The Best Way to Prevent Aging is to Start in Your 20’s & 30’s

Many young women don’t realize the importance of skincare.

When we’re young we mostly focus onpreventing the occasional breakout, covering up the dark circles under our eyesfrom lack of sleep and not looking pale. Unfortunately, the consequences ofneglecting our skin at this age are harsh!  As a medical provider I seeclients of all ages, races and a variety of skin complaints. The number onecomplaint is always age related. In older generations sunscreen wasn’t used,sunbathing was glorified and skincare products didn’t exist. The hardest thingto do as a provider is reverse the signs of aging. Prevention is so criticaland can have such a large long term impact that I can’t stress it enough to myyounger clientele.

Weall know we’re supposed to wear sunscreen and not smoke, but there is so muchmore to skin care especially when preventing signs of aging. Here’s my list:

Don’t neglect your neck and chest.
The neck and chest age quicker than your face. The skin on your chest is very thin and it’s takes on pigmentation easily. Count the freckles you have on your chest and multiply that number by 10, that’s about how many sun damaged areas you have that will show up when you’re older as of right now. You have to apply sunscreen with helioplex to this area daily and multiple times if you’re at the beach or exercising outdoors. There are very few treatments that can erase the lines on the chest and the sun spots. You can’t botox or use filler to fix these lines, once they’re there they’re permanent! Your neck is also thin skin and the skin is constantly being stretched by your movements. If you want the skin to stay tight start using a neck cream like <a href="http://""“>Nectifirm.

Start using a Retinoid cream.
Retional creams have powerful anti-aging properties. They force your skin to constantly regenerate a new fresh layer, leaving you with radiant skin. They can even help treat adult acne and reduce fine lines. There are several options available over the counter or see your provider for a prescription version. They’ll make your skin more photosensitive so you’ll have to wear sunscreen with helioplex during the day. I recommend SkinCeuticals Retinol Cream

Preventative Botox. I realize that many people are hesitant about Botox or think they don’t need it, however Botox is not just for the correction of wrinkles and lines but also to prevent them. Look at the lines on your forehead when you raise your eyebrows. You’ve been creasing those lines for 20-30 years and at some point it will be 50 years! There comes a point where Botox will no longer help reduce that line. The line will be permanently etched into your skin due to the loss of collagen in the skin from the constant creasing. Getting Botox while the lines are mild, paralyzes the skin temporarily so it has a chance to regrow collagen exactly where it was previously creasing. In addition, if you have a Botox treatment every 4-6 months at this age you will need less and less of it as you get older. That will save you a lot of money and you will be getting carded for wine well into your 40’s!

MOISTURIZE, MOISTURIZE, MOISTURIZE! My younger clients always laugh when I suggest they use a night cream. They think night cream is something from the 1950’s that’s sold on QVC or door to door by Mary Kay reps. If you have dull skin, dry skin, wear foundation or you use acne creams you need a non-comedogenic (doesn’t clog pores) night cream. My favorite is <a href="http://""“>Neutrogena deep moisture night cream. Put it on immediately after the shower, put some on your neck and chest and I like to put some on my legs because they get dry after shaving, but that’s another article.

Wash your face in the shower and stop using towelettes. Whether it’s a cleanser or an acne wash, it’s best to use it while in the shower to ensure no residue is left on your face. Residue from soap leads to bacteria and fungus growth which leads to more acne and build-up of dead skin cells. Towelettes basically spread the dirt and bacteria on your face to different areas. Although they’re convenient they have to go! I suggest trying exfoliant cleaners with medicated beads such as <a href="http://""“>Neutrogena Grapefruit Face Wash or the Fresh Star line by Dermaologica (available in my office)

Genetics. Take a look at mom and dad. How is their skin? Do they have a lot of wrinkles, sun damage? Is their skin hanging? We can learn about how our skin will age from our parents. If you’re the spitting image of mom you better believe you’ll have her jowls too. How do you prevent sagging skin? Maintain an effective skin care regimen, avoid smoking, sun exposure, keep the skin tight with PRP facials to boost the collagen, sleep on your back and avoid excessive weight gain.

