Laser Treatments Becoming More Popular

As technology advances, more and more medical spa procedures involve a laser. People are not as intimidated by laser treatments as they are with others because lasers are non-invasive and usually require less down time. Recently a new laser technique has been discussed that could change the game yet again. Read more about this by starting the article below and then following the link to continue reading.

Clinicians and dermatologists have seen a rise in demand for minimally invasive laser-based treatments, including tattoo removal. However, it is difficult for the laser light to be perfectly and selectively absorbed by only the targeted birthmark or tattoo. Now, researchers have developed instruments that transmit laser light into the tissue through direct contact. The techniques developed will reduce safety concerns in laser dermatology by improving laser transmission.


Things to Know About Injectables/Fillers

Are you nervous about trying injectables or fillers for the first time? Do you simply want to know what to expect or how to know what you’re getting is legitimate? This article from Elle Magazine will explain everything you should know! As these procedures are getting more and more common, everyone should be in the know of how they work and what to expect.


Make sure your doctor is an official vendor of everything you’re getting injected. Allergan, Merz, and Galderma are three of the top manufacturers of neurotoxins and fillers, and Allergan also makes the fat-dissolving Kybella. To reduce the risk of getting a subpar, potentially dangerous product, some manufacturers’ websites offer a tool to search by zip code for every licensed physician who’s obtained their product legally.

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If the price is questionably low for Botox or filler, you may be getting a diluted dosage, says West Islip, New York–based dermatologist Kavita Mariwalla, MD. Another possibility is that your doctor purchased the product from a supplier in a country such as Canada or the United Kingdom, where government price controls keep pharmaceutical prices substantially lower than those in the United States. Not only is it illegal (with very few exceptions) for doctors to intentionally purchase medications outside the country for use on patients within the U.S., manufacturers also say that unauthorized suppliers may compromise the effectiveness and safety of injectables by, for example, not storing them at the proper temperature or even offering counterfeit products.

That said, prices for in-office treatments tend to be higher in metropolitan regions, such as New York, Chicago, and Dallas, where there’s a greater demand for cosmetic procedures. To find out the price range in your area, call around. New York-based dermatologist Elizabeth Hale, MD, adds that you’re usually better off with a doctor who bases his or her fee on how many units of product are used, rather than how many different zones of the face are injected. “All the muscles in the face are intertwined, and even when I treat, say, just the ’11’ lines between the brows, I always put a tiny bit in the forehead to balance things out—I don’t count that as two [separate] zones.”


Most Botox and filler veterans know to lay off anticoagulants such as aspirin and ibuprofen before treatment, since those types of drugs hinder blood clotting and increase the risk of bruising should the needle nick a blood vessel. But Manhattan dermatologist Patricia Wexler, MD, has a longer list of things to forgo, including some seemingly innocuous pantry staples. “No fish oil, multivitamins, green tea, cinnamon, ginger, and red wine a full week before treatment,” she says. “Antioxidants, though not all of them, can increase the fragility of blood vessels and prevent clotting.” Ask your MD at least two weeks ahead of time for a full list of what to avoid.

“No fish oil, multi-vitamins, green tea, cinnamon, ginger, and red wine a full week before treatment,” Wexler says.


“The person performing the injection should have you smile and frown and raise your eyebrows,” Hale says. “An experienced professional is carefully evaluating you that whole time to see how different areas of your face naturally move, so that he or she can keep you looking refreshed instead of expressionless.” Some derms like to ask patients to talk about something they’re passionate about to gauge facial movement. You should also be given a thorough health assessment prior to the injection. Certain antibiotics, specifically in the aminoglycoside category, like gentamicin (prescribed for bacterial infections), can increase the potency of neurotoxins. (To avoid risk, don’t receive treatment for the duration of your antibiotic prescription.) Worst-case scenario: You end up with a droopy lid, according to Mariwalla.


Neurotoxins generally require finer needles and are usually placed more superficially than fillers, but any injection could potentially hit a vessel, causing blood to pool beneath the skin and form an unattractive black-and-blue blotch. Fortunately, many dermatology practices, including Hale’s, offer a next- day complimentary vascular laser treatment, which breaks down pooled blood into smaller particles, thereby greatly diminishing bruises within 24 hours. “It’s a good idea to ask up front if whoever you’re going to offers it,” Hale says. “Our patients take a lot of comfort in knowing they can come back for that.”


“Never get silicone. It’s the one filler we see the most complications from,” says Mariwalla of one injectable that’s occasionally used—but not FDA approved—to fill wrinkles in the face. Unlike malleable hyaluronic acid–based fillers, which can be absorbed by the body and will eventually break down, silicone is a synthetic material that can’t be metabolized and can harden over time, creating unsightly, uneven bulges. “It’s permanent, and it does not age well with you,” Mariwalla says.

This article originally appeared in the May 2017 issue of ELLE.


Everything You Should Know About Cellulite

According to this article, 9 out of 10 women have cellulite to some extent on an area of their body. It has become a conscious-worthy feature that people stress over and try to hide as much as possible. But, if 90% of women have it, why is this? This article from Day Spa Magazine dives into all things cellulite and how it can be treated. Check it out!

Cellulite spa treatments

[Image: Getty Images]

The time is nigh to unpack swimsuits and shorts—and thus, to confront cellulite, the alltoo-visible skin surface rippling that occurs, to some degree, in 9 out of 10 women. Although cellulite treatment research is ongoing, there’s still no magic cure that can truly eliminate this complex problem. However, it is helpful for both clients and professionals to understand exactly how and why cellulite occurs, and what you can do about it. We turned to doctors, nurses and industry experts to make sure we could give you the latest science about the causes of, and best ways to address, “orange-peel syndrome.”

Why Mainly Women?

