retin a Archives | The Aesthetic Clinique

The Latest Trend “Prejuvenation” – Preventative Rejuvenation

It’s been touted for years by the aesthetic physicians – “Prejuvenation” – starting maintenance treatments in one’s late teens or early twenties. The Kardashians have popularized these minor cosmetic tweaks to stay youthful and refreshed with visits to their Beverly Hills physician, documented regularly on “Keeping Up with the Kardashians”. There is increasing pressure to get that perfect selfie for Instagram or to look cool and attractive on a “Snap”. Unfortunately filters don’t work well with videos unless you want to look like a cute puppy. Doctors are in agreement (for any disease process) that it is much easier to treat problems in their early stages than to reverse them after they have spiraled out of control. Small preventative treatments early on, can maintain and even enhance one’s looks for many years and avoid invasive surgical procedures in the future. The question is, which procedures should be considered for Prejuevenation?

Neuromodulators: These wrinkle improving injections take less than 5 minutes and have no downtime. Millions of these procedures are done each year and it is the most popular cosmetic procedure performed worldwide. Most often these are used in the younger population in the frown lines (glabella), forehead lines, and crows feet. Treating these areas before the lines set in at rest, known as “etched in” lines, is one of the fundamental concepts of Prejuvenation. (Suggestions: Dysport, Botox)

Dermal Fillers: Dermal fillers made from hyaluronic acid (HA) are used to improve the minor volume loss which occurs with age. In the more athletic patients, fat loss can be appreciated in the face as well as throughout the body. Supple enhancements can be added to the mid cheek and around the eye to stave off this premature volume loss. HA fillers are also used to plump up the lips to create a youthful appearance. (Suggestions: Restylane Refyne, Restylane L, Restylane Lyft, Sculptra)

Chemical Peels: To keep the skin in top notch shape and to reverse early sun damage, chemical peels can exfoliate the superficial layers of skin. This renews the texture and pigmentation and leaves a youthful and glowing quality to the skin. (Suggestions: Illuminize, Vitalize, ZO 3 Step Peel)

Skin care: Great skin care is the basis for good looking skin. Most would agree that some type of Retin A or Retinol is essential for maintaining youthful skin. These products lead to increased turnover of the skin cells, improve dyspigmentation (pigmentation problems), thicken the skin, and create a more hydrated skin. Sun protection with an SPF should be part of one’s daily regime. It is also highly recommended to apply growth factors to the skin to reverse the aging process. (Suggestions: ZO Skin Health, Lifeline Stem Cell Skincare)

Prejuvenation is a trend that is here to stay. Preventative maintenance will prolong the need for more aggressive corrections in the later years. With short, no downtime procedures such as neuromodulators, chemical peels, fillers, and a good skin care regime, youthful, natural appearances will persist for years. Stay ahead of the curve with Prejuvenation.

Beauty and Skin Tips for those on a budget.

This blog will elucidate that small changes to one’s lifestyle and a small investment in skin products, will lead to significant improvements in one’s skin health and beauty.

Protect from the sun with daily sunscreen, sun protection, and Heliocare. The number one enemy to skin is sun exposure. The sun’s UVB rays lead to activation of enzymes that destroy the skin’s collagen leading to wrinkling and thinner skin. Skin pigmentation problems (melasma, solar lentigos) are exacerbated by the sun. Skin cancers are almost always related to exposure to the sun’s damaging rays. Studies have shown that just using sunscreen can improve ones looks. Heliocare contains Polypodium leucotomos which is a fern extract that is an antioxidant that reverses and protects against the radiation effects of the sun on skin cells. Heliocare has also been shown to improve melasma, because even indoor artificial light can exacerbate this condition where sunscreens don’t offer protection. Wearing a large brimmed hat, SPF rash guard (if at the beach), and staying under an umbrella/shade should be considered during periods of prolonged outdoor sun exposure.
Stop smoking. Smoking is probably a close second to the sun as a factor affecting skin health and beauty. The toxins in smoking cause contraction in vessels in the skin, leading to poor oxygenation of the skin cells. Smoking essentially strangulates one’s skin causing loss of elasticity, viability, and thickness. Other side effects include increased wrinkles, a change in the color of the skin, thinning of the hair, halitosis, and dental disease.
Apply topical Retin A or Retinol. It has been well established with research dating back over 25 years, that Retin A has anti-aging qualities. It has been shown to increase cellular turnover in the skin, thus creating skin cells that are younger and more vibrant. It increases collagen in the skin and improves hydration in the skin by increasing the GAG’s. Pigmentation abnormalities are improved as well. Precancerous changes are reversed and prevented to a certain extent. Wrinkles and photodamage have been shown to improve with just using Retin A. One word of caution. If you choose to use Retinol because it has less peeling, you have to use a strength that is higher than what is found in most OTC cosmetics.
Maintain hydration, drink plenty of water. This is somewhat controversial, but there are anecdotal reports of improvements in overall looks with just making sure you are fully hydrated. There are obvious other benefits as well including kidney, bladder, blood pressure and circulatory health.
Topical Growth Factors and Antioxidants. Growth factors stimulate skin cells to become more youthful and recruit stem cells which may lay dormant in the skin. Antioxidants help the skin fight off the environmental stress that attacks the skin, including the sun’s damaging radiation. Products that fall into this category are: TNS Essential Serum, Lifeline Day and Night Cream, and Neocutis Journee.

