Dr. Alex's Blog

Dermal Fillers

2012-03-04T18:32:00.000-08:00

As we age, we lose fat in the skin that gives it its youthful appearance. Additionally collagen and elastin production slow down, leading to laxity and sagging. At the same time bone resorption occurs leading to volume loss. Together, these lead to changes such as formation of nasolabial folds or smile lines, marionette lines, and jowls. Dermal fillers are products which are injected into the skin to reverse these changes . Common fillers unclude Juvederm, Restylane, Perlane, Radiesse, Sculptra, and Artefill. They last anywhere from six months to over two years depending on the filler and the person. The great thing about dermal fillers is that, unlike Botox, chemical peels, or laser procedures, results are seen immediately, which is perfect for those who want instant gratification. It is minimally invasive, which is nice for those who don't want surgery. Prior to the procedure the skin is numbed with a topical cream or injection so that the procedure is painless. The procedure can be performed in less than 30 minutes. Common areas of treatment include smile lines, lips, and areas under the eyes. Women who are pregnant or breast feeding should not be treated.

Hyaluronic Acid

2012-02-26T02:55:00.000-08:00

As we age the skin loses its ability to retain moisture, leading to dryness, elasticity, and a saggy appearance with fine lines and wrinkles. It is important to counteract this by using products such as hydrators and moisturizers. Hydrators, also known as humectants, bring water into the skin from the blood supply whereas moisturizers prevent the water in the skin from evaporating. Hyaluronic acid is a naturally occurring substance found in the skin and is a powerful hydrator because it binds 1,000 times its weight in water. When used with moisturizers water is brought into the skin and stays there, allowing for healthy skin function. Hyaluronic acid is found in many skin care products and is responsible for making the skin look smooth and plump. Add a hyaluronic acid product to your skin care regimen to see the effects for yourself.

Stress and the Skin

2012-02-19T21:27:00.000-08:00

Stress can have a direct and major impact on the skin. Stress can induce or exacerbate any skin condition; common ones include acne, eczema, and psoriasis. It can also make healthy skin appear unhealthy. There are many forms of stress, and all types affect the skin. Physical and emotional stress are common. Other stressors include poor diet, lack of exercise, and inadequate sleep. Hormonal changes such as the menstrual cycle can also affect the skin. Any type of internal illness or medical condition can affect the skin as well. The environment can cause stress on the skin; for example ultraviolet rays from the sun and pollution in the air damage the skin. Additionally, poor lifestyle choices such as smoking, drinking, or using illicit drugs can have a direct impact on the skin. Even prescription medications may also affect the skin.

With all of these types of stressors, it is important that we maintain a healthy lifestyle to keep the skin looking and feeling healthy. These include using sunscreen daily, exercising regularly, eating a healthy diet, getting an appropriate amount of sleep, and avoiding behaviors such as smoking and using UV tanning beds. Other helpful activities include meditation, relaxation through massage, engaging in hobbies, and maintaining healthy interpersonal relationships at home and at work. While this may seem like a lot, doing these things will keep your skin healthy and at the same time have a direct effect on your health.

"I Didn't Peel"

2012-02-12T22:19:00.000-08:00

One of the most common comments I hear from patients who have chemical peels is "I didn't peel." It is important to understand what a chemical peel is and does as well as its goals. Chemical peels remove the dead skin cells on the surface and stimulate cell turnover and collagen production. It can treat a variety of conditions and is appropriate for healthy and unhealthy skin alike. The goals of a peel are to address specific concerns, such as acne or fine lines. The goal is not to peel. Many people do not see visible peeling of the skin. This does not mean that they did not get results. In these situations the exfoliation is occurring, but at a microscopic level, so we do not see visible peeling. It is therefore important to take photographs before and after the procedure and compare them to see the results.

Importance of Washing Your Face

2012-02-05T10:37:00.000-08:00

Washing your face is the first step in any skin care regimen and its importance can not be understated. It should be performed twice daily. Washing removes oil, dirt, debris, makeup, sunscreen, and anything else that may accumulate on the surface during the day or at night. Impurities on the skin surface will block the absorption of skin care products. They can also induce or exacerbate breakouts. In addition, face washing provides hydration to dry skin, particularly in climates with low humidity. For these reasons I always say clean skin is healthy skin.

Gentle cleansers work for most people while gels work especially well for those with oily skin. Find one that works well for you and does not irritate your skin. The product should be in contact with the skin for at least 30 seconds for an effective wash. Products such as the Clarisonic Pro brush are excellent because they provide a gentle yet thorough rubbing of the product with the skin surface for a full minute. Ensure that your face is completely dry by using a towel and even a blow dryer before applying subsequent products. Washing your face twice daily will lead to clean, healthy skin. Make it a routine, just like brushing your teeth.

A E Skin Brightening Cream

2012-01-29T22:22:00.001-08:00

Many people have concerns over skin discoloration. The most common concern is hyperpigmentation, which is darkening of the skin color. This has many causes including sun exposure (most common), pregnancy, hormones, medications, acne, scars, and more. The discoloration is the skin's natural reaction to insults. In the case of sun exposure, for example, the reaction is a tan or in severe cases a burn.

Many products are available for lightening the skin color including hydroquinone (strongest), kojic acid, alpha-arbutin, licorice extract, coffee berry, and more. A number of them are available over-the-counter in low strength. A common complaint I hear is "I've tried everything for the discoloration and nothing works." This is partially true because the patients have tried a lot of over-the-counter products with minimal to no results. In these cases I recommend stronger products that are available by prescription or through doctors only.

The A E Skin Brightening Cream is a powerful blend of products leading to fast improvement in discoloration. It contains hydroquinone at three times the strength of over-the-counter products (fears of hydroquinone are addressed here). It also contains kojic acid, another brightening agent, as well as tretinoin, which enhances cell turnover and stimulates collagen formation. When used in combination with other products such as exfoliants, antioxidants, and sunscreens and procedures such as chemical peels and photofacials, impressive results can be seen.

This product should not be used in women who are pregnant, trying to become pregnant, or breast feeding.

Hydroxy Acids

2012-01-22T20:33:00.001-08:00

Hydroxy acids are products used to exfoliate the skin. They are classified by their chemical structure as either alpha-hydroxy acids or beta-hydroxy acids. Alpha hydroxy acids are typically derived from plant sugars and include glycolic acid, lactic acid, citric acid, mandelic acid, malic acid, and tartaric acid. The most common beta hydroxy acid is salicylic acid, which is found in many acne products. Beta hydroxy acids are stronger than alpha hydroxy acids and thus lower concentrations are used.

As we age, dead skin cells accumulate on the surface. This is because skin cell turnover slows down over time. The effect of this is uneven texture and overall dullness to the skin. Hydroxy acids remove the dead skin cells on the surface by breaking the bonds holding them together, resulting in a brighter glow and radiance. They also act in the deeper layer of the skin to stimulate collagen formation improving fine lines and reducing pore size and laxity.

With all of these beneficial effects, hydroxy acids can be used in any skin care regimen. Other components of a good skin care regimen include face wash, toner, antioxidants, retinoids, hydrators, moisturizers, and sunscreen.

Laser Hair Removal on Tanned Skin

2012-01-15T19:31:00.000-08:00

Many people advertise lasers that work for hair removal on tanned skin. A common question I get is "Is this true?" The answer is that it is partially true. The reason for this has to do with the physics and biology involved. The target for lasers used for hair removal is melanin. Melanin is abundant in dark hairs (blond and red hairs have a different kind of melanin that does not absorb the light well). Melanin is also produced in the skin when people get a tan. In fact, the tan that is seen after sun exposure is directly due to the increased formation of melanin.

Melanin will absorb the laser or light energy wherever it is. So the melanin in the hair shaft will absorb the energy and destroy the hair. At the same time the melanin in the skin can absorb the energy and burn the skin. For this reason, people with tanned or dark skin require lower energy to prevent burns and blisters. When lower energy is used, there is also a decreased effect in terms of the hair removal. This usually means more treatments will be required.

So while laser hair removal can be done on tanned skin, it is not as effective and more treatments will likely be required if it is done on tanned skin versus untanned skin. Therefore, to get the maximum benefit from laser hair removal, be sure not to tan the few weeks before each session.

Spray tanning will not interfere with laser hair removal because it does not add melanin to the skin. Sun tanning and UV-based tanning is not recommended because it can cause signs of premature aging such as fine lines, discoloration, and laxity and because it increases the risk for skin cancer.

