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JUMPHEAD medestheticsmagazine.com | JULY/AUGUST 2017 55 Generational Dermatology Dr. Roberts was working in academics at Loma Linda Uni- versity in California when the opportunity to branch out on her own fi rst arose. A colleague asked her to cover his practice on the weekends and, through him, she learned that a local dermatologist was interested in selling a failing practice in Rancho Mirage. "It was great because I got a re- ally good deal. The downside was, I didn't have any patients so I had to build it from the ground up," she says. "People thought I was crazy, but it was a fun process." Her philosophy of preventive care—which she refers to as "Generational Dermatology"—helped her attract a loyal patient base. "It involves combining medical, cosmetic, sur- gical and oncologic strategies over the decades of a patient's lifetime to optimize skin performance," she says. She analyzes patients' skin, hair and nails, and monitors the changes that occur over time. Her treatments are based on the four levels of preventive care, which she described in the Journal of Drugs in Dermatology (December 2013). Primary prevention reduces the risk factors before a disease or condition occurs. Secondary prevention allows for early detection while the patient is asymptomatic, in order to prevent, postpone or attenuate the condition. Tertiary pre vention involves treating an existing symptomatic disease to alleviate it or delay its progression. Finally, quaternary preventions mitigate unnecessary/excessive interventions. "Generational dermatology is all about practicing in the primary and secondary versus tertiary and quaternary lev- els," she says. "It's like that movie Back to the Future. If you could go back 20 years in time and counsel your patients, what would you tell them? "First, you would want to know if they look like anyone in their family," she continues. "These relatives can show you what's coming down the road. Does the patient have hair loss patterns like his father? Does she have skin texture or nails like her mother had?" Dr. Roberts calls this "deep medicine," because it allows her to get to the heart of each individual patient's physical history. Based on this information, she develops a com- pletely customized treatment protocol with the goal of maintaining their skin health and putting them on the path to healthy aging. "My patients tell their friends and family that I went over them head-to-toe and am going to keep their skin from looking aged," she says. A New Skin Classifi cation System To help her select the best and safest treatment options, Dr. Roberts created the Roberts skin type classifi cation system, which expands upon the iconic Fitzpatrick skin type scale. It is a four-part classifi cation system in which the clini- cian evaluates four quantitative and qualitative elements of T he R o ber t s s k i y pe e v a l u at c l u de s a r e v i e w l i i ca l h i st o r y , v i s u a l e x a m i t t e st s it e r ea c t a l e x a m i t o f t he p at t ' s s k i .