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The new Trusculpt iD technology from Cutera damages fat cells (adiposites) using heat. This technology has a higher patient satisfaction rate when compared to “fat freezing” technology and also tightens the skin, a claim that cannot be made with “fat freezing”.

Treatments are completed in 15 minutes with no downtime. Patients can have their treatments and go directly to the gym. Results take at least 3 months to appreciate and almost a 25% reduction is seen in a single treatment.

The highest rated fat reduction treatment on www.realself.com

Tretinol, the active ingredient in Retin A is irritating to the skin. Retinol, an over-the-counter medication gets absorbed into the skin and then converted into this active compound that works as tretinol. In general, Retinol products are less irritating than tretinol.

The benefits of these products is well known. They reduce fine lines and wrinkles, even out skin tones, and reduce acne. Unfortunately, many suffer from the irritation that they can cause.

How can I avoid the Retinol Burn?

  1. Apply the smallest amount of product possible. For an entire face, a pea-sized amount is all that should be used. The more you use, the more irritation it will cause.
  2. When starting these products, use them only twice a week. Let your skin get acclimated to it and increase slowly over a few weeks to every night.
  3. Only use gentle products when starting these products. Do not use acne cleansers, scrubs, alcohol, mechanical brushes, or any other products that irritate the skin. If you break down the skin’s natural barrier, you are more at risk for irritation.
  4. Moisturize your skin! Keeping your skin barrier well-lubricated will reduce your chances of irritation.

What can I do if I get irritated from Retinol or Retin A?

  1. Stop using the product until all of the irritation resolves.
  2. Moisturize the skin with a thin coat of Vaseline daily until the irritation resolves. You can use a gentle moisturizing cream, but Vaseline is safer and works better. An alternative is Aquaphor Ointment.
  3. You can use 1% hydrocortisone OINTMENT twice day for one week then once a day for one week if needed. Do not use near the eyes. This works great and definitely get the ointment and not the cream.
  4. If recommended or given by your Dermatologist, give them a call and ask for their advice.

We all know that eating healthy is important to combat the effects of aging, but what else should we be doing? Every day I get asked about fillers to plump up lines and other procedures to make one look better. People tend to forget about what else they should be doing to better their overall health and combat the effects of aging.

STRENGTH TRAINING

Many are intimidated by just the thought of strength training, but the benefits are well known and well worth the effort. Muscle mass drops by about 4% each decade after the age of 30. That is a lot of muscle loss! Strength training is the best way to reduce this loss in addition to keeping you fit and functional. In fact, many believe that strength training is actually more important than aerobic exercise to slow the aging process. Common sense tells us that the more strength that we have, the more things that we will be able to do. In short, strength matters.

Are you still not sold on the benefits of strength training? Let’s look a little deeper into this.

  1. Strength training burns calories and boosts your metabolism.

The more muscle that you have, the more calories you burn.

2. Strength training strengthens muscles and reduces the risk of osteoporosis.

This is especially important for women, who are most at risk of having brittle bones. Lifting heavy weights stimulates bone production. People often confuse weight lifting with heavy weight lifting. What is the difference? Doing squats with a weight in which one can only do 12 reps if very different than using a weight where one can do 30 reps.

3. The stronger one is the lower the risk of falls or injury

As we lose muscle, the risk of falls or injury increases. In addition, if we are stronger we maintain better balance, further reducing the risk of falls.

4. A lower body fat percentage lower the risk of heart disease and diabetes.

Get rid of that belly fat and you will be healthier. Period. You don’t even have to pick up a weight to enjoy these benefits. You can perform exercises without a single weight such as squats, deadlifts, lunges, push-ups, pull-ups, and tricep dips.

Taking an over-the-counter antihistamine, such as Allegra, has been shown to help patients with alopecia areata grow new hair. This medication is available without a prescription and the generic form is available as well. Hair regrowth was specific for bald patches due to alopecia areata and worked well when combined with other treatments.