Cellulite forms when the fat in our tissue pushes or “herniates” through the inner layers of the skin. The migration of this fat results in numerous “pockets,” held in place by thick, fibrous bands, which create lumps that are visible on the surface. Nature predisposes females to cellulite for three main reasons.

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The first is their tissue structure. Although cellulite is unrelated to overall body weight, it does tend to appear in fleshy areas such as the thighs, buttocks, abdomen and upper arms. “In women, these body parts have three layers of fat as opposed to one, so they’re the most susceptible to cellulite formation,” explains Flora Vergnolle, founder of Provence Cosmetics and Bioslimming. In men, the subcutaneous tissue is structured differently, so they’re much less likely to be affected.

The second reason centers around the ability of hormones to influence the rate and quantity of fat production. It’s no coincidence that women first develop cellulite after puberty. “Scientists postulate that the rapid deposition of fat during puberty leads to the herniation of fat through the skin,” notes Jessie Cheung, M.D., a dermatologist based in Willowbrook, Illinois. Moreover, cellulite formation tends to peak around another major hormonal phase for women: menopause.

Finally, genetics tend to determine whether a woman is going to have to tackle a predisposition to cellulite. After you explain all of this to your clients, they may respond, “Does this mean fighting cellulite is a lost cause?” Fortunately, the answer is no. Although we can’t change our nature-given physiology, there are numerous factors that contribute to the appearance and effects of cellulite. These can be addressed with a combination of lifestyle changes and treatments.

Contributing Factors

Wellness practitioners cite a multitude of causes to explain variances in the visibility and severity of cellulite. Some are not surprising: an increase in fat cell size and amount, for instance. Katherine Tomasso, national director of education for Yon-Ka Paris, describes cellulite as a “connective tissue disorder that develops from excessive fat in the hypodermis, plus inflammation.” According to Vergnolle, new research does indeed point to inflammation playing a role in the formation of cellulite. “Inflammation in the body, over time, contributes to the breakdown of collagen,” she says.

Lack of exercise is another factor. “Inactivity and weight gain often make cellulite more noticeable,” confirms Fayne Frey, M.D., a West Nyack, New York-based dermatologist. Low physical activity is a problem for two reasons: One, it allows muscles to lose tone, resulting in slackened skin that “showcases” cellulite; and two, “long periods of sitting reduce blood flow and lead to poor lymphatic drainage,” says Rhonda Nesbitt, RN aesthetic nurse specialist and esthetician at Skin Boutique in Birmingham, Michigan.

Melissa Morris, corporate educator for Pevonia, regards cellulite as a “toxic” body condition. “You must start at the source,” she reminds. “If your body is not eliminating waste properly, it becomes stuck in the colon and carried into connective tissues.” The lymphatic system plays an important role in removing cellular waste—lymph vessels work like the body’s vacuum cleaner, therefore a lymph massage and regular body brushing can stimulate those vessels.

RELATED: The Science Behind Stem Cells in Skin Care

Many wellness practitioners point to inadequate blood circulation as a likely contributor to cellulite because it occurs directly under the skin, an area that doesn’t normally get a lot of circulation. This, says Vergnolle, sets up a chain reaction. “You get less oxygen and nutrition to those areas, and that causes a decrease in collagen production,” she explains. “At this point, fat cells become larger; they begin protruding through the collagen and become the bumpy fat known as cellulite.” Without collagen fibers to keep tissue structure firm, “fat cells escape from tightly packed groups, move to the skin’s surface and enlarge to their full size,” explains Elaine Kroytor, rejuvenation specialist at the âme Spa & Wellness Collective at Turnberry Isle Miami.

Finally, there’s the question of diet. Tomasso advises that clients cut down on dairy, high-fat products, refi ned and processed foods, as well as those containing sweeteners, additives and unnecessary chemicals. Susan Ciminelli, a Los Angeles-based holistic skincare and nutrition expert, recommends a diet high in potassium—found in dark leafy greens, white beans, yogurt, bananas and avocados—as well as liver-cleansing milk thistle and dandelion supplements. “A toxic liver leads to excessive cellulite,” she explains. “Clients should minimize consumption of alcohol and manage stress to keep the liver functioning optimally.”

Smoothing Things Over

With so many identified potential causes, how does a spa practitioner work with clients who need help tackling their cellulite? You can start with education. Vergnolle believes the conversation should begin as soon as the client expresses a concern—which could be early. “We’re seeing teenage girls develop cellulite,” she says. However, sometimes that conversation comes much later, as Jennifer Masson, a nutritionist and esthetician based in Tampa, Florida, points out. “In older women, decreased estrogen from menopause impacts blood vessel circulation, and reduced blood-delivering nutrients and oxygen means less collagen production,” she explains. “So, fat cells get larger and appear as lumps and bumps.” The fact is, cellulite can appear at any age. “Yo-yo dieting and changes in metabolism can trigger cellulite formation, as can liposuction,” says Kroytor.

The consensus is that a multilayered approach is the only way to really make a dent in—well, the dents. “An effective cellulite program involves educating the client about cellulite’s causes and contributing factors—which include fatty foods, excess sugar, alcohol, insufficient water, circulation-restricting garments and stress—along with an internal detoxification regimen,” says Morris, emphasizing that the primary objective of cellulite treatment is to encourage elimination of trapped waste, rather than weight loss. “A comprehensive anti-cellulite plan may require partnering with local nutritionists, personal trainers, chiropractors or holistic doctors,” she says, and that requires commitment by guests to make lifestyle changes.

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A cellulite client who follows a complete plan will benefit most from the treatments you can off er her in the spa, which range from the traditional to the highly technical. All of them, however, are aimed at encouraging lymphatic drainage, removing excess fluid and impurities, boosting metabolism, encouraging circulation or some combination of these. “Massages performed manually with strong and quick movements, for instance, are effective in helping to drain excess fluid,” says Elizabeth Murchison, director of education at Guinot. Using a steam room or sauna draws out fluid and impurities via the pores. Detoxifying body wraps can produce immediately visible—albeit temporary—results, as can other wet body treatments. Ciminelli recommends dry-brushing clients, then preparing a soak with algae powder. “The liquid seaweed bath helps to reduce water retention, remove toxins and stimulate circulation,” she says.