Difference Between Retinoids and Retinols

2012-01-10T19:29:00.000-08:00

Retinoids and retinols are structural derivatives of vitamin A which are used topically on the skin to treat acne, to improve fine lines, to decrease laxity, and for overall facial rejuvenation. The action of retinoids and retinols is to stimulate cell turnover, hence removing the dead skin cells on the surface, and to stimulate collagen synthesis, leading to improvement in fine lines and laxity and decreasing pore sizes. They improve the overall health of the skin and are outstanding products to prepare the skin for procedures such as chemical peels or laser resurfacing. Skin heals much faster when people use retinoids.

Retinols, once absorbed by the skin, are converted to retinoids such as all-trans retinoic acid or tretinoin (also known as retin-A). The conversion rate varies from person to person, but is generally 5 - 10 %. Retinols can be found in over the counter products whereas retinoids are available by prescription only in the United States.

The only data available on the action of these products is from retinoids. Retinoids provide better and faster results than retinols. Retinoids can cause irritation to the skin, while retinols are not as irritating. For this reason, some people first starting retinoids begin by using them every other day and slowly ramp up to daily use. Retinoids can cause dryness and peeling, so it is important to provide moisture to and hydrate the skin regularly. They also make the skin more sensitive to the sun, so it is important to use sunscreen every day while using retinoids. Retinoids can be degraded by sun, which is why they are applied at night.

Retinoids come in various strengths and formulations. For example, tretinoin comes in 0.025 %, 0.05 %, and 0.1 % strength, where the higher the percentage, the stronger. Also it comes in cream or gel; gels are absorbed more and are stronger than the equivalent strength of cream.

Other retinoids are available as well. Adapalene (Differin) is less irritating than tretinoin, but also less potent. Tazarotene (Tazorac) is stronger than tretinoin, but more irritating. For these reasons, many people start with adapalene and subsequently transition to tretinoin and then tazarotene.

Retinoids should not be used in women who are pregnant, breast-feeding, or trying to become pregnant.

A E Skin Triple Antioxidant Serum

2012-01-04T18:08:00.000-08:00

The A E Skin Triple Antioxidant Serum is an outstanding product to add to any skin care regimen. It contains a unique mixture of vitamin C, vitamin E, and ferulic acid which together neutralize free radicals and provide protection against ultraviolet rays. Antioxidants can also protect collagen from degrading, providing firmness to the skin, preventing laxity, improving fine lines and wrinkles, and decreasing pore size. They also prevent certain types of skin cancers. Using topical antioxidants will provide a youthful radiance to the skin and promote skin health.

Many people say that they do not need topical antioxidants because they take multivitamins regularly. However, orally ingested vitamins go initially to the liver, where they are processed. Then they travel to all parts of the body. So only a limited amount gets to the skin. Of all the parts in the body, the skin needs more antioxidant protection because it is exposed to the sun's ultraviolet rays.

The A E Skin Exfoliating Serum, as in all A E Skin products, contains no preservatives, which is why they have an expiration date of six months after production. Contact us today (info@aeskin.com 818-835-1833) so Dr. Alex can start a personalized regimen perfect for your skin.

Top Ten New Year’s Resolutions for Healthy Skin

2012-01-01T00:19:00.000-08:00

Wear sunscreen every day. The SPF should be at least 30 and it should have UVA and UVB protection. Use sunscreen even if it’s cold or overcast and even if you don’t go outside.
Wash your face twice daily. Clean skin is healthy skin. Using a brush like the Clarisonic Pro can be six times more effective in cleansing.
Talk to a doctor to start a good skin care regimen.
Use a night cream that contains powerful retinoids (tretinoin or retinoic acid). These prescription-strength products work much more effectively than any over-the counter products containing retinols.
Add a topical antioxidant such as vitamin C to your daily regimen. This will help give your skin a radiant glow.
Exfoliate daily by using products containing hydroxy-acids such as glycolic acid, lactic acid, and salicylic acid.
Stay hydrated throughout the day. Drink at least eight cups of water each day.
Hydrate your skin using products containing hyaluronic acid. Also keep your skin moisturized by using a moisturizer at least twice daily. This is especially important in dry climates and on windy days.
Exercise daily. Regular exercise boosts your metabolism and supplies blood to the skin, making it function better.
Eat healthy. Avoid fatty and greasy foods and maintain a diet filled with vitamins by eating vegetables and foods with omega-3 fatty acids such as fish.

My Makeup Has Sunscreen in It

2011-12-27T14:52:00.000-08:00

One of the most common comments I hear from patients is "I don't use sunscreen because my makeup has sunscreen in it." Sometimes people don't use sunscreen because it is in their moisturizer. And some don't use it because they do not like the way it feels. I recommend daily use of sunscreen, whether it is sunny or raining, hot or cold, winter or summer, and whether or not you are outside. According to the American Academy of Dermatology, sunscreen should have a minimum SPF of 30 and it should have UVA and UVB (or broad spectrum) protection, which should be evident on the label. There are many different brands of sunscreen. Find one that feels comfortable and has a minimum SPF of 30 with UVA and UVB protection.

Both UVA and UVB can cause damage to the skin. The damage is seen as fine lines, textural irregularities, and laxity; signs of premature aging. Additionally, sun exposure can lead to pre-cancerous lesions called actinic keratoses as well as cancers such as basal cell carcinoma and squamous cell carcinoma. To prevent premature aging, pre-cancers, and cancers, daily sunscreen use is essential.

There are various components in sunscreens which contribute to the overall SPF value. However, they are not all additive and the association is not linear. For example if a moisturizer contains sunscreen at an SPF 15 and makeup contains sunscreen with SPF 15, the total SPF is not necessarily 30. This is why I recommend sunscreen to be included in everyone's skin care regimen even if other components such as moisturizer and makeup contain sunscreen. Sunscreen should be applied after moisturizer and before makeup. For an added boost, use daily topical antioxidants such as vitamin C. These antioxidants neutralize the residual damage that occurs to the skin even when sunscreen is used properly.

New A E Skin Exfoliating Serum

2011-12-23T14:17:00.000-08:00

Introducing the newest product in the A E Skin line: Exfoliating Serum. This product contains 2 % salicylic acid, a beta-hydroxy acid which removes the dead cells on the surface layer of the skin. As we age these dead skin cells accumulate on the surface, giving an uneven texture and a dull appearance when in the light. Exfoliation with this serum provides a smooth texture to the skin along with a radiant glow. Only five to ten drops are required and it is to be used once a day in the morning immediately after washing and toning the face. This is an outstanding product for anti-aging because it improves fine lines and textural irregularities such as open pores and scars. It is also effective for acne and is contained in many acne products. It provides a gentle daily exfoliation which makes procedures such as chemical peels, microdermabrasion, and laser resurfacing more effective. The A E Skin Exfoliating Serum, as in all A E Skin products, contains no preservatives, which is why they have an expiration date of six months after production. Contact us today (info@aeskin.com 818-835-1833) so Dr. Alex can start a personalized regimen perfect for your skin.

New A E Skin Hydrating Serum

2011-12-19T11:54:00.000-08:00

Introducing the newest product in the A E Skin Care line: A E Skin Hydrating Serum. This product contains 60 % pure hyaluronic acid, a naturally occurring substance found in the skin. Hylauronic acid binds 1,000 times its weight in water, providing a tremendous amount of hydration to the skin. Only two to four drops are required. When used twice daily, just prior to use of a moisturizer, the water balance in the skin becomes perfect for maintaining the natural metabolic functions of the skin. The Hydrating Serum causes the cells in the deep layer of the skin to work more effectively, restoring collagen and providing tighter skin. It also works as an antioxidant, reversing damage to the skin caused by sun and chemicals. The A E Skin Hydrating Serum is another product in the line which can be added to any skin care regimen.

Red Carpet Peel

2011-12-16T11:06:00.000-08:00

Do you want to reverse the aging process? Unlike any other procedure, the Red Carpet Peel will enhance your skin’s natural beauty and give you a youthful radiance, making you look your best for any special occasion. Using a synergistic combination of ingredients, the Red Carpet Peel improves fine lines, wrinkles, and discolorations, while at the same time stimulating the production of collagen, leading to tighter skin and closing pores. It is also perfect for acne and acne scars. You will see dramatic results in about a week with this virtually painless procedure which takes less than 15 minutes.

