Hawaii Bans Sunscreen in an Effort to Protect Coral Reefs

Written By: Jamee Bonner

In an effort to protect its marine environment, Hawaii becomes the first state in the nation to ban synthetic sunscreen that is harmful to the coral reefs. The law specifically prohibits the sale and distribution of sunscreen containing oxybenzone and octinoxate, which will take effect in 2021.

“At first this may seem like a shocking decision that leaves tourists choosing between sunburns, skin cancer, or injuring our coral reefs, but it is crucial to realize only sunscreens containing two specific ingredients are included under the ban,” explained dermatology physician assistant Lindsey Smith. “There are still plenty of sun protective options to consider when visiting Hawaii including many sunscreens.”

The two additives included in the ban — oxybenzone and octinoxate – are said to cause, “mortality in developing coral; increase coral bleaching that indicates extreme stress, even at temperatures below 87.8 degrees Fahrenheit; and cause genetic damage to coral and other marine organisms.” A study published in the journal Archives of Environmental Contamination and Toxicology from 2015, found that 14,000 tons of sunscreen end up in and around coral reefs each year in Hawaii and in the Caribbean.

Sunscreens containing oxybenzone and octinoxate are known as synthetic sunscreens and soak into the top layers of our skin. Synthetic sunscreens protect us by absorbing UV rays, and then converting them into infrared rays. While they make up a large portion of sunscreens on the market due to their more cost effective price point they are not the only options available. Sunscreens containing titanium dioxide and zinc oxide are known as mineral sunscreen and are not affected by Hawaii’s recent legislation. It works by forming a protective layer on the skin and physically reflecting UV rays.

“All sunscreens, including chemical sunscreens, have safe ingredients that have not been scientifically proven to be toxic or hazardous to humans. The effect of chemical sunscreens on the coral reef does warrant more research and exploring other options when traveling. Mineral sunscreens are the types of sunscreen I recommend anyway, so it does not make a really significant change in my opinion, “ said Smith.

Which one should I be using?

Most dermatologist would agree that the best sunscreen is the one that you will use. Both types of sunscreens are effective and it all comes down to your circumstance and situation. What matters most in ensuring broad-spectrum protection from UVA and UVB rays, and diligently using whatever type you choose.

The American Academy of Dermatology Association has expressed concern that the restrictions could lead to an increase in skin cancer, particularly melanoma, which the organization says is already 30% higher in Hawaii than the national average. Nevertheless, doctors see this as an opportunity to increase their efforts in educating the public on the importance of sun protection.

“When visiting Hawaii consider investing in a mineral sunscreen or if all else fails use additional sun safety practices such as seeking shade, wearing protective clothing, and limiting time in the sun between 10am and 4pm,” said Smith.

As far as sunscreen usage in Utah no changes need to be made. Continue to wear SPF 30 sunscreen of any brand and type, reapply every 1-2 hours, and remain aware of how much time you are spending in the sun.

Written by Jamee Bonner

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I AM GOING BALD

I am going through some major hair loss right now and each time I shower and brush my hair I feel like this lady below, seriously though!

hair loss

My baby is now almost four months old and I am currently going through a type of hair loss called Telogen Effluvium. I was hopeful I would not get it this time around because the delivery and first three months were much less traumatic, but it is here and I hope it is at the peak and will start to slow down.

There are many types of hair loss, but I will be talking about this one since it is pretty common and I am currently experiencing it:) Did you know that is can be normal to lose up to 100 hairs a day due to the normal hair cycle? I don’t know about you, but 100 hairs seemed like a ton to me. What is a normal hair cycle?  The hair growth cycle can be divided into three cycles: 1. Anagen – actively growing hair 2. Catagen – Transition phase lasting 2-3 weeks where growth stops and follicle shrinks and 3. Telogen – Resting phase for 1-4 months (up to 10% of hairs in a normal scalp).

Now think about this, if there is a shock to your system, such as child birth, your hair cycle can reverse the ratio and your Anagen (growing) hairs can be triggered into Telogen (resting) phase.

