Washington DC Medical and Cosmetic Dermatology Blog

My Own Sculptra Story

2012-02-03T12:40:00.000-08:00

Most if not all of the services that we make available to the patients in my office I have used, samples or subjected my friends and family to. If I can’t understand the use or the benefit, how can I explain it to a patient who wants to know what they will get out of it. The world of fillers and antiaging services just got a lot easier for me to share with my patients.

Although I have had a lot of experience injecting patients I was always struck with how enthusiastic they were AFTER they saw the results. In almost every case, they got MORE than they expected from Sculptra. I had had personal experience with other products and so had my patients. I found it always surprising just how thrilled they were when they used the sculptra, even if they had had other products.

I will share my photos with you. I have to tell you that it is kind of hard to photograph the subtle differences in the before and after. My friends and family (and some patients that I don’t see very often) comment on how well I look. Have you lost weight? You are getting younger? Why don’t you stop lying about your age? I have gotten all of these questions since having two sessions of sculptra. These photos were taken before and then six weeks after the second session. Sculptra is like the gift that keeps on giving since it makes your body produce more volume over time.

How painful was it? Not very because my skin was numbed by some very excellent topical cream applied 30 minutes before the product is delivered deep to the surface layer of skin. Sometimes patients bruise but I didn’t really do this (even though I consider myself someone who bruises easily). If bruising does happen, it goes away in a few days and can be covered up with foundation. So far, the men I have treated have not had to do this.

After the first treatment, I waited 6 weeks for the second session. I was planning on getting the third treatment 6 weeks after that but decided that it wasn’t necessary. Any filler can be overdone but I don’t think anyone wants to look like they have never looked before! The idea of sculptra is to replace the volume that is lost from intrinsic aging. This is generally in the temples, the cheekbone region, the crease between the mouth and cheeks (called the nasolabial fold). There are areas that sculptra is NOT to be applied and these include the lips, under the eyes and anywhere superficially. It is a DEEP filler and if placed incorrectly, bumps will form that take a long time to go away.

I am pleased at how subtle it is. As the volume is put back, the skin smoothes out and therefore you look fresher. When the skin becomes more three dimensional, light reflects better so patient tell me they feel as if they are glowing. Now I know what they mean!

A Complete Examination?

2011-12-27T12:18:00.000-08:00

I was surprised last week when a patient whom I had not seen in about ten years came back to the office after having moved out of "driving range" from my office. She told me about seeing a doctor without seeing a doctor. I asked her what she meant.
If you make an appointment to see the doctor and the person who comes in and introduces themself to you is NOT a doctor then I say "buyer beware". To say what happened after this was a disaster is putting it mildly. My message to you is ask if you can see the doctor at some point in the visit. If that is not possible maybe you can ask to come back later or reschedule. This is really important if surgery is planned. Maybe the Doctor would not need to do surgery to find out what the assistant could not diagnose. I would bet on it. You are entitled to get what you paid for.....a doctor visit!

Demand Quality Care !!

2011-12-08T07:53:00.000-08:00

The sad truth is that quality care costs more. If you are spending your health care dollar to see a doctor, then I think you deserve to see a doctor! This sounds simple but what has been happening lately to many people who are UNAWARE of who is sitting across from them in the "Doctors " office is really a shame. You pay your monthly insurance premium to company X. You make an appt to see the doctor for your cold, or gyn checkup or skin exam. When you get to the office the "health care provider" turns out to be a nurse practioner, a physician's assistant or someone who did not go to medical school but perhaps is masquerading as a doctor. Your insurance company gets the bill and it says that you saw a doctor. You didn't! You spent the same dollar, but you did not get the expert. If I went to see a doctor, but the doctor wasn't a doctor or did not come in to see me, I would leave! I think you should too! You are paying for the expert so thats what you should get. Buyer beware, because here you generally DONT get what you paid for if you did not receive treatment from the expert. No, the nurse practioner does not know as much as the doctor. They may call themselves doctors of nursing but, trust me, the training is not equivalent. You all be careful out there!

The Safety of Laser Hair Removal in Ethnic Skin-Pt 1

2011-12-06T12:14:00.000-08:00

I was shocked to learn how often patients are told by misinformed health professionals that "dark skinned people" should not get laser. This is absolutely untrue. It is true that there are important differences in various shades of people. The melanin absorbs the laser light and so it can cause problems if the laser physician is unfamiliar with the settings that are necessary to use for each patient. I also think it is important to see a PHYSICIAN for treatment such as laser when, not know how to use the device, can lead to serious consequences!
Nearly every patient I that I have used the laser on in my 25 years of medical practice has been a skin type 4 or darker. I think these are some of my most satisfied patients because they had been told "it couldn't be done!" Before treatment, we explain the risks, benefits, and alternatives to the laser. We will have more on shaving alternatives in the next blog. Stay tuned!

How to have better nails!

2011-12-06T07:00:00.000-08:00

The dry winter air, from having the heater on, can make it hard to stay moisturized in the colder months. You need to drink more water and pay attention to replacing the moisture on your hands after you wash them. This is really important when you use sanitizing hand gels. They contain alcohol which is potentially drying to the skin and the nails. Use cuticle oil, found in the nail polish section , and apply it to the nail AND the skin around the nail whenever you can.
Your diet also is important. If nails are brittle and fragile, Salem, OR-based Elizabeth Somer, RD, author of Age-Proof Your Body (McGraw-Hill, 2006), recommends consuming iron-rich foods such as black bean soup or the occasional cut of steak. "Iron is essential for the growth and maintenance of the nails and nail bed," says Somer. "If nails are deprived of iron for too long, they can flatten out or curve abnormally." Somer adds that cooking foods in a cast-iron pan can also help increase your iron intake. The iron from the pan infuses into whatever dish you're preparing. I hope this information helps you have long and strong nails this winter!