Mechanical modalities such Endermologie and electrolymphatic therapy work to manipulate the tissues via rolling and suction actions. Sometimes massage is paired with the use of high-tech devices meant to penetrate tissues via enhanced temperatures, light or energy waves. Examples of this include infrared, cryotherapy, lipo laser treatments and radio frequency. “Tissue massage combined with diode laser therapy or infrared light and radio frequency, performed in a series of monthly treatments, produces results that typically last six months to a year,” reports Dr. Frey. It should be noted that any treatment that causes the skin to swell, such as heat-driven therapy, will temporarily reduce the appearance of cellulite.

The next step up in cellulite intervention is medical spalevel procedures such as mesotherapy injections, designed to “melt” fat in confined trouble spots. Nesbitt reports that Skin Boutique offers a Thermal Butt Lift that includes toning treatments followed by microneedling with the client’s own platelet-rich plasma (PRP) to stimulate collagen production. A new FDA-approved medical treatment for thighs and buttocks called Cellfina involves a physician using a “numbing wand” as local anesthesia and a needle-sized device to directly treat the underlying fibrous bands that tether the skin. Though the device is new, the process isn’t, says Dr. Cheung. “This technique is called subcision, and can be performed surgically or with a laser,” she explains. Subcision is done in a single treatment and results last up to three years.

In addition to following a lifestyle plan and receiving in-spa treatments, cellulite clients should be sent home with topical products formulated to increase blood fl ow to the skin, ideally used just after exercise when the metabolism is stimulated. Emphasizes Tomasso, “The best treatment products can multitask, metabolizing the skin while providing thermal and mild analgesic benefits, all to help support lipolysis and maintain the health and elasticity of tissues and capillaries.”

A successful anti-cellulite campaign requires time, patience and consistency from both client and practitioner. Even then, the best possible result is a reduction in the appearance of that orange-peel skin, because researchers still haven’t identified a treatment that may permanently reverse the effects. It is possible, however, to improve the condition enough so that clients will be able to face swimsuit season with their heads held high.

–by Katie O’Reilly


You Need to Know These Things About Lip Injections

The pointers in this article about lip augmentations (including injections and fillers) need to be known by anyone thinking about getting a procedure done for the first time. We love that Elle Magazine laid them all out in an easy to understand way. People are getting their lips done more frequently these days, so if you’ve been wanting to don’t do it without know this information first!

If you’re a lip filler rookie looking to go under the needle for the first time, you’re not alone. According to data from the American Society of Plastic Surgeons (ASPS), lip procedures are the second-fastest growing facial procedure in the United States, second only to dermabrasion. But the ubiquity of lip fillers doesn’t mean they’re suddenly risk-free.

Before going ahead with the procedure, “first schedule a consultation, tell the doctor what you’re looking for and listen for his or her answers,” advises Joshua Zeichner, MD, Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City. Most importantly, “make sure the physician you are going to is board certified in dermatology or plastic surgery,” adds dermatologist Kavita Mariwalla, MD, FAAD, who specializes in correcting botched procedures. Here, the experts share their tips for lip filler first-timers.

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1. Use hyaluronic fillers (HA fillers) that are FDA approved.

Because duh and also, “other fillers may leave lips firm or hard and more prone to visible lumps,” says Zeichner, who cautions against the use of silicone or permanent fillers because they’re irreversible and can cause “severe reactions.” No thank you.

2. Each product has slightly different characteristics.

Both Juvéderm ultra and Juvéderm Volbella are FDA approved for lips. “If you are looking for significant volume in the body of the lip, Juvederm ultra would be your go-to product,” Zeichner says. “For fine lines around the mouth, and subtle plumping, Volbella is a softer filler and doesn’t provide as much structure as its sister product.”

3. Prices vary.

When it comes to lip fillers, expect to pay anywhere from $500 – $800 per syringe. “If you are paying less than $500, it should make you a little bit weary,” Mariwalla says.

4. Results can last anywhere between three and nine months.

Results are dependent on what is used to fill. However, the latest generation of lip fillers, Juvederm and Volbella, can last upwards of one year.

5. Botched injections are reversible (but it’s complicated).

If your lips turn out lumpy, asymmetric, or too-big, an enzyme called hyaluronidase can be used to dissolve the product altogether. “The problem is that it can dissolve some of your natural hyaluronic acid in your lip so you typically want to wait a little bit before re-injecting them,” explains Mariwalla. “I have had patients who have had their lips filled overseas or by non-qualified injectors and are not sure what was put in. This is the toughest because I’ve seen everything from silicone to implants placed that cannot be undone. The only option there is to ‘fill around’ or try to correct the defect with injections that can be undone and hope that the substance you are injecting and the substance that is already in the lips do not interact.”

6. Let your doctor know if you have a history of cold sores.

Injections may cause a cold sore outbreak, “if you get them already and do not take prophylaxis,” says Mariwalla, so pop a preventative Valtrex.

7. Bring a reference picture.

But be realistic. “I have had patients who genetically have very thin lips come and show me pictures of some models and I tell them it will not be possible to achieve that without looking ducky,” Mariwalla explains. “It’s helpful though because we can deconstruct the photo and they can tell me which parts they like the best and we can do that.”

8. Avoid supplements and medications that thin the blood.

Aspirin, ginkgo, fish oil, and vitamin D and E supplements are all off-limits for two weeks leading up to your injection appointment. Alcohol should be avoided for 72 hours before injections.

