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Collagen Induction Therapy

18 Sep

 Although not a new technique, this skin care treatment is certainly the hottest trend right now.  This procedure, also known as Micro-Needling, is clinically-proven for treating aging, pigmentation, and scar tissue, and recently, stretch marks.
This minimally invasive procedure uses a sterile, automated, micro-sized needle device system to build up the connective tissue in the lower skin layers (dermal layers) while keeping intact the protective layers of the skin (epidermal layers).  In fact, CIT is the only skin rejuvenation treatment to target and regulate all 3 skin cells (keratinocyte, melanocyte and fibroblast) without compromising the integrity of the epidermis.
Controlling the depth, angle, pressure, and speed of the needle is imperative to the safety and outcome of the treatment, and cannot be done effectively with manual rollers (dermal rollers).

How Does It Work?
Collagen Induction Therapy works by creating a controlled “injury” to the skin, resulting in a systematic interaction of complex cellular events.  In order to work effectively, the mechanical stimulation of the dermis must activate a wound healing response, but the wound must close quickly or scar tissue will form.
 CIT can penetrate the skin anywhere from 0.5 mm to  2mm depending on the depth of the skin condition needing remediation.  The skin bleeds slightly but for only a short period (seconds).  When the dermis is penetrated by the needle, the skin activates the complex cascade of growth factors that eventually result in collagen production.

By inducing the healing response system in a controlled manor, scarless healing and normalized collagen structures result.  The growth factors released stimulate regenerative healing (collagen forms from the base upwards) resulting in type III collagen or healthy collagen as opposed to the growth factors released when the epidermis is damaged by ablative or heat methods, which result in cicatricial healing (collagen forms from the top down) and is type I collagen or scar collagen.
As the collagen matures and remodels, it tightens the skin.  A thickening of the epidermis by as much as 40% has been observed.
Because there is no heat involved in the process, there is a low risk of post-inflammatory hyper-pigmentation, making it safe for all skin types.

Enhanced Product Penetration
The “wounds” created by the needles also act as channels through the skin layers, and therefore a product will penetrate deeper into the skin when applied topically.  Large molecules that cannot typically pass through the epidermis alone, such as hyaluronic acid, will penetrate very effectively through the channels.
Although channels should close 15-20 minutes post-treatment, it is imperative post-care involves using ONLY the topical products instructed by the provider to avoid any reactions.
This makes a great treatment with Platelet Rich Plasma…. Blog coming soon!

Micro-Needling VS. Alternative Treatments

This system has many benefits compared to other more invasive and painful treatment options.

  • Reduced risk of hyper-pigmentation and scarring therefore safe on ethnic or dark skin.
  • Suitable for thin and sensitive skin.
  • Can be done on areas of skin not suitable for laser or peels.
  • No line of demarcation between treated and untreated skin, as usually occurs with other resurfacing procedures.
  • Regular activities can be resumed within a few days, depending on the depth of penetration of the needles.

Basically, it was so impressive that after reading about it and seeing it done on a surgical scar, I tried to buy it an hour later.  It’s been the longest three weeks of my life.  😒.  But my new employee HAS a micro-needling system.  So for your viewing pleasure…. I had it done (and I skipped out on Pure Barre I wanted to do it so bad!).  (Also… I was planning on going to the Container Store… As I mention in the video–totally worth it!).


Although I am very red in the video, by the time I left the office it only looked like a slight sunburn.

A few hours later my face peeled like crazy.  I was sloughing off layers of skin while I applied hyaluronic acid.  I thought I eould continue to peel, and didn’t immediately take a picture.  By the time I woke up the peeling had subsided.

Not everyone will experience peeling, but if you do, don’t pick at it!

Post-procedure care 
It is imperative patients follow post-care instructions after professional Collagen Induction Therapy.

  • You cannot go in the sun for 24 hours and you have to wear sunscreen.
  • In the case of acne scars, after the skin needling procedure, the face should be cleaned with a gentle cleanser before bed. The next day, the face may be cleansed and makeup, lotions and other topical products applied as instructed.
  • Rejuvenation of skin may be seen as soon as 2 weeks and as long as 6-8 months after the medical procedure.
  • Burn scars are slow to respond. It can take up to 6 months to 1 year to see the final results from a single treatment.

For more information…. Stay tuned!

Post Treatment Day 1


  

Patients have been thrilled with this treatment.  For more information, A Girlfriends Guide to Vampire Facelifts a first hand account from Kim as she describes her treatment with me.

Aesthetic Consultation: Botox and Fillers

25 May

What to ask for and expect during consultations for Botox and fillers. consultation video

Sun Block and Photoprotection

29 Apr

Everyone should be wearing sun block. But is that enough?

Prolonged unprotected sun exposure damages cell DNA. Not only does this result in premature aging, but can also cause melanoma and other skin cancers. I am a HUGE believer in wearing sun block (and not just in your make-up… that really doesn’t count).

When Buying Sun Block

If you’re not wearing it year round (which you should be), you should replace your sun block every year. Products can break down from heat exposure and from not being stored properly. It’s worth doing. You want to make sure you’re getting the best protection you can. Check your bottle for the following:

  • “Broad Spectrum” (protects from UVA and UVB light)
  • SPF 30 or higher
  • Zinc Oxide or Titanium Dioxide (physical blocks)

For more on sun block read It’s Sunny Out! (A Post in Honor of Sun Block).

