treatment Options for Melanoma Treatment depends largely on the stage at diagnosis: ● Surgical Excision: Early-stage melanomas are treated with surgical removal, often with a wider margin of healthy skin. ● Sentinel Lymph Node Biopsy: For deeper melanomas, this procedure helps determine whether the cancer has begun to spread. ● Advanced Treatments: More advanced melanomas may require immunotherapy, targeted therapy, or radiation, typically in collaboration with oncology specialists. Actinic Keratosis: Precancerous Skin Lesions What is Actinic Keratosis? Actinic keratosis (AKs) are rough, scaly spots caused by cumulative sun damage. While they are not cancer, they are considered precancerous because they can progress into squamous cell carcinoma if left untreated. AKs commonly develop on the face, scalp, forearms, and hands. Treatment Options for Actinic Keratosis Managing actinic keratosis early is an important step in skin cancer prevention. Treatment options include: ● Cryotherapy: Freezing the lesions with liquid nitrogen. ● Topical Medications: Such as fluorouracil, which targets abnormal cells over a treatment period. ● Photodynamic Therapy (PDT): A light-based treatment designed to selectively destroy precancerous cells. The Importance of Early Detection and Regular Skin Exams While skin cancer is common, the good news is that early detection saves lives. Regular full-body skin exams allow dermatologists to identify suspicious lesions before they become more serious. You should schedule a professional skin exam if you notice: ● A new or changing spot ● A lesion that doesn’t heal ● A mole that looks different from others ● Any growth that bleeds, scabs, or feels tender Expert Skin Cancer Care in Knoxville, Tennessee At Refine Dermatology, our goal is to provide expert, compassionate care at every step—from screening and diagnosis to treatment and follow-up. As a board-certified dermatologist, I’m here to guide you through the process so you feel informed, supported, and confident in your care. If you have concerns about a spot on your skin or are due for a routine skin check, we encourage you to schedule an appointment. Your skin health today plays a vital role in your long-term well-being. Early detection makes all the difference!