9. Injections don’t have to hurt.

“Don’t get me wrong, compared to other parts of the face, the lips are the most sensitive,” Mariwalla says, but many injectables are spiked with anesthesia so you get more numb as you go. “Most doctors will numb the lips either with an intra-oral block, injecting anesthesia from inside the mouth to block the nerves supplying sensation to the upper and lower lips, or will have patients numb long enough so that the injections are not that painful. Plus, experienced injectors try to avoid multiple needle sticks to minimize pain.”

10. Results are immediate.

However after injection, the lips initially may look more puffy then they will end up because of initial swelling from the injections themselves.

11. Expect temporary swelling and bruising.

While swelling typically improves within 24 to 48 hours, you might want to NOT schedule injections the day before a big presentation, your wedding, etc. Most swelling can be successfully treated with ice. “Rarely, however some patients may develop more significant swelling requiring a prescription medication to help treat it,” says Mariwalla, who suggests waiting 24 hours before applying concealer or lipstick to the injection site.


Men Can Get Work Done Too

Plastic surgery and cosmetic procedures are not just for women. More and more men are trying out different procedures these days as the desire to look younger grows stronger. So what procedures are the most popular for men? The article below from Elle Magazine dives into this topic, and explains why it has always been ok for both genders to get work done.

Dr. Stafford Broumand, who is based in Manhattan, cites shifting expectations around aging as one of the main motivating factors. “Sixty is the new 40,” he says. “I’m in my fifties and feel like I’m in my thirties.” Like many women, “men don’t feel their age and don’t want to look their age, and now they know what they can do to improve their appearance.”

He said, ‘My wife has been on me for five years.’ So I asked, ‘What motivated you now?’ and he said, ‘My mistress started giving me a hard time.’

“I get men in their forties who have young kids and want to treat the wrinkles between their eyebrows,” says Dr. Doft. “They say, ‘I feel like I look angry when I speak to my children or my wife.” For them, she continues, it’s “not so much the prevention of wrinkles, like, ‘I can see how this will benefit me, and this is what I can get done.'”

Of course, plenty of men come in purely to improve their appearance. Dr. Doft had a French patient who came in for his sagging neck. “‘He said, ‘My wife has been on me for five years.’ So I asked, ‘What motivated you now?’ and he said, ‘My mistress started giving me a hard time.'”

“Look, I never thought I would be that guy,” says Rich, a New York City–based 33-year-old manager for a rental-car company and marathon runner who asked that we not use his last name. He went in for liposuction a year and a half ago for fat on his lower abdomen. “I told my wife and my sister, but I didn’t go broadcasting it to my friends. But I was more embarrassed about that little bulge in my stomach area than anyone finding out. I’m a super competitive person and I don’t want to look like someone who is out of shape.”

“I’ve never had a female patient pass out on me. I have had a handful of men [pass out].”

Though there are the obvious, non-gender-related reasons why men and women pursue these procedures—vanity, competition, some grasping at an ineffable edge in our perpetually measured world—several of the doctors I spoke with noted differences in the way that men and women approach the procedures. “A lot of my female patients almost want me to be a friend, a confidant. Sometimes they want to come in and talk about the decision two or three times,” says Dr. Doft. Men, she says, tend to be more businesslike about it. “I know the gender of a caller in one question: ‘How long do I have to be there?'” Dr. Stevens says.

Male patients, Doft says, “want to hear about the technology, like Vaser-assisted liposuction,” a technique that uses ultrasound energy to liquefy fat cells before they’re suctioned out. Doctors also say that male patients need more reassurance about pain. “Men in general have a lower pain threshold than women,” says Dr. Daniel Maman, who practices in New York City. (Science is on the fence about this, fwiw.) “I’ve never had a female patient pass out on me. I have had a handful of men [pass out] and they’re less than 10 percent of my practice.” Another difference: “Men do not bring in pictures,” says Dr. Broumand. Another crucial division: Women face more criticism for this kind of alteration, at least for now. “Men’s faces aren’t as scrutinized for imperfections or modifications,” says Alex, “and so our decision is maybe a little less embattled.”

But if the trend lines continue, will the scales equalize? Will men, too, find themselves subject to the kind of endless dissection of laugh lines and stretch marks that can torment women? Or will we all be just a bit happier to let the doctors do their job? Either way, nothing distracts from the sting of the needle like faux snakeskin walls and an endless loop of the Swimsuit Edition. Says Dr. Stevens: “It’s a palpable, smellable difference.”

Marisa Meltzer is a freelance writer based in New York City and a frequent contributor to ELLE.

*Some names have been changed.


Injectables Explained

Injectables (and anything involving needles for that matter) can be intimidating to a lot of people. You see horror stories or “botched” procedures and immediately lose interest in trying it for yourself. However, as more and more physicians are being trained and licensed to perform these treatments, they are becoming more talked about and tried. Learn more on this in the great article from Elle Magazine below.

It goes without saying that no one wants to look done. Still, we’ve all seen it, or maybe it’s even happened to us: the brow too high, too low, too frozen; the balloonish lips or Angelina-Jolie-in-Maleficent cheekbones that give the game away. Here is a person, these all-too-obvious needle- assisted interventions say, who hoped to look younger, prettier—someone who strove to arrest aging, à la Blake Lively’s magical imperviousness to time in The Age of Adaline, or even to reverse it, like Benjamin Button—and overshot the mark.

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Thankfully, as dermatologists have grown more sophisticated in their methods and the array of fillers, neurotoxins, and fat dissolvers like Kybella has become more diverse and specialized, patently obvious nonsurgical work is becoming the exception rather than the rule. (And surely, if the 9 million-plus injections done in the United States in 2015 had made us a nation of funny- faced freaks, we’d know it.) The best needle wielders now recognize that the most natural-looking effects are achieved incrementally, with tiny, almost imperceptible adjustments.

