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.

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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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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

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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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Science and not blowing the lid on the cancer and sunscreen “myth”

Is sun screen really effective in counteracting damage from overexposure to the sun? Dermatologists agree that sunscreen is a necessary preventative measure for sun damage to the skin and even skin cancer.

Every now and again an article will appear in print or on the Internet discussing the dangers of sunscreen or claiming that the sun and skin cancer link has been debunked. I recently re-read an article online that stated, “Scientists blew the lid on the cancer and the sunscreen myth”.  Reading it made me grin, as these articles always do, because….no we didn’t.

These articles are mostly click-bait, sensationalized journalism that distorts science and fact to support an eye-catching headline. I respect the innovation and manipulation, as well as the need to simply increase the size of the audience. But the amount of ridiculousness in this article is hilarious, so I couldn’t help but respond.

The foundation of this article and others like it is a Swedish study published in 2014 and it’s an interesting study.

Lets review the facts of this study.

29,518 Swedish women from ages 25 to 64 answered a survey with a variety of questions principally aimed at how frequently they sunbathed. For 20 years the women were followed and national databases were checked to see who died and who developed melanoma.

The survey study found that all-cause mortality (death for any reason) was inversely related to sun exposure habits.  Meaning that over the 20-year period, twice as many women from the lowest sun exposure group died as compared to the highest sun exposure group.

The study has no idea as to what the participants died of and does not comment on significant baseline health habits of these groups, though their data showed the non-sunbathers group to have a higher rate of non-exercisers and obesity. The study also does not measure vitamin-D at any point, nor does the study have anything to do with sunscreen. In fact, the words sunscreen or sunblock are not found in the study at all. Not even as commentary.

That’s it. Those are the facts. Notwithstanding, the association is truly fascinating and has value on its own. But any statement that expounds upon the aforementioned finding is conjecture, and while conjecture is an important part of discovery it should be taken, as they say, with a grain of salt.

The authors of the study surmise that perhaps low vitamin D is to blame for the noted trend of increased death among the non-sunbather group. It is certainly a possibility. Vitamin D is an essential vitamin and sun exposure is a significant source of vitamin D production and important in Vitamin D levels. In order to come to this conclusion the authors of the study make a few assumptions.

First, that the women’s sun exposure habits did not change over a 20-year period. Second, that the consequences of an unhealthy lifestyle, obesity and lack of exercise, that appeared to be more prevalent in the non-sunbather group, did not affect their results. Third, that Vitamin D levels were chronically low in the women who self-reported to have low sun exposure, and that the other group’s levels were not.

Now, the issues with the first two assumptions are relatively clear. But the problem with the third assumption may not be as clear, so lets talk vitamin D.

Dermatologists and other medical practitioners agree that vitamin D is an essential part of a healthy lifestyle, but how much is too much?

I don’t think any physician would challenge the importance of Vitamin D. It is essential for a number of physiologic processes and organ systems. It appears to be protective in several conditions including more aggressive forms of melanoma, and a growing number of studies support the idea that low levels of vitamin D are linked to an increased risk of heart disease. This vitamin is something you need and want in your body.

But remember that vitamin D is not obtained by sunlight alone. And there is a limit on the amount our skin can produce.  As such the vitamin is also, in many instances,  an essential part of our diet.

Only a modest amount of sun exposure is required to make sufficient amounts of the vitamin, several minutes at midday in the summer months are sufficient for many Caucasians. And after reaching the production limit, further exposure may actually destroy the vitamin.

Furthermore, UV exposure is unlikely to produce enough vitamin D in people with very dark skin. People with darker skin types produce less of the vitamin in response to the same amount of sunlight. Also, the elderly have a reduced ability to synthesize vitamin D from sunlight, and during the winter, sunlight is insufficient to produce vitamin D in people living above 42 north latitude, which includes Boston and northern California.  Sweden, where the study was conducted, is well north of this. Which means that regardless of how frequently a study participant sunbathes, vitamin D may need to come from the diet as well for a significant part of the year.

The authors of the online article are more shameless in their assumptions. They assert, “Researchers concluded that the conventional dogma, which advises avoiding the sun at all costs and slathering on sunscreen to minimize sun exposure, is doing more harm than actual good.” This is a lie on two accounts, the definition of dermatologic dogma and about the researcher’s thoughts on sunscreen.

The current dermatologic dogma is focused on sun protection, not sun avoidance. No reasonable dermatologist would advocate for complete sun avoidance unless you are a vampire, have a photosensitive disorder, or have undergone a recent procedure that warrants temporary but strict sun protection for an optimal outcome. And sunscreen, as mentioned above, is not part of the referenced study.