The Color Divide

2011-11-19T14:22:00.000-08:00

The issue of skin color is still with us, in the era that some people call "Post Racial" America.
A movie will come out this fall produced by the actor Bill Duke, called Dark Girls. I was interviewed by a reporter from WJLA about this topic. Yes, people still come to the dermatologist hoping to find a way to change their overall skin color. Its sad, but true. Here is a link to some of the conversation that I recently had with reporter Jummy Olabanji.
http://www.wjla.com/articles/2011/11/new-film-explores-the-issue-of-skin-tone-69074.html

Give yourself a Birthday gift

2011-11-02T10:35:00.000-07:00

Skin screenings can detect cancer early
Baby boomers who baked in the sun during their youth are increasingly developing skin cancer, with 1 in 5 Americans projected to develop skin cancer sometime during their lives, according to the Skin Cancer Foundation. Early detection and treatment can prevent extensive damage and mortality. Patients should remain alert for asymetrical, multicolored, uneven or large moles or lesions, and patients who do not have insurance coverage can check the American Society for Dermatologic Surgery's website for local free screenings. The best gift you can give yourself is to maintain your health. Happy Birthday to all my fellow Scorpions!

Beware of Brazilian Blow Out!!!

2011-10-18T11:13:00.000-07:00

In todays Washington Post, Health and Science section, there is a front page article on a hot topic in the dermatology offices in this town. If you are thinking it would be great to have silky straight hair without the traditional permanent method, please think again.
There is a popular myth that this is NOT dangerous to your health or your hair. NO it really is.
Scientists will tell you that formaldahyde is not something you should be exposed to as it is a well known carcinogen. Doctors use formaldehyde to preserve the biopsy specimens that we ship to the lab for processing. The morgue uses formaldehyde to process the remains of the deceased. The controversy is this. The Brazilian treatments are unsafe because they become formaldehyde when heated up by the blow dryer or styling wand. Methylene glycol is NOT free of the hazards of formaldehyde....it is dangerous and will cause harm to the person who breaths it. How much is safe to be around? Do you want to take that chance with your body? I urge you curly haired people who want straight hair to at least read this article in todays newspaper and if nothing else, get the STRAIGHT facts on this liquid formaldehyde process. Hair breakage and permanent damage ( remember "Rio" back in the day? Same thing different decade) are nothing compared to lung damage or cancer from inhaling formaldehyde.
http://www.washingtonpost.com/national/health-science/straight-hair-at-what-cost-treatments-using-formaldehyde-may-pose-a-risk/2011/10/07/gIQAgrI8rL_story.html

Rosacea Demystified

2011-09-28T12:56:00.000-07:00

Hello to all of you who might be thinking that you are too old to have acne! Well, Acne Rosacea is a skin disorder that typically gets started in the adult years. It can happen to dark skinned patients although the derm textbooks seem to focus on the fair haired, lighter skinned sufferers. Bill Clinton and Princess Diana come to mind. I came across this link to just about anything you need to know about Rosacea and want you to check this out....

See your dermatologist for the best treatment regimen for your particular stage of the disorder.

Save with Sculptra

2011-09-27T06:26:00.000-07:00

I am often asked by prospective filler patients...."Why choose Sculptra" over some other products that cost a bit less. "Is it worth it?" The reasons for having Sculptra treatments include--

Its lasting effect. The fragile state of our world economy has many people wondering what to invest in. Its always a good idea to invest in YOURSELF. When you look younger you may actually feel younger, more energized and boost your self esteem. Take care to do it for yourself though, not for some other person's approval.

Its gradual onset. You get the first treatment and it gradually causes the volume of space that has decreased ( the wrinkle maker) to fill up again and smooth out the top layer of your skin. It makes you skin appear more radiant since light reflects more. People won't see it, as it will sneak up on you. Sculptra has been called the "liquid facelift".

It costs a bit more but its worth it. When (and if) you decide on a touch up, you'll pay much less that your original investment. Call the office and schedule a free consultation to discuss Sculptra with us.

Lessons learned by health insurance executive

2010-12-27T08:08:00.000-08:00

We need to read this story and pass it to our friends and family. The art of medicine is different from the science of medicine. http://www.bloomberg.com/news/2010-12-24/my-wife-s-cancer-holds-lesson-for-health-care-commentary-by-david-klein.html

Hair Loss 101

2010-12-18T09:40:00.000-08:00

When I write for this blog, it is often because I am inspired by real life events. Today, I am sitting in the hair salon, trying not to eavesdrop on a conversation that is taking place near me!
A client entered the shop. She seems to be new, and gives the owner a detailed account of her problem with her hair loss. Even if I could not hear her words, my eyes tell me what the problem is ( or at least what a significant part of it is). Client X wants to see if she can buy something to "make her hair grow". I get asked this same question EVERY DAY that I am in the office seeing patients.
What client X has in common with my patients , 9 times out of 10, is a pattern of hair care that is detrimental to keeping ones hair on ones head. First, the home permanent. Client X buys something from the beauty supply shop and puts it on. Even if she has advanced degrees in cosmetology, this is not a good idea once you are losing your hair. Stop. Walk away from the perm, even if it is labeled Kiddie Perm Safe For Newborns! It isnt.
Second, Client X seems to enjoy lighter, blonder, bleached hair. When you remove color from your hair you can count on it being weaker and more susceptible to breakage. Stop. Let Tina Turner have the blonde and you go back to being brown, black or some combination of the two.
There is some good, basic information about the common causes of hair loss in all women. I refer you to the American Hairloss Council, via the following link.
www.ahlc.org

Moles Before and After

2010-12-05T14:52:00.000-08:00

BEFORE
AFTER

Every time I see a photo of Morgan Freeman taken in the last several years, I am reminded how much improved the skin looks when the moles, called DPN's are removed. The name Dermatosis Papulosa Nigra described these dark brown, warty growths that can be pinpoint or flat and as large as quarters, usually on the face, chest or back. Patients ask, "Why me?" The answer? Because you were born in your family. These lesions run in families, are genetic and you certainly do not get to choose your family!