These recommendations are a good start to improve skin health for all individuals, regardless of budgetary concerns. The younger these are implemented, the less correction that will be needed in the future. Consider following these guidelines as an “investment in the future”.

Here are Dr. Weiner’s top 5 things “Not to Do” to improve your skin and looks.

There are hundreds of articles on beauty and skin telling you what you should be doing to improve your looks and skin health. I’m going to take the opposite approach. There are numerous activities and habits I see in our office that is just plain counterproductive to what I’m trying to improve. If you just stopped these 5 things, your skin, looks, and sometimes overall health would be significantly better.

Don’t smoke! Without a doubt, this is the worst habit for your skin’s health. The nicotine causes the small vessels in the skin to contract. This “strangulates” the organs and deprives the skin of oxygen and it’s vital blood supply. Toxins from the tobacco enter the blood stream and are distributed throughout the body and skin as well. Worst of all, smoking gives you smokers lip lines – a very difficult problem to fix.
Don’t use tanning beds! I’m surprised that tanning beds are still legal. There is no doubt in the medical community that tanning bed use increases skin cancers: basal cell, squamous cell, and even melanoma. Looking beyond cancers, severe premature aging of the skin is a result. Just as sun exposure does, tanning beds cause breakdown of collagen and elastin fibers leading to loose, thin, nonelastic skin. Volume loss associated with aging is exaggerated.
Don’t pick! I see numerous scars related to acne, particularly deeper cystic acne, that the patient tries to “improve” by picking, poking, and needling. This can lead to a worse infection, sometimes MRSA, that requires antibiotics and creams to improve. The end result is often scarring and hyperpigmentation which can require skincare, peels and often lasers or RF treatment.
Don’t listen to your friend/neighbor who recently became a skincare expert! Isn’t it funny that your friend now knows all about what’s good for your skin and they have the perfect product that will do miracles that they want to sell you. For additional convenience, they will also ship it to you on a monthly basis. Keep your guard up with these folks. Most often, the products are nicely repackaged creams available OTC from multiple different companies. Only physicians can sell certain products which are prescription strength or certain product lines that have peer reviewed research behind them. Aestheticians spend months in the classroom and devote their livelihood to skincare and are truly experts in guiding your skin care regime. At The Aesthetic Clinique, we have 4 fulltime aestheticians, 1 nurse, and Dr. Weiner to give you a team approach to your skin. We offer multiple skin care lines which we have chosen for their particular strengths in certain age and disease related processes.
Don’t expect a face lift to fix everything! It happens daily in our office. “I’m trying to decide if I should do skincare, peels, filler, lasers, Botox, Ulthera, Infini or JUST GET A FACELIFT”. A facelift will help with laxity, improve the jowls, improve some wrinkles but there is so much more that won’t get treated. In most cases, some sort of neck lift must be done to improve the jawline and “to match the face”. Getting a facelift does not mean you can eliminate Botox. A facelift will do absolutely nothing for the skin damage that would benefit from lasers, skincare, and peels. Volume loss is not addressed by a facelift unless a secondary procedure with fat grafting is performed. It’s been my experience that patients who have had facelifts actually have more volume loss related to fat atrophy in the preauricular area as a result of the flap elevation (lifting the skin). Rejuvenation around the eyes is not part of a standard facelift and requires another procedure called a “blepharoplasty”. The point is that it takes a multifaceted approach to improve all the aspects of the aging face, and a facelift only addresses a small part the problem.
Bonus (Addendum) Don’t drink from straws. This habit leads to those ugly lip lines, even if you don’t smoke.

Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

Website: http://www.theclinique.net

Dr. Steve Weiner: “FINALLY…A Radiofrequency (RF) Skin Tightening Device that Makes Sense. Infini by Lutronic.” Includes an overview of the RF skin tightening industry.

Before and after one treatment with the Infini. After is 8 weeks after the treatment.

Infini treatment of forehead lines. After (right) is 8 weeks after one treatment.

Infini RF treatment of face and neck. After (right) is 6 weeks after 1 treatment. Show improvement in jowls, jawline, upper eyelids, and cheeks wrinkles.

Infini treatment for neck and lower face wrinkles.

15 hours after having the Infini Treatment, ready for work

3 hours after Infini Treatment, she had already gone to yoga

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Dr. Weiner’s White Paper on Infini (more medical terms and more detailed than blog)

Dr. Weiner explains why Coagulation is so important in tightening skin

Radiofrequency use in medical treatments has over a 70 year history. It has been used for multiple applications but the most exciting innovations recently have been in skin tightening. Thermage in 2002 was the first to market a device which was FDA approved to tighten skin and improve wrinkles. Since then, there have been a least a dozen devices come to market with similar technology including: Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime, Fractora, Evolastin, and most recently Infini. The “knock” on most of these devices has been:

The results are variable – most patients get minimal or no results
Multiple treatments (6 or more) are often needed with touch ups with some of the devices

This blog will help the reader understand how RF devices tighten skin, the problem with most RF devices (why they mostly don’t work), and why the Infini by Lutronic is a game changer in this group. Research has shown that heating the dermis to a certain temperature will cause collagen stimulation and contraction. By heating to 40-45 degrees Celsius, enough heat is created to cause the body to try to repair the area by laying down new collagen. Higher temperatures, in the 65 degree range, will denature collagen and cause contraction. Obviously this requires more energy but this equates to more visible results. Here’s the problem with all cutaneous devices (Exilis, Venus Freeze, Pelleve, Viora Reaction, 3Deep RF, Accent XL, eMatrix, eTwo, TriPolar RF, ReFirme, Sublime): It is very difficult to heat the dermis to a temperature that is effective and still maintain safe temperatures for the skin surface. If the surface were to reach the 40-45 degree area, it would burn. So, these device’s solution has been to try to cool the surface while pumping in energy to the deeper layers. This becomes a very difficult and unpredictable task. The devices rely on the tissues to carry the energy to the right level. Differences in skin thickness, hydration and the composition of collagen and fat can lead to placement of the energy at unknown or variable depths. If the energy is placed too deep, you can get fat necrosis, as what was occurring with the early Thermage device, and if placed too superficial, the skin can burn or get hyperpigmentation. Also, if you don’t actually reach the critical temperatures, you will get no stimulation of collagen. Multiple treatments are the norm for several of these devices because getting collagen stimulation is very difficult with the one treatment. The bottom line is that

ALL CUTANEOUS RF DEVICES, NO MATTER WHAT THEY ARE CALLED, HAVE THE PROBLEM WITH UNPREDICTABLE HEATING OF THE DERMIS AND THEREFORE UNPREDICTABLE OR VERY LITTLE RESULTS.

Skin surface is cooled and RF energy is pumped through the skin surface to heat dermis is UNPREDICTABLE manner

During Thermage, the skin surface is cooled and then RF energy is pumped through the skin surface to heat the dermis in an UNPREDICTABLE manner

Infini vs Other RF Devices

Ever since Fraxel was approved in 2005, the concept of treating areas fractionally has been the desired treatment modality for most devices. By treating only a fraction of the tissue, you can have more safety, more comfort, yet still get fairly similar results than treating the entire area. This concept has been borne out mainly with lasers in the arena of fractional laser resurfacing. Now comes another “knock” for the majority of RF devices: Almost all of the devices use a bulk heating method and not a fractional heating, so the risk, downtime, and discomfort are high. By keeping surrounding tissues untreated (fractionally) as with the Infini, you get faster healing, less pain, and much less risk. So how can we get more predictability with RF? Penetrate the skin to the level you would like to heat with microneedles and bypass the superficial layer that must stay cool and untreated. You can heat the deeper tissues to a much higher level with this technique, leading to greater collagen remodeling, collagen contraction, and stimulation. As a secondary benefit, the actual penetration with microneedles has been shown to mechanically stimulate fibroblasts to produce collagen.