Avoiding White Residue

I know people hate the white residue you get from zinc oxide or titanium dioxide, but these ingredients really are the best for sun protection. If you don’t like the white residue on your face, consider either buying a tinted SPF or buying a product that has a micro-ionized formula (smaller particles). I’ve found people really love SkinCeuticals Sheer Physical UV Defense SPF 50. It’s really light weight, doesn’t smell, and doesn’t leave a residue. The product retails for about $34, so it isn’t super expensive either.

C E FERULIC

While on the subject of SkinCeuticals products, and sun block, I have just started using their C E Ferulic serum. C E Ferulic contains ferulic acid, an antioxidant that doubles the synergistic benefits of C E – neutralizing free radicals, building collagen, and providing improved antioxidant protection. No other antioxidant technology has been shown to deliver comparable levels of photoprotection. This product has won multiple awards including:

  • Allure Best of Beauty Three-Time Award Winner Category: Best of Skin Care – Serum
  • InStyle Editor’s Pick – 2011 Best Beauty Buy Best Antioxidant Serum
  • NewBeauty – Beauty Choice Award The Best Anti-Aging Antioxidant Product

Although retinol (Every Woman Should Own A Retinol Product.) and sun block are the only topical products proven to prevent fine lines and wrinkles, I think a good anti-oxidant is almost equally important. For those of you who prefer not to use a retinoid in the summer months, C E Ferulic is definitely a good product to add to your beauty routing; it is outstanding in conjunction with sunscreen!

**Products can break down if not stored correctly (like I said before) and pharmaceutical grade products like C E Ferulic should never be bought online. Just like it’s worth it to buy new sun block, it’s also worth the few extra dollars to know your product wasn’t exposed to extreme temperatures, tampered with, or expired. Talk to a medical aesthetician if you’re interested in learning more about C E Ferulic!

Why Is Photoprotection Important?

Photoprotection is a measure of a product’s ability to neutralize free radicals and protect against oxidative stress (which can be caused by UV rays). Oxidative stress leads to premature aging, hyperpigmentation, and loss of elasticity… my three biggest fears!


Recent Studies Reveal We May Not Be As Protected As We Think:

  • People don’t apply enough sunscreen to achieve full SPF. Real-life application of an SPF 20 sunscreen yields an SPF of only 3 to 4.
  • Even when applied properly, sunscreens only block 55% of free radicals.
  • Considering what we now know about sunscreens, photoprotection is more important than ever.

The sun is stronger than it used to be, and protecting your skin is not an option. It’s time to add an anti-oxidant to your daily skin care regiment!


XOXO, LK

Clarisonic;

6 Jan

I have heard many praises about the Clarisonic. In fact, I have NEVER heard anyone say anything but how much they love it. I was so excited when we did an in-service with the Clarisonic Rep. I am so impressed by this company! I copied the “Overall Rating” on this product from their website, which reflects everything I’ve heard on the streets.

Overall Rating


4.9 / 5

Works well with cleansers


4.9 / 5

Durability


4.8 / 5

Ease of Use


4.9 / 5

Effectiveness – Skin Appearance


4.8 / 5

Effectiveness – Skin Texture


4.8 / 5

961 out of 974(99%) customers would recommend this product to a friend.

**I will be recommending this product to every person I know!

What is Clarisonic?

The Clarisonic uses sonic frequency of more than 300 movements per second to clean, soften and smooth skin. It should be used as part of a daily skin care regimen (which should also include retinol and sunblock!) to provide smoother feeling and looking skin.

It is ideal for all skin types, and used and recommended by leading dermatologists and cosmetic surgeons. Most importantly, it is recommended by me!

Benefits of Clarisonic

  1. Cleanses Better

Sonic cleansing is the essential first step in a healthy skin care ritual (using proper skin care products is also very important. The Clarisonic comes with its own skin care cleanser, but I love my Image Cleansers, so I used Image Ormedic Cleanser instead).


  1. Healthier Skin

Using Clarisonic Sonic Skin Cleansing Systems helps to remove impurities and clear pores. Sonic Cleansing Systems are a gentle, natural way to cleanse your skin.  I suspect even the “natural” people in Brookline and Cambridge are loving this system. If I had to do the holidays over again, I would just purchase 20 Clarisonics. Perfect gift for ANYONE!

  1. Gentle

Sonic cleansing is a natural way, but effective, way to thoroughly cleanse all skin types — even skin affected by complicated conditions such as seborrheic dermatitis, rosacea, and acne. It is so gentle it can be used twice a day.

  1. Enhances other Products

Without proper cleansing, pollutants, oil and bacteria accumulate on the skin, clogging pores and causing blackheads, blemishes and dullness. This prevents your pharmaceutical-grade skin care products from performing to their fullest potential. I am obsessed with using good skin care products, and getting “the most bang for your buck.” The Clarisonic absolutely helps accomplish this.

  1. Improves Skin Texture

I love studies and statistics. As part of a study to measure the effectiveness of the Clarisonic PLUS (the model I have) for Face and Body, dramatic changes in skin texture occurred.

Fifty-five women participated in a four-week home use test to evaluate the Clarisonic PLUS for Face and Body. The subjects used a body cleanser of their choice to cleanse areas of the body requiring extra care and attention.

After four weeks of use, 85% of participants noticed an improvement in the texture of their skin after using the Clarisonic PLUS for Face and Body. They also noted that this product was beneficial in cleansing areas of the body needing special attention and care.