The treatment is relatively quick and is done with topical anesthetic if necessary. Usually an ice pack is all that is needed. We dry the lesions with the quick application of an "electric pen" called a hyfrecator. The moles fall off later that day or in several days. No scarring is associated with the treatment if the patient follows the treatment plan....ie doesn't try to make the moles hurry up and fall off by scrubbing or exfoliating. If left alone to fall off slowly, the dpn treatment is not going to cause scars to form.

Ethnic Skin and Hair Care

2010-12-05T14:27:00.000-08:00

Is there a secret formula for taking care of skin of color? I may alone in believing that there is not one secret, but many! As there is no ONE SIZE FITS all solution to the problems that my ethnic skin ( read, non white) patients present with. I mean, havent you ever put a "flesh colored" band aid on after an injury and then wondered whose flesh it was designed for?

I believe that as long as the correct diagnosis is made, then anyone with education and experience can treat skin of color. Yes, diagnoses can present differently in different skin types and the explanation is not always the difference in melanin. If you think only white patients will get skin cancer, then its hard to make the diagnosis when a dark skinned patient has a "funny looking mole". I had a teacher once tell me that there were only two diagnoses I could never make. The one I didn't know about and the one I did not think about!!

It is absolutely necessary to NOT put everyone, brown, black or white into the same stereotypical framework for practicing dermatology. If a patient is concerned about "dark spots" they are probably not going to undergo a treatment that will leave the spots darker afterwords. If a physician ignores the plea for help with the blemishes then that practitioner is likely to lose that patient! The differences are probably most apparent when discussing hair care with patients who straighten their hair. Products that dry the hair more, or require frequent shampooing will not be used and there is a good chance that the patient will seek help from someone who is knowledgeable and experienced with hair that may be breaking due to hair styling methods.

Younger Looking Men?

2010-12-01T21:03:00.000-08:00

It is no longer an unusual day when several new patients are men who "want to look better". While patients of both sexes usually want help with diseases or disorders ( ie non cosmetic issues), it used to be the norm for women to ask for my help with changes in appearance . The man will ask, what can I do to make these marks go away? I used to have acne and I don't now but the scarring is really not attractive so what do I do?
Another frequent question men ask is "what can I do to get rid of shaving bumps"? The answer, if you aren't ready to grow a beard, may be laser hair removal. It takes at least six treatments, spaced 3 to 4 weeks apart. Even if some of the hairs regrow, they are usually miniature versions of themselves (vellus hair) that will not grow inward causing shaving bumps.
The third issue that brings the guys to the office is complexion blending or "getting rid of the dark spots". Darkness caused by hypertension medicines, sunlight without sunscreen can make some people look old before their time. We prescribe creams or make other suggestions to turn back the clock, or at least, keep it from ticking so loudly! I am glad that so many men are trying to look as well as they can for their age. Its really not about the pursuit of YOUTH as much as the quest for being attractive at any age!

Don't sweat any longer..

2010-11-07T05:31:00.000-08:00

It happened again this week. A new patient came to the office after spending WEEKS OR LONGER searching online for help with a disturbing, longstanding problem. He did not know that there was a solution, and that it has been in use for years now.

We dermatologists often take for granted that patients know all the things we can do for them. In fact, some studies have recently reported that many have no idea what the difference is between the dermatologist and all the other people who label themselves "skin specialists".

The dermatologist spends an internship year then three years of residency training after going to medical school. Next, they take a board exam to become certified by the American Academy of Dermatology. This means that they have proven that they received the required training and met the standards to qualify for being "the expert" in diagnosing and treating diseases of the skin ( also hair and nails).

So, back to Botox. You need not suffer the embarrassment of excessive sweating. You can wear a silk blouse, raise your arms to grab the overhead bar on the subway, or take off your jacket during your office staff meeting. Get help with excess sweating in the dermatologists office. Its really that simple.

To find a board certified dermatologist, go to www.aad.org and click "find a dermatologist" in your zip code.

Don't Let the BedBugs Bite!!! From the Washington Post

2010-10-10T14:22:00.000-07:00

I read this article in Sunday, October 10th's Washington Post. Every one needs to read this .

Don't let the bedbugs bite; The little suckers are back

How to check your hotel room bed for bed bugs
Wayne White is a board certified entomologist who works for American Pest in Takoma Park, Md. He shows how to inspect a hotel room bed for bedbugs.
»
By Andrea Sachs
Washington Post Staff Writer
Friday, October 8, 2010; 11:59 AM

If evolution really worked in our favor, bedbugs would be as large as melons, with neon carapaces and a courteous deportment, announcing their presence every time a newcomer entered a hotel room. Alas, the vampirish insects are neither obvious nor polite: They're tiny and reddish-brown like freckles, and masters of subterfuge

*

At hotels haute to low, exposure to the pests can be higher than at home, because of the rapid turnover of guests who act as a private bug delivery service. In addition, the guaranteed food source - see above - encourages the insects to stay. The bed bug-traveler cycle is endless. But it can be broken.