$Precise fractional controlled thermal injury of the Infini$

Precise fractional controlled thermal injury of the Infini, vs monopolar and bipolar RF, vs ablative laser

There currently are many popular treatments based solely on microneedling (Vampire Microneedling). By creating an opening in the skin with the needles, topical therapeutics can be applied at the conclusion of the treatment which will get to levels much deeper than when typically applied to the surface of the skin. These can include: growth factors (rejuvenation), Vitamin C (for collagen), hydroquinones (for pigment), Retin A (rejuvenation and acne). Going deeper into the skin allows for some treatment opportunities which haven’t been/or poorly been addressed in the past with RF devices: Acne treatment (attacking the sebaceous glands), acne or other scarring (particularly darker skin types), and sweating (attacking the sweat glands). There are 3 devices on the market which use this microneedling concept:

Evolastin
Fractora
Infini

Evolastin: Uses 32g needles in depths which are between 1-2mm. The needles enter the skin in a tangential manner, so the exact depth is hard to predict. The energy transmits between paired needles, so the heating in fractional and localized. The major problem is that the patient requires tumescent anesthesia (infiltrating lidocaine mixed with saline) into the area being treated. This adds additional time, discomfort, and risk. Another concern is that this solution actually changes the tissue characteristics, so the treatment becomes less predictable – maybe more or less effective in different areas or maybe safety concerns in certain areas.

Evolastin has tangential needle placement and large caliber needles

Fractora: Uses needles which have a fixed depth of 1mm. The energy is transmitted through the needles and circles back to the electrode sitting of the surface of the skin. The surface probe has a sensor to monitor the skin temperature so as to maintain it within safe parameters. This is truly NOT fractional because the energy is dispersed in the areas between the needle tips and the skin surface. Here we go again with unpredictable traveling of the energy through the tissues and bulk heating. Concerns for safety and discomfort come to mind.

$Fractora electrodes are not insulated and treatment is not fractional.$

Fractora electrodes are not insulated and treatment is not fractional.

Infini: Uses needles which are 200 microns (small). Has variable depth of penetration from 0.5mm to 3.5mm so in the same treatment, several different levels of the dermis can be treated PREDICTABLY. Also, some parts of the face have different thicknesses of dermis, so the variable depth allows for treatment of the entire face. A depth of 3.5mm is much deeper than the other 2 needle devices. The energy is transmitted between the needles which results in true fractional RF ablation in the dermal tissue. The energy only travels a very small distance so the discomfort is minimized. (The more distance the energy travels through tissue, the more pain is felt.) The surface tissue is safe because the needles are at a level that won’t transmit energy to the epidermis. The treatment time is fairly quick: full face treatments take about 30 minutes, as do the neck procedures. For optimal results, it can take 2-3 treatments and full results take the standard 4-6 months to fully achieve (when the collagen remodeling is complete.)

$Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels$

Infini showing the microneedles causing a small precise fractional dermal injury at multiple levels

The wide spectrum of indications of the Infini are:

Improving superficial fine lines and wrinkles of the face, eyes, neck
Improving the elasticity of aged and solar damage “thin” skin
Treating scars of all types but particularly acne scars. It has a great advantage over laser for darker skin types. Infini might turn out to be the “go to” device for scars over the Fraxel Dual 1550 because of deeper treatment levels (3.5mm vs 1.8mm of the Fraxel) and without the pigmentation risks.
Tightening loose skin on all parts of the body including: arms, chest, knees, abdomen. There are no limitations as to where the skin can treated on the body.
Potentially a treatment for acne and hyperhidrosis
No exclusion of patients based on skin type with no risk of hyperpigmentation.
Downtime is limited to only about 2 days of sunburn like sensation and slight redness

When comparing to the Ulthera, the differences are:

Ulthera is more for lifting than for the superficial lines and wrinkles
Ulthera is only used on the face and neck at the present time
Ulthera is still being evaluated for acne scars
Ulthera can be used in conjunction with Infini for even greater tightening and lifting then just Infini or Ulthera alone
Ulthera results in 15,000 coagulation points with a treatment, Infini is over 50,000
Ulthera depths are below the dermis for the most part where tissue tightening is not very effective.