Different Models

There are several different models of Clarisonic. I stepped right up to the Cadillac of Clarisonic, the Pro. This model cannot be sold in retail chain stores. It can only be purchased from a Doctor, Nurse, or Esthetician who is authorized to sell. For another $100 you get so many more options, including different brush heads and speed settings. And it’s going to last you years. So I really recommend investing in the higher end models. Plus, if you buy it from a professional, they will be able to train you in how to use it correctly, and all of the options for your personal beauty needs. Sorry, but the college kids working at Sephora do not have this level of expertise.



Clarisonic Systems Compared

Here are the basic stats on Clarisonic Models.

Mia
Compact, for at home or on the go
Mia 2
Functionally enhanced, travel-friendly model
Aria

Sleek design with drying stand and USB-enabled charger
Plus
For the face and body
Price $119 $149 $199 $225-$235
Speeds 1Speed 2Speeds 3Speeds 3Speeds
Kit Includes
  • 1 Sensitive or Normal Brush Head
  • 1Universal Voltage Charger
  • 1 Sensitive Brush Head
  • Universal Voltage Charger
  • Protective Travel Case
  • 1 Sensitive Brush Head
  • USB-enabled pLink Charger
  • Drying Stand
  • 1 Sensitive, Normal or Deep Pore Brush Head
  • 1 Body Brush Head
  • Universal Charging Cradle
Warranty 1 year  2 Years  2 years  2 years 

Pro


Exclusive model used and sold by skin care professionals

Price $195-$225
Speeds 4Speeds
Kit Includes
  • 1 Sensitive or Normal Brush Head
  • 1 Body Brush Head
  • Universal Charging Cradle
Rechargeable Battery Life 30 minutes with Facial Brush Head or 20 minutes with Body Brush Head 
Warranty 3 years

Different Brush Heads

Which brush head is right for your skin type?

(In case you can’t see… the bristle thickness and length differs in all brush heads)

Normal:

Perfect for normal skin, shaving prep and for use on the décolleté and body.


Sensitive:

Comes standard with most of our cleansing brushes. An easy introduction for sensitive to normal skin types.


Delicate:

Ultra-gentle for those with delicate or extra-sensitive skin.


Deep Pore Cleansing:

Ideal for cleansing oily skin, large pores or hard to reach areas of the face, such as around the nose.  Gentile enough for daily use.


Acne Cleansing:

Extra-plush bristle gradation helps to provide ultra-gentle cleansing for sensitive and acne-prone skin.


Body:

For cleansing areas of the body needing extra care and attention, including the décolleté, hands, arms, elbows and feet. For Clarisonic Plus and PRO models.


My First Clarisonic Experience

My Clarisonic came in the mail on Friday.

The second I got home I tore open the package, like a kid on Christmas. I plugged in the charger immediately, hoping to use it right that second. I was pumped to see what all the girls were talking about. I decided to actually read all the papers in the box. Good thing I did, too, because the hand piece needed to charge for 24 hours before using it. Normally, I would totally ignore any sort of manual (unless it was from Ikea, those you actually need to follow). But I didn’t want anything to ruin my first Clarisonic experience. I was going skiing for two whole days, it would charge, and I wouldn’t be home to be tempted.

For two days, all I talked about was how excited I was about the Clarisonic.

I was not excited about a 3 hour drive home from New Hampshire, but I knew I had the Clarisonic at home all charged up to use the second I walked in the door. And literally, the second I walked in the door at 1 a.m. I went straight to the bathroom to wash my face.

I know I sound a little nuts, but I really WAS this excited and I must confess: The Rumors Are True! Clarisonic is everything I heard it was: AMAZING!!!

I text the office manager at 1 am on a Saturday to place an order for my mother, my cousin, AND my gay best friend. She may kill me Monday morning, but I couldn’t wait to share this wonderful beauty tool!


XOXO. LK.

Structural Changes in the Aging Face

3 Jan

Wrinkles and sun spots aren’t the only things we can expect to happen to our face as we age. There are many structural changes going on below the skins surface that contribute to an aging face that most people would never have noticed when they look in the mirror.

The young face on the left is round, contoured at the cheeks, and has a sharp jaw line (oh and hair and no wrinkles). The face on the right appears narrower, sunken, and droopy.

So besides the integrity of your skin, what else has changed?

Below the Skin

Bone Structure

Let’s start at the ground level. Your bones.

Your bones are always being built up and broken down. The rate at which the bone is broken down slowly starts to exceed the rate at which the bone is being built up as you age.

Bone changes cause:

  • a reduction in facial height
  • Increase in facial width and depth
  • The fat pad under the eye to bulge
  • A change in the shape and projection of the chin

Teeth

Injury and periodontal diseases result in loss of teeth, and it’s not like when you were young and the tooth fairy came and left you a dollar and a new tooth grew in (I hear with inflation it’s like $5 now!).

Loosing teeth affects the jaw bone and the muscles which attach to the jaw bone, which can result in make the face look narrower, hollow, and concave on profile.

Taking care of your teeth is super important, and not just for that pretty smile!

Fat Compartments

Collapsing fat compartments in the cheeks and temples reduce support to the overlying skin (side note: don’t worry! These fat cells go to other places… like your hips! j/k).

Splitting the face into thirds


Upper Third

Most people miss this when they look into the mirror at their aging face, but loss of fat in the temples results in the phenomenon I like to call “peanut head, ” which is also noticeable on super athletic people.

The presence of peanut head reflects a lack of support of the outer brow, which, along with loss of subcutaneous fat in the upper lid, causes the appearance of a droopy upper brow.

Blephroplasty anyone?  (Observing Surgery: Blepharoplasty.)