“I’m a big believer in ‘You don’t fill up the gas tank in one try,’ ” says Los Angeles-based dermatologist Annie Chiu, MD. “Softly adjusting gives the most beautiful results, and budget-wise it’s more reasonable as well. You can always add, but it’s harder to take away. Hyaluronic acid fillers are reversible, but you obviously don’t want to do that unless absolutely necessary.”

“I call them little tweak-bits,” says New York-based derm Dendy Engelman, MD. “This is the secret behind all the celebrities who the layperson thinks are just genetic phenoms. They are able to age beautifully because they’re not doing major overhauls. They’re not changing their faces, adding tons of volume, or erasing their expressions. They’re just focusing on tiny changes that really fly under the radar. They’re not so perceptible that it’s like, ‘Oh, she went and got her eyes done’ or ‘She’s changed her lips.’ Nobody can tell.”

With injectables, small hits can have a big impact—and not necessarily in the places one might expect. Engelman, for example, sometimes uses “a tiny bit of Botox at the base of the columella, which is that divider between the nostrils,” to lift the tip of the nose. “There are a lot of small physiological changes that people don’t really notice as signs of aging, which we can address,” she says. Another trick: making the eyes look bigger by injecting a baby dose of neurotoxin just underneath the eye. “If you just put one unit of Botox there,” Engelman says, “it drops the lower eyelid about one or two millimeters and opens up the aperture of the eye. So you look a little more awake, a little younger or prettier—but not noticeably different.”

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In more traditionally treated areas, derms tend to stay with standard doses of Botox and fillers—”I believe that if you use too little between the eyebrows, you’re not going to prevent those etched lines from getting deeper over time,”says New York–based dermatologist Whitney Bowe, MD.

“And I find that I need to put in .1 to .2 ccs—the more traditional doses of filler—along the cheekbone in order to get the lifting effect I’m after.” But for the rest of the face, Bowe says, “I’ve completely changed my injection technique.”

To address crow’s feet, for example, Bowe “wraps” microdoses of neurotoxin—delivered with an ultrathin tuberculin needle—around the eye, starting from the tail of the eyebrow and finishing under the lower eyelid.”Instead of hitting that area with just three injections on each side, which is what was studied during FDA trials, I actually do a series of about six or seven injection sites,” she says. “That way, I get a very gentle, natural, widespread effect that opens up the eye and lightens up heavy lids. It also changes the texture of the skin in a way that traditional deeper injections don’t, because I’m actually affecting only the very superficial muscle fibers. So when people complain that they have crepey or cigarette-paper skin around the eye, it helps to smooth that out.”

Similarly, Bowe uses minuscule doses of hyaluronic acid fillers in marionette lines, smile lines, and nasolabial folds, placing them shallowly into the dermis “to gently hydrate the skin from beneath the surface.” This imparts an immediate dewy glow but also, she says, galvanizes a longer-term benefit: “It triggers your own body to make more collagen. I’m deliberately wounding the skin in tiny points down and along those lines in order to tell your body to start healing itself. I find that by doing this injection technique, I’m able to get a much more powerful preventive effect from the filler, because I’m creating ten- sion on the fibroblast cells, making them create more collagen. Again, it’s very off-label, but if I see people every three months and I use very low doses distributed in a lot of different areas, I’m able to get healthier-looking skin over time. So even after the enzymes in our bodies break down that hyaluronic acid filler, the skin looks tighter and firmer.”


Stay Hydrated This Spring and Summer

Part of staying healthy and on top of your health and wellness goals is staying hydrated. This includes drinking enough water throughout the day, but it is often overlooked and forgotten. The good news is that there are foods that are good sources of hydration! Try snacking on the options listed below this spring and summer along with drinking lots of water and see how great you feel!

When talking about keeping ourselves hydrated, water is most likely the first thing that will cross your mind. After all, this is our constant source of hydration. However, drinking water alone can get boring at times. This is why we turn to fruit juices, tea, and sodas to quench our thirst. Sadly, some types of beverages like soda and pre-made juices are high in sugar content which can affect our health.

Fortunately, we have found foods that are actually rich in water content which can help you keep your body properly hydrated. Do you want to know what foods these are? Here are some to include in your list of foods to eat.

  • Cucumbers. Cucumbers contain up to 95% water which can help you quench your thirst as you would when you drink a glass of water. Aside from hydrating your body, cucumber also contains fiber and vitamin C. This vegetable is not just for making salads only but you can also find plenty of interesting recipes for this one from soups, to dips, to main course meals.
  • Watermelon. Don’t forget to include watermelon in your diet as it is one of the best sources of water. At 92% water content, it is not surprising why this fruit is among the top favorites during the summer. Another reason why you should opt for watermelon is that it contains calcium, salt, as well as magnesium which are important when it comes to keeping dehydration at bay. You can also get a decent amount of vitamins A, C and potassium too.
  • Salad greens. Eating salad greens is one way to keep your weight down as two cups of this food only delivers 15 calories. But did you know that it also contains about 90% water? These greens are also good sources of folate, fiber, vitamin C, and beta-carotene which play important roles in our health. You can have it during lunch or dinner to get some much needed nutrients into your body.
  • Strawberries. Another source of water that you should be adding to your diet is strawberries. This sweet treat not only satisfies your love for sweets but you can also eat it to keep dehydration at bay. Strawberries contain up to 92% water and come with plenty of vitamin C and fiber. Regardless of whether you will be eating them raw or making a summer cocktail out of it, strawberries will definitely help quench your thirst.
  • Yogurt. Most of us associate yogurt with weight loss but did you know that it can also help hydrate your body? Yogurt contains up to 85% water which helps keep your stomach full while ensuring that you have water in your body. It also comes with B vitamins and calcium which are important to your overall health.

As you can see, water isn’t the only option out there to help you stay hydrated because there are several kinds of food that can keep the water levels in your body high. Adding these to your diet will definitely prevent dehydration from occurring.