To summarize, RF skin tightening has over a 10 year history which has been fraught with several different technical hurdles: unpredictable results, discomfort, and safety concerns. Using microneedling RF, we can get the energy down to the level needed with more accuracy and more safety. Infini seems to have the right combination of the transmission of energy through their needle tips as well as having variable depths to be the ideal RF Skin Tightener at the present time. It also has a broad list of indications including acne scars, skin tightening on the body, and improving the fine lines and wrinkles of facial skin.

Dr. Steve Weiner is a Facial Plastic Surgeon who “laid down his scalpel” in 2005 and concentrates solely on non invasive and minimally invasive cosmetic procedures at The Aesthetic Clinique. He is one of the first 15 adopters of the Infini in the United States. His website is http://www.theclinique.net . Call for a consultation: 850.622.1214

This link is from a European round table discussion about Lutronic Infini and Spectra (both at The Aesthetic Clinique). Infini discussion starts on page 7. http://digital.miinews.com/publication/?i=174629

Blog: http://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial

How to improve your melasma

Melasma is skin pigment disorder (hyperpigmentation) which occurs in patches, which is often caused by fluctuations in hormones. It occurs mostly in females, most commonly affects the cheeks, forehead, nose, jawline, and upper lip. When associated with pregnancy it is called Chloasma, “mask of pregnancy”. It is exacerbated by oral contraceptives and exposure to sunlight and heat. Most people have fluctuations in their pigmentation, with the summer months being the worst.

There still is no consensus as to the exact etiology of the disorder. It seems that the melanocytes, the cells which produce pigment (melanin), are abnormally hyperactive. There are 3 forms of the disease: epidermal (superficial), dermal(deep), and mixed. It is often a frustrating disease for both patients and physicians because there is no easy cure. Recurrences are the rule. Often after taking months to improve, one or two sun exposures will reverse the disorder to it’s original state.

The first steps to improve melasma are:

Limit sun exposure. Use hats, suncreens, and sunglasses daily! Physical sunscreens are better because they also reduce the skin temperature.
Try to reduce the hormones in your BCP’s or use another form of birth control
Even if you are fully protected from the sun, heat can exacerbate the pigment, so try to limit outdoor exposure.
Even visible light has been shown to exacerbate melasma. We now recommend daily use of Heliocare to combat this.

If simple measures don’t improve melasma to your satisfaction, then try these measures from your Dermatologist or Plastic Surgeon:

Begin Retin A or Retinol. This suppresses the melanocyte and increases cellular turnover thereby decreasing pigmentation.
Hydroquinone 4%. This is a cream which suppresses the pigmentation production from the melanocyte. Although some physicians go to higher strengths, there are more risks of getting complications and rebound hyperpigmentation. (Please see the link, hydroquinones are on the way out.)
Lytera from SkinMedica. This is a new product that attacks pigmentation at 4 different levels.
Chemical Peels. Regular chemical peels seem to help control melasma and are the mainstay of therapy at The Aesthetic Clinique. It seems the consensus among Dermatologists as well.

After exhausting all the above measures and your melasma is still a concern, it’s time to consider using lasers. Only as a last resort are laser used because there are risks of making melasma worse. There are 2 lasers FDA approved for melasma and The Aesthetic Clinique has both of them. The Fraxel Dual is a resurfacing laser and treats the superficial epidermal form of melasma. Usually one to three treatments are needed and there are a few days of downtime. The other laser is the Lutronic Spectra Q switched laser. This is used for all types of melasma and there is no downtime. The Spectra can require 5 to 10 treatments with 1-2 touch ups per year. This laser might give a longer term solution to the problem because it actually causes permanent change to the melanocyte whereas the Fraxel Dual affects the pigmentation secreted from the melanocyte.

Although melasma can be a frustrating stubborn disease, there are many treatment options available. The Aesthetic Clinique has the 2 lasers which are FDA approved for treating melasma.

Please call our office to see what treatment options are available for you melasma. 850.622.1214. The Aesthetic Clinique, Steve Weiner, MD, Facial Plastic Surgeon, between Destin and Panama City Beach, Florida.

The various treatments for Acne Scars (scarring) at The Aesthetic Clinique

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Dr. Weiner answers questions about acne scars

Acne scarring is a very prevalent problem in our society. It also a very common concern for clients in our office because it most often affects the face and becomes a cosmetic concern. Treatment options are based of the severity of the disease and the intensity/aggressiveness the client desires. One must accept the fact that scarred skin will never improve 100%. However, once a scar in improved, it should persist indefinitely, unless further acne causes more scarring.