Discovery of Latisse

2011-12-11T18:08:00.000-08:00

Latisse is an outstanding product that is used for eyelash hypotrichosis, or inadequate eyelashes. The discovery of this prescription medication, like many others, is very interesting. Allergan, the maker of Latisse (and also Botox and Juvederm) was using the active ingredient (bimatoprost) to treat glaucoma in Lumigan. Patients using Lumigan noticed that their eyelashes were becoming darker, thicker, and fuller, an apparent side effect of the medication. Since the active ingredient was already approved by the FDA, Allergan was able to quickly convert it under the name Latisse and promote it for eyelash growth. Latisse is applied nightly and initial results appear in as early as four weeks, with full results apparent in twleve to sixteen weeks. It should not be used by women who are pregnant or breast feeding.

Holiday Open House 2011

2011-12-09T14:55:00.000-08:00

Our 2011 Holiday Open House was held on Wednesday December 7, 2011 at our new location: 15840 Ventura Bl. Suite 106, Encino, CA 91436. It was a great success. Many patients, both new and old, attended and took advantage of our exclusive specials, including discounted Botox, Juvederm, chemical peels, Latisse, Clarisonic Pro, and all skin care products. Patients also had the opportunity to meet our new colleagues, dentist Dr. Soheil Amir Moazzami of Alliance Dental, chiropractor Dr. Paul Chen, and aesthetician Suzie Bridges. The event was catered by Nuts and Berries Cafe and sponsored by Allergan. We had a live demonstration of a chemical peel, where guest got to observe the simple procedure. The festivities concluded with a raffle; prizes included Juvederm, chemical peels, and the new Red Carpet Peel. We wish everyone a happy and healthy holiday season. May 2012 bring more joy and beauty to all.

Effects of Smoking on the Skin

2011-11-14T17:50:00.000-08:00

We all know that smoking is bad for the heart and lungs, but many people do not understand the harmful effects it can have on the skin. Tobacco leads to free radical and oxidant formation throughout the body. In the skin, this manifests itself as fine lines, wrinkles, laxity, and discoloration; in other words, premature aging. Similar to smoking, sun damage causes premature aging of the skin. We protect our skin from the sun using sunscreen and antioxidants. At the same time we must avoid behaviors such as smoking that lead to premature aging of the skin. Otherwise our efforts will be of no use. Smoking cessation will have a significant and direct impact on the look of your skin, not to mention the other health benefits it provides.

A E Skin's New Location

2011-11-07T14:18:00.000-08:00

As of November 1, 2011 A E Skin is at a new and better location, just a couple of miles from our previous location. The address is 15840 Ventura Bl. Suite 106, Encino, CA 91436 at the southeast corner of Ventura Bl. and Gloria Ave. The nearest freeway exit is Haskell Ave. off the 101 freeway, 1/2 a mile west of the 405 freeway. We now share a suite with dentist Dr. Soheil Amir Moazzami, DDS (soheil95@yahoo.com) of Alliance Dental, chiropractor Dr. Paul Chen, DC, and medical aesthetician Susie Bridges of Skin Bliss. Validated parking is available in the building garage (enter on Gloria Ave.). Be sure to check out the delicious cafe in the lobby: Nut's and Berries. Same outstanding products. Same outstanding service. Beautiful new location. Contact us for a free consultation.

California Bans UV Tanning Bed Use by Minors

2011-10-21T00:12:00.000-07:00

On October 9, 2011 Califorina Governor Jerry Brown signed a bill into law prohibiting the use of indoor tanning for minors under 18 years of age, making California the first state to ban it for those aged 16-17. Ultraviolet tanning beds are dangerous to all people, not just minors, because it induces photodamage to the skin, which is evident as fine lines, discoloration, sagging skin, and laxity. Even more important is that it increases the risk for skin cancer, both melanoma, the deadliest form of skin cancer, and non-melanoma skin cancer, the most common type of skin cancer. For these reasons dermatologists recommend against ultraviolet tanning beds. Spray tanning gives a similar effect without the risks. Dr. Ronald Roy, president of the American Academy of Dermatology Association commends "the California legislature for their efforts to help reduce the future incidence of skin cancer by protecting youth from the dangers of indoor tanning." The legislation was sponsored by the California Society of Dermatology and AIM at Melanoma, a non-profit organization involved in research and education in the area of melanoma.

Botox Before and After Pictures 3

2011-10-13T10:50:00.000-07:00

The three most common areas for cosmetic treatment with Botox are the forehead, the glabella (area between the eyebrows), and crow's feet. Below is an example of an outstanding result for wrinkles on the forehead. The patient is attempting to raise his eyebrows in all pictures. Usually several injections are made over the forehead to relax the thin but broad muscle.

The next picture is an example of another great result, this time in the glabella. This patient is attempting to frown in all six pictures. Generally five to seven injection points are made in this area. While the area is not as large as the forehead, this muscle is large and requires a good dose for relaxation.

The picture below is another of the glabella, but this time a side view. Here you can see the bulge formed when the muscle is contracted is smoothed out after treatment. Again, the patient is attempting to frown in both pictures.

The other common area of treatment is the crows feet which appear around the eye when people smile or squint. Great results can also be obtained in this area. Because of the rich blood supply in this area, it is the most common place to get bruises after treatment. Bruises are temporary and the risk is minimized by placing ice over the area for a few minutes several times a day. Below is a before and after of a smiling patient who got great results. Treatment in this area can also give a cosmetically desirable lift to the outer part of the brow which is subtle yet evident in these pictures. In these areas anywhere from one to six injections are made.

Exfoliation

2011-10-05T11:24:00.000-07:00

As we age, dead skin cells accumulate on the surface of our skin. When light hits this skin it does not reflect, giving a dull appearance. Exfoliation helps remove this layer. The fresh cells that remain underneath reflect light and give a youthful and radiant appearance to the skin. Exfoliation can be done manually with scrubs, chemically with solutions, and with treatments such as peels and laser treatments. Using products containing acids such as salicylic acid, glycolic acid, lactic acid, and phytic acid daily in combination with procedures can help with a variety of conditions such as acne and provide a beautiful glow.

What is Dysport?

2011-09-29T15:28:00.000-07:00

Dysport (abobotulinum toxin A) is a neuromodulator like Botox (onabotulinum toxin A) that received FDA clearance in 2009 and is becoming a popular alternative to Botox. The active component of the two products is identical and both give similar results for improvement of wrinkles caused by muscle contraction such as those between the brows. The units of the two products are not equivalent. Most doctors equate 2.5 to 3 units of Dysport to 1 unit of Botox; so more units of Dysport are required to produce the same effect as Botox. Hence the per unit cost of Dysport is significantly less. Clinically, Dysport diffuses more than Botox, which may lead to potential adverse effects depending on where it is injected. Speak with your doctor about which product is best for you.

Distant Spread of Toxin Effect: Postmarketing reports indicate that the effects of Dysport and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses.

Laser Hair Removal Demonstration

2011-09-23T21:24:00.000-07:00

Laser hair removal begins with cleaning the area to be treated, in this case the upper lip. An eye shield is used to protect the patient's eyes. Next a thin layer of gel is applied to the area to be treated. This allows the light to penetrate the skin and keeps the skin cool to prevent burns and blisters. Then the appropriate settings are entered. These are adjusted for each patient. The laser is then applied to the skin. This laser has a sapphire tip which is chilled to protect the skin. Additionally a chiller is used to blow cold air onto the treated area, further protecting the skin. Pulses are made with slight overlap until the entire area is covered. Any area on the body can be treated except around the eyes. Common areas of treatment for women include the upper lip, sideburns, underarms, and legs. For men, common areas of treatment include chest and back. Women who are pregnant or breast feeding should not be treated.

Chemical Peels

2011-09-18T22:12:00.000-07:00

A chemical peel is a simple procedure done in the office for a variety of skin concerns. After washing the face, a controlled amount of a chemical is carefully applied to the skin. Patients will experience a stinging, burning, or itching sensation. Often times a fan is used to help with this. After a short time the solution is neutralized or diluted with water, although some preparations do not require this step. After a few days, the skin begins to peel, removing the dead skin cells on the surface. Usually by one week, the new skin that re-grows is refreshed and rejuvenated, and you see improvements in terms of color, texture, and tone. During this period a list of aftercare instructions are provided to prevent unwanted effects such as scars or blisters.

As we age, dead skin cells accumulate on the surface of the skin. When light hits such skin, it does not reflect, giving a dull appearance. Exfoliation with scrubs, at home solutions, and chemical peels removes this layer and provides a glow to the skin. It works great for a variety of skin conditions including acne, discoloration, enlarged pores, scars, and even some pre-cancerous lesions. When performed in a series at monthly intervals and combined with skin care products such as anti-oxidants, exfoliants, retinoids, bleaching agents, and sunscreens beautiful results can be obtained.