Start sleeping on your back. Often people have asymmetries in their face. You can prevent an exaggerated flattening on your cheek and drooping on one side by sleeping on your back. You can also prevent wrinkles. This rule also applies to leaning on your hands which stretches your face and repetitively touching or rubbing your face.

Prevent acne before it leaves a scar. Medicated masks and cleansers are important. Another pertinent factor at this age is pregnancy acne. It’s safe to have Lactic acid chemical peels during certain trimesters of your pregnancy. They can help treat the acne and reduce scarring. Remember with everything regarding skin it’s much easier to prevent than to repair. The <a href="http://""“>Peter Roth Sulfur Mask is great for acne prone skin and for spot treatments!

What do I do if I already have fine lines, sun spots, acne scars or losing youthful volume in my face? Your custom treatment plan would be based off the depth of damage you already have. In most cases we clear the sun spots first and then start a series of Platelet Rich Plasma facials (vampire facial). This quick, painless procedure is as effective as most lasers and is the only procedure with only 1 day downtime that can actually reverse the signs of aging. There are no injections involved and post procedure redness usually resolves overnight. Platelet Rich Plasma (PRP) facials, also known as collagen induction therapy provokes your body to rebuild the collagen in your skin for a more youthful skin texture and glow, while reducing fine lines and acne scars. In combination with a skin care regimen you should be able to regenerate new radiant skin and maintain it.

In my practice we offer free consultations so that the clients have an opportunity to discuss all their concerns, explain what’s available to them and realistic expectations. We create custom plans for each client and can even design them around a specific date (for example a wedding). We carry a variety of skin care products in the office and have the ability to order or prescribe whatever you may need. Packages are available for multiple skin treatments and combination therapies.

Now is the time to start preventing aging!!

All About Lip Injections!

When enhancing the lips there aretwo routes to consider: Dermal fillers and Platelet Rich Plasma.

Dermal fillers are used to add shape, structure and volume to the lips.They are made of a liquid gel called Hyaluronic acid (HA). HA is a naturalsubstance found in our bodies. The version used in medical offices is producedby bacteria in a lab and is sterile.

Platelet Rich Plasma (PRP) is a protein and growth hormone rich solution derived from the clients own blood. Blood is drawn just like it would be for a normal doctor visit, only a few tablespoons are needed.  Since PRP comes directly from the client there is no risk for allergic reaction. PRP provides small amounts of volume and stimulates the body to regrow collagen in the lips over time.

The focus of this augmentation was to decreases the visibility of asymmetry and add a natural volume to the upper lip.

Whywould you use choose one product over another?

Both Dermal fillers and PRP havetheir benefits. Dermal fillers offer immediate volume, they’re longer lastingand dissolvable. PRP offers a temporary enhancement allowing you try out a pairof voluminous lips before committing to more treatments or a dermal filler.This treatment is desirable for those who have had reactions to dermal fillersor are uncomfortable with the use of dermal filler.

Howlong will it last?

Depending on the brand of dermalfiller used, your lip filler can last from 6 months to 1 year. One treatment ofPRP will last 1-2 weeks, after 3 treatments you can expect a natural growthover the course of 6 months.

Whichbrand of dermal filler is right for me?

After discussing the goal you wouldlike to achieve during a consultation with our provider, the provider willchoose the brand that’s most suitable for the desired result.

Willit hurt?

We take every precaution to keep youcomfortable. We apply numbing cream before the procedure AND every product weuse contains a numbing agent. In addition, you have the choice of having adental block where, you’re entire mouth will be numbed by intraoral injections.

Howlong will I be swollen or bruised?

This is entirely patient dependent.We advise avoiding alcohol, vitamins, NSAIDS (ibuprofen, aleve, advil) for 48hours prior to your procedure to decreased bruising. Applying ice after theprocedure can help reduce swelling. Arnica cream, which is readily availableover the counter at all pharmacies, can also help resolve bruising. Mostbruises can be easily covered by makeup. If you have a bleeding disorder or aretaking blood thinners make sure to alert your provider. It’s best not to planany important events or photos until one week after the procedure.