Middle Third

Eye sockets become wider and longer, resulting in a bulge of the cushiony fat pad that lies underneath the eye.

The cheeks start to flatten out, and the fat from the cheek descends to create a deep nasolabial fold.

The tear trough (area where eye skin and cheek skin meet) becomes noticeable. The middle third no longer has that fluid contour. This loss of fullness and form change causes shadowing in the trough, making a person appear to have dark circles, resulting in a tired appearance (just one of the things that causes dark circles).

Angles of the nose change, giving the appearance of increased length and the tip of the nose begins to droop.

Decrease of collagen and increase in tooth display at rest cause the upper lip to lengthen. Fun Fact: the upper lip can stretch by almost 4mm as you age.

(Stolen from another site…shhhh…) Image A shows a youthful face. Look at the contouring from the eye to the cheek. As you age, it can be convex like image B, which shows the fat pad bulging, or it can be concave like image C, making the eyes look hollow. Both B and C show a flat cheek when compared to Image A.

Lower Third

With all this stuff happening in the upper portions of the face, skin sags and starts to hang in the lower third. Adding insult to injury, the angle of the jaw changes, the jaw line, becomes less defined, and the chin shortens. Excess skin droops from the jaw line from gravity and loss of elasticity. Loss of ligament support in the jaw leads to the formation of jowls.

Even with droopy skin, the lower portion of the face starts to look smaller than the upper and middle third.

advancedskinwisdom.com a

(This image was also stolen).

What are your options?

Don’t worry. There are things you can do for volume loss! They do NOT include Oil of Olay, although the new commercial on tv claims it can (they lie).

Injections

For advanced volume loss, Sculptra is really the best injectable product. This product is a biostimulator; it works by stimulating your body’s own natural collagen. Results are the most natural of all the fillers, and the product lasts 2 years. I plan on writing a lot more about Sculptra, so stay tuned!

If you aren’t mentally or financially ready to jump into Sculptra, Radiesse is a wonderful thick, volumizing filler. It is usually my product of choice for cheek augmentation, naso-labial folds, and marionette lines.

For tear troughs, I LOVE Belotero (which is made by the same company as Radiesse). Filling this area literally takes ten years off your face, but remember, it is a very advanced procedure. Stick to a friend’s referral as to who to go to; I have seen a lot of over treated troughs!

For more help with fillers, check out What Goes Where?.

Surgical

Another option is fat transfer. I have assisted in several fat transfers; it is a very interesting procedure. If you are planning on liposuction, I highly suggest inquiring about fat transfer as well.

For sagging skin around the neck and jaw line, surgery is the only real option to date.

XOXO, old LK

(I found the ‘Age My Face’ Ap… yes… there’s an ap for that!)

What To Do With A Scar

2 Nov

My friend Nicole had a thyroidectomy and she was asking me about what to do with the scar to help it heal. The neck is a tough area, so I directed her to ask a dermatologist, but I told her I’d research it a little. Scars can be very bothersome to people, especially when they can’t hide them. My friend Amy’s son just required a couple of stitches from a hockey accident. I told him not to worry though. Chicks dig scars. Fact.


Scars are visible signs that remain after a wound has healed. They are unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be raised or recessed, different in color or texture from surrounding healthy tissue or particularly noticeable due to their size, shape or location.

I assisted in a scar revision surgery from a tummy tuck done in New Jersey that did not heal well. This woman went in to have the abdominal muscles repaired from her pregnancy, and left with a whole new embarrassing problem that still kept her out of a bikini.

What Causes Scar Tissue

One word: Trauma. Whether you fell of your bike or barstool, had surgery, were in a car accident, decided to take the brakes off your rollerblades even though you didn’t know how to rollerblade and you decided to start with going downhill (I like to live dangerously… what can I say… I was 13). I have a few scars that particularly bother me.

So you fall and you bleed. What happens? In the LK abridged version (for all intensive purposes):

Treatment can depend on what type of scar you have. These are several different types of scars including:

  • Hypertophic: Raised and red scars that cover the site of the original injury. Just your basic run of the mill scar.
  • Keloid: result of overly aggressive healing process, extending beyond the site of the original injury. (Interesting fact: 50% of people with Japanese heritage form keloid scars.)
  • Contracture: results from a burn when the skin tightens and can impair muscle and nervous tissue.
  • Acne: result from severe acne.

Treatment Options

As you are healing from a wound… proper nutrition is very important!
The healing process places extra demands upon the body. Adequate protein intake and vitamins are essential for wound healing.

  • Vitamin A is essential for replacement and healing of epithelial tissues
  • B-vitamins are needed by cellular enzyme systems
  • Vitamin C is essential for production and maintenance of collagen and development of new blood vessels
  • Vitamin D is needed for bone healing and formation
  • Vitamin E may help prevent some types of tissue scar
  • F, G, H, I, J are nonessential. There are no such vitamins. Interesting that they skipped out on these letters. I wonder why. (I digress).
  • Vitamin K is essential in the blood clotting process.

Topical Treatments

  • Creams/Ointments/Gels
    • Topical Vitamin E while the wound is healing. The process of massaging the cream during application is also good for the scar. I think it’s the main ingredient in Mederma. Which according to the box (see picture below) it is the #1 recommended product for scars. I’m not sure if this is true or not. I’m just saying that’s what the box says.