Laser Leg Vein Treatment

2011-09-11T21:59:00.000-07:00

Many people are surprised to learn that lasers can be used to treat leg veins, and veins anywhere on the skin for that matter. Amazing results can be achieved on a variety of veins, from the larger deep blue ones to the tiny superficial red ones. The principal is the same as that for hair removal, but the target is the blood instead of the hair. A laser or light based device, sometimes combined with radiofrequency is used to target the blood and destroy the vessel. Treatments are sometimes uncomfortable, but most people see results almost immediately. A series of at least three treatments is usually needed in four to eight week intervals. Like laser hair removal, it should not be performed on patients who are pregnant or breast feeding.

Laser Hair Removal

2011-08-27T23:38:00.000-07:00

Laser hair removal is a common procedure for permanent hair reduction. A Laser or light-based device, sometimes combined with radiofrequency, is used to target the base of the hair and destroy it. Anywhere from six to ten treatments are required in 4-8 week intervals and results are usually fantastic. Little or no discomfort is experienced during the procedure because of various types of cooling mechanisms used. The procedure can be performed on anywhere there is hair except around the eyes. Commonly treated areas include sideburns, upper lip, chin, underarms, and legs for women and chest and back for men. Settings are adjusted based on skin type. Laser hair removal can be less effective or ineffective if you have a tan in the area. It also does not work well for red, blond, grey, and white hairs. It should not be done on patients who are pregnant or breast feeding.

Laser Skin Tightening

2011-08-17T23:06:00.000-07:00

Laser skin tightening is a great procedure for those interested in a non-invasive approach to improving skin laxity. The modalities are numerous, including laser or light based devices, radiofrequency, ultrasound, and cooling. Many of these methods work by heating the deep layer of the skin called the dermis, serving to denature the collagen and causing it to snap, leading to tightening of the skin. Other methods work by destroying or decreasing fat cells. Either way impressive results can be seen in areas such as the chin, neck, jawline, and cheeks. Multiple treatments are generally required and results improve over time. Combining such treatments with fillers, Botox, topical creams, chemical peels, and other laser treatments can lead to outstanding results.

Proper sunscreen application

2011-08-09T20:56:00.000-07:00

Proper sunscreen application begins with choosing the right sunscreen. The American Academy of Dermatology recommends a sunscreen with an SPF of at least 30 with UVA and UVB protection. This should be evident on the label. As long as these criteria are met, use any such sunscreen that is comfortable.

Sunscreen should be the last step in a skin care regimen in the morning before any makeup (if any). The amount required for an appropriate application to the face is approximately the size of a quarter. It should cover all exposed surfaces of the skin. Common areas that are missed include the ears, front and back of the neck, and upper chest. Sunscreen should also be applied to all exposed areas of the body, including the trunk, arms, legs, and feet. Spray on sunscreens work well for these areas.

Makeup or moisturizers that contain sunscreen should not be used as a substitute for sunscreen or part of the SPF. For example if a moisturizer contains SPF 15, adding a sunscreen with an SPF of 15 will not necessarily bring the total SPF to 30. Use a sunscreen with an SPF of at least 30.

Sunscreen should be applied 30 minutes prior to going outside so it can be completely absorbed for a full effect. It should be applied whether the forecast calls for overcast or sunny skies. It should be applied year round. If outside for long periods of time, it should be re-applied every couple of hours.

In the event of water exposure such as when at the pool or the beach, sunscreen should be re-applied more often. Sunscreens are not waterproof. Some sunscreens claim to be water resistant, meaning that they are still active after water exposure. However, re-application after water exposure is highly recommended.

With proper sunscreen application and sun protective behavior, risks of wrinkles, discolorations, and skin cancer can be minimized.

Alternate Uses for Botox

2011-08-02T20:12:00.000-07:00

Most people are aware of the common uses for Botox: forehead lines, frown lines, and crow's feet. Other cosmetic uses include injections on the bridge of the nose for bunny lines, around the eyes to open up the eyes. In the lower face, injection sites include the edge of the nose to help lower the lips when people smile. This is particularly useful for people who show a lot of their gums above their teeth when they smile. At the same time, such injections decrease the depth of laugh lines. Injections in the chin can improve lines and bumps that occur in those areas. Injections just beside the chin can elevate the edge of the lips, leading to a less angry appearance.

Non-cosmetic uses for Botox include various areas for migraine headaches and in the underarms and palms for excessive sweating.

Distant spread of toxin effect
Postmarketing reports indicate that the effects of BOTOX® Cosmetic and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botunilum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spacticity, but symptoms can also occur in adults treated for spacticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spacticity in children and adults, cases of spread of effect have occured at doses comparable to those used to treat cervical dystonia at lower doses.

Essentials of a skin care regimen

2011-07-21T13:48:00.000-07:00

Great skin does not occur on its own. An appropriate skin care regimen is required for healthy and beautiful skin. A skin care regimen should be performed twice daily. The regimen starts with washing the face. Clean skin is healthy skin. Brushes like the Clarisonic Pro can be used to more effectively remove oil, dirt, debris, or makeup. Next is a toner, which helps close pores and prepares the pH of the skin for the subsequent steps. After this, vitamins, nutrients, and growth factors are added, for example vitamin C serum or Skin Medica's TNS Essential serum. Eye creams are also applied here. The following step is when a variety of other products can be added, prescription or non-prescription. These include exfoliants such as salicylic acid, acne products such as benzoyl peroxide, steroid creams, antibiotic creams, bleaching agents such as hydroquinone, kojic acid, or licorice extract, and retinoids (nighttime only). The regimen concludes with a moisturizer followed by sunscreen with SPF of at least 30 and UVA and UVB protection (daytime only). Determine the best regimen for you, stick to it, and look forward to looking and feeling your best!

Summer Skin Care Tips

2011-07-13T21:36:00.000-07:00

Skin care during the summer months is extremely important. Sunlight can cause a lot of damage to the skin including fine lines, wrinkles, age spots, and skin cancer so it is important to protect yourself every day. Wear a sunscreen with SPF 30 or greater with UVA and UVB protection (this should be written on the container). Apply a liberal amount of sunscreen 30 minutes before going outside. Don't forget areas below the neck which may be exposed such as the chest, back, arms, and legs. Those areas can get sunburned too. Try to stay out of the sun between 10 AM and 4 PM when the sun's rays are strongest. If outside stay in shady areas if possible and when outside for more than two hours, re-apply sunscreen every couple of hours. Wear protective clothing such as hats, sunglasses, long-sleeved shirts, and pants. Finally, be sure to stay hydrated by drinking 6 to 8 cups of water each day.

Causes of Wrinkles

2011-07-05T16:37:00.000-07:00

There are multiple different causes of wrinkles, each with its own treatment. As we age, the outer layer of our skin becomes thinner and retains water less effectively. Moisturizers help with dryness. Additionally, with age our skin produces less collagen and it is broken down more quickly, leading to laxity. Creams such as tretinoin help to counteract these effects. Over time sun exposure and other insults such as air pollution and cigarette smoking cause damage to the skin. The best protection from this is preventive by using sunscreens and anti-oxidants such as vitamin C. Chemical peels and laser resurfacing procedures also treat such damage. Gravity and shrinkage of fat lead to the descent of the cheek fat pad, laugh lines, and jowls. Fillers such as Juvederm and laser skin tightening procedures are effective treatments for these conditions. Finally, the use of muscles of facial expression cause wrinkles overlying those muscles. These wrinkles are treated with Botox.

Descent of the cheek fat pad

2011-06-21T16:09:00.000-07:00

Everyone is born with a fat pad on the cheek just under the skin. Over time, due to gravity, this fat pad starts to descend, leading to the formation of naso-labial folds, also called smile lines or parentheses lines, as well as jowls, which are visible portions of the fat pad along the jaw line. Fillers such as Juvederm and skin tightening procedures work well to improve these changes that occur as we age.

Importance of Using a Toner

2011-06-09T20:24:00.000-07:00

A toner is an important part of a skin care regimen that many people do not think about. Toner should be used as the second step in the regimen immediately following a face wash. The face wash cleans the skin, eliminating oil and debris and simultaneously opens the pores. The toner serves to close the pores and decrease the pH of the skin, allowing for better penetration and absorption of the subsequent products such as exfoliants, retinoids, vitamins, moisturizers, bleaching agents, and more. Use of a toner twice a day will increase the efficacy of the products in the regimen, leading to brighter, healthier skin.