In rare cases, cosmetic fillers can swell slightly after a vaccine. This has been recently reported with the COVID vaccine. This reaction is temporary and usually resolves within 24-48 hours and can be treated. None of the reported cases were serious, life-threatening, or had long-term complications. For this reason, one who has a history of having fillers may get the COVID-19 vaccine.

This post is not skin related, but important for pubic health. Remdesivir was just approved for the treatment of Covid-19 hospitalized patients with lower respiratory tract infections. This is good news! In a study published in the New England Journal of Medicine, patients who received remdesivir had a 33% shorter hospitalization (10 days versus 15 days).

This is a major step forward and I expect more FDA approvals of other drugs in the immediate future.

INJECTABLE SKIN FILLERS

With fillers being so common today, the number of options is very high and very confusing. Which product is best for me? Who should perform the procedure? Where should I have it performed?

Let us take a look at some of the most important questions that you should be asking.

  1. Who is going to perform the procedure? How many of these procedures has the physician performed? How many times a day or week does the physician perform this exact procedure? Is the physician board-certified?
  2. What results can I expect? How long will it take to recover from the procedure? Can I see before and after pictures?
  3. What are the risks of the procedure? What happens if I have a problem? Will the doctor be available if there is a problem?
  4. Where is the procedure being performed? The procedure should always be performed in a medical center or doctor’s office, not a non-medical spa, shopping mall, or private party.
  5. Am I paying too little? If the price seems too good to be true, there is a good chance that the product could either be diluted–which would increase the risk of contamination–or purchased from an illegal source (which is much more common than one would think)
  6. Which filler is best for me? For the most part, there are two major product lines used: Juvederm and Restylane. While there are differences between the lines themselves, they are somewhat comparable with advantages and disadvantages of each and cost varies so ask. Within each line, there are products that are better for fine lines and ones that are best to add volume. No one product is best for all. Yes, there are other products such as Radiesse and Sculptra, which have a unique place in this filler arena.

Getting a filler or a neurotoxin is a medical procedure, and knowledge is power. Patients must ensure that what is being injected into their skin is legitimate and purchased form a reliable, legal, U.S. source. Patients should ensure that they are being treated by a highly trained professional. A board-certified dermatologist, plastic surgeon, or facial plastic surgeon who has been trained in the proper use of fillers and neurotoxins can help you get the results that you want and reduce the risk of complications.

Freckles on face
Freckles

Freckles are brown spots that commonly occur in sun-exposed areas on the skin that are harmless. As one gets sun exposure, the spots darken. When one avoids the sun or UV exposure, the spots lighten. The face is the most common area affected, but the arms and legs are common sites as well. It is most common for one to have many of these lesions in an area, and not one or a few.

Freckles can be confused with “age spots” or moles (nevi), which do not get darker and lighter the way that freckles do.

Any lesion that has multiple colors, is larger than 4-mm, is asymmetrical, and/or has irregular borders should be checked by a board-certified Dermatologist.

PREVENTION

As Sun-exposure, natural and/or artificial, makes them darker, avoidance is paramount. One should avoid midday Sun, wear protective clothing (i.e. wide brimmed hats and shirts), and use a broad-spectrum sunscreen that contains titanium dioxide and/or zinc oxide in high concentrations. Topical Vitamin C preparations can help prevent new spots and lighten existing spots.

We carry many sunscreens that afford superior protection. Click here to see our Sunscreens.

TREATMENT

Prescription creams can be used to lighten these spots and are extremely effective. We use a prescription that must be compounded (mixed by a pharmacist) that is extremely effective. Over-the-counter preparations containing hydroquinone , Kojic acid, and/or Vitamin C are all helpful to lighten these spots. We have two products that work well to lighten the spots:

FADE 1 2 3 which contains 2% hydroquinone and should be used until the desired color is seen. SPOT TREAT ONLY as it will lighten any skin that it is applied to

Cerum which contains Vitamin C and Ferrulic Acid, which prevents further damage and lightens brown spots. This works great to prevent darkening and helps lighten as well.

