Wednesday, September 23, 2015
It takes about 4-6 months to see results. The same is true with ThermiRF. A procedure called SmartLift uses the SmartLipo probe to deliver heat under the skin and could potentially mimic ThermiRF. The difference is in the control and constant feedback of the heat delivered to get effective yet safe treatment. We are not using SmartLift/SmartLipo as much in our practice now due to having the more advanced ThermiRF.
Tuesday, August 25, 2015
STOP sweating Forever!
And STOP wearing deodorant Forever!
Do these scenarios look familiar? Tired of your expensive clothes getting nasty sweat stains? Embarassed of smelly underarms that sweat in an instant without warning—especially when presenting that important project in front of a room full of people? You have tried all the deodorants on the market, even prescription strength ones—nothing is working. Baby powder, talcum all to no avail. Have you tried the underarm sweatshield pads?
Well, if you’re not too keen on sporting these beauties or spending money and time washing and buying new ones, there are certainly some great options that get rid of sweating AND odor! The best on the market and our favorite is ThermiDry
1) ThermiDry is an awesome procedure. Here is how it works. After doing a sweat iodine test to locate where the sweat glands are located, the area is numbed with a local anesthetic. You are completely awake and alert for this procedure. Once the numbing takes effect, there is absolutely no pain. A tiny needle puncture is made and a small canula is placed under the skin. It is slowly threaded in and out in a fan like pattern directly under the skin, until all the sweat laden skin areas are treated. The energy emitted from the tip of the canula is Radiofrequency (controlled electricity) that heats and disables the sweatglands, PERMANENTLY! Once the areas are treated to the desired time and temperature, the canula is removed. The tiny needle puncture usually closes within 24 hours and is difficult to even locate. No Pain, and that’s it! The procedure is extremely safe as a thermal camera makes sure the skin temperature stays in a safe zone.
2) Botox: Tiny injections with neurotoxin into sweaty areas works like magic to stop the sweating and odor. Sadly it is not permanent, but can last sometimes up to a whole year in some patients. I have even seen some patients no longer requiring Botox injections after a few visits…almost as if they are cured. However, in reality, Botox does not provide the permanence of ThermiDry.
3) Vaser Liposelection. Instead of the ThermiDry probe, the Vaser ultrasound probe can also be used to heat and destroy the sweat glands. It’s a good option, but it does not have the control of ThermiDry. Therefore, our preference is definitely ThermiDry for superior, safer and more controlled results.
The other consideration is the potential dangers of using deodorants. 80% of what we put on our skin gets absorbed! There are many chemicals such as parabens which are in skin products such as deodorant that end up in areas like biopsied breast tissue. It can't be good. The above procedures can help eliminate these from our medicine cabinets for good and help us lead a cleaner, healthier life.
To this end, I have created my own line of organic skin care creams for the face, as well as an awesome scrub and masque. You can find these at www.mokshaorganics.com and include an Anti-Aging crème, Skin Repair crème, Skin Brightening crème, Skin Tightening crème, Face & Body scrub, Face & Body masque.
Thursday, August 20, 2015
With age, volume loss occurs in not only face and hands but also the lips. The upper lip lengthens with a drooping of the cupid’s bow. The lips loose volume and become more flattened. This causes the mouth to appear wider and the corners of the mouth droop.
Here’s how it looks:
Filling of the lips is an artform. Too much in the wrong place and one can look ducky. But placed correctly, it gives an instant facelift, giving a younger youthful appearance immediately.
Besides adding volume to the red part of the lip, the upper lip skin needs to be addressed first, as this is where the lift comes from. The lengthening of the upper lip has to be shortened, the cupid’s bow has to be restored and the philtrum rebuilt. After this, the red of the lip can be slightly inflated. It is natural for the upper lip to project slightly beyond the lower lip. The lower lip needs equal attention to match the upper.