The Aesthetic Show 2011

2011-06-05T16:46:00.000-07:00

The Aesthetic Show 2011 was held at the convention center at the Aria resort and casino in Las Vegas, NV June 2-5. Numerous world-renown experts in the field gave talks on various topics including neurotoxins such as Botox, fillers such as Juvederm, chemical peels, Latisse, skin care products, laser therapy, and much more. Also present were representatives from various companies including skin care lines, lasers, and others. Doctors, nurses, aestheticians, and staff members travelled from all over the world to attend this exciting conference. The highlight of the show was the ceremony on Saturday night hosted by Dr. Andrew Ordon of the award-winning television show "The Doctors." Multiple awards were given for best procedures and several prizes were given away in a drawing including products, a vacation, and even a Syneron eMatrix laser for sublative rejuvenation. The show was a great hit and should be again next year!

Growth Factors for Your Skin

2011-05-27T12:14:00.000-07:00

As we age our skin changes. The production of growth factors that occurs in young, radiant skin slows down as we age. Collagen, an important molecule in providing firmness to the skin, is broken down and it's formation slows down. This leads to laxity, fine lines, and wrinkles. Retinoid compounds have been used for many years to restore collagen. A unique product from Skin Medica, TNS Essential Serum, contains growth factors, peptides, and antioxidants to counteract the aging process. Overall there are over 100 active ingredients in the product. The growth factors stimulate collagen production to strengthen the extra-cellular matrix and the peptides and antioxidants prevent the aging process. It provides improvements in terms of color, texture, and tone. It plumps and brightens the skin. And it prevents free radical damage that occurs from sun exposure. Many people see improvements in a matter of days. This is a great product that can be added to any skin care regimen.

Clarisonic Pro

2011-05-21T17:07:00.000-07:00

The Clarisonic Pro is a great product to help clean the skin. It can be used with any facewash and it's waterproof, so you can take it in the shower. The gentle micro-massage loosens dirt and debris that builds up on the skin, leading to cleaner and healthier skin. Studies show that using it leads to much cleaner skin that manual cleansing. It removes makeup more effectively than manual cleansing. It improves absorption of skin care products. And it reduces signs of photo-aging. It has multiple brush heads which can be used for the face or body, and for all skin types from oily to sensitive. There is even a travel size option called the Mia. It's a great supplement that can be used with any skin care regimen.

Importance of a Daily Skin Care Regimen

2011-05-17T22:22:00.000-07:00

The importance of a daily skin care regimen can not be emphasized enough. This is important whether or not you are having a procedure done. A good facewash twice daily is the first step; clean skin is healthy skin. Sunscreen is important to prevent discoloration, fine lines, and laxity and to prevent skin cancer. Anti-oxidants such as vitamin C also prevent sun damage. Exfoliants such as tretinoin and salicylic acid help remove the surface layer of dead skin cells. This gives the skin a youthful radiance. Bleaching agents such as hydroquinone, kojic acid, and licorice extract decrease hyperpigmentation (dark discoloration) and prevent it from occurring after a procedure.

Sublative Rejuvenation

2011-05-13T15:02:00.000-07:00

Sublative rejuvenation with the Syneron Matrix RF is a new and effective method to improve textural irregularities in the skin. This resurfacing device uses radiofrequency to heat up the deep layer of the skin called the dermis. It stimulates collagen regeneration, giving a smooth appearance to the skin. It works great for acne scars, enlarged pores, fine wrinkles, and discoloration. The best thing is that it does not use a laser or light source, which makes it safe for all skin types. The before and after photographs above show a typical result after a series of treatments. Most patients have a series of at least three treatments in one month intervals.

See the video below for more information.

http://www.youtube.com/watch?v=gmu1mD86PbM

Top Ten Skin Care Tips

2011-05-10T12:17:00.000-07:00

1. Use sunscreen every day. Even if it's overcast or if you're not going outside. Wear sunscreen with at least SPF 30 and with UVA and UVB protection.

2. Wash your face twice daily. Clean skin is healthy skin.

3. Avoid excessive sun exposure. Wear sunglasses, hats, and protective clothing. Avoid the sun during the middle of the day and try to stay in the shade when outside. Sun damage can lead to wrinkles, laxity, color irregularities, and skin cancer.

4. Use an antioxidant such as a vitamin C product. This will help prevent sun damage and maintain a youthful and radiant appearance.

5. Use a retinoid such as tretinoin. This will remove the dead surface layer of the skin giving the skin a brighter glow. It also helps restore collagen, which will decrease laxity.

6. Stay hydrated by drinking plenty of fluids throughout the day.

7. Exercise regularly. This will promote blood flow to the skin and give you a healthy looking complexion.

8. Eat healthy. Avoid oily and fried foods, while consuming foods rich in nutrients such as fish and dark green vegetables.

9. Get an appropriate amount of sleep every day. This is especially important to avoid puffiness and bags around the eyes.

10. Maintain a healthy lifestyle by avoiding tobacco, excessive alcohol, and non-prescription drugs.

Fears of hydroquinone

2011-05-02T13:51:00.000-07:00

Many people express fears of the compound hydroquinone, which is the active ingredient in a number of skin bleaching agents such as the Obagi Clear, Blender, and Sunfader. Hydroquinone is a naturally occurring chemical found in coffee, tea, beer, wine, blueberry, wheat, grass, and other foods. People ingest it daily.

Some side effects such as redness or irritation are common and to be expected. It should not be used in women who are pregnant, breast feeding, or trying to get pregnant. Over the counter products contain it in up to 2 % strength. The most common prescription strength is 4 %.

Fears of this product stem from a study in which rats genetically prone to kidney tumors were fed hydroquinone many times the normal dose. These rats were found to have kidney tumors. When applied topically to humans, it has never been shown to cause cancer. While hydroquinone can bleach the skin effectively, it's use should be supervised by a doctor, and when used topically (not orally) at the appropriate doses for an appropriate time frame, there should be no concern for cancer.

Tretinoin

2011-04-24T17:42:00.000-07:00

Tretinoin is a prescription-strength vitamin A derivative that can provide phenomenal results when applied topically to the skin. Some products which contain tretinoin as the active ingredient include Altinac, Avita, Refissa, Renova, Retin-A, Retin-A Micro, and Solage. Tretinoin stimulates skin regrowth, stimulates collagen production and reduces its breakdown, and improves blood flow to the skin. It also thickens a layer of the skin called the dermis, which gives a more youthful appearance to the skin. This leads to improvements in roughness, fine lines, and laxity. Tretinoin comes in different vehicles such as cream or gel and in different strengths. It is an outstanding product for acne, acne scars, textural irregularities such as enlarged pores, and aging skin.

Retinol, on the other hand, is a derivative of tretinoin that is found in many over-the-counter products. It's action is similar to tretinoin, but it's effects are not as strong. Iso-tretinoin is another derivative of tretinoin that is an oral medication that has been used for acne, but has numerous potential side effects which have limited its use.

New Obagi Elastilash

2011-04-20T20:13:00.000-07:00

The new Obagi Elastilash is an alternative to Latisse. It is not prescription strength and does not have the side effects known to occur at times with Latisse such as iris pigmentation. Also Elastilash has not been shown to lengthen the lashes, but it does provide impressive results in terms of fullness and thickness. The price per bottle is significantly less than Latisse, and one bottle last 2-3 months, rather than one month.

Benefits of Vitamin C

2011-04-12T19:46:00.000-07:00

Vitamin C is the strongest antioxidant available for the skin. It has a number of beneficial effects. It stimulates collagen synthesis, which can improve laxity. It reduces inflammation, decreasing potential redness. It enhances UV protection by sunscreens, leading to decreased pigmentation, age spots, wrinkles, and risk for skin cancer. It is a great moisturizer. Finally it replenishes vitamin E. With all of these benefits, vitamin C is an outstanding choice to add to your daily regimen regardless of skin type. It will give you a youthful glow and radiance.

More on chemical peels

2011-04-06T09:02:00.000-07:00

An occasion such as a wedding is an outstanding opportunity to make your skin look younger and more radiant. You can get this look with a number of approaches. Chemical peels work great for this purpose. A series of three treatments once per month can give amazing results. The treatment takes only a few minutes and is completely painless. Within a week you will see softer, more radiant skin. Improvements are seen in discoloration, textural changes such as fine wrinkles and pores, tone, acne, and overall aging. Have you gotten your peel yet?

More Botox before and after pictures

2011-04-01T21:47:00.000-07:00

Botox works well for horizontal lines on the forehead. Look at the significant improvement the patient below got with a single treatment.