"People need to be proactive," said Joseph A. McInerney, president of the American Hotel and Lodging Association. "This is something that we're going to have to live with for a while."

After a dormant period following World War II, Cimex lectularius is back. In the 1990s, the insects started reemerging in overcrowded urban settings and of late have catapulted to star bugdom status, surfacing in hotels nationwide, in Manhattan retail stores, in Broadway theaters and in other environments that involve numerous people in a semi-somnolent state.

"They're all around," said Wayne White, a board-certified entomologist with American Pest in Takoma Park, who attributes the rise in bedbugs to the uptick in international travel and a shift in pesticide usage. "They're just finally showing up in places that are more public."

In the 2010 Comprehensive Global Bed Bug Study, conducted by the National Pest Management Association and the University of Kentucky, 95 percent of the 1,000 participating pest-management pros said that they had encountered an infestation in the past year, up from 25 percent a decade ago. The experts reported the highest incidences in private residences, followed by hotels and motels, college dorms, various modes of transportation, laundry facilities and movie theaters. In late August, pest control company Terminix released a list of the 15 bedbuggiest cities in the United States. New York, Philadelphia, Detroit, Cincinnati and Chicago filled the top five spots; Washington ranked ninth.
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"We have 3.5 million people in the United States staying in hotels every night, and the number of people bitten is minuscule," said McInerney. "But when it happens to you, it's a big deal."

To learn how to detect and repel bedbugs on the road, I met with White at the company's Takoma Park office, then later in a hotel room where he performed a live bedbug inspection.

At our initial meeting, we sat in a brightly lit room with vials of bedbugs representing the various stages of life, from the dots of eggs to the flat, apple seed-size adults.

White explained that the insects are nocturnal and typically cluster in dark, cave-like shelters, such as the seams of mattresses and the corners of headboards. They are drawn to the body heat, scent and carbon dioxide exhalation of animals and prefer crawling along humans' hairless surface to bushwhacking through fur. They work best in undisturbed areas, such as your bed in the middle of the night, when you are deep (read: immobile) in sleep. Able to crawl 14 inches in five minutes, the bugs will travel for food, crossing the room for a meal. For greater distances, they rely on hitchhiking in luggage, shipping containers and your child's Teddy bear.

"The more you travel," said White, "the higher the likelihood that you will bring them home."

To help you avoid unwanted souvenirs - red welts and/or six-legged stowaways - White laid out a multipart strategy that covers the before, during and after periods of your vacation. The battle against bedbugs starts now.

Before your trip

Video

How to check your hotel room bed for bed bugs

Wayne White is a board certified entomologist who works for American Pest in Takoma Park, Md. He shows how to inspect a hotel room bed for bedbugs.

» LAUNCH VIDEO PLAYER

Prevention starts at home. Even if you've never seen the bugs in your boudoir, White recommends sealing your mattress and box spring in clear plastic or vinyl coverings. Choose a mattress model without handles or seams, eliminating hiding spots. Major retailers such as Walgreens and Sears sell the encasements. He also suggests placing the legs of the bed inside an insect interceptor, a ringed plastic saucer that creates a slippery surface as treacherous as Everest after an icestorm. The container traps the bugs so that they can't venture north to your mattress.

"This will help you inspect and detect the problem," said White. It will also stanch migration from your house to the wide, wide world.

Also, before booking a hotel, check the Bed Bug Registry (bedbugregistry.com) for reports. A recent submission for the Trump Plaza and Casino in Atlantic City, for instance, stated, "Got bit to death here."

At the hotel

Before sniffing the toiletries or perusing the minibar, conduct a bed inspection. Prep your station: Slip on disposable plastic gloves and keep a strong flashlight at the ready. A magnifying glass with LED illumination will also come in handy; the eggs are pinprick-small.

Start with the headboard, a favorite hiding spot. Many hotel headboards aren't attached to the bed but hang on brackets like a utilitarian piece of art. Lay the piece on the bed and inspect the wall for the telltale signs of infestation: black specks (the - ick - fecal matter), molten sheddings (like pencil shavings) or the bugs themselves (in their various stages of life). Also scan the corners of the headboard.

If the board does not disassemble without heavy machinery, run a piece of white paper (try the breakfast-order card) along the wall and board. The idea is to scrape up some bugs or force them out of their redoubt.

Now, it's time to attack the bed.

Start with the duvet and the sheets, studying them top to bottom before pulling them back to reveal the next layer. Inspect the seams, edges and any puckering sections of fabric. Fortunately, most hotels dress their beds in snowy white linens, so the bugs will stand out.

Rather than tearing off the sheets, fold them in the middle - the easier to remake the bed. When you reach the mattress, remove the cover, paying special attention to the folds, seams, piping and other sneaky hideouts.

Next, slide off the mattress and inspect the box spring. (If it's too heavy, push it aside enough to expose as much of the bottom foundation as possible.) Check the underside, and don't forget the corner protectors (if they are opaque, peel them off). "Take the box spring out of the frame and look around the base," advises White. Because of their claws, bedbugs prefer fabric they can cling to, but scan the metal frame just in case.

Finally, remove the dust ruffles or, if they're stapled to the bed, flash your light in the folds and along the edges.

At this point, your bed will look as if it has been mauled by a mercurial Sandman. But on a more positive note: If you haven't uncovered any evidence of uninvited guests, they're most likely not inhabiting your lair.

"If I hadn't found anything on the headboard, mattress, box spring or frame, I'd end the inspection," said White. "I'm not gonna spend an extra hour worth of my time."

However, if you're especially concerned about bites (about 50 percent of people break out in itchy welts; the other half have no reaction) or are an entomophobe, broaden your search to the outlying furnishings. Look in the drawers of the nightstand, for instance, among the creases of the curtains and deep in the closet.