    • Corticosteroid or Antihistamine creams if scars are itchy or sensitive.
    • Retinol (More on Retinoic Acid (my fav!)can minimize post-scar formation pigmentation. Use 30 days after the scar has formed.
    • Silicone gel sheets can be placed over a wound when it has healed. I am using these right now on my breast augmentation incision. I will let you know how it turns out!
    • Tension and Pressure
    • Bandaging a wound applies pressure to the area.
    • Steri-strips applied to keep the wound closed as it heals.

Minimally Invasive Procedures

  • Stitches and Staples:
    • For wounds that require a visit to the ER, you may get stitches or staples. Follow your home care instructions if you do wind up in an ER (or if instructed to do so by a doctor or nurse). Not only will it decrease the likelihood of a scar, but it will also decrease the likelihood of things like infection. Yup. It’s true.
    • I highly suggest requesting a plastic surgeon stitch a facial wound. I know it’s the last thing you think about when bleeding profusely from a head wound, but they really do the best work, at the very least, much better than the ER intern who has never done it before. It’s your face. They can practice elsewhere.



  • Injections:
    • Steroid injections can be used for protruding scars. I actually had a scar on my back injected. The area was numbed with lidocaine and then injected with a corticosteroid. It took about 6 weeks to see a difference (sorry no pictures of before and after!). It can take several treatments to work. Which reminds me I should probably have it injected again.
  • Laser:
    • Vascular lasers may be used to lighten scars that are pink to purple in color. It may also facilitate the flattening of raised, red scars.

Surgical Revision

There are many options under this category including skin grafts, excision or laser surgery.

The tummy-tuck scar surgery I assisted in was an excision. The scar tissue was numbed with local anesthesia, which was difficult due to the fact that the tissue is fibrous, making it hard for the anesthesia to localize through the area. After the patient was numbed, a cauterizing tool was used to remove the scar tissue. The wound was re-stitched and a steroid impregnated tape was applied with a pressure dressing over it. The whole procedure took about 30 minutes.

I have also seen CO2 laser scar revision for acne. There is a lot of down time with this, but the end result is really nice.

Treating Acne Scars

I think it’s something like 3 out of 4 people suffer from acne some form of acne some time in their life, so acne scars are an issue for SO many people. Acne marks that are left behind after a breakout heals (usually reddish or brownish in color) will eventually fade without any intervention. But… most people will pick at acne with their fingernails, which causes a lot of damage to the skin and can also introduce bacteria to the site. Don’t do it. You will make it worse and increase the likelihood of scarring. A person’s acne needs to be under control before scars can be treated. Retinol. Cough.

Depending on the severity of the scarring, there are several possible avenues of treatment. I’d stay away from over the counter products when it comes to acne scars. First, they’re not going to help any, and second they can irritate the skin making a scar even more noticeable.

  • Mild scars: Microdermabrasion. and chemical peels (‘Tis the Season for Chemical Peels!.) will help with mild issues of the texture and tone of the skin.
  • Moderate scars: Laser skin resurfacing is recommended. I had this done at the office. It HURT. It usually takes between 3 and 10 days for the skin to heal completely.

I get asked all the time to put filler into a scar. Personally, I think there are better options. In order to inject filler, the scar tissue needs to be excised (yes, it is as uncomfortable as it sounds). It’s the same idea as numbing a scar with an anesthesia, the tissue just does not allow liquids (or gel’s like fillers) to penetrate evenly. This is my personal experience, but I know it is very common so I guess maybe some people have a better technique? I’m not sure.

  • Severe scars: CO2 laser can only be done by a doctor, under anesthesia. There is a lot of downtime with this procedure, unfortunately, but it yields fantastic results (I’ve seen it done a few times). I have never seen or heard of grafts for acne scarring.

XOXO, LK

Safety during Pregnancy: What You Should and Shouldn’t Include In Your Beauty Regiment

6 Sep

It seems like it’s in the water with co-workers and friends (as evidenced by the three pregnant ladies to the left from Sylvestre Franc). I’ve had a lot of questions about what is and isn’t safe to do when you’re pregnant in regards to skin care products, laser, and injectables. It is understandable that women want to look their best during this time and hormonal changes during pregnancy can sometimes result in acne, unwanted hair growth, melasma and other skin problems. So what is safe to use and what isn’t?

Not surprisingly (to me anyways), there really is not a lot of information on product safety during pregnancy. The FDA rates products on their risks during pregnancy as follows:

Rating Definition

A

Controlled Studies Show No Risk.  Studies in pregnant women show the medication causes no increased risk to the fetus during pregnancy.

B

No Evidence of Risk In Humans.  Studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals or in the absence of adequate human studies, animal studies show no increased fetal risk.

C

Risk Cannot Be Ruled Out.  Studies are unavailable and animal studies have shown a risk to the fetus or are also lacking. There is a chance of fetal harm if taken during pregnancy but the potential benefits may outweigh the potential harm.

D

Positive Evidence Of Risk. Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk such as in life-threatening situations.

X

Contraindicated In Pregnancy. Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Skin Care Products

Most skin care products fall into the Class C category; however, some products are recommended by doctors not to be used during pregnancy (although there is not enough evidence for or against them).


Not Recommended:

  • Retinoids
    • In A Practical Guide to Dermatological Drug Use in Pregnancy (Zip, MD, FRCPC) category B topical such as erythromycin, clindamycin, and benzoyl peroxide were recommended over topical tretinoin. This study states reports of congenital malformations in infants whose mothers used tretinoin during the first trimester.
    • This ingredient is found in anti-aging products such as moisturizers, and acne products.
    • Chemically a form of vitamin A, which in high doses can cause birth defects.
    • Oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.