It also works great on frown lines between the brow. The patient below is attempting to frown in both before and after pictures, but again the lines have disappeared with a single treatment.

Botox can make you look more rested

2011-03-30T12:50:00.000-07:00

That's right, Botox can actually make a person look more rested. The patient shown below had a treatment between the eyebrows, relaxing the muscles that pull down the brow, giving her a nice lift. You can also see the reduction in the upper eyelid lag. The sclera (white area) of the eye is more visible. The eyes look larger and she looks rested and rejuvenated.

Latisse special offer

2011-03-25T19:53:00.000-07:00

Latisse is a great treatment for what is called eyelash hypotrichosis, which is not enough eyelashes. It is a simple once a day treatment that leads to longer, darker, and fuller lashes. Initial results are seen in as little as four weeks with full results in 12 to 16 weeks. A one-month supply comes with the liquid medication and 30 pairs of applicators, one per day. One drop is applied on the applicator tip and applied to the area where the eyelash touches the skin. Results are sustained as long as it is used.

Allergan, the company that makes Latisse (and also Botox and Juvederm), is offering a special which expires at the end of April 2011. If you buy one bottle of Latisse, you can get another mailed to you for free. Contact us for our current specials: 818-835-1833, info@aeskin.com.

See before and after pictures of models below.

Botox before and after pictures

2011-03-22T20:56:00.000-07:00

Check out the new Botox before and after pictures below. This patient had a treatment on her forehead to improve the horizontal wrinkles that appear when she raises her eyebrows. The before pictures are shown on the left and after on the right. Three different angles are shown. The patient is attempting to raise her eyebrows in all images. Notice the lack of lines on the right. Amazing!

This is an actual patient who signed a release allowing use of photography for marketing purposes.

What is a photofacial?

2011-03-19T17:53:00.000-07:00

A photofacial is a simple procedure where a laser or lighgt-based device is used for color correction. It works great for dark spots, freckles, and generalized redness. It uses the same priciple as laser hair removal, so you may experience hair loss in the area (good or bad). It wroks especially well when used in combination with bleaching creams such as hydroquinone.

Also, a photofacial is not necessarily limited to the face. It can be used on other areas with age spots or dark spots such as the backs of the hands and arms or upper chest, just about anywhere with undesired pigmentation.

Be sure to consult with a doctor if you have suspicious moles in the area so a potential cancer will not be affected.

Dandruff

2011-01-20T10:51:00.000-08:00

Dandruff, or seborrheic dermatitis, is a common condition which is seen in about one out of every 30 people. Flakes can be seen in many different areas, most commonly on the scalp, eyebrows, sides of the nose, and underarms. It is caused by a yeast called Pityrosporum ovale. The easiest form of treatment is with shampoos containing selenium sulfide or pyrithione zinc such as Selsun Blue and Head and Shoulders. The key to treatment is to leave the shampoo on for several minutes. If rinsed off immediately, there is not enough time for the medication to work. An easy thing to do is apply the shampoo immediately after wetting the area(s) as the first part of a shower routine. While waiting for it you can wash your body, brush your teeth, shave, etc.

Rosacea Part 2

2011-01-07T21:14:00.000-08:00

The cause of rosacea is not clear, but numerous treatments are used. Use of sunscreen, sun avoidance, and cosmetic coverage can be used. Topical medications include metronidazole (most common), sulfur, azelaic acid, benzoyl peroxide, antibiotics, tacrolimus, and tretinoin. Oral medications include various antibiotics and isotretinoin (Accutane). Laser treatments can be used to improve redness and rhinophyma, a large red appearance of the nose. Impressive improvement can also be seen with circular massage for several minutes per day.

Rosacea Part 1

2011-01-04T19:59:00.000-08:00

Rosacea (also known as acne rosacea) is a common condition causing redness usually in the central face. It occurs most commonly in people aged 30 to 50 and in those with fair skin and affects women more than men. The most common areas affected are the cheeks and nose, then brow and chin. The areas around the eyes are generally spared. Symptoms include generalized redness, appearance of tiny vessels called telangiectasias, and red pustules. Rosacea can be stimulated or exacerbated by emotional stress, hot beverages, spicy food, exercise, alcohol, heat, or cold.

Clinical Photography

2010-12-30T22:16:00.000-08:00

Clinical photography is the art of taking photographs used in medical records to compare physical attributes such as the skin before and after treatments or time. They are invaluable for patients and doctors because they can clearly show differences in the skin. Digital photography has become so commonplace that this can now be done at home. There are numerous technical aspects, but the most important thing is consistency. Every part of the photograph should be consistent every time. This includes the position, location, angle, lighting, background, removal of makeup and jewelry, covering of clothing and hair, and use of flash. Consistent settings help to clearly define what a treatment has done.

ABCDE's of Melanoma

2010-12-29T17:51:00.000-08:00

The ABCDE's of melanoma are signs to look for in moles which cause concern for malignant melanoma. If you see any of these signs, you should have the mole looked at by a dermatologist and possibly have a biopsy to make sure it's not malignant.

A: Asymmetry

The mole should look symmetric. If one side looks different than another, it may be a good idea to have it looked at by a doctor.

B: Border Irregularity

The border should be smooth. Jagged or irregular edges are signs for concern.

C: Color Variegation

The color of the mole should be uniform throughout. If there are multiple colors, or new colors such as black, blue, or red, you should have the mole checked.

D: Diameter

The diameter of a benign mole is generally no more than 4-5 millimeters, which is about the size of a pencil eraser. Moles that are larger than this size should be checked, especially if they are actively growing.

E: Evolution

If there is anything about the mole that is changing or evolving, it is a good idea to have the mole checked.

Botox Myths and Facts Part 3

2010-12-27T18:49:00.000-08:00

Myth: Botox will leave me with a frozen face.

Fact:

Although results are visible, treatment with Botox does not make you look like you had work done. The muscles causing the frown lines are relaxed, so you can still have expressions, just without the wrinkles.

Myth: If I stop using Botox, my face will look different than before.

Fact:

The effects of Botox last 3-4 months. When the drug wears off, your face will look like what it did before the treatment.

Botox Myths and Facts Part 2

2010-12-25T10:28:00.000-08:00

Myth: Botox is only for the rich and famous.

Fact:

According to the Aesthetic Surgery Education Research Foundation Botox Cosmetic Use Survey of 1048 patients (2005) the most common users of Botox are working mothers aged 40-55; and those with an annual household income of less than $ 100,000 are more likely to use Botox than those with an annual household income of more than $ 150,000.

Myth: Botox isn't for men.

Fact:

Men make up nearly 10% of all Botox treatment and that number continues to grow.

Botox Myths and Facts Part 1

2010-12-24T09:35:00.000-08:00

Myth: Botox is not safe.

Fact:

Botox has been used therapeutically for 17 years. The same formulation received FDA approval in 2002 for treatment of moderate to severe frown lines between the brows. It has also recently been approved for treatment of migraine headaches. It is used off label for wrinkles on the forehead, around the eyes, on the nose, and around the mouth as well as treatment for excessive sweating in the palms and underarms.

Myth: There are creams that work better than Botox.

Fact:

Topical creams work on the surface of the face. Botox works on the the muscles under the skin which cause the deeper wrinkles to form. Once the muscles relax, the skin overlying it can smooth out. When used in combination with creams such as Obagi Elastiderm, better results are seen because treatment is directed at both the superficial and deep wrinkles.

Acne

2010-12-21T18:39:00.000-08:00

Acne is a common problem affecting many people. It is common during puberty and in adolescence, but can occur throughout a person's life. It is caused by plugs in glands and affects the face, trunk, and buttocks. You can see blackheads (open comedones), whiteheads (closed comedones), pustules, nodules, and cysts. Hormones or other causes lead to increased keratin production, which blocks sebum secretion, leading to these lesions. This creates an environment suitable for the growth of the bacteria P. acnes, which leads to inflammation. Other causes of acne include emotional stress, excessive pressure on the skin, certain medications, and various topical products. Contrary to popular opinion, foods such as chocolate have not been proven to be associated with acne. But you can avoid such foods if you feel it helps.