The article also paraphrases a well-known dermatologist who effectively said, “There’s no proof that increased exposure to the sun increases the risk of melanoma.” True, but this is only part of the story.

Does the sun cause skin cancer. Yes. Unequivocally yes. Ultraviolet (UV) radiation from the sun causes mutations in the DNA of skin cells that are very closely linked to certain types of skin cancer. What often gets overlooked is the fact there are different types of skin cancer. Squamous cell carcinoma and basal cell carcinoma are highly associated with the amount of sun exposure and sun damage over a person’s lifetime. Melanoma is a different beast and while there is no evidence to suggest a causal relationship between simple sun exposure and melanoma, there does seem to be an association of some kind.

The article then goes on to reference a second Swedish study published in 2000 titled “Sunscreen use and malignant melanoma”. They misrepresent the authors by saying that the study “concluded that higher rates of melanoma occurred in those who used sunscreen versus those who did not.”

While this is technically true it is seriously misleading. The authors of the study actually concluded, “sunscreen use, by permitting more time sunbathing, is associated with melanoma occurrence.” This statement/theory on the researchers part was further supported by the fact that the association between more frequent sunscreen use and melanoma was stronger in men, and people using sunscreens with SPF of 10 or lower. Meaning that the people using more sunscreen where hypothesized as getting more sun exposure and using the sunscreen ineffectively.

Regardless of the facts and your interpretation thereof, skin cancer is not the only untoward effect of excessive sun exposure. Sun damage also results in wrinkles, loss of collagen, uneven pigmentation, and premature aging.  And many people find these reasons for sun protection to be more compelling.

Overall, there are clear benefits from prudent exposure to the healing rays of the sun, physically and emotionally. But protection and moderation is, at this time, what the medical community painstakingly tries to suggest.
The best approach to sun exposure, as recommended by cosmetic dermatologists, is moderation and spf protection.

If you’re simply thinking I’m biased because I’m a dermatologist, you’re probably right.  I suppose that in the end, more UV radiation is ultimately good for business.  If we really do need to get more sun, and subsequently increase the incidence of sun related skin conditions, in order to better our chances of living longer, then I’ve got plenty of job security to look forward to.

Exciting News for Aging Hands

Dr. Smart treated this patient's sagging skin, a sign of aging often shown first in the thinner skin of the hands and neck, with simple cosmetic dermatology procedures in his Salt Lake City dermatology clinic.

Do your hands give away your age?

Frequently we focus on the face when discussing cosmetic improvement, but there are other telling locations that can be treated.   One the areas that most give away our age is the hands. As we age, our hands lose firmness and plumpness and begin to look fragile and bony. The veins become more prominent, the skin starts to look thin and often becomes speckled with brown spots from sun exposure.

Combating the aging hand takes more than hand cream, though that simple step does make a difference. But cosmetic filler is often the answer.

This month the US Food and Drug Administration (FDA) approved the injectable dermal filler Radiesse (Merz North America, Inc) for hand augmentation to correct volume loss in the dorsum, or back, of the hands. This is great news!!   Radiesse is a fantastic way to turn back the clock and bring a youthful soft appearance to the back of the hands.

Radiesse injections immediately revitalize and replenish the volume of the back of the hands. And provide a supple and youthful appearance instantly. Placed beneath the skin, Radiesse raises the skin level so that tendons, joints and veins lose their prominence.

Also, because Radiesse provides support and a scaffolding for the deep skin tissue, the body’s own collagen is stimulated and begins to interweave with the filler and helps keep the skin feeling soft, natural, and smooth.

The Results typically last 1 – 2 years with immediate improvement.

In the studies used to gain FDA approval the most common side effects were extremely mild and include injection site reactions such as swelling, redness, pain, and bruising, which were usually mild to moderate, short in duration (lasting about 1 week), and required no treatment. No severe adverse events were reported.Signs of aging showing in hands before simple cosmetic dermatology procedures to reduce signs of aging performed by Dr. Smart at The University of Utah's Salt Lake City clinic

Tight Skin! ThermiTight

Over time the effects of gravity and aging slowly take their toll on us all. And for several reasons certain areas on the face and body unfortunately start to droop and sag, and the skin loses its youthful rebound and tension.

In short, life happens. Skin gets loose. And people want to keep it tight.

thermi-tight

Skin tightening is a popular request in a dermatologist’s office, and the world of aesthetic medicine and technology continues to try to meet the increasing demand with new approaches and treatments. A relatively new treatment modality of an already proven technology is ThermiTight.

ThermiTight is an application of the ThermiAesthetics system that uses radiofrequency (RF) technology to safely rejuvenate the skin. It is also one of the most effective “non-surgical” skin-tightening treatments I’ve seen. We’ve had great results.