If you do find evidence, go to the front desk and ask for a room change. Also, inquire about the property's pest-management plan. If they don't have one, the whole hotel could be infested. Start racking your brain for the name of that hotel you passed right off the exit.

If you agree to a reassignment, avoid the rooms adjacent to and across from your original one, as well as those on the floors directly above and below it. It's also within your rights to ask the manager to conduct an inspection of your new room. Use this downtime to toast your CSI-caliber skills.

Unpacking and storage

The worst place to keep your clothes is on the bed. The bugs will take one look at those soft warm piles and think, "Our upholstered chariot awaits."

Create some distance between the bed and your luggage. Store your bag atop the armoire, for instance, or in the main room of a suite. Avoid the luggage rack, which White calls "a way station" for bugs, because of the constant transference of guests' bags. The middle of the room is also preferable to the periphery.

To really safeguard your belongings, slip your luggage into a plastic or vinyl cover, preferably one with a small-toothed zipper (harder for them to slip through) and a latch to secure the closure. Avoid products with seams and handles, which bugs can burrow into. Another option: Store your clothes in Ziploc bags. You can keep them in your luggage or in the bureau, just remember to always zip that loc after use.

The closet is also a potential hazard, thanks to those dark, cozy corners. If you want to leave your shoes on the floor, encase them in sealed plastic bags. For clothes that need to stay vertical, hang them on the shower rod. The bathroom, with its slick surfaces, is a veritable safety zone. In fact, if you really want to outsmart the bugs, sleep in the tub and stash your clothes in the sink.

After checking out

Whether you're returning home or moving on to another hotel, it's wise to hit the laundry room - the dryer specifically. Bed bugs can't survive the heat.

White suggests tossing your clothes into a dryer set on low or medium. Let it spin for 15 to 30 minutes and don't think about what the lint basket might catch. (Washing, by the way, won't do the deed: 33 percent of bedbugs and a whopping 98 percent of eggs survive a normal cycle.) In the heat of summer, you can also leave your bag roasting in the car. A road trip they'll never forget.

Once home, leave your suitcase in the garage and store it in a large leaf or garbage bag between trips. If you are a frequent traveler, you might consider the PackTite, a portable heating unit that disinfects your luggage and its contents. The more DIY method is to toss your belongings in the dryer, and rest assured that those bed bugs' traveling days are not just numbered but over.

For more information on bedbug prevention: www.pestworld.org or www.ahla.com.

Sauer's Manual of Skin Diseases

2010-08-23T13:13:00.000-07:00

Just published, this tenth edition of Sauer's Manual of Skin Diseases, is a handy reference for students of dermatology and practioners of other medical specialties who need a quick reference guide to look up conditions that they may not be familiar with. Dr Beverly Johnson and Dr Cheryl Burgess collaborated on writing chapter 35, titled Skin Diseases in Ethnic Skin. This important topic was included in the textbook in order to teach students of dermatology to recognize differences between white skin and ethnic skin. The phrase "Skin of Color" has been though to refer primarily to black skin. In the US, individuals with pigmented skin come from a variety of racial and ethnic groups. The diversity of ethnic and racial groups makes it necessary for chapters like ours to be included in comprehensive textbooks. We not only want to serve our patients, but our goal is to train the doctors who will take care of the other 99 percent of the population that never makes it to our offices!!!!

From the Inside Out

2010-06-06T09:22:00.000-07:00

Thank you, Dr Oz, for making this subject easily digestible for the average person. Who doesnt want to look younger, feel better, live longer and healthier? In his book, "You:On a Diet", the authors Dr Mehmet Oz and Mike Roizen discuss the Five Food Felons which we should all be trying hard to live without. 1. Saturated fat (meat, poultry skin, palm and coconut oils) 2. Trans fats (see snack foods and commercial desserts 3.Simple sugars 4. Added sugars including syrups 5. Any grain that is NOT a whole grain.

The best diet for all of us starts with fruits and vegetables. No, you cannot get enough. We need to consciously add an extra serving each day. You might not already know that the soluble fiber in some fruits and vegetables escorts cholesterol right out of your clogged arteries through your digestive system (pears, apples, eggplant to name some of my favorites).

Don't try to eliminate all fat (impossible, then you feel bad for failing). Instead, replace it with GOOD fats found in avocados, nuts olive and seeds. They reduce the LDL (Lousy fat) with HDL (Heart healthy fat). Can we learn to love nuts instead of potato chips? Or, use avocado instead of mayonaise? I'm trying!

So what does this have to do with the skin? Eating healthy should be as much of a pursuit as making yourself look younger is!

Enjoy this season of readily available good food.

Another reason to skip the sodas........

2010-05-05T11:49:00.000-07:00

Phosphate consumption may accelerate signs of aging

30 April 2010

FASEB J 2010; Advance online publication

MedWire News: High phosphate levels act to accelerate signs of aging such as skin atrophication, show results from a study in mice.

The researchers believe this finding could be important as phosphates are routinely added to processed foods and soft drinks.

“Soda is the caffeine delivery vehicle of choice for millions of people worldwide, but comes with phosphorous as a passenger,” said Gerald Weissmann, Editor-in-Chief of the FASEB Journal and Professor at New York University School of Medicine, USA. “This research suggests that our phosphorous balance influences the aging process, so don't tip it.”

Mohammed Razzaque (Harvard University, Boston, Massachusetts, USA) and Mutsuko Ohnishi (Nagasaki University, Japan) investigated the affects of phosphates on aging in three groups of genetically modified mice.