  • Beta Hydroxy acids (Salicylic Acid)
    • Ingredients used for their exfoliating and acne-treating properties. They penetrate deep inside the pores and clean out excess oil and dead skin cells that can clog pores and cause acne, blackheads and dull-looking skin.
    • High doses of the acid in its oral form have been shown in studies to cause complications and birth defects.
    • Small amounts applied topically are considered safe (over the counter face wash for example), but peels containing Salicylic Acid are not considered safe when pregnant.

  • Hydroquinone
    • Clinically used for pigmentation for conditions such as melasma, and it is used cosmetically as a skin-whitening agent. Although a large percentage of this topical agent is systemically absorbed, the use during pregnancy does not appear to be associated with increased risk of congenital defects. This finding, however, is based off one study, with a small sample size (so it is recommended to avoid hydroquinone during pregnancy).


Safe

  • Vitamin C, Glycolic acid, and Lactic Acid: derived from fruit and milk sugars, considered nontoxic.

  • Hyaluronic Acid. This is a product your body naturally produces (which means its safe). Because of its molecular size, hyaluronic acid cannot penetrate the skin’s surface, and it is not systemically absorbed.


  • Benzoyl peroxide. Only 5% of topical benzoyl peroxide is absorbed through the skin. It is completely metabolized to benzoic acid within the skin and excreted.

Self-Tanners

Dihydroxyacetone is a color additive that is found in self-tanning products to produce an artificial tan. Color develops following topical application. These products contain dihydroxyacetone in concentrations ranging from 1% to 15%, and when applied topically, systemic levels are minimal (0.5%), and are considered safe to use.

Hair Removal and Bleaching Agents

  • Sodium, calcium, and potassium hydroxide, which are also found in depilatory creams, disassociate into sodium, calcium, potassium, and hydroxide ions, which are all present in the human body. Topical application of these products would not disrupt serum levels and would not be considered a problem for use during pregnancy.
  • Hydrogen peroxide. Hair-bleaching creams contain low concentrations of hydrogen peroxide, making it unlikely to be systemically absorbed. In addition, should it be absorbed, hydrogen peroxide is rapidly metabolized. Therefore, use of these products during pregnancy is not expected to be a concern when done in moderation.
  • Laser has some controversy as to whether or not it’s safe; again, there isn’t a lot of information. Lasers do not penetrate very deep and there is not chemical exchange into the body. One interesting thought from me, (not speaking from personal experience) the body becomes more sensitive during pregnancy, and some laser treatments hurt to begin with. I’m not sure I’d want to get laser under those circumstances!

Botox and Fillers

The safety of Botox injections during pregnancy is unknown (Class C), and while I wouldn’t recommend intentionally getting Botox injections during pregnancy, many women receive injections prior to being pregnant or when they do not know they are pregnant, and have not had any problems. Botox Cosmetic has never traveled systemically, and works only on the muscles into which it has been injected. Therefore, one could presume it is safe to undergo this procedure. But I still don’t recommend it.  Unless you’re planning on having a “Toddler and Tiara” baby.  Then it’s ok.

 

xoxo,

not pregnant LK


What Goes Where?

4 Aug

Prior to 2002, there was one type of facial filler: collagen. Many products have been developed over the past ten years which have caused collagen to become obsolete. There are now multiple categories of fillers, all made of different materials. The products in these subcategories have properties which make them better in treating some signs of aging than other areas or other products. Remember, fillers are different than Botox (it’s not all just Botox!). So what goes where?

Hyaluronic Acid (HA’s)

Synthetic forms of hyaluronic acid (a sugar that your body naturally produces) include products like Juvéderm, Perlene and Restylane. HA’s increase fullness and enhance the viscosity of the naturally occurring hyaluronic acid in your body. Although it may cost a little more, Juvéderm is currently the longest lasting product (in some cases lasts twice as long, and therefore is worth the extra $100 or so per syringe). I have performed over 200 Juvéderm procedures, and have personally been injected with this product many times!

*note: My face is just a model, I haven’ had all this work done I swear! I just love “Paint.”

  • Best for superficial lines (not very deep, not folds).
  • They are used in areas where “plumpness” is desired (like your lips!)
  • They can be used in cheek augmentation, vertical lip lines, and nasolabial folds, but might not be the best product. Cheeks and Nasolabial folds typically require a lot of filler, and cost-effectiveness wise, this isn’t the product. But if you just need to fix a little sagging, it can be used in the cheeks. If you want to overpay for deep nasolabial folds, then this product also can be placed in this area.
  • Vertical Lip Lines are usually superficial, which would make Juvéderm a good product, HOWEVER, if it is not placed right, the result is a monkey face.

Tips on Hyaluronic Acid

  • When I’m filling lines in the glabella, I always administer a dose of Botox to the area 2 weeks before injecting Juvéderm. This allows me to inject directly into the line; it is easier to aim at a stationary target! How do you know if you will need Botox and Fillers? If you have a line in between your brows at rest (a “1”, “11”, or “111”) and you pull that line apart with your fingers, do you still see a crease in the skin? If yes, you need both, if no, Botox is enough.
  • I always apply numbing cream 20 minutes before injections.
  • I never inject too close to the outer rim of the eye (distal orbital rim), it usually irregularities in the contour of the face.
  • Injecting into the tear trough is a very advanced procedure. I can’t tell you how many times I’ve seen this area over filled (which looks TERRIBLE). My recommendation: it is better to under-fill and book a follow-up. This area requires a minimal amount of product, and my personal policy is to allow a client to come back at no charge if they require a small amount more (within reason).