Fillers such as Juvederm UltraPlus XC, Restylane, Perlane and Voluma are great choices for lips. They are made of hyaluronic acid (sugar polymer) which is naturally occurring in our skin and is hydrophilic (attracts water). This gives a good plumpness and longevity of at least 1-2 years. We have found that lip fillers tend to hold much longer than fillers applied to other parts of the face. The same is true for under eye fillers, which also tend to last longer than injections elsewhere on the face.
Treatment is performed with a tiny needle. A nerve block or topical numbing can be applied ahead of time. However, I find this is usually not necessary. Many patients don’t like the numb feeling that can persist after a nerve block for a few hours. Topical numbing is not overly effective. Recently a patient who had filler by another physician insisted on topical numbing cream. I told her to try without, and she actually found it less painful with my technique. And, of course, she loved the results! The products we use all have local anesthetic mixed into the formula, providing increased comfort for the patients.
There will be some immediate swelling and possible bruising. This can be minimized by icing afterwards, taking arnica montana tablets, and avoiding aspirin, ibuprofen, fish oil, and garlic supplements prior to the procedure. Most patients, however, love the swollen appearance, and wish it would stay just so! After a few days to a week, the swelling will settle down, revealing new plump lips. If more volume is desired, it can always be added in at this point. I recommend starting with a minimal amount and building up gradually to the final desired appearance. Each patient’s desires and end goals are different and being in tune with that goal is extremely important to achieving the right result for each patient. It is truly one of the most enjoyable and rewarding aspects of my work.
Wednesday, August 19, 2015
Don’t forget about your hands! As we age, our hands may show our age even as we take care of our face, neck and décolletage. The hands become less full appearing, more easily showing veins and tendons. The skin becomes thinner, lending to wrinkling. Brown spots and keratoses (raised spots) begin to appear. It’s important to apply sunscreen and antioxidants to the hands just like we do for our face, neck and décolletage. However, at some point, a little help from a few simple procedures can make a big difference. It’s best to begin when the earliest signs of deterioration are noticed.
To combat plumpness, we can add volume back to get rid of the bony and veiny look. Radiesse is a great choice for this problem. It is especially suitable for injections into the hands. Carefully placed and gently spread through the hands, it adds an instant lift. Recovery time can include some initial swelling and bruising. It’s best to avoid blood thinning medications such as ibuprofen, aspirin, fish oil and garlic supplements for 10-14 days in advance.
Injection foam sclerotherapy is also a great option when the veins are especially prominent. This can be seen even in younger patients and can easily masculinize one’s appearance. Just like superficial unwanted leg veins, hand veins can also be eliminated with injection sclerotherapy or laser vein treatments, though sclerotherapy is usually the first choice.
Laser resurfacing procedures such as Fraxel are wonderful in stimulating new collagen and elastin fibers for frail skin. A few simple treatments and the hands will look refreshed and healthier. Fraxel laser is great for wrinkling and pigmentation. If the brown spots are especially prominent, the Q-switched 532 nm laser works best for eliminate and wipe the spots away. Broad Band Light is also an option that can be helpful when the spots are flat. For elevated brown spots and lesions, other specialty lasers are great at smoothing out the spots.
As the premier cosmetic dermatology destination, we are able to offer 25 different lasers and technologies to help you achieve your goals using the best technology that is best suited and will give the best results for a given problem. We really pride ourselves in keeping ourselves up to date and able to give the best solutions to our patients. All procedures are carefully thought through and administered to give the best results.
We highly recommend protecting your hands early on. Use the same products you use on your skin on your hands. Especially apply an antioxidant serum daily, containing Vitamin C, Resveratrol and/or green tea extract. Sunscreen is great, but it wipes off with handwashing, whereas the antioxidants will give more lasting protection and do not wipe away with handwashing. Our specially formulated organic, chemical free antiaging creams are also an excellent choice. When driving, watch the amount of sun exposure your hands are receiving and try covering with a light scarf. UVA radiation is able to reach through car windows!