The first group lacked the klotho gene, causing them to have a toxically high level of phosphate in their bodies. The second group lacked both the klotho and NaPi2a genes, which led to the mice having substantially reduced phosphate levels. Finally, the third group was genetically the same as the second group but was fed a high-phosphate diet.

The klotho^- mice only lived for 8 to 15 weeks and displayed many signs of premature aging, including atrophy of the skin, skeletal muscle wasting, emphysema, and osteopenia.

The low phosphate levels in the klotho^-, NaPi2a^- mice seemed to result in significantly reduced signs of premature aging compared with klotho^- mice. These mice had normal reproductive ability and body weight, and had reduced atrophication of skin and other organs, as well as suppressed ectopic calcifications.

Interestingly, when the third group of klotho^-, NaPi2a^- mice was fed a high phosphate diet, signs of premature aging re-appeared, suggesting that phosphate toxicity is the main cause of the premature aging symptoms seen in klotho^- mice.

“The results of our dietary and genetic manipulation studies provide in vivo evidence for phosphate toxicity accelerating the aging process and suggest a novel role for phosphate in mammalian aging,” conclude the authors in The FASEB Journal.

They add: “The mechanism by which phosphate toxicity accelerates the aging process requires further study.

“It is likely that high phosphate exerts its cytotoxic effects to compromise the physiological functions of various organ systems.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Which laser is safest for skin of color?

2010-04-14T19:00:00.000-07:00

I get asked this question by a lot of patients... The real answer is really the laser that is being used by a persn who KNOWS what they are doing! Seriously, you can take a great technology and not understand how to use it and disaster happens. Before you sign up for laser treatments, ask your board certified dermatologist or plastic surgeon if they have had actual experience with skin of color. I know that the laser companies will swear that something is safe but they don't always have the studies to back up those claims.

The first laser that I brought into my practice is still my workhorse. It has stood the "safety test of time". The N Lite laser is a HeNe pulsed dye laser that is safe for most if not all patients. It doesn't require a separate cooling device. If the patient is in pain, then the setting is adjusted to a gentle "ping", less than getting popped by a rubber band. The treatment serves to stimulate collagen in the dermis, so it is great for filling up gently sloped scars (not the ice pick type) and fine lines and wrinkles. The treatment stops at the eyelids so its not going to take the place of an eyelid lift (blepharoplasty). The skin gets fuller, tighter and smoother. Of course the results vary but most patients are extremely satisfied. This is a "no downtime" or lunchtime procedure that takes about 15 minutes for the face and neck. The best results come with a series of at least six sessions given a month apart. What happens to the new collagen? It actually behaves the same way as your own original....it is subject to the normal aging process so ideally you would get maintainence treatments further down the road. The gradual improvement that happens with 3 to 4 week interval treatments peak at about 4 months. I wouldn't bother with this if you are a confirmed smoker who won't use sunscreen and loves to tan...would be a complete waste of your time and mine! The rest of you would look a bit more rested and smooth, especially if the treatment is combined with some personalized skin care. Please call the office and ask for a free consultation for N Lite laser treatment.

What's New? Sculptra!!!!

2010-04-09T13:09:00.000-07:00

While this product has been in use for a long time, it has been recently given FDA approval for use in cosmetic patients who want the youthful appearance of a fuller, rounder face. I have seen it in practice and the fabulous results that can only come from using this injectable filler. The good news includes its longevity, its safety and its subtle onset. Its been called the "liquid facelift" that appears gradually so that your friends won't really know that you have "had anything done". It is mostly water when first injected. In fact, we have to mix it days before you come in for your treatment session. In the first day the result is a temporary restoration of volume since it is mostly the water we used to reconstitute the product. Within a day, the water is absorbed and the Sculptra ( poly L lactic acid... ) is left behind to stimulate your own collagen and support substance to take the place of the missing volume. I know that this is hard to image, but take a look at the photos on the company website to see the GRADUAL progression. If needed, you come back for a second session and this is when you really begin to see what your final result will be. The third session is two months after the second session. Patients with HIV who have lost a lot of facial volume from the disease treatments will usually get more treatment sessions than the healthy, cosmetic patient. Take a look and see what Sculptra can do. It isn't for everyone. Some patients who wish to look more rested and less aged, can do this with Juvederm (hyaluronic acid) or Radiesse (calcium hydroxylapatite) and don't really have the volume loss that Sculptra is made for. My experience has been that it is a fantastic product for the properly chosen patient. Call the office for a free consultation to see which one is best for you.

Fill her up fast!

2010-03-01T05:59:00.001-08:00

Fillers are a group of product often used to make wrinkles less noticeable. They can also correct asymmetry of the cheeks or other areas.

The best thing about using fillers is that you see the result IMMEDIATELY. Patients can ask for more product at that point if they desire it. See how the right side was smaller in the photo on the right?

Doctors have a variety of products to use to fill the midface volume that is lost as we "climb the ladder of life". When our table (midface volume) gets smaller but the tablecloth (the skin) stays the same size then sagging or wrinkling appears. The youthful face is round. Light reflects better and patients tell me they feel as if they are "glowing" after the filler procedure is done. It is also relatively painless because the product is mixed with local anesthesia. I think this photo shows clearly how you can improve the appearance of the facial skin when you "pump up the volume".

These Eyes Have IT!!!

2010-02-25T17:43:00.000-08:00

Maybe you have eyelashes like this naturally. I'll bet that you don't. When I see thick luxurious eyelashes such as these in a "woman of a certain age" who is NOT wearing any makeup I am sure of this: she either has glaucoma or she is using Latisse by Allergan.