This client wanted a large increase in volume in both her upper and bottom lip. This picture was taken immediately after injection. You can see swelling in the top lip border which will resolve in 1-2 days.

Whatif I don’t like the way they look?

The initial volume associated withPRP injections resolve on its own in a few days to one week. Dermal fillers canbe easily dissolved in minutes with injection of a dissolving agent.

Howmuch does it cost?

Pricing for dermal fillers dependson the amount you receive and the brand. For example one full syringe ofJuvederm Ultra, which lasts one year, is $600. Currently this is the mostpopular brand due to its lasting ability. If it any time you decide to dissolveyour filler the fee is $350.

Whatabout cold sores?

If you have an active cold soreinfection you’ll have to wait until it has cleared to undergo injections. Ifyou have a history of cold sores, but no active infection you may undergo theprocedure. Lip injections can trigger an outbreak. Be sure to let your providerknow so they can give you a prophylactic antiviral medication to prevent theoutbreak.

Mylips are naturally uneven can that be fixed?

It’s very common for people to haveasymmetries in their face. Usually one side of the face is smaller orflattened. It could be genetic or if you’re a side sleeper it could be the sideyou sleep on. Think of the right and left side of your lips as a balloon, ifone balloon is large than the other and I add one cup of fluid to each balloon,one balloon will still be larger. Corrections can be made however, it’s nearlyimpossible to correct 100% without correcting the entire side of the facethat’s affected. Discussing asymmetries with your provider is advised toexplain realistic expectations.

What is a PA?

PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality.

PAs are educated at the master’s degree level. There are more than 250 PA programs in the country and admission is highly competitive, requiring a bachelor’s degree and completion of courses in basic and behavioral sciences as prerequisites. Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience, having worked as paramedics, athletic trainers, or medical assistants, for example. PA programs are approximately 27 months (three academic years), and include classroom instruction and more than 2,000 hours of clinical rotations.

PAs’ specific duties depend on the setting in which they work, their level of experience, their specialty, and state laws.

Generally, PAs can:
• Take medical histories
• Conduct physical exams
• Diagnose and treat illness
• Order and interpret tests
• Develop treatment plans
• Prescribe medication
• Counsel on preventive care
• Perform procedures
• Assist in surgery
• Make rounds in hospitals and nursing homes
• Do clinical research

At the practice level, there are likely more similarities than differences between PAs and NPs. However, there are two key differences:

• PAs are educated in general medicine, which offers a comprehensive view of all aspects of medicine. NPs must choose a “population focus,” e.g., pediatric nurse practitioner or women’s health nurse practitioner.

• PAs are trained to practice medicine using a curriculum modeled on medical school education. NPs are trained in the advanced practice of nursing.

**This adorable shirt is from Medthusiast.


The 10 most common causes of hair loss and the Best Treatments

  1. Pregnancy:Post pregnancy hair loss is very common. There is a temporary thinning and sometimes breakage of hair due to the drastic changes in hormones. The body will resolves this issue itself within about three months after the signs appear.
  2. Genetics: When thinning hair occurs at a young age, you can blame your parents! This is often the hardest form of hair loss to treat and should be addressed early on
  3. Damaged Stem Cells in the hair follicles: This most commonly appears as patches of thinning hair or bald spots. Repeated trauma to the scalp or scarring is the main cause.
  4. Lack of Protein: When protein is limited or there’s a sudden change in protein intake one might experience hair thinning or loss. I mostly encounter this issue with clients who recently changed from an animal protein diet to being a vegetarian.
  5. Excessive amount of Vitamin A: Ingesting too much Vitamin A can alter the hair growth cycle. Once you stop overusing this supplement the hair growth should return to normal
  6. Nutrient and Vitamin Deficiencies: Lack of B vitamins can cause thin hair, while lack of iron can cause slow hair growth. Crash dieting also has an effect on the ability of hair to grow due to the fluctuations in nutrient intake.
  7. Stress: When your body is stressed an uneven number of hairs enter into a resting phase. These hairs will also fall out at the same time appearing as large amounts of hair loss
  8. Menopause: Estrogen is the hormone responsible for protecting hair. Once estrogen decreases the hair thinning begins. This can also be noted in clients with Polycystic Ovarian Syndrome and other hormone disorders.
  9. Medical & Autoimmune Conditions: When your body is constantly fighting a disease the nutrients and growth hormones go to the vital organs, leaving very little for hair, nails and skin. Hair thinning and loss can also be seen in thyroid disease.
  10. Sudden weight loss: Losing 25lbs or more in one month can cause hear to weaken and break due to loss of healthy fats.