Particulated Fillers

These products, like Radiesse and ArteFill, contain synthetic beads or particles in different liquid carriers. They last longer than HA’s, because the body doesn’t break them down as fast. They are also thicker than HA’s, which means they satisfy a larger area of volume loss. These products are injected deeper in the layers of skin (never superficially like HA’s are). Why? Because they’re made out of beads in liquid… and in superficial skin that would make bumps! This means they NEVER get injected into the tear troughs or into the lips. EVER. For very, very deep glabellar crease, Radiesse can be used (but usually an HA is a better choice).

  • These products are for moderate to severe volume loss. As you age, facial skeletal changes, general tissue volume loss, and the effects of gravity flatten out your cheeks. If you look at the contour of my face on right side of my face (your left), you will see how round my cheek is. I think you can see in this picture that the apples of my cheeks are round as well. A lot of women will look in the mirror at their nasolabial folds and want to go straight for filling only those, but that doesn’t give the youthful round shape back to the face. On some people I like to do cheek augmentation with Radiesse as well as nasolabial folds. I always do cheeks before folds, because the cheek bone is the scaffolding for the lower face skin. When you change that, the depth of the NL fold will also change. Always top to bottom, never bottom to top, when it comes to your face fillers! **When you have extra weight on your face, you keep the roundness. Skinny people have really flat cheeks when they age. HA. Take that skinny people.
  • The marionette lines, prejowel, and oral commissure are usually treated as one area that needs to be fixed. They’re kind of like vector components of each other (for all you Geometry dorks out there, *brushes shoulder off*).
  • Again, skeletal changes that occur as you age cause your chin to recess and along with volume loss, change the angles of your jaw and chin. This is another area a lot of people overlook when spending that quality time in the mirror pulling at their face in the “this is what I would look like if I had a face-lift” pose. Even if you do have a traditional facelift, you aren’t doing anything about the volume loss. This contributes to the unnatural look of a face-lift.
  • Radiesse and Juvéderm can be used in conjunction to fix contour irregularities in the nose.

I hope that cleared up the two main classes of fillers. It’s a lot of information!!! The next post will be about Sculptra, which gets grouped in with fillers… but this is already too long! Lol.

xoxo SPRAY TAN – O – REXIC LK

Prepping Your Skin for a Peel

28 Jun

It’s not exactly the best time of year to be doing chemical peels (or laser treatments) because most people want to be outside enjoying the sun. But I’ve been doing a lot of training with Alexis Robertson, the Massachusetts rep for Image Skin Care, and I just finished reading a book she gave me on Chemical Peeling. So I had to post something before I gave her back her book! Stay tuned for more posts on different types of Peels or start researching with   ‘Tis the Season for Chemical Peels!.


ßAlexis is peeling Andrea Purcell, an excellent aesthetician in North Reading at Stephanie Cogliano on Main Street. Andrea is a candidate for a peel in the summer because she has prepped her skin, and she will not be in the sun. She is a trained professional.

Why Peel?

Chemical Peels are great ways to reduce fine lines and wrinkles, clear up acne, and fade hyperpigmentation. But before you have a peel there are a few things you should be using on your skin to prep it. This will ensure you get the best results from your peel. Ideally, these products should be started two to four weeks before a peel, depending on the state of your skin to start and the type of peel that you will be receiving.

Prepping is important for several reasons.

  • It will reduce wound healing time.
  • Allow for more uniform penetration of the peeling agent.
  • Decrease the risk of post inflammatory hyperpigmentation.
  • Enforce the concept of a maintenance regimen and determine which products your skin tolerates.
  • Establish compliance and eliminate inappropriate peel candidates.

So what products should you be using to prep your skin? Here’s a little guide.

Retinoic Acid

(ex. Retin A, Trenitoin) By now you should know how much I love retinol! The use of Retinoic Acid 2 weeks before a TCA peel will speed up re-epithelization of cells (which prevents infection). Since Retinoic Acid thins the top layer of dead skin cells (stratum corneum), it allows for better penetration of the peeling agent. Retinoic Acid has also been shown to have some skin lightening effects. It is also my FAVORITE skin care product.  More on Retinoic Acid (my fav!).

 

AHA’s

(ex. Glycolic acid) AHA products also thin the stratum corneum and allow better penetration of peeling agents. They also have been shown to have some skin lightening effects.

*My Favorite Product EVER is an AHA/RETINAL Blend:


MD Reconstructive Repair Crème. Hands down best product on the market.

Bleaching Agents

(ex. Hydroquinone, kojic acid) These products are not exactly bleaching your skin. They inhibit tyrosinase, an enzyme involved in the production of melanin, making hyperpigmentation reactions less likely. Personally, I love kojic acid, it smells like Mexico. No, not the dirty part… the part that smells like Piña Coladas. We will from now on refer to this product as the Cancun of skin care. Minus the hangover.

Currently, there is some controversy over the use of hydroquinone. It should not be used for long periods of time, or on pigmentation that is caused by hormones (also known as melasma). Be careful with this ingredient. It’s used in a lot of medical product lines (like Obagi… which I’m not a fan of).

Sunblock

Get used to it. SPF BABY! Remember stick to physical blocks with Zinc.  It’s Sunny Out! (A Post in Honor of Sun Block).

So why is it important to establish a baseline?