If you have glaucoma then you use eyedrops that the eye doctor prescribes to keep your pressure in the eyes normal (and prevent blindness caused by having eye pressure that is too high). Glaucoma runs in families so if you know its part of your heritage, please do yourself a favor and have your eyes tested. One of the effects of the glaucoma medication is the effect on the lashes! They become longer, thicker and darker.

Thanks to Allergan Pharmaceuticals, the company that tested this application (making the lashes look fabulous WITHOUT having any effect on the eye pressure of normal individuals), you can get lashes like this without having glaucoma and getting drops in your eyes.

The product is used along the eyelid margin, and is applied much like you would apply eyeliner. You only need to apply it to the upper lid before bed. In no time, the lashes look like the ones shown in this actual patient. You have to get the Latisse from your dermatologist. It isn't covered by insurance because, although it is a prescription drug, its not being used for medical purposes. If you like what you see, as about Latisse during your next office visit.

The Vitalize Peel before and after

2010-02-04T10:23:00.000-08:00

The weather channel is predicting record snow this weekend. I really want to stay on track with this blogging task so I am giving you my very own before and after photos and describing the process.

One week ago, I had my very capable assistant, Mrs C. Benjamin, give me the "chemical peel". We do this periodically to train other staff and basically I needed one!

After washing my face, she applied the three step Vitalize peel which I find is very well tolerated by most patients. It is not the strongest peel we use, but it is good for mild acne (seen on my face) and some hyperpigmentation. At the end of the peel I held the electric fan near my face for about a minute, which is about how long it stings. Next, she applied the sunscreen and my face felt completely normal. Approximately two days later I began to look as if a mild windburn had happened only on my chin. I was able to cover this with extra moisturizer. This second image is my face one week later. Clear skin. Just in time to put on my ski mask and shovel the driveway!! Just kidding. I should get some help with the driveway....

The Amazing Cucumber

2010-02-03T06:42:00.000-08:00

This information was in the New York Times several weeks ago as part of their "Spotlight on the Home" series that highlighted creative ways to solve common problems. I have selected the ones that pertain to your health.

1. Cucumbers contain most of the vitamins you need every day, just one cucumber contains Vitamins B1, B2, B3, Vitamin B6, Folic Acid (so important for EVERYTHING), Vitamin C, Calcium, Iron, Magnesium, Phosphorus, Potassium and Zinc.

2. Feeling tired in the afternoon? Put down that caffeinated soda and pick up a cucumber and get a quick pick-me-up that can last hours.

3. Want to avoid a hangover or a terrible headache? Eat a few cucumber slices before going to bed and wake up refreshed and headache free. Cucumbers contain enough sugar, B vitamins and electrolytes to replenish essential nutrients that the body lost, keeping the equilibrium that will defeat a headache and a hangover!

4. Stressed out and don't have time for massage or a visit to the spa? Cut up an entire cucumber and place it in a boiling pot of water. The steam creates a soothing, relaxing aroma that has been shown to reduce stress in new mothers and college students during final exams!

5. You didn't bring your gum or mints to your business lunch? Take a slice of cucumber from your salad and press it to the roof of your mouth with your tongue for 30 seconds to eliminate bad breath. The phytochemicals will kill the bacteria in your mouth that are responsible for causing sour breath.

Pass this blog along to everybody you know who could use this information!

Is it true, Dr House??

2010-02-03T05:20:00.000-08:00

Many of you may have seen the episode of House that aired on Monday night. There was an African American football player who was sick with some bizarre symptoms as is usually the case on that show. Dr House is right on the money with his assessment of this patient. Do blacks get skin cancer? Absolutely. Is it usually on the palms and soles? Yes it is! We are talking about Malignant Melanoma which is the most deadly type of skin cancer. For reasons that aren't clear, the incidence is increasing at an alarming rate. It affects the white skin of darkly pigmented persons ( ie the palms and soles). When I see a brand new patient in my office, I offer them the opportunity to get a complete skin exam. It doesn't cost any extra, its just the way we get to know our patients . Many times we find something that the patient is not aware of ( eczema, infections, contact dermatitis and yes even skin cancer). I had a plastic surgeon colleague, now retired, whom I used to send a lot of my patients to when their skin tumors were too large for me to deal with in the office. He joked that I was a "cancer magnet" because I found the tumors that no one else did. When patients were reluctant to get completely undressed, I could usually get them to at least let me look at their feet and hands.

The only part of the tv show that did not really ring true was the end of the story. I think that symptomatic patients like the football player have metastatic disease which is not really compatible with long life. Cutting off his toe won't mean that his liver, brain etc will snap back to normal. Science is making strides with metastatic melanoma though. Clinical trials of new drugs are showing a lot of promise and vaccines are being developed. The last point we need to get out to folks is that this diagnosis should prompt every doctor and patient to inform their first degree relatives to get checked. Melanoma runs in families. For more information go to the American Academy of Derm website and look for "Information for patients".
http://www.aad.org/

News You Can Use

2010-01-22T18:39:00.000-08:00

I just returned from the Orlando Aesthetic Dermatology conference which took place at the Peabody Hotel in Orlando, Florida. For three warm days and nights, the thought leaders in the cosmetic and medical fields gave us a lot of new information to help our patients get the best results for the things that often arise in practice.
A great result depends on the doctor giving an honest assessment to the patient as to what is possibl:e and realistic. The buzzword now is "volumizing". With the current fillers such as Radiesse (my particular favorite), Juvederm and Sculptra, we try to turn back the clock to the time when our faces had a fuller appearance in the cheeks, the jaw and even the lips. If you imagine a table and a tablecloth covering it ( your skin over your skeletal frame). As we age, the table gets smaller but the tablecloth does not! The folds around the mouth ( the "parentheses") should not be injected with filler. Instead, the cheeks are plumped up in a subtle way so that the skin no longer has the same parentheses! You can watch faces and see how this happens. Observe Grandmother and Mother and Daughter in the family photo and you will see what happens to the face as we "climb the ladder of life".
So we all strive to put our best face forward. The key is OUR best face, not someone elses! There were some awful pictures shown as examples of "What Not to Do". The Before pictures were normal but the After views were scary! A lot of new information was available about product ingredients and whats really helpful (vs what is just marketing hype). While the conference was mainly geared to teach new derm residents about the cosmetic practice portion, it served as an update for the more seasoned practictioners. I am inviting all of you blog readers to make an appointment for a free cosmetic consultation this next month. Just mention ORLANDO when you call.