How do we combat hair thinning and hair loss at my practice?

After evaluating the client for theabove list of causes we are able to create a custom treatment plan. Somepatients require a combination of supplements and PRP treatments, while othersneed treatment for underlying medical conditions.

I like PRP (platelet rich plasma)therapy because of the statistically significant outcome. Clients can seethicker hair and a decrease in hair loss in the first 3 months and new hairgrowth in 6-8 months. On occasion I have seen new hair growth even earlier!Hair thickness increases by 60-80%. PRP can even restore the hairs originalcolor. I also recommend PRP as a preventative measure to preserve the integrityof the hair in those clients that are just beginning to notice a change. Theearlier you start tthe longer the longevity of the hair.

Micro-needling with PRP(platelet rich plasma)

What is Micro-needling?

Micro-needling is a cosmetic medical procedure by which an electric skin needling device is used to create tiny channels in the skins surface layer to induce production of collagen and elastin. The device is pen-shaped, studded with 12 very fine needles. This medical device breaks down scar tissue, stimulates cell proliferation and improves the blood supply to the skin. The result is plumper, thick skin which reduces the appearance of scars, fine lines and wrinkles.

Description of the Procedure:

The skin is cleaned and numbing cream is applied to reduce discomfort. The needling device which has a sterile disposable tip with 12 micro-needles is used penetrate the skin. The device is adjustable and allows the provider to change the speed and depth of the needles and increases the absorption of products. For the best results, Hyaluronic acid or PRP (platelet rich plasma) are used during the procedure and rubbed into the skin channels.

The micro-needling procedure itself takes 15-20 minutes. The numbing cream applied before the procedure must sit for about an hour to be effective.

What should I expect after the procedure?

Most people will experience redness and mild swelling similar to very mild sunburn for 24-48 hours. There may be pin-point bleeding. Within a week or two you will notice that you skin is smoother and more radiant looking but the full effects won’t be seen until a few months later.
We recommend applying hyaluronic acid at home after the procedure. Preferably no makeup applied for 24 hours. We also recommend wearing sunblock for one week following the procedure.

How many treatments do I need?

For best results we recommend treatments be spaced 4-6 weeks apart. The number of treatments required to reach the desirable outcome depends on the skin condition. For example, fine lines and wrinkles typically improve after 3 treatments where acne scars can sometimes take up to 6 treatments.

What it’s used for:

  • Reduce the appearance of stretch marks, scars, fine lines and wrinkles
  • Pore size reduction
  • Improves skin texture
  • Stimulates tissue regeneration

Am I a candidate for Micro-needling? Micro-needling can be safely performed on all skin types and skin colors

However it is not suitable for patients who:

  • Have used Accutane (isotretinoin) within the last six months
  • Have open wounds, cuts or abrasions on the skin
  • Have had radiation treatment to the skin within the last year
  • Have any kind of current skin infection, condition, herpes simplex in the area to be treated
  • Are pregnant or breast feeding
  • Have a history of Skin cancer on area to be treated
  • Have a history of keloid or hypertrophic scars or poor wound healing
  • Have been diagnosed with Scleroderma, Collagen Vascular Disease, Rosacea, blooding clotting disorders, platelet abnormalities, anticoagulation therapy (i.e. Warfarin), dermatological diseases affecting the face (i.e. Porphyria),
  • Scars less than 6 months old and Botox/facial fillers in the past 2-4 weeks.
  • Precaution must be taken in patients with a history of eczema, psoriasis and actinic keratosis

PRP treatments for Osteoarthritis of the Knees

PRP or platelet rich plasma injections for knee arthritis can alleviate the pain of arthritis, improve your quality of life and slow the progression of your arthritis. The research surrounding PRP is significant.