Wednesday, February 18, 2015
With Spring and Summer approaching, that means warmer weather and it means more of your skin will be visible as it escapes the confines of winter clothing. For many women, cellulite, veins, hairs and brown spots are common concerns. Fortunately, there are some simple ways to help you enjoy the warmer weather with confidence. Veins can be treated with sclerotherapy or laser, hairs can be zapped away with lasers too, and brown spots do great with, you guessed it, lasers, too.
But cellulite-- how do we deal with the lumpy areas and indentions under our skin? Not even liposuction is overly successful at removing cellulite. Cellulite is a combination of 1) Thinning of the skin-- with age collagen is not as tightly wound up; 2) Overgrowth of fat lobules which poke through the thinned skin—they cause constriction to the vessels traveling through the fibrous septae; and 3) Constriction of the fibrous septae due the overgrown fat lobules near the skin surface. To address cellulite successfully, all three aspects need to be addressed.
We have two methods of treatment. The first are the noninvasive treatments. These include Velashape, Thermage and Exilis Elite. Velashape uses a combination of suction, infrared head and radiofrequency energy to heat and knead the skin. The idea is to achieve localized fat apoptosis, to lengthen the fibrous septae and to stimulate collagen in the skin. When performed diligently by an experienced and dedicated clinician, the results are actually very good. Periodic maintenance after a series of treatments is a good idea to keep the areas smooth. Thermage and Exilis Elite both use monopolar radiofrequency to deeply heat the tissue to induce apoptosis of the fat cells and stimulate collagen in the skin, essentially achieving very similar results. Thermage is an excellent treatment and can be accomplished in a single visit (though a repeat treatment after 3-6 months would yield heightened results), but it is painful. Exilis Elite is performed in a series of 4 weekly treatments. Hydration is very important with all these procedures as well hydrated skin allows for delivery of higher temperatures through the skin for greater efficacy.
The second method are the minimally invasive technologies which include Cellulaze, VaserSmooth, and the latest ThermiTight. With all three procedures, the skin is first numbed using a local anesthetic solution. All of these procedures require wearing a compression garment immediately following treatment for 1-2 weeks and all three follow a single treatment protocol. With Cellulaze, a spagethetti thin canula is threated back and forth through the cellulitic areas to 1) melt and destroy fat cells, 2) pop and break through the fibrous septae and 3) stimulate collagen via heat delievered directly under the skin. VaserSmooth works in an identical fashion, but instead of laser energy, uses the gentler power of ultrasound to accomplish the same three goals. The advantage of VaserSmooth is less disruption to the vessels and nerves, where the laser cauterizes through these structures. Therefore the recovery time is a bit faster with less bruising and less swelling. The third method called Thermitight again accomplishes all three end goals, but utilizes Radiopfrequency instead. The greatest advantage with Thermitight is the strict temperature control of the device both internally and on the skin. An infrared camera is constantly watching the skin temperature to keep it in a safe therapeutic zone and the tiny probe under the skin also allows delivery of exact therapeutic temperatures to effectively destroy fat cells, break through the fibrous septae and tighten the skin. Of all three technologies, Thermitight yields the best skin tightening effects and effectively treats the fat and septae as well. These minimally invasive treatments are perhaps more permanent than the noninvasive options. Recovery time is typically one to two days with return to exercise after 2-3 weeks.
Which method to choose can become a challenge, especially when there are so many great options. The first consideration would be whether a minimally invasive option is acceptable for the patient. If so, VaserSmooth or ThermiTight would both be great permanent treatments. If minimally invasive doesn’t sound appealing and there is no time for wearing a garment or recovery, the noninvasive options are all great choices. The newest of the noninvasive procedures is Exilis Elite. Even though it is a series of treatments, patients prefer the price point and the comfort during treatment (compared to Thermage which can be painful while being administered).
We highly recommend doing some research and then coming in for a consultation for further discussion.
Results from ThermiTight
Exilis Elite Results