Feel Good Friday Cosmetic Seminar

2010-01-07T10:28:00.001-08:00

In December we hosted the latest in our series of Feel Good Fridays. Thanks to the generosity of Allergan and Bioform Medical, I was able to invite some of my favorite patients (send email if you want to be included in the next one) and some lucky individuals were chosen to receive free treatment . These beautiful people consented to have the rest of the guests watch and see just how simple the treatment was. Before got started, everyone shared some good food brought to us by Bioform (the makers of Radiesse). Thank you , Rebecca Merchant, for all of your support every time we have these seminars!

First we had a demonstration of Botox Cosmetic, injected into the frown lines between the eyes. It didn't take long for everyone who came to see how quick, and painless the injections are.

I could hear the sighs of relief when the guests who had never seen Botox injected before saw that the demonstration was so easy. No more fears of the needle, which is smaller than a sewing needle!

Later, we also "gave away" a filler to the person who was willing to let everyone watch her treatment. The Before and After are better seen in the gallery photos on our website.

The final demonstration was facial mole treatment. The tiny brown dots on the skin below this beautiful lady's right eye? They are gone now. It takes a few days for the treated moles to fall off. No scarring. No downtime.

Make sure you send your email to us at info@skinhairnails.com if you want to be included in the next Feel Good Friday seminar!

Skin Tone Alert!

2010-01-07T08:21:00.000-08:00

Skin tone, coloration seen as most obvious signs of aging.

The UK's Daily Mail (1/6) reported that "skin tone," and not the lack of wrinkles, "is apparently much more important for a youthful complexion." After taking "high-resolution digital images of 170 women between the ages of 11 and 76 and" showing "them to members of the public" who were asked to guess the women's ages, Procter & Gamble researchers concluded that "those in pursuit of a fresh-faced look might be better off ditching the anti-wrinkle creams and concentrating on the condition and color of their skin instead." A major clue to" the "perception of age" is how even or uniform your complexion is.

As the cold weather keeps us inside, now would be the best time to invest in yourself. Our office provides state-of-the-art treatments for the uneven complexion you see as you age. We have chemical peels, microdermabrasion and pulse dye lasers for the refinement of your complexion.

Thankful

2009-12-21T11:04:00.000-08:00

Back in the kitchen this morning instead of the office. If there is another way to cheer up a hungry family, I don't know what it is. Smell the baking bread...doesn't matter if it made in the bread machine. I am all about the Ease of Preparation. Martha Stewart does not have to worry about me applying for her job. I was really ready to sit back, relax and read the Washington Post ( or at least do the crossword). Suddenly, a steady drip drip drip from the window frame...not the window. So what can you do about melting snow on the roof coming into your house? You can call the guy who cleans the gutter. Instead of declaring that nothing can be done just now, Mr Jack Spenser and his crew showed up within the hour and climbed up ladders and poured hot water on ice dams and repaired the drain situation! Whew. It stopped raining inside. I am so thankful for them that I gave them one of the tins of christmas cookies fresh out of the oven. When trouble finds you , you always find out who you can count on. I also find that most people are happiest when you feed them!

Winter Skin Tip Number Two: Let the dishwasher wash most of the dishes or else wear thick yellow playtex gloves. Your nails will grow and your skin will feel better.

In the kitchen in the Blizzard of 2009

2009-12-20T20:17:00.000-08:00

I am sure that you, like everyone else on the east coast, was forced to take five and stop the crazy pace of life during this holiday season. Thank you for the vacation. I really needed it. This photo of my neighbors treelights was a welcome view from the front window. One of the great discoveries for me was a movie on the On Demand tv menu ...Julie and Julia. I really enjoyed this movie! If you are anything like me, then spending two days in the house means spending at least one of those days in the kitchen. No, I cannot claim to cook like Julia Child but at least now I understand what blogging is all about!!!! The movie was fun to watch because when has Meryl Streep ever disappointed??

I found myself thinking about the folks who like to find other things in their kitchens like home remedies for skin ailments. Some recent ones I have heard: coconut oil for acne (no, no, no no!), shea butter for anything ( probably wont hurt, probably wont help) and, most dangerous of them all, putting chlorine bleach directly on skin that is itching. Sorry, but I can't condone any of these things, even if Grandma gave it the OK.

Welcome!

2009-11-14T12:53:00.000-08:00

Hello to you all out there. I am a baby boomer who doesn't tweet, or facebook but I shall blog right here and now. Please let me know what is on your mind and I promise to do the same. The newly redesigned website is up and running thanks to Yonat Lurie and J.S. Rum and Company in Bethesda. Very easy to work with and I recommend them highly.
Winter time is the time there never seems to be enough lotion at hand! Its cold and dry and we turn on the heat which makes us even drier. My tip for you today is to ALWAYS PUT THE LOTION ON WHEN YOUR SKIN IS DAMP. It seals in the lost water and your skin will remember it.