UPDATE: We now offer Infini, a radiofrequency microneedling device. This appears to be a great alternative to laser for acne scars. Please read the link.

Topical treatments are needed for all cases acne scarring. The regime should include: Retin A or Retinoid, serum with growth factors (TNS Essential Serum or Lifeline), and sunscreen.

Early scarring, which is the result of recent acne can be treated best with the VBeam. The VBeam will help with the redness and hopefully slow or prevent the progression of the scar turning into a mature and firm scar. The VBeam also helps with future acne breakouts.

Ice pick scarring can be treated with punch excision which involves removing the scar in a sleeve like fashion and closing the skin with a stitch. The more preferred way at our office is to use high concentration TCA and to chemically burn each individual scar in a series of 4 or 5 treatments. This method is called TCA Cross technique.

For more severe global acne scarring, the Fraxel Dual 1550 nonablative laser is probably the gold standard. This laser has more studies and experience treating acne scarring than any other laser. There is some mild swelling for a few days but no open wounds to dress. Peeling occurs for a few days a well. The number of treatments varies according to severity of disease and desired effect, but could be up to 10 treatments. It is safe for all skin types. Ablative erbium or CO2 lasers are used for acne scarring as well but we don’t have these lasers in our office. It’s been our experience that patient’s prefer the less invasive lasers with less wound care. less risk, and downtime.

For minimally depressed scars, using dermal fillers like Restylane can be a quick and easy medium term (9-12 months) improvement. Artefill has just published a study and will probably get FDA approval for acne scars in the near future.

There is research being done for using Ulthera, LaViv, and stem cells for acne scars as this blog is being written.

In general, there are several different choices to treat acne scars. Lasers are required for the most severe cases. Treating acne aggressively to prevent scarring is obviously highly recommended because treating the scarring is much more difficult.

Dr. Steven F. Weiner’s Top 10 Beauty and Longevity Recommendations

After being a physician for 25 years, I have read countless medical journals and listened to hundreds (if not thousands) of lectures. I have sifted through all those years to come up with my top 10 recommendations for a long and beautiful life. Here is my last 25 years summed up:

Topical Retin A – Some sort of Retin A, Retinol, Tretinoin used regularly will keep the skin youthful, vibrant, less pigmented, and minimize acne breakouts. It accelerates skin turnover, decreases sebaceous secretions, thickens the dermis, hydrates the skin, and reverses DNA damage which could lead to cancers. There is over 25 years of research behind this compound so don’t worry over side effects from prolonged use.
Antioxidants – Oxygen free radicals are the main cause of aging and cancer. These are produced daily throughout our body and skin. There are numerous articles touting the benefits of red wine, chocolate, and fruits for their health impact which is mainly due to their antioxidant qualities. Dr. Weiner is especially fond of GliSODin Skin Nutrients which contains the very powerful enzyme, Superoxide Dismutase (SOD). Antioxidants (several are found in SkinMedica TNS Essential Serum) placed directly on the skin help protect from the damaging sun rays. Resveratrol, the antioxidant found in red wine has been thoroughly studied to have benefits for multiple medical conditions (we sell MegaResveratrol). Other oral antioxidants I recommend: bromelin, tumeric, astragalus, polypodium leucotomos (Heliocare), vitamin C, co-enzyme Q10, selenium.
Aspirin – A daily baby aspirin, 81mg, will help prevent strokes, heart attacks, and cancers. Make sure it’s a coated aspirin to prevent stomach ulcers. Remember that the blood thinning effects will last 12 days.
Stay trim – This is a fairly broad recommendation which includes eating right, regular exercise, and choosing active recreational sports. Don’t be a couch potato.
Don’t smoke – Smoking strangulates the skin and other vital organs. The blood vessels contract with the drugs in tobacco. Smoking cessation can reverse most of the damage created so it’s never too late. There is no question at this time that a smoker’s risk of heart attack, stroke, cancer, and lung disease are significantly elevated.
Minimize sun exposure – The number one cause of collagen loss in our skin is sun exposure. Protecting with sunscreen and antioxidants will reduce this breakdown. Skin cancers – melanoma, basal cell, squamous cell, have all been linked to sun exposure. Cataracts can also be caused by the sun so wear sunglasses. Wear hats, rash guards, and use an umbrella when at the beach.
Moderate Alcohol Consumption – There has been numerous studies which tout the benefit of 1-2 drinks per day. Some studies have shown this to be almost as efficacious as exercise. The benefits are lost with consumption that is higher than 2 drinks per day and becomes detrimental.
Daily Exercise – Keeping in good physical shape is beneficial to the heart, lungs, bones, and mental health. It also helps maintain your body weight which is very important as stated in #4.
Don’t wait too long to see a doctor when having problems – I can’t tell you how many times I’ve seen people walk into my office with an obvious cancer. The treatment becomes much more difficult the longer you wait. Its not going to go away if you ignore it. So if you experience a growth, abnormal bleeding or bruising, rapid weight loss, prolonged fevers, night sweets, chest pains, non traumatic body aches, or new neurologic symptoms, please see your doctor soon.
Maintain social awareness, activities – Its important to keep abreast of current affairs, participate in local activities and maintain friendships. It keeps your brain stimulated and mental health stable. Challenge your brain with learning new things, word and math problems, reading, and new hobbies. Go back to school, change jobs or careers to keep stimulating yourself. Don’t fall into a routine which becomes mundane.