There are a number of treatments for acne depending on the severity. These include topical products such as benzoyl peroxide and topical antibiotics such as clindamycin or erythromycin. Some products contain combinations of these. Products containing acids such as glycolic acid and salicylic acid help with exfoliation. Retinoids such as Retin-A (tretinoin), Differin (adapalene), and Tazorac (tazarotene) can provide significant improvement, but may also cause irritation. For this reason these are often started on a three to four time per week regimen and gradually increased to daily use. They should not be used during pregnancy or when females are breast feeding. Oral antibiotics such as doxycycline, minocycline, and tetracycline can be added for moderate acne. Use of sunscreen is imperative because these medications cause sensitivity to the sun. Oral contraceptive medications may improve acne for females who have more problems during their menstrual period. Accutane (isotretinion) is an oral medication used for severe acne when other medical treatments do not work. This has become less popular for a number of reasons including side effects such as dryness and the possibility of birth defects as well as requirements for regular blood tests. Procedural treatments for acne include manual extraction, chemical peels, and laser therapy.

This is a patient who saw improvement after four weeks of the Obagi Clenziderm system, which includes 2 % salicylic acid and 5 % benzoyl peroxide.

Melasma

2010-12-20T20:09:00.000-08:00

Melasma, also called chloasma, is a disorder where dark or hyperpigmented patches appear on the skin. It usually affects the face. Common areas of involvement include the cheeks, forehead, upper lip, and jaw line. Women are affected about ten times as often as men. It is more common in patients with darker skin tones such as those with ancestry from the Middle East, Southeast Asia, Africa, and South America. Melasma is sometimes called the mask of pregnancy because it can be induced by hormonal changes that occur during pregnancy, and also around menopause. Other causes include sun exposure, genetic predisposition, contraceptive medications, other medications such as dilantin, or unknown or idiopathic causes.

Melasma sometimes goes away spontaneously, that is without any treatment. But when it doesn't, it may be difficult to treat. Bleaching agents such as hydroquinone are the mainstay of treatment. Hydroquinone is available over-the-counter at 2% strength. Usually stronger doses are needed; these require a prescription. Other, less effective, bleaching agents include azelaic acid, kojic acid, and licorice extract. The use of daily sunscreen is also mandatory. Sunscreens with SPF of at least 30 with UVA and UVB protection are recommended by the American Academy of Dermatology. Other medical treatments include retinoids such as retin-A. Procedural treatments which are often used in conjunction with medications include chemical peels and laser therapy.

Below are pictures of patients with melasma who saw improvement after 12 weeks of using the Obagi Nuderm Condition and Enhance system, which contains a cleanser, toner, exfoliant, sunscreen, and 4 % hydroquinone.

Sclerotherapy

2010-12-20T02:04:00.000-08:00

Sclerotherapy is a procedure to treat spider veins. Spider veins are small, superficial veins that appear of the surface of the skin, usually on the legs. They can be blue or purple and appear in a lattice pattern. Spider veins are completely harmless. They occur frequently in women in the aged 30-50.

Almost anyone with unwanted spider veins can be treated, except women who are pregnant or nursing. Other relative contraindications include those with skin infections, uncontrolled diabetes, fever, history of deep vein thrombosis, anticoagulant therapy those patients taking corticosteroids.

Sclerotherapy is performed by injecting a sterile solution into the small veins using a very fine needle. The chemical irritates the small vein and over two to four weeks, the vessel turns into scar tissue that fades, eventually becoming virtually unnoticeable or invisible. Some blood vessel may have to be injected more than once, some weeks apart, depending on its size and response to treatment. In any one treatment session a number of vessels can be injected.

Sclerotherapy is generally used for the very small superficial veins next to the skin. It is not effective for large veins and requires large amounts of the sclerosants with the potential to be absorbed. When large veins are treated with sclerotherapy, a stronger solution and a higher volume is required. Following the treatment for larger veins, compression hose stockings are usually recommended to be worn for at least 2 weeks. It is best to get spider veins treated in the winter months as one can easily wear stockings.

Walking is highly recommended soon after the procedure. But any high activity sports should be avoided for the first two to three days.

Sclerotherapy should never be done on the face and hands. The hand veins may not look pretty at times, but they should never be treated. If the facial veins are very conspicuous, laser is a better option than sclerotherapy.

Besides some stinging pain, sclerotherapy can rarely cause a few side effects. Allergic reactions are rare. A few individual may develop irritation or intense itching at the site of injection. If the chemical is injected outside the vein, profound discoloration and pain can occur.

There are certain things that can be done to minimize spider vein formation. Regular walking with low-heeled shoes and exercise as well as wearing support hose may prevent formation of some spider veins.

Juvéderm

2010-12-18T22:27:00.000-08:00

Juvéderm is a hyaluronic acid compound used as a dermal filler. Juvéderm has been approved by the FDA for use in cosmetic treatments of fine facial wrinkles and folds, such as nasolabial folds (the creases running from the bottom of your nose to the corners of your mouth, aka smile lines or parentheses). Treatment with Juvéderm can smooth out folds and wrinkles, add volume to the lips, and contour facial features that have lost their fullness due to aging, sun exposure, illness, etc. Facial rejuventation can be carried out with minimal complications.

Juvéderm is injected into the skin with a very fine needle. The injection process generally takes only about 15 minutes. The product produces a natural volume under the wrinkle, which is lifted up and smoothed out. The results can often be seen immediately. Most patients need one treatment to achieve optimal wrinkle smoothing and results last for approximately one year.

Treating wrinkles with Juvéderm is fast and safe and leaves no scars or other traces on the face. Most side effects are mild or moderate in nature, and their duration is short lasting (seven days or less). The most common side effects include temporary injections site reactions such as redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration.

Vitamin C and your skin

2010-12-17T17:14:00.000-08:00

Vitamin C is a great product for almost all skin types. It is an anti-oxidant and has a lot of effects. Anti-oxidants reduce free radicals, which can lead to aging such as wrinkles and sun damage. Vitamin C stimulates collagen synthesis, improving laxity, reduces inflammation, suppresses pigmentation, retains moisture, enhances sun protection, and replenishes vitamin E. The active form is L-ascorbic acid. It is found in a number of foods including artichokes, asparagus, avocado, broccoli, carrots, cauliflower, corn, cucumbers, green peppers, lima beans, mushrooms, onions, peas, potatoes, spinach, squash, and sweet potatoes. A lot of these ingredients are used in facial treatments. Other anti-oxidants include coffee berry, kojic acid, and green tea; but these do not have all of the effects as vitamin C.

What is your skin type?

2010-12-15T18:14:00.000-08:00

The Fitzpatrick skin type scale was developed in 1975 by Dr. T.B. Fitzpatrick in the Department of Dermatology at Harvard University. There are six types, numbered in Roman numerals from I to VI. Type I is the fairest and type VI is the darkest. Red and blonde hair with freckles and blue eyes are common in lighter skin types while black hair and dark brown eyes are common in darker skin types. It is based not only on the color of the skin, but more importantly, the reaction of the skin to sun exposure. This scale is important when considering procedures because darker skin types have a propensity for a phenomenon called post-inflammatory dyspigmentation, which is a change in color after inflammation caused (in this case) by a procedure. For example, procedures such as chemical peels, laser resurfacing, or dermabrasion have the potential to cause color changes in dark skin types. One way to reduce the possibility for this is to use bleaching agents such as hydroquinone for 4-6 weeks prior to the procedure and continue for several weeks after the procedure.

Type I: very fair, always burns, never tans

Type II: fair, burns easily, sometimes tans

Type III: light olive, rarely burns, usually tans

Type IV: olive, rarely burns, always tans

Type V: brown, rarely burns, tans profusely

Type VI: dark brown, never burns, tans profusely

How does Botox work?

2010-12-14T20:17:00.000-08:00

Botox is a protein derived from the bacteria Clostridium botulinum. The protein interacts with nerve endings in contact with muscles, like the muscles in the face. This interaction prevents the release of a molecule called acetylcholine, which is required for the muscle to contract. In this way, the muscle becomes relaxed, and the wrinkles on the overlying skin disappear. It is important to note that during a Botox treatment, the bacteria are not injected into the skin, it is only the protein, so there is no infection and there should be no signs of botulism.

Where can Botox be injected?

2010-12-13T22:02:00.000-08:00

Botox can be injected in a number of locations. For cosmetic procedures, it can be injected in a number of locations on the face. It is FDA approved for injection into the glabella, the area between the eyebrows, to improve frown lines. It is also used in the forehead to improve the horizontal wrinkles formed when one raises one's eyebrows. It can also be injected into the crow's feet areas, those areas just beside the eyes which form wrinkles when a person smiles. Botox can be injected into specific locations in the forehead and around the eyes to produce a non-surgical facelift. It can improve the so-called smoker's lines, the vertical lines above the upper lip when injected in small amounts in these areas. It can lift the edge of the mouth if injected into the DAO muscle in the lower face. Less commonly, it can also improve neck lines and chin lines.