Hydroxy Acids and Your Skin

If you are curious about how different facial treatments work and what goes into them, then look no further. The article below talks about different hydroxy acids in chemical peels and how they work. There is a lot of science behind many facial treatments that can be intimidating to some, but learning about them can ease nerves before trying them out.

Hydroxy Acids are ubiquitous in aesthetic medicine. Alpha- and beta-hydroxy acids (AHAs/BHAs) are the most widely used ingredients for chemical peels; they have also become popular topical agents for antiaging, hyperpigmentation and acne. In recent years, they have been joined by polyhydroxy acids (PHAs) as a less irritating alternative for patients with sensitive skin. “I recommend AHAs for everybody—antiaging, acne, rosacea patients. It’s really one of the best things you can do for the skin,” says Monica L. Halem, MD, FAAD, a dermatologist in private practice in New York City.

Here, we look at the science behind hydroxy acids in topical skin care.

The main purpose of AHAs is desquamation, or the removal of the outer layer of the skin. “There are five primary AHAs: glycolic, lactic, malic, maleic and mandelic,” says Robert Manzo, chemist and founder of Skinprint skin care. “Anything that is not glycolic is really window dressing. The other ones are nice, but they’re all variants of glycolic acid, and from a pure chemistry and pure functional standpoint, glycolic acid provides the most effective desquamation.”

AHAs are carboxylic acids with one hydroxyl group attached to the a-position of the carboxyl group. “The corneocytes on the surface of the stratum corneum are attached to the skin and each other by desmosomes. Glycolic acid specifically targets the chemistry of a desmosome bond to release those surface cells,” says Manzo. “Of the AHAs, it is the smallest molecule and offers the best removal.”

In addition to its exfoliating properties, glycolic acid has been shown to accelerate collagen synthesis. While the exact mechanism of action is unknown, a February 2003 study in Experimental Dermatology (supplement) outlined the effects of the acid on in vitro and ex vivo human skin biopsies. Yuri Okano, et al, found that glycolic acid directly accelerates fibroblast collagen synthesis and regulates extracellular matrix degradation, both of which contribute to the recovery of photodamaged skin.

A study on the use of glycolic acid for acne scarring (International Journal of Dermatology, October 2000), highlighted its ability to lighten areas of hyperpigmentation. The authors posited that the acid both disperses pigment in lesions as a result of desquamation and reduces new melanin formation in the melanocytes by inhibiting tyrosinase. For the study, Zulal Erbagci, et al, compared the outcomes of two groups of patients with atrophic acne scars—one group was treated with bi-weekly serial glycolic acid peels and the other with long-term daily use of topical low-strength glycolic acid. They concluded that, “Long-term daily use of glycolic acid is effective on scars and may be recommended for patients who cannot tolerate the peeling process.”

“I think glycolic acid should be a staple in skin care,” says Dr. Halem. “It gently removes dead skin cells revealing fresh skin, decreases pore size, hydrates, stimulates collagen and elastin, eliminates fine lines and wrinkles, and helps treat acne.”

“AHAs have renewing effects across multiple layers of skin,” says Barbara Green, head of R&D and clinical research at NeoStrata. “There’s a loosening of the bonds between surface cells, encouraging exfoliation at the very top layers. In the epidermis there is enhanced cellular turnover and a more even distribution of pigmentation for improved skin tone and clarity. Studies have shown that AHAs can also increase collagen and hyaluronic acid.”

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Lactic acid shares glycolic acid’s exfoliating abilities and also affects the lipid structures of the skin, offering additional moisturizing benefits. “Lactic acid penetrates the skin and changes the structure of the lipids in the stratum corneum,” says Manzo. “It does that by aligning them differently, which traps moisture in. So lactic acid is a very effective tool for skin hydration, whereas glycolic is a more effective treatment active for lightening and desquamation.”

While AHAs are among the most proven actives in skin care, it is important to remember that they will not get rid of deep wrinkles. “They are good for superficial wrinkles where you’re removing a few layers of skin, because this reveals the younger skin underneath and addresses tone and texture,” says Manzo. “From that perspective AHAs, specifically glycolic acid, work very well. But they will not get rid of deep wrinkles.”

For this reason, it’s necessary to manage patients’ expectations about what a topical can do for them, says Laurel Morton, MD, of SkinCare Physicians in Chestnut Hill, Massachusetts. “They provide significant results, but not dramatic results,” she says.

Dr. Morton also points out that although AHAs are tolerable across all skin types, there are still some considerations for patients on both ends of the spectrum. “People with darker skin types are going to be more prone to discoloration from any inflammation, so proceed cautiously,” she says. “Patients who have fair skin may not have long-term issues, but they must be very careful about sun protection; they’ll be a little more prone to irritation when using acids in the presence of sunlight.”

At NeoStrata, formulators often choose to work with glycolic acid for antiaging (with citric acid added for antioxidant benefits). For oily and acneic skin they use mandelic acid, “which is a more oil-soluble form of glycolic acid, e.g., phenyl glycolic acid,” says Green. “All AHAs have proven to be tolerable across the full Fitzpatrick skin type range, but for sensitive skin types and postprocedure care, we use Polyhydroxy Acids (PHAs), which are still in the AHA family but have more water-attracting hydroxyl groups on the molecule; they’re inherently more moisturizing and conditioning, and less stinging than the traditional AHAs.”

One of the most widely used PHAs in skin care is gluconolactone. In “Applications of hydroxy acids: classification, mechanisms and photactivity” (Clinics of Cosmetic Investigative Dermatology, November 2010), Andrija Kornhauser, et al, noted that PHAs offer antiaging and skin-smoothing benefits comparable to AHAs, as well as some additional advantages: They function as humectants, moisturizers and antioxidants.