What is PRP and how does it work

After 24 weeks, nearly 84 percent of patients who received PRP injections reported a 25 percent or greater reduction in pain

In order for body to repair an injury or in the case of osteoarthritis, the loss of cartilage, is to recruit platelets to the area. As we age or due to severity of injury the body may create an insufficient amount of effort to repair. Often the pain caused by osteoarthritis is the result of something called an osteochondral lesion. These are small ‘potholes’ of missing cartilage in the knee joint. When you walk and exercise you put immense pressure on these areas, about 3x your weight. Since the bone in these areas is not covered by cartilage it begins to swell and breakdown. This bone swelling also known as reactive bone edema is one of the most common causes of knee pain.

The platelets in PRP are packed with growth and healing factors, platelets initiate repair and attract the critical assistance of stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets.

The goal of PRP therapy is to initiate a reaction in the knee that stimulates the body to heal the area. You will not regrow the cartilage you had as a teenager but you can reduce the reactive bone edema and swelling that is causing pain.

How do we create PRP?

To create PRP therapy, a small sample of your blood is drawn (similar to a lab test sample) and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The concentrated platelet rich plasma (PRP) is then injected into and around the point of injury, jump-starting and significantly strengthening the body’s natural healing signal. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.

No hospital stay is required. The procedure is performed safely in a medical office and takes approximately 30 minutes, including preparation and recovery time. In fact, most people return to their jobs or usual activities right after the procedure.

Microdermabrasion & how it can help YOUR skin

Microdermabrasion is the most natural way to evenly and safely exfoliate the skin without chemical or laser. It’s one of the most requested non-invasive cosmetic procedures. Fine crystals gently resurface superficial layers of the skin. A series of treatments are required to provide the best results.

Microdermabrasion is used to treat acne, reduce fine lines and wrinkles and brighten a dull complexion.

We recommend a bolus of two treatments per month initially. The maintenance schedule will be determined by your provider depending on your condition.

Botox Basics

Botox and Dysport (brand names) are purified proteins that are produced by the Clostridium Botulinum bacteria. They are used to temporarily improve the wrinkles and signs of aging of the face. Both have been used safely for over 10 years.

Uses for Toxins:

  • Lifting brows
  • Improve wrinkles of the forehead, between eye and crows feet (sides of eyes)
  • Treat excessive sweating of underarms, hands and feet

Botox for excessive sweating:

Botox is very effective for the treatment of uncontrollable sweating of the underarms hands and feet. There is usually mild temporary weakness of the treated limb. This usually lasts 2-3 weeks. The improvement in sweating can last for 6 months or longer.

How Toxins work

A few drops of toxin are injected with a tiny needle into the muscle causing the wrinkle. Over the next few days the toxin effect begins. The toxin blocks motor impulses to the muscle which temporarily weakens the muscle and causes the wrinkle in the overlying skin to gradually soften and disappear. The effects last about two to four months.

It takes 10-14 days to see the full effect of Botox takes place. If you have an event coming up plan to come in 1 month ahead of time. If this is your first time having Botox plan on having a trial run 3-4 months before the event to make sure you are happy with the look of the Botox. This is especially important for brides!

Possible side effects of Toxins

  • When injected in the forehead there is a small chance of bruising. This usually lasts for 5-7 days.
  • When injected around the eyes there is a small risk of drooping of the brows (called Ptosis). This is also temporary and can be improved with medicated eye drops.
  • When injected into the underarms or hands there is mild, temporary weakness of the hand. For example, it might be more difficult to open a tight jar, but typing ability would not be affected.

Although toxins are safe, they should not be used in pregnant women or anyone with specific neurological diseases.