No one likes the look of dark circles under their eyes, which can make one look tired. Unfortunately, treatment of this common complaint can be difficult as several factors play a role in their appearance. 

What causes dark circles under the eyes

  • Genetics. This is the most common cause of dark circles. In darker skinned individuals, too much pigment or too much skin can cause dark circles. In lighter skinned persons, thin skin can reveal blood vessels below, giving the skin a blue-purple hue.
  • Tear trough or bulging fat pad. There is a natural transition from where the eyelid meets the cheek, which is apparent in everyone. For some this gets hollowed out and forms a deep groove. For others, the skin just below the eyelid bulges outward, thus forming a deep groove below. This occurs due to natural aging and some are more prone due their genetics. 
  • Aging. With age, the skin thins. Underlying blood vessels become apparent, the skin develops fine lines, and their is a change is texture and tone. As the skin loses its elasticity, it tends to bunch up, which makes it appear dark.
  • Seasonal Allergies. Hay fever and other allergens can result in the dilation of blood vessels under the eyes. This causes the skin to appear dark due to the increased blood flow. The released histamine can result in puffiness as well. 
  • Not enough sleep. Although, most blame a lack of sleep to having dark circles, it is not common. If one does not get enough sleep puffiness can develop under the eyes. 

How to treat dark circles under the eyes

While we cannot treat one’s genes, we can do things that reduce the appearance of dark circles.

Eye creams

Certain active ingredients in eye creams, such as retinol and peptides, increase collagan and elastin, reducing fine lines and “bunching” of the skin.  Retinol also reduces pigment, as do other ingredients such as vitamin C, kojic acid, and niacinamide. Topically applied caffeine constricts blood vessels, making dark circles appear lighter.

Dermal fillers

Restylane can be injected into the hollows or grooves under the eyes to reduce their appearance. This safe and effective procedure has results that last approximately six months or longer.

Chemical peels

Chemical peels have been used for centuries to tighten and lighten the skin. While still a good option, newer modalities have given other options, often with faster recovery, than chemical peels.

Microneedling

Microneedling is safe for all skin types, but by itself is minimally effective. When microneedling is combined with radiofrequency, significant improvement can be seen with minimal to no downtime. More than one treatment session is required for optimal results.

Fractional laser resurfacing

Laser skin resurfacing is extremely effective tool used to tighten the skin and stimulate collagen production by creating hundreds and hundreds of tiny round wounds that takes well over a week to heal. For those with fine lines and skin laxity, this is a great option for those who can have at least a week of downtime and several weeks of pinkness on the areas treated.  

How do I get the best result

For most, there is not one treatment that will work to reduce the dark circles, but several. For skin laxity and fine lines, creams containing retinol can help, while chemical peeling, laser resurfacing, or surgery may be needed for moderate to severe laxity. For hyperpigmentation, actual increased pigment that is not due to laxity can be treated with creams containing retinol, Vitamin C, kojic acid, niaciniamide, and/or caffeine. Stronger prescription agents containing hydroquinone can be used for moderate cases. For severe cases, chemical peeling and/or laser resurfacing can be used. For puffiness caused by a visible fat pad, Restylane can be injected into the tear trough, or hollow under the eye, to reduce the appearance of the “bag” or surgery can be performed to remove the bag itself in some cases. 

In short, for most creams and Restylane injections can very helpful at reducing the appearance of bags or darkness under the eyes. 

According to a study published in the Journal of the American Academy of Dermatology, patients who were treated with Mohs’ Micrographic Surgery had a higher 5-year survival rate than those treated with excision.

Despite this, many insurance carriers do not view Mohs’ surgery as “medically necessary” for the treatment of these tumors.