Telogen Effluvium is a non-scarring type of hair loss where over-shedding occurs 2 to 6 months after an inciting event that stops active hair growth.

It is commonly caused by the following stressors:

  1. Fever, weight loss, pregnancy/childbirth
  2. Illness, psychological stress (Accident, death, divorce, etc..)
  3. Surgical operations, medications and others

 

You will not go bald with Telogen effluvium, even though you will feel like it! It is self-correcting and rarely influenced by any treatment that can be given. The biggest thing in treatment of this condition is fixing the inciting event.

Now I want to mention one thing about hair vitamins that seem to be all the rage right now. If you have some sort of social media account I am sure you have seen celebrities and bloggers push Sugar Bear Hair vitamins. These blue gummy candies look cute but they are not going to help your hair grow! They contain vitamin A and C and a couple different B vitamins and Biotin. Biotin is not the holy grail when it comes to hair loss and there are actually very weak studies to suggest that Biotin improves hair, unless you have a Biotin deficiency which is really rare. I am not saying it won’t help, the power of placebo is real, and it won’t hurt so you can give it a try. However, a deficiency in Iron, Ferritin, vitamin B12, folic acid can slow hair growth. In short, my opinion is eating a healthy diet high in protein, fruits and vegetables is probably better for your hair than blue gummy bears:)

 

 

 

50 Shades of Red

Blog-Rosacea

April is Rosacea Awareness Month, which is fitting since the spring can be considered “rosacea season” due to the weather changes causing many to flare this time of year. Rosacea is more common than you may realize and can often be misdiagnosed as Acne.

What is Rosacea?

  • Rosacea is a fairly chronic inflammatory disorder of the hair and oil (pilosebaceous unit) glands on the face that is coupled with increased capillary reactivity which leads to flushing and superficial blood vessels.
  • It most commonly affects adult women with fair skin and Celtic origins.

What does Rosacea look like?

  • The rash usually involves the face symmetrically. Early on flushing is characteristic along with prominent blood vessels causing the characteristic “red face”.
  • Papules and pustules can develop and it can look similar to acne, but the biggest difference with acne is that there are no comedones (black heads and white heads) present.
  • Late stages of Rosacea can cause deep red bumps and nodules underneath the skin and can lead to disfigurement of the nose, forehead, eyelids, ears and chin. Men more commonly  have this type.
  • The eyes can also be involved. You may notice dry, red eyes and a gritty sensation and it rarely can lead to more serious problems such as; corneal ulcers.

What triggers Rosacea flares?

  • Increase in skin temperature in response to heat stimuli
    • Exercise, sun exposure, hot baths, hot or spicy foods/liquids
  • Alcohol and caffeine
  • Emotional stress
  • Change in environment (cold, hot, humidity, wind etc..)
  • Medications
  • Facial creams or oils, Topical steroids

Is there a treatment for Rosacea?

  • Unfortunately the exact cause of Rosacea is unknown and there is no cure, but it can be controlled. Recurrences are very common and it usually waxes and wanes, but it can also spontaneously resolve over a few years.
  • Avoiding triggers is key!
  • Topical make-ups in a green tinted base help to camouflage the redness. Make sure to use gentle products that are fragrance free.
  • Topical treatments include; Metronidazole cream, Soolantra cream, Sodium Sulfacetamide, topical antibiotics.
  • Oral medications are usually more effective than topical treatments and tetracycline antibiotics are the mainstay of therapy.
  • Isotretinoin has been used for severe cases.
  • Laser therapy is very effective for treating the redness and any facial disfigurement.

Melanoma does not always play fair

Most melanomas I see look funky and problematic before a biopsy is ever done. However, recently I had another scary case that took me by surprise and served as a reminder that melanoma does not always play by the rules.  I had a patient come in to see me concerned about a new spot on their back. At a quick glance I thought it may be simply an inflamed flesh colored mole or possibly a Basal Cell type of skin cancer. The picture below is not a picture of my patient, but it is very similar to the spot.