By starting on products prior to peeling, a baseline can be established as to what your skin normally tolerates when it’s not inflamed or irritated. Also it establishes some good habits, like the need to wear sunscreen. If you go in for a peel, and you don’t wear sunscreen, you are going to be in some serious trouble. The same goes with using Retinol products. But, it all honesty, we sometimes ignore home care instructions because we don’t understand why we are being told we need to do something. We need a consequence before we follow a rule. Well… I forgot sunscreen one time while using retinol. I won’t do that again. Caused my own little chemical peel. Not pretty.

Noncompliance is a HUGE problem in health care. And chemical peels can be dangerous if you’re not going to listen to post care instructions. If you can’t follow a few instructions before a peel, you certainly aren’t going to follow them after. This just proves to you and your skin person that you are not an eligible candidate for a peel. But if you CAN follow instructions, it gets you into a good regiment which you will need to continue post peel. Remember, your skin cells are constantly cycling, and therefore it is extremely important to ALWAYS be taking care of them.

This is not a one and done procedure (like liposuction is… lol.).

“Youth No Longer Wasted On the Young”


Love LK.

P.S. I am sticking to being brunette. But I’m keeping my twitter name as @Boston_Barbie. I will forever be a blonde (and a child) at heart. You can follow me and Alexis at @ImageSkinCareMA.

More on Retinoic Acid (my fav!)

22 May

I LOVE RETINOL.  Every Woman Should Own A Retinol Product.  (Although the strength shouldn’t be the same for every woman!)

It is not just for acne; this cream has revolutionized nonsurgical treatments for sun-damaged skin (wrinkles!). Research shows it improves signs of both photoaging and photodamage.

Physical Change Results
Thins and compacts the top layer of the epidermis Smoother, softer skin texture
Thickens the lower layers of the epidermis Tightens the skin
Reverses keratinocyte atypia (some big acne word) Improves acne
Disperses melanin throughout epidermis (color of skin) Improves discoloration
Increases glycosaminoglycan deposition (sugars used for skin health) Increases dermal volume and tightens the skin
Increases neovasularization in dermis (blood flow) Gives a pinker, rosy hue to the skin

(Funny Story: My BFF Alexis recently read an article “Has facebook made you a narcissist?” … I told her “No, I’ve always been this way”… but really, your face is ALWAYS available to the public now.  Even if you’re not famous, you ARE!  Make sure you always looks picture perfect!  Nice skin makes life SO much easier AND more low maintenance.)

I’ve always recommended patients start on using a retinol product once a week and working their way up, but I’ve been reading that it should actually be done daily, starting at a low dose and working your way up. Retinol comes in several different formulations, the lowest being .01%. It can take two weeks for the skin to become acclimated to this product, and a little bit of redness or peeling can be expected.

If you are younger, and have less photodamage, or if you are older with sensitive skin a conservative approach to retinol therapy will give a good result (which will have little to no peeling or redness). Aggressive therapy is the only approach for thick, tough skin with severe sun damage. Peel baby peel (but don’t worry, the peeling will only be for two weeks or so, until your skin gets used to it… or physiologically… until your skin gets rid of all that dead stuff on top that’s making it look dull and yucky.)

If you are seeing an aesthetician and doing aggressive treatments like Microdermabrasion. or in-office chemical peels (‘Tis the Season for Chemical Peels! –but the summer is NOT) you should not use retinols until you are done with your treatments. AND hopefully after your treatments are finished you can use a more conservative retinol product to keep your skin looking good after treatments.

Retinol comes in 3 forms:

  1. Cream (.025%, 0.05%, 0.1%)
  2. Gel (0.01%, 0.025%)
  3. Liquid (0.05%)

But guess what. The carrier of the product can intensify the results. Creams are more moisturizing. Gels contain alcohol, and this makes it penetrate deeper. Alcohol also has a drying affect, which can irritate the skin even further. The liquid also is drying due to the effects of alcohol content.

(Yes. I really own this much retinol)

How to Use:

More is not better! Start with a pea size amount for your entire face.

(Retinol products are always yellow-ish in color).

My Skin:

I personally use a night cream that has Retinol and Glycolic. Once a week or so I add a Retinol booster (liquid retinol) to my moisturizer which sometimes makes my skin peel a little because it boosts the effect of the retinol by allowing it to penetrate. I recommend retinal products for everyone. Remember, this product makes you photosensitive; i.e. you should not be in the sun when you use it! …But you shouldn’t be in the sun anyways. SUNBLOCK cough.  It’s Sunny Out! (A Post in Honor of Sun Block).  Also, because of this photosensitivity don’t put these products on during the day.

A Client of Mine…

Came in for Botox and I couldn’t get over her skin. I asked her what she was using. She said to me, I’ve been using that cream I got from you once in the morning and once and night. The cream she was talking about was the Reconstructive Repair Crème with the retinol in it. Well…. she looked amazing, and thank god it was during the winter time and she wasn’t out in the sun! She also told me she always used the sunblock/moisturizer on top of the crème. I’m not recommending anyone do this! I’m just saying, it made SUCH a difference in her skin! I could feel the difference when I injected her. Of course, I told her not to do this in summer time. J Mistakes are how we learn!

Product
Spotlight!

Image Reconstruct Repair Crème:

A highly concentrated blend of retinol, glycolic acid and oil soluble Vitamin C to resurface, rejuvenate and repair aging skin. Leaves skin youthful, firm and radiant after just a few applications.

Reconstructive Retinol Booster:

Mix two drops with the Vital C anti-aging serum or the MAX serum as directed. Must not be applied directly onto skin without prior mixing! Use only at night.

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