Treating the difficult acne sufferer with Levulan for prolonged improvement

Acne is an extremely common disease, affecting approximately 17 million people in the United States. It’s presentation is varied; ranging from small occasional blemishes, to deep painful cysts, to infected pustules on the skin surface. The consequences of acne can affect ones self confidence, social life, and interpersonal relationships. Facial scarring from acne can affect individuals into their adult lives, even after the disease process has long subsided.

The disease process is due to a combination of factors, but primarily related to excessive secretion of sebum, which is the product of sebaceous glands and often an associated infection. Topical therapy can control most cases and is essential to maintain skin health for acne sufferers. Retin A (or derivatives such as retinols, Tazorac, Renova) is indicated for ALL acne patients, whether the problem is mild or severe. Other topicals used, depending of the severity and type of acne are: Antibiotics, Benzyl Peroxides, and anti-inflammatories as well as chemical peels. For the most recalcitrant forms of acne, Accutane has been used with fairly good success. This drug has very strict guidelines because of it’s multiple and often severe side effects which include: birth defects, liver inflammation, depression/suicide ideation. Lower doses (20mg/day) seem to have fewer side effects but monitoring is still required whenever taking the drug.

For the patient with acne that’s not responding to topicals and wants an alternative to Accutane, Photodynamic Therapy (PDT) with Levulan is a great choice. (Levulan is currently not FDA approved for this disease but is currently undergoing clinical trials for acne treatment.) The process starts out with a thorough cleaning of the skin with acetone. The skin is then prepared with microdermabrasion or dermaplaning (if the skin is not too inflamed or infected) to allow for greater penetration of the Levulan when applied. The Levulan is spread over the affected area and allowed to “incubate” for anywhere from 30 minutes to 1.5 hours usually with the skin occluded with plastic wrap as well. During this incubation time, the Levulan is slowly being absorbed by the sebaceous glands. After the desired time has completed, the Levulan is thoroughly washed off and then it is activated by light. At the Aesthetic Clinique, activation is performed with both the VBeam (pulsed dye laser) and the Blu U so as to achieve the maximum results from the treatment. At this point, the patient can experience burning and stinging, which can last for several hours, like a bad sunburn.

For the next 36 hours, the area treated needs to be protected from any form of light (sunlight, light bulbs). Even when leaving the office, we make sure the face is wrapped in a scarf and a hat is on. We have found it’s best to be treated in the late afternoon/early evening so you can resume your normal schedule at treatment day +2 in the AM. At about day 3-4, the skin will begin to peel and will do so for about 48 hours. During this time, a flair of the acne can occur and is nothing to be concerned about and can be treated with antibiotics if needed. The full results will take about 12 weeks to appreciate and it is recommended to have 3 treatments, spaced about 3-4 weeks apart. Long lasting improvements of about 75% can be obtained for 9-12 months or longer. Some doctors have shown slides at meetings of 5 year or more improvements. Typically, a “refresher” treatment at 1 year is recommended. Results which are similar to Accutane are not uncommon, but without the associated side effects of the drug.

(It’s not uncommon to have to treat the acne scarring after the acne is under control. The Vbeam and/or the Fraxel Dual 1550 are good treatment options for the scarring.)

At the Aesthetic Clinique, there have been many happy clients who suffered for years with their acne, who have had success with using Levulan (PDT) and the recommended topical therapy. Call our office for a consultation. 850.622.1214