Because PHAs do not cause the irritation seen with glycolic acid, they have become popular actives in postprocedure skincare formulations. “PHAs have been found to be compatible with clinically sensitive skin, including rosacea and atopic dermatitis, and can be used after cosmetic procedures,” wrote Pearl E. Grimes, MD, et al, in “The Use of Polyhydroxy acids in photoaged skin” (Cutis, February 2004), adding that “PHA-containing products were shown to be compatible with African American, Caucasian and Hispanic/Asian skin and provided significant improvements in photoaging in these populations.”

Image: Getty Images


Beta Hydroxy Acids

Like AHAs, BHAs are carboxylic acids with one hydroxyl group, but the hydroxyl group is attached to the ß-position of the carboxyl group. True BHAs, such as benzoic and butyric acids, are not commonly used in skin care. “Benzoic acid is an active in some prescriptions, like Bensal HP and Whitfields Ointment. It works with salicylic acid to deliver desquamation in addition to controlling infection,” says Manzo. “We do some formulations for plastic surgeons and dermatologists if they want that specific blend, but it’s pretty rare.”

Some acids, including malic acid and citric acid, are considered BHAs because they have one carboxyl group in the a-postion and one in the ß-position. Similarly, salicylic acid is not a true BHA—its hydroxyl and carboxyl groups are directly attached to a benzene ring—but it is often included in this group.

Salicylic acid is indicated primarily for acne because it is a keratolytic (peeling) agent, but it has other benefits as well. “It has some antiaging properties and decreases pigmentation too,” says Dr. Halem. “Especially in patients who have acne and a lot of the acne stains, it helps treat both the acne and the resulting hyperpigmentation.”

“There are two goals of salicylic acid on skin: down regulate oil through sebaceous interference, and desquamation,” adds Manzo. “And at 1% you get a nice anti-inflammatory property out of it.”

Formulation Challenges

The secret to formulating an effective hydroxy acid topical lies in buffering, pKA and pH levels. “In order for AHAs to absorb, they need to be in their acid form—not their neutralized form. The chemist must formulate around the acid’s pKa, which is the relative strength of that specific acid,” says Green. “For example, glycolic acid has a pKa of 3.8, so if a product is formulated at a pH of 3.8, approximately half of the glycolic acid would be available as free acid and half would be present as neutralized salt, which would not penetrate as readily. You maximize effectiveness by balancing the pH of the formulation, bearing in mind the pKa of the acid. Recognizing that pH is a logarithmic scale, as one increases pH there is a fast decline in the amount of the free acid form; there is a sensitive formulating balance required to achieve effectiveness and tolerability.”

In addition, the acid can lose potency from the time it leaves the bottle to when it’s applied to the skin. Adding water to a glycolic cleanser to form a lather, for example, will dilute the acid and decrease its effectiveness. “A big problem with cleansers that claim to have glycolic acid is that they self-buffer before getting to the face and therefore don’t work as well,” says Manzo. “So look for buffered glycolic acids in cleanser form that have a pH between 3 and 3.5; that will work much better than a cleanser that starts at 4 and is then diluted for a resulting pH of 6.”

He notes that AHAs do work nicely in lotion and especially serum forms. “AHA is a very robust chemical. The ability to combine lactic and glycolic acids, buffer it well and formulate them to get both hydration and cellular removal properties is tricky, but we can do it,” says Manzo. “At Skinprint, we’re adding time-released retinoids to AHA formulations as well, so the retinoid is released over a six to eight hour period plus you get all the AHA properties. These combinations are very potent.”

Salicylic acid differs from AHAs in that it is oil-soluble. “If you have an oil-soluble compound and you’re putting it into an aqueous base, you have to formulate it such that it precipitates onto the skin in the closest way it can so it gets into the sebaceous glands,” says Manzo.

Image: Getty Images


Over-the-counter salicylic acid-based products typically contain 1% to 2% of the acid. “The 2% is generally for people with acne and it suppresses the sebaceous glands,” says Manzo. “The 1% allows the skin to turn over and regulate, and acts as an anti-inflammatory. Anything over 2% is prescription. We make up to 15% for sebaceous hyperplasia and issues where patients have rhinophyma on the nose—at high levels it works extremely well to suppress those concerns, particularly in the nose area.”

AHAs can be easily incorporated into homecare routines, as they are available in various formulations. “I recommend AHAs in the form of cleansers, serums or moisturizers—it depends on the patient’s preference, so I offer all of them,” says Dr. Halem. “A cleanser is still effective even though it is washed off, but I like to add a serum that’s going to stay on all day. As long as you’re incorporating it somehow, that’s where benefits come in.”

Dr. Morton suggests combining AHAs with other actives for optimal results. Patients can use AHAs with a retinol for antiaging, or with bleaching agents for pigmentation concerns, for example. “For antiaging, I would recommend an antioxidant, like vitamin C or resveratrol, and a glycolic acid either in lotion form or serum form, and then I think retinols are important too,” says Dr. Morton. “Patients can alternate the glycolic and the retinol every other night so as not to cause too much irritation. By combining things, you get an overall better result.”

Dr. Halem notes that patients, especially those with sensitive skin, should be cautious when starting an AHA product. “Any time patients start glycolic acid, they should only use it a couple times a week and increase as they go to make sure they don’t get too dry or irritated. Someone who is super sensitive might want to use it less frequently,” she says. “And I personally don’t recommend it for the undereye area; the skin is a little too delicate for that.”

Patients using glycolic acid-based topicals must be diligent about using sun protection—especially if they are also applying a retinol—because it can make skin more sensitive to sun exposure.

Manzo reminds practitioners that they must be aware of factors affecting the bioavailability of active AHAs and BHAs, particularly when it comes to cream cleansers. “Creamy cleansers deliberately provide an occlusion by precipitating waxes on the skin to prevent the barrier function from releasing water. If the next step in the regimen is to apply an active, the waxy substance isn’t going to let it penetrate,” he says.

Laura Beliz is the associate editor of MedEsthetics.