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If you are not too familiar with skin cancers, in general, Basal Cell and Squamous Cell skin cancers are more common and generally less aggressive. They can become a big problem locally, but they do not commonly kill you. Melanoma, by comparison, is much more serious and more likely to be fatal.

Now back to the patient. During the exam I noticed two other areas that were much more atypical looking, but thankfully we still performed a biopsy on that initial pink spot. I ended up doing three biopsies on this patient and all biopsies came back as skin cancer, but the one that looked “not s0 concerning” came back as a melanoma metastasis that was very deep. I was quite surprised.  As always, the worst part was having to tell the patient that not only do they have melanoma, but a very serious one that was already at an advanced stage.

The ABCDE’s of Melanoma are a helpful tool when looking at your own spots.  Like I said earlier, most melanomas follow these rules and look abnormal. The more uniform a spot is, the better. The more variety in color and pattern in the lesion, the more likely it needs to be checked.

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However, as the story above illustrates, melanoma does not always play fair. And our patient had an amelanotic variant, which means it didn’t have a brown or black color from melanin in the skin.  Amelanotic melanaoma, in my opinion, is the scariest melanoma because it lacks pigment, making it look more like a basal cell carcinoma, acne, or even like nothing at all.  Luckily, these are not too common.

Now, not every mole is a perfect brown round circle.  In fact, most of them are not and yet most of them are still benign. This is where something called the “ugly duckling” rule comes in to play. The ugly duckling sign refers to how similar the moles look to each other. If you have a mole that looks a little funny, but happens to look pretty similar to other spots then that is usually a good sign. If you have a mole that does not follow the rules and you can not find another spot on your body that appears similar, then it is an ugly duckling and deserves further evaluation.

The key is early detection for all types of skin cancers, and when it is all said and done any new or changing spot should be evaluated by a dermatologist.  No one will fault you for coming in for a spot that was benign. I always tell my patient’s that it is better to be safe than sorry. If you never have had your skin checked, now is as good a time as any. Also, if you go get your skin checked then you might as well really get it checked. That means don’t be afraid to get naked and show your skin, and make sure that whoever is doing your exam checks everywhere because some types of Melanoma occur where the sun does not shine.

Lindsey Smart Smith  PA-C

References: American Academy of Dermatology, Spot Skin Cancer

Microneedling and the Vampire Facial

 

vampire.jpgVampire facial, what the heck is that?  The name certainly sounds intriguing.  Who doesn’t want to be a vampire these days, am I right?  Well, the term vampire facial is actually a nickname for a skin rejuvenating procedure involving micro-needling and platelet rich plasma.  The treatment is so-called primarily because it uses the patient’s own blood (platelet rich plasma) to make improvements in the skin.  But also when combined with micro-needling, because the many fine needle punctures in the skin leave the patient looking rather bloody immediately afterward.   

kardashian-vampire-facial.jpgThe vampire facial has gained significant popularity over the last year or so, as it is something that certain celebrities (ie Kim Kardashian) have been known to apparently undergo regularly as part of their skin care regimens. 

The procedure itself is quite straightforward.  After applying a good thick layer of topical numbing cream and letting that absorb for an hour or so, the skin is then cleansed and a device with multiple fine needles that rapidly punctures the skin is passed over the treatment zone.

The needles are used to puncture the skin to a precise depth, creating controlled skin injury, and are passed over the skin until pin-point bleeding is noted from hundreds of micro injuries.   

How does it work?  Each puncture creates a channel that triggers the body to fill these microscopic wounds by producing new collagen and elastin.  New collagen and new elastin are essential for youthful healthy appearing skin.  Through the process of healing and new collagen growth, there is improvement in skin texture, tone, and firmness, as well as reduction in scars, pore size, and stretch marks.

Now, lets go back to the first.  How does one’s own blood get used to rejuvenate the skin?  Well, before removing the numbing cream and cleaning off the skin, the patient’s blood is drawn, just enough to fill up a small tube.  Then while the micro-needling is being performed, that blood is being spun down and separated into what is know as platelet rich plasma or PRP.

microneedle prp.jpg

PRP contains a wealth of growth factors and cytokines, chemicals that signal healing to the body.  Thus, PRP works on the simple principle of utilizing your own natural platelets to instruct the body to create new collagen for tauter, smoother and better toned skin.  

Once this golden yellow platelet rich portion of the blood is obtained, and the completed micro-needling has created many fine fresh channels into the deeper layers of skin, it is then applied and absorbed into the dermis where it can be of most benefit.   

While both PRP and micro-needling are effective rejuvenating therapies on their own, the combination is synergistic, with greater improvement achieved by combining them together.  (1,2)

On a slightly more scientific note:

While there are some detractors from this procedure online, it is only when the procedure is labeled the vampire “facelift” that I agree with them. Calling it a vampire “facelift” is misleading and frankly incorrect.  It is not a facelift, nor does it take the place of dermal filler.  Which means it is the wrong choice for patients that have volume loss and skin laxity as their primary problem.  However, it has been extensively studied in the treatment of various skin textural and color issues, such sun damage, fine lines and wrinkles, as well as acne scarring. (3)

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B&A MIcroneedle tx.png

The above pictures show before and after results of micro-needle therapy alone, without PRP.

On a more personal note:

My experience has been overwhelmingly positive.  The downtime associated with this procedure is extremely small. Mild redness lasting for 1-2 days for most people is the average healing time, and makeup can be worn the next day.  No swelling, no peeling.  This is less downtime then any conservative laser “resurfacing” modality.  And even less then most chemical peels which do much less collagen production by comparison.

In my experience, It is this great blend of results and minimal downtime which make this procedure ideal to perform on occasion for skin health maintenance, or in a treatment course for more targeted correction.

References:

  1. Asif M et al. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 2016 Jan 8.
  2. Chawla S. Split Face Comparative Study of Microneedling with PRP Versus Microneedling with Vitamin C in Treating Atrophic Post Acne Scars. J Cutan Aesthet Surg. 2014 Oct-Dec;7(4):209-12.
  3. Hou A et al. Microneedling: A Comprehensive Review. Dermatol Surg. 2016 Oct 13.

     

Moisturizers, not all are created equal

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I think that winter finally decided to show up just in time for the Holidays. And with winter comes lots of dry, cracked skin that can lead to rashes.

I have a lot of patients at my Park City clinic that are from the East Coast and they always tell me similar stories, ever since living here their skin is very different. It is very dry and gets irritated easily or they have never had eczema in their life until moving here.

We do live in the 2nd driest state in the country and our skin takes a beating, especially in the winter. Consequently, we have to be extra vigilant in taking care of it.

Xerosis is the medical term that means dry skin and it usually has a very dry, rough and scaly texture to it. It can develop little tears that can lead to some serious rashes and infections.

You may not have “eczema”, but we all deal with dry skin at some point or another, especially here. I don’t have particularly dry sensitive skin, but my hands sure do get hammered in the winter because I wash them 100 times a day to try and keep the winter bugs away from my baby.

Regardless of how mild or severe your dry skin may be, it is a sign of barrier dysfunction. There are different factors that can play a role in barrier dysfunction, but in short it doesn’t keep water in and allergens and irritants out!

How do we repair our barrier and keep our skin healthy and soft? Applying a good moisturizer frequently is critical.

However, the term moisturizer is a marketing term and not all moisturizers are created equal.

I have patients tell me all the time, well I apply my Bath and Body works hand lotion daily and then we go on to have the discussion that the term moisturizer is a marketing ploy and they are not all created equal.

 

Step 1 ; picking a good moisturizer

  • Ointments are better than creams, and creams are better than lotions. This comes with a caveat, you have to like the feel of what you put on or else you won’t use it frequently enough. Don’t smear Vaseline all over your body and dread it, just remember in general the thicker (higher oil content than water and alcohol content) the better.
  • Look for the terms, emollient and humectant
  • Products should contain ceramides
  • Products should not contain fragrances and soaps
  • Good ingredients include; Urea, petrolatum, dimethicone, etc..

 

There are many different brands you can find at your grocery store with these tips in mind. If you do have very sensitive skin that is prone to eczema then my favorite is the Vanicream line of products because it is in my opinion the most hypoallergenic product out there.

There are also some prescriptions medications that repair and protect the skin barrier that many patients have had less eczema flares with and you can talk with your doctor about those.

 

Step 2; Frequency of application

            –The more you use it the better. Your moisturizer should be applied at least twice a day with one of the applications being immediately following showering when your skin has highest absorption.

 

Other tips to avoid further drying out your skin this winter

  • Frequent washing, especially in really hot water
  • Hard water, which increases skin pH
  • Soaps and antiseptics
  • Extreme temperatures
  • Excessive chlorine in pools and hot tubs

 

Basically, if you want your skin silky smooth at all times, move to Hawaii and avoid the low humidity, wind and cold that comes with Utah winters!

Lindsey Smart Smith PA-C

Should you rub that fruit on your face?

 

vitamin-c fruits

No, don’t rub fruit on your face.   I’ve seen several posts and articles about the benefits of certain foods and about applying them topically on your face to get the benefits of these ingredients.  Why don’t I agree with this?  I’ll tell you, and I’ll start with a metaphor I heard and really like for this.   Imagine walking into a critically acclaimed restaurant run by a celebrated and highly educated chef, barging back into the kitchen, and saying, “Oh, chocolate soufflé? Well, I’ve got an oven and a bar of chocolate right here, I don’t need your fancy kitchen shenanigans.”

Sure, you can make a chocolate soufflé on your own.  And yes, you don’t need to get it from an expensive restaurant for it to be good.   But if you have had no training or even practice in this area, it’s a bit unreasonable to suggest that you’re going to out-cook someone who’s devoted years of their life to the culinary arts.

The same can be said of beauty products. Cosmetic chemists go to school for years so that they can understand the science and make expert products that are effective, safe, and long-lasting.

Home made products are especially not worth it in the case of vitamin C, and vitamin C is the main reason why so many beauty blogs will suggest rubbing these things directly on your skin.  Here’s a just a couple of reasons why:

  1. Instability: L-ascorbic acid is very unstable. It’s one of the most effective forms of vitamin C, but it degrades in heat, light, and air.  Stabilizing vitamin C is not always an easy or cheap process.
  2. The wrong pH: The skin is slightly acidic, with a pH around 5.5 or 6.5, and mildly acidic products do the best on the skin.  Specifically, Vitamin C penetrates the skin best at an acidic pH and in order to effectively enter the skin, it must be formulated at a pH lower than 3.5. However, a pH too low is going to cause irritation, sun sensitization, and dry skin.

So, these products are formulated by professionals who spend their time researching and developing the coming up with the most effective methods. While something in your kitchen might be readily available and safe, it’s still not likely to work as you intend it to.  When it comes to vitamin C, irritation will probably be the biggest issue, but even if its not.  Without the right pH, a stabilized formulation, and additional ingredients, it won’t even work.

My advice? Let’s be more demanding. Demand more and better research from our cosmeceutical companies.  Require products that have solid scientific evidence to support their efficacy.  And when it comes to home remedies, consider sticking to professionally formulated products that work and won’t be irritating to your skin.

 

Metaphor and content drawn from several sources. Principally see Futurederm.com Skincare by Natalie Bell.

 

Smoother than a Baby’s Bottom

Baby-Skin-Care

We are all born with skin, the largest organ, and it plays many vital roles. Most importantly it serves as the physical barrier between the outside world and us. It provides protection against harmful UV rays; it prevents water loss, regulates body temperature and plays a major role in sensory perception.

Infant skin is different than adult skin and it undergoes a significant maturing process the moment after delivery through the first year of life. The development of the skin barrier increases with gestational age, meaning that preterm infant skin is even more fragile. Newborn skin is more susceptible to infections, heat loss, damage from chemicals and heat, and isn’t as effective at keeping things out that are supposed to stay out. I think it is most helpful to think of Infant skin as having a slightly impaired barrier.

How do we care for such fragile skin as it is still developing? Are there products we should use and ones we should avoid? How often should we bathe our babies? Can we prevent our children from having dry or diseased skin in the future?

One thing that I noticed that was different when I gave birth from when my mom delivered me in the hospital is that they do not immediately bathe the baby anymore. This is because of the special coating brand new babies have on their skin called the vernix caseosa. It is a protective coating that develops during the last trimester of gestation. It is composed of water, proteins, sebum lipids and antimicrobial peptides. The coating on the skin surface contributes to a higher skin hydration, a lower skin pH and relates to a reduced heat loss after birth. Basically I wish that protective coating were on their skin forever!

One of the most common diseases in young skin is Eczema, a disease of dry skin. This condition tends to run in families and these kids can also develop two other closely related conditions, asthma and seasonal allergies. While there is no cure for this disease, a recent study performed in the United States and the United Kingdom provides evidence that might be able to help prevent it. The study took hundreds of infants at high risk of developing eczema and showed that that daily full-body moisturizing from birth can prevent eczema.

The exact way that it prevents the disease is not fully understood, but the study proposes that emollients, moisturizing creams and ointments, correct the skin barrier and the early inflammation in at-risk infants by improving skin hydration and reducing skin permeability. This in turn leads to preventing skin dryness and cracking, as well as reducing irritation and allergic reactions. It also stops some infants from developing eczema.

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Some skin cleansing tips for babies

  • Use Emollient based liquid cleansers that are pH neutral or mildly acidic.
  • Avoid cleansing bars or scrubbing brushes that can further damage a fragile skin barrier.
  • Although they smell nice, avoid the fragranced body washes. Lavender oil can be allergenic and can further irritate dry skin.
  • Limit baths to no more than every other day and bathe in luke warm water.
  • Immediately following bath time, apply an emollient based, fragrance free thick moisturizer from head to toe. Moisturizers in pump bottles tend to have more preservatives in them so they will spread easier, but have less of an occlusive effect making them less effective. The thicker the better!!
  • Avoid products with excessive ingredients and preservatives like formaldehydes and parabens.
  • Some great products are; Cetaphil Baby, Aveeno Baby, Vanicream is one of my favorites and believe it or not good old Vaseline or Aquaphor! For those babies that already have eczema give Robathol bath oil a try.

 

 

 

 

 

 

 

 

 

 

Vitamin C: For Younger, Brighter Skin

skin care Vitamin C dermatology.jpg

Vitamin C really can make your skin look younger and brighter.

While vitamin C is most commonly thought of as a citrusy supplement that boosts the immune system, there are several more benefits to this vitamin.  When applied topically vitamin C is a powerful addition to an anti-aging skin care regimen.

Vitamin C is an essential water soluble vitamin that also lightens and brightens the skin, is an impressive antioxidant, and is essential in collagen synthesis.

This rather versatile and tasty vitamin smoothens the tone of aging and damaged skin by lightening and brightening the skin. The blotchy coloring that appears on the skin over time, and with sun damage, is due in part to the uneven production of brown pigment in the skin cells.  This brown pigment comes from a molecule called melanin.  Over time, some areas or cells start making more melanin.  Vitamin C smoothens out the tone by causing those overproducing areas to start making less melanin and start matching the rest of the skin.

For those wanting a slightly more scientific explanation of this, read this paragraph:  Tyrosinase is the enzyme that makes melanin.  Vitamin C interacts with copper at the tyrosinase-active site and inhibits action of the enzyme, thereby decreasing the melanin formation.

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Vitamin C is also a powerful antioxidant.  An antioxidant is a molecule that inhibits the oxidation of other molecules. Oxidation is a chemical reaction that can produce free radicals, which are atoms or molecules with an unpaired electron.  When a free radical then steals an electron from one of the proteins in a strand of collagen, it creates damage or a break in that strand. The more breaks you get, the more damage you see, such as sagging and wrinkles. Since vitamin C is an effective electron donor, it helps reverse and prevent signs of aging.

Essentially what this means is that Vitamin C can effectively protect the skin from damaging chemical reactions caused by sun exposure, pollution, and time.

Finally, vitamin C is a necessary component in the building of new collagen, and new healthy collagen is the building block of young vibrant skin.

These three functions of vitamin C have several applications when it comes to skin health. And solid, reproducible and reliable studies have also shown the following benefits of using topical vitamin C preparations:

  • Improve skin appearance by reducing fine lines and wrinkles.
  • Improved skin health and wound healing as it aids in stabilizing collagen.
  • Increased protection and/or lessening the severity of sunburns.

Ok, now keep reading because this next bit is the most important part.

It is important to note that vitamin C is an unstable compound, and not all formulations are created equal.

A correctly formulated topical vitamin C preparation is a difficult and costly process. Many formulations on the market, or made at home, are manufactured cheaply and are basically ineffective. The problems lies in the fact that vitamin C is most commonly found in the form L-ascorbic acid. This is highly unstable when exposed to oxygen, which renders the vitamin essentially useless topically. In addition, many of the currently available topical vitamin C preparations do not penetrate the skin sufficiently to make any difference. Research is continually underway to optimize stable and effective topical vitamin C formulations.

If you are considering using topical vitamin C you should consult your pharmacist, doctor or dermatologist before starting.

Kybella! Liposuction in a needle

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

This is really cool stuff! It literally lends credibility to the title of this post, liposuction in a needle. The product is called Kybella (deoxycholic acid) and with it, a sharper jaw line may be just a few injections away.

The FDA recently approved Kybella for treatment of adults with moderate-to-severe fat below the chin, known as submental fat. This is fairly groundbreaking as kybella is a first-in-class medication. There is literally nothing else on the drug market that is FDA approved to dissolve fat in this manner.

A bit of history:
Compounds like kybella have been injected into the body for many years to try and tighten skin and destroy fat, but this is the first time that a medication like this has successfully undergone the rigorous study and clinical trials to obtain FDA approval.

Kybella is deoxycholic acid, a secondary bile salt, found naturally in the body. Its job in the body is to emulsify or surround fat and help the body absorb dietary intake. When Injected directly into fatty tissue the deoxycholic acid ruptures cell membranes and causes destruction of the fat cells. Once destroyed, those cells can no longer store or accumulate fat.

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

What is treatment with kybella like?

First, we will clean the skin and mark out the area to be treated under the chin. The area is then typically numbed with either topical or injected numbing medicine such as lidocaine. Kybella is then injected directly into the submental fat pad under the chin. The entire treatment lasts for about 15 min.

In the Kybella studies approximately 70% of patients were getting their desired results in 2-4 treatment sessions, but the treatment can be repeated as necessary to achieve the desired outcome. Treatments in the study were spaced out every 4 weeks, but I think we will find that this is too close together and that waiting closer to 8 weeks in-between treatments will give a more accurate perspective on results.

Since fat cells do not regenerate, once the desired aesthetic outcome is obtained, the need for retreatment at any time is not expected. Even if weight is subsequently gained.

Expected side effects from the treatment include redness, bruising, and swelling. Discomfort, as would be expected from the sensation associated with a bruise, is also common. These last anywhere from 3-7 days on average. Rare side effects noted in the study were all temporary but included difficulty swallowing or nerve injury resulting in an uneven smile for a few weeks.

Overall, I’m very excited about this therapy. It’s new, it’s safe, and it works.

See some before and after pictures below:

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

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kybella fat destruction double chin treatment at University of Utah dermatology David Smart

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

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