Botox does not work on all wrinkles. For example, the nasolabial folds, also called smile lines, do not improve with Botox injections. Fillers such as Juvederm work well in these areas.

Botox is used by doctors other than dermatologists and plastic surgeons for other indications. For example, it has recently been approved by the FDA for use in the therapy of migraine headaches. This has been highly publicized. It can also be used to improve hyperhidrosis, or excess sweating, in the palms, underarms, and soles of the feet. The amounts used for these purposes are significantly higher than those used on the face.

What is Latisse®?

2010-12-10T18:06:00.000-08:00

Latisse^® is prescription-strength product which enhances the upper eyelashes by increasing their growth including length, thickness, and darkness. Latisse^® is the first and only FDA-approved drug for eyelash hypotrichosis, which is a name for inadequate eyelashes. It is not available at retail stores or over the counter.

The product is applied to the eyelashes daily. Applicators come with the product, and application is easy. The onset is gradual. Initial results are seen within four weeks, and full benefits occur after four months of continuous treatment. Mascara can be used at the same time.

Patients with glaucoma are cautioned when using this product. Common side effects include itchy eyes and eye redness. There may be temporary darkening of the upper eye lid and there is a possibility of permanent iris darkening.

The way Latisse^® was discovered is interesting. Allergan, the company that makes Latisse^®, marketed a medication called Lumigan, which contains the same active ingredient (bimatoprost) as Latisse^®. They found that patients using this medication for glaucoma had the side effect of growing longer lashes. They then did a study on safety and efficacy and Latisse^® was approved by the FDA in December 2008. In the two years since then, over 1.5 million bottles of Latisse^® have been sold. It has gained a lot of exposure by spokesmodels including Brooke Shields and Claire Danes.

What do Chemical Peels do?

2010-12-08T11:00:00.000-08:00

You’ve heard of Botox and laser hair removal, but what is a chemical peel and what does it do? A chemical peel is a simple procedure used to improve the color, texture, and smoothness of the skin. Chemical peels and other skin treatments have been performed for many years to treat a variety of skin disorders. Many skin conditions can be improved when receiving a series of peels. It helps with blemishes, fine wrinkles, and uneven color. Fine lines will be softened, dull skin will appear more radiant, rough or uneven skin will become smoother. Sun damaged skin or blotchy skin will even out. Acne scarring may be softened. A peel does not eliminate sagging or excess skin. Each treatment is customized for patient skin type, specific problem areas and the delicate areas of the face.

Chemical peels are usually performed on the face, but can be done on anywhere on the skin. A controlled amount of acid is gently and carefully applied to the skin, causing the surface layer to slowly peel off over a period of a few days to a week. The new cells and collagen are stimulated during the healing process to produce a smoother, tighter, younger looking skin surface. The acid is left on the skin for a short period of time. Then, depending on the peel, it is neutralized with water or base. The procedure generally takes less than 15 minutes.

There are different types of acids used in chemical peels. Glycolic acid is the weakest, providing a mild peel. Salicylic acid is somewhat stronger, but still providing a superficial peel. The gold standard is the TCA (trichloroacetic acid) peel, which provides a superficial to medium depth peel. Phenol is a deep peel and is not commonly performed because it requires a heart monitor. Additionally, many fruits contain acids which are commonly used for chemical peels; these are usually weaker than glycolic acid peels. Within these categories, the strength of the peel can be changed by adjusting the percentage of the acid, the amount used, and the time of exposure. For example, a 35 % TCA peel is stronger than a 10 % TCA peel. Also, two passes on the skin will produce a greater effect than only a single pass, and the longer the acid is left in contact with the skin before neutralization, the stronger the effect.

Most of the discomfort after a chemical peel will be during the first four to eight hours after treatment; over-the-counter pain medication helps. The first two days after the peel, patients will have pinkness of the skin, giving it a “rosy” glow. Avoid exaggerated facial expressions during this time because this may lead to scarring. The skin will feel tight for two to three days, then it will begin to peel or flake which continues for seven to 10 days.

Aftercare instructions are very important to prevent scarring and discoloration. Apply Aquaphor® up to six times per day for the first few days in a thin layer to improve healing. Do not remove flaked skin by pulling, picking, or rubbing. This can cause discoloration or scarring. It is important that during this time you minimize sun exposure and wear protective sunscreen every day. Use a sunscreen every day, even if you avoid the sun. Recommended sunscreens have SPF of at least 30 and provide UVA and UVB protection. Protective hats and sunglasses are also recommended. Do not use a jacuzzi, steam room, or sauna for two days. Do not perticipate in physician activities which results in sweating for two days. Wash your face with a gentle cleanser daily. Do not use wash cloths, mechanical scrubs, glycolic acid, salycylic acid, retinoids, skin lighteners, wax, or strong astringents for seven days. Do not get electrolysis, collagen injections, Botox, depilatories, and facial waxing for seven days. Do not tan for the next month.

What can lasers do?

2010-12-07T14:05:00.000-08:00

It's amazing to see all the new applications that are available using a laser. It seems like every day there is something new that can be done.

By now everyone is familiar with laser hair removal. This is the most common laser procedure and ranks second to Botox in outpatient cosmetic procedures over the past few years. A laser or light source is applied to the skin causing the growing hairs to be destroyed. Multiple treatments are required and different lasers and setting are used based on skin type.

Another popular application is the use of lasers for pigmented and vascular lesions, that is dark spots and veins. Again, various lasers or light sources are used depending on the type and location of the lesion as well as the patient's skin type. Multiple treatments are required, but the results are often amazing. This is the principle behind the common procedure called "photo-facial."

Skin tightening is used for loose skin. If there is too much laxity, surgical intervention may be better. Talk to a doctor to see which is best for you. In this treatment, it is not really the light, but the heat caused by the laser or light source that has the effect. The skin is heated via a laser, light source, or radiofrequency causing the collagen in the skin to contract and leading to the formation of new collagen. This causes the skin to tighten. It is used commonly to treat places like sagging jowl lines.

Resurfacing is one of the most expensive procedures, but has the best results. This is used for improving surface texture, fine to deep wrinkles, pores, and scars. There is ablative and nono-ablative resurfacing. Ablative resurfacing produces better results, but has a longer down time. There are also fractional devices which partially ablate the skin. In this procedure, tiny portions of the skin are destroyed. When new skin forms over the wound, the skin is smoother in texture and color. It is also tighter and has a youthful glow to it.

Sun Protection

2010-12-07T10:31:00.000-08:00

Protecting the skin from the sun is very important. Sun exposure can lead to cancer and pre-mature signs of aging including wrinkles, laxity, roughness, and color irregularities. There are multiple ways to protect yourself from the sun.

Limit direct exposure to the sun during the peak hours of sunlight: 10 AM - 4 PM. When outside, wear long sleeved shirts and long pants to protect your arms and legs. Wear a hat with a broad brim when outside. Wear protective sunglasses when outside. Stay in shady areas when outside. It is important to remember that you can have sun exposure in places like a car through the windows, so protect yourself there too.

Avoid artifical tanning devices such as salons. This is perhaps the worst thing you can do to your skin. Spray tans are fine. Get regular skin checks for melanoma, especially if you have a family history of skin cancer.

Wear sunscreen every day, even if it is overcast. Even on cloudy days, some sun penetrates the clouds and reaches the skin. Use sunscreen with an SPF value of at least 30. Use a broad-spectrum sunscreen with protection against UVA and UVB. If outside for prolonged periods, re-apply sunscreen every two hours. Surfaces such as water and snow can reflect a significant amount of sunlight, so be sure to use sunscreen when around such surfaces.

The majority of sun exposure a person receives is in the first two decades of life. Thus it is very important to protect children in these ways. Teach by example, apply sunscreen, wear protective clothing and eyewear, stay in the shade when outdoors, and avoid sun exposure during peak hours.

Afraid of Botox?

2010-12-07T10:15:00.000-08:00

Afraid of Botox?

This is a common comment. Many people are afraid to get Botox because it is a toxin. Below are three facts that dispel the myths associated with Botox.

1. Botox does not contain the bacterium Clostridium botulinum, the bacterium that causes botulinum. It only contains the protein which is involved in the effect. Unless the bacteria are in the body, the protein will not continually be produced.

2. Botox is injected very superficially into the skin. It does not reach the bloodstream sufficiently to cause the symptoms associated with botulism.

3. The amount required to cause symptoms of botulism is approximately 100 times the amount injected into the skin.