Image: Getty Images


If You Have Oily Skin…

Oily skin causes a lot of people headaches when they cannot seem to find the right regimen. However, we have good news! The article below explains many different things you can try if you want to get your oily skin under control. A good skincare routine is key in aging gracefully and protecting your skin from the environment. Learn more below!

We all know that people have different types of skin. Some are dry, some are oily, while others were born with the perfect skin condition. Those who have oily skin often experience acne breakouts and blemishes because the extra oil that their skin produces often end up clogging their pores along with dirt and other particles. What’s more, that extra sheen in the afternoon can also be a source of embarrassment but not when you practice proper skin care to minimize the overabundance of oil on your skin. If you are wondering what skin care regimen to try to help reduce acne breakouts, here are a few tips to try.

  • Cleanse. If you have oily skin, it is important that you cleanse your skin. However, it might be tricky to wash away any excess oil without stripping the natural oils of your skin not unless you find the right cleanser to use. Beauty experts recommend that you look for a cleanser that is specifically designed for oily skin so that you will be able to clean your skin while still retaining its natural oils. After you have washed your hands, gently massage the cleanser onto your skin using a sponge then rinse after. Pat your skin dry.
  • Shea butter and tea tree oil. This combination certainly works for those with oily skin as the tea tree oil helps clear up any skin blemishes that you have while keeping it moisturized with the aid of shea butter. Try using a moisturizer that contains these two and you will see how soft and glowing your skin is minus that excess oil you are so worried about.
  • Tone your skin. Another trick that you can use to tame your oily skin is to use a toner. Of course, it is imperative that you look for a toner that is designed for oily skin so that you will not strip your skin of its natural oils. You can apply toner with the help of a misting spray or cotton pad whichever you prefer.
  • Use makeup remover. If you often wear makeup, make sure that your nighttime skin care routine includes removing any traces of makeup before you go to bed. This will help prevent acne breakouts from occurring and will not make your oily skin worse too.
  • Masks can help. Applying nighttime facial masks for oily skin is another trick that you can use to help minimize the oiliness of your skin. Facial masks for oily skin not only reduce oil production but they will also help maintain moisture so that your skin will remain soft and smooth. These masks can be applied using your hands or a brush. Leave it on for three to five minutes before rinsing.
  • Exfoliate. Oily skin needs to be exfoliated at least once every week to help get rid of dead skin cells that can clog your pores. You can make your own exfoliating mask or use those that are already pre-made to help revive your dull looking skin. Make sure that you don’t scrub your skin too hard when exfoliating so as not to aggravate your skin’s condition.
  • Serum or lotion. Adding lotion or serum to your oily skin may sound weird but it is necessary to deliver nutrients to your skin. It’s just a matter of finding which one works best for your skin. Moisturizing lotions are perfect for everyday use while the serum is suitable if you want to moisturize your skin on a cellular level.

These are just a few examples of skin care regimen that you can do to help maintain clear skin even when your skin is oily. With these practices, you will be able to keep acne breakouts at bay for long periods of time.


“Cleaning” Up Your Diet

If you are unhappy with your midsection or another area of your body you might want to consider changing things about your diet. That and a CoolSculpting appointment with us may greatly improve the appearance of stubborn fat in areas of your body. The article below discusses how eating clean can not only help you lose weight but feel better from the inside out. Read about it and talk with us about CoolSculpting, too!

You’ve probably heard about clean eating but don’t know how or where to start. Clean eating is basically shifting to foods that are considerably healthy compared to your current diet. This means that you will be eating more vegetables, fruits, whole grains, lean meat, and the like to ensure that you are getting sufficient nutrients into your system. This also pertains to reducing your consumption of refined sugar, salt, and even unhealthy fats so that you will be in the best health at all times. So how will you start clean eating? Here are a few tips to consider.

  • Identify what clean eating is for you. Clean eating comes with a host of interpretation based on individuals. Identifying what clean eating means for you is a good way to start healthy eating practices. This can be something simple as reducing intake of refined sugar and carbohydrates, or even upping your consumption of fiber, protein, and the like.
  • Reduce processed foods. Most of us follow a diet that consists mainly of processed foods as they are already pre-packaged and ready for cooking which is convenient for our busy schedule. Unfortunately, processed foods don’t contain much nutrients which is why you need to reduce your consumption of them. A better option would be to stock your pantry with healthy food choices such as fermented foods, vegetables, fruits, whole grains and the like.
  • Indulge once in a while. There is nothing wrong with indulging yourself every once in a while but you need to clarify how often will this be. If your idea of occasional indulgence is once every day then you need to find a way to avoid this or at least put a few days in between until the next time you treat yourself.
  • Limit your consumption of saturated fats. Not all fats are bad for your health. Monounsaturated fats are among those that are actually good for your health. Saturated fats, on the other hand, belong to the fats that you need to reduce consumption or avoid altogether as these can clog your veins and increase your risk of heart problems. Swap saturated fats with healthier options such as canola oil and olive oil to raise your good cholesterol levels.
  • Invest in a cooler. If you are trying to practice clean eating, a good step to take is to invest in a cooler which you can bring you with you wherever you go. Simply pile it up with healthy snacks like apples, salads, and such and add some ice packs so they will keep for hours.
  • Minimize alcohol intake. Reducing your alcohol intake is a must when it comes to clean eating as it will help save your liver significantly. If you often drink alcoholic beverages, it is high time that you reduce your intake to lower the amount of calories that you are putting into your body.
  • Avoid too much salt. Another tip to clean eating is making sure that your consumption of foods high in salt will be reduced. Too much salt can actually hurt you because it can cause your blood pressure to spike. A good place to start with this is to reduce your consumption of processed foods as stated above.
  • Give yourself time. Jumping on the clean eating bandwagon is all well and good but you need to give yourself time to adjust as ditching the foods that you normally eat won’t be that easy to do. By making small changes to your diet, you will be able to ease into a clean diet without any hitch.