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New Year, New Skin

1/22/2023

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​Using RF Microneedling to rejuvenate your skin!

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It goes without saying that aging is inevitable. But getting old? Not so much. We can apply a lot of resistance to getting old. Many say that getting old is only in your mind, and there is a whole lot of wisdom and truth in that statement. But looking old isn’t just in your mind. ​

Looking old isn’t just in your mind.     There are many things that we have no control over.​

As we are forced to take part in the inevitable process of aging our bodies start to look older. There are many things that we have no control over. Genetics, environment, and the human condition to name a few. The Yin is, there are plenty of things that we have lots of control over and can use that to our advantage to look much younger than our actual age. There is a Yang, of course, and that is there isn’t a magic pill, yet, and looking young is a lifelong process.
Our bodies accumulate a lifetime of cellular and molecular damage that ages our skin. The goal for looking youthful despite your age is to prevent as much of that damage as possible from happening as well as repairing the damage that does happen. 

 We know without any doubt that UV rays damage our skin and cause it to look aged. Sunscreen prevents the UV radiation from penetrating the skin and causing damage. 

​First, let’s discuss prevention. It all starts with SPF. We have a complicated relationship with our Sun. It giveth and it taketh away. It gives us life and strips us of our youthful complexion. But we have a great defense, and that is sunscreen. We know without any doubt that UV rays damage our skin and cause it to look aged. Sunscreen prevents the UV radiation from penetrating the skin and causing damage. On top of that, hats, sunglasses, UV protective clothing, and umbrellas are all great ways of preventing those harmful protons from penetrating our skin.
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Our bodies accumulate a lifetime of cellular and molecular damage that ages our skin. The goal for looking youthful despite your age is to prevent as much of that damage from happening and repairing the damage that does happen. 

First, let’s discuss prevention. It all starts with SPF. We have a complicated relationship with our Sun. It giveth and it taketh away. It gives us life and strips us of our youthful complexion. But we have a great defense, and that is sunscreen. We know without any doubt that UV rays damage our skin and cause it to look aged. Sunscreen prevents the UV radiation from penetrating the skin and causing damage. On top of that, hats, sunglasses, UV protective clothing, and umbrellas are all great ways of preventing those harmful protons from penetrating our skin.
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The second step is repairing and restoring the skin that does get damage. As great as SPF and other preventative steps are, some skin damage will inevitably happen from the sun, from other environmental causes and from natural aging as well. Thankfully we can help the body repair much of the damage.
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Radio Frequency (RF) Microneedling uses heat energy to encourage the skin to heal. Pulses of energy released into the dermis stimulate collagen and elastin production providing a tightening and smoothing effect. The old damaged skin is sloughed off revealing new skin with a younger appearance. 

Because it only affects a small fraction of the skin, downtime is short (a few days) compared to more intense ablative laser services or chemical peels. At SkinWise Rx we have multiple RF microneedling devices that provide reliable and comfortable treatments and results.

RF Microneedling will also improve wrinkles, texture, acne scars, active acne, cellulite, and hyperhidrosis (too much sweat). Importantly, RFmicroneedling is effective on all skin tones and types because the needles deliver heat evenly and directly beneath the epidermis.
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AGNES Precision RF

1/13/2023

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Introducing AGNES - Precision RF Technology

AGNES Precision RF is a new, unique nonsurgical radiofrequency (RF) device that uses micro-insulated needles to precisely penetrate the skin at specific points, delivering RF energy to reduce unwanted fat and improve skin laxity.  Each of the micro-needles is partially insulated minimizing unnecessary damage to