There are many different devices in this non-surgical skin-tightening realm. Some work well, some less so, but none that I have yet seen work better or as reliably as the TermiTight. This is not to say that I don’t like, use, and recommend other methods. I do. But I’ve recently been quite impressed with the results of this treatment method.

ThermiTight’s RF energy induces the reduction of wrinkles, tightens skin and helps contour the body by heating underneath the skin, the hypodermis, and the layer of adipose tissue found there. It causes the release of liquid fat from fat cells and induces fat cells to shrink in the treatment area while also stimulating new collagen formation and contraction.

This procedure may be administered on several areas:

  • Lower face and neck
  • Arms
  • Legs
  • Stomach
  • Breasts
  • Hips
  • Back

It is also frequently combined with other procedures such as liposuction or laser resurfacing which reduces fine lines and wrinkles on the surface of the skin.

The fact that the RF energy is applied directly to the hypodermal layer is what makes it stand out. A fact that likely accounts for increased efficacy, but does make it minimally invasive. Unlike ultrasound or laser techniques, in which energy is placed on the surface of the skin and directed internally, RF energy stimulates the skin from within. The use an internal probe to apply energy below the surface of the skin directly targets the collagen.

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The treatment begins by administering local anesthetic to the treatment site. Tumescent anesthesia is used, which means that a diluted lidocaine mixure is used to flood the target area.   A thin, specialized probe is then inserted through a very small incision (2-3mm) to reach the subdermis. The probe is then slowly moved back and forth to evenly heat the treatment area. The continuous temperature monitor on the probe is set to the desired level required to tighten the skin, while an infrared camera is used to monitor the skin surface temperature and ensure the heat energy is maintained at an effective and safe level. The treatment lasts for less than 60 minutes, with results that develop gradually over 3-6 months. After the procedure, the patients are free to resume normal activities the next day. There is very little recovery time, with temporary bruising or swelling being the most common side effects.

For patients with skin that is drooping naturally from aging or significant weight loss ThermiTight might just be exactly what they are looking for.

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Stretch Marks

Stretch marks are noticeably lighter and less visible after only five laser treatments from Dr. Smart at The University of Utah's Department of Dermatology
Before and after 5 treatments of the Fraxel laser

The Stretch Mark

Why do stretch marks form? Well…. from stretching right? Probably, but the precise cause of stretch marks, also known as striae, is not quite understood. While many believe that mechanical stretching of the connective tissue causes rupture and their subsequent appearance, there is more to it than that. And even normal growth associated with high levels of steroid hormone may be the cause.

Whatever the cause, many of us have a stretch mark or two. They are a very common cosmetic concern and more than twice as likely in women, compared to men.  But regardless of gender, they can be frustrating to us all.

Keep in mind, we divide striae into two groups, striae rubra (SR) and striae alba (SA). SR are a little bit pink, red, or purple, relatively new, and may be raised. SA are typically older, light colored and slightly atrophic or thinned. These categories are important because they are treated a little differently.

How to treat your stretch marks:

Treatment of stretch marks includes a variety of topical and injectable medications and laser therapy and resurfacing techniques.

Tretinoin and similar topical creams have shown to clinically improve the appearance of SR in clinical trials. Daily application over the period of 3-4 months may help exfoliate and tighten the mark. Other topical therapies that show benefit are glycolic acid and Trichloroacetic acid (10-35%) These are typically applied at monthly intervals.

Another proven therapy is microdermabrasion. By carefully and gently abrading the superficial layer of skin, deeper new collagen regeneration is stimulated and the texture of the striae can be smoothened and strengthened.

There are also a variety of laser and light devices that have been studied to treat these pesky stretch marks. By using a combination of different lasers, such as the V-beam and Fraxel lasers, Good to great results can be achieved in both newer red stretch marks and older white colored ones.

Personally, I like the results I get with laser resurfacing. Fractionated laser resurfacing will help tighten the skin and improve the appearance of stretch marks both new and old.

A few technical details:

 The PDL 585-595nm lasers have perhaps the most evidence and are able to achieve good results when treating the early SR. Their effect is less impressive on mature SA.   Though caution should be used on much darker skin types with this laser. And in darker skin types one might consider a different wavelength such as a 1064nm ND: YAG. This provides increased safety when treating dark skin types, while still provided collagen regeneration and targeting vasculature.

The treatment of SA is more difficult and less predictable.  Studies show conflicting results with various fractionated laser modalities. but both ablative and non-ablative fractionated lasers have shown improvement. And both should be considered options in patients with mature striae.

Another consideration in SA may be the 308nm excimer laser. Multiple studies have documented improvment and repigmentation in white or light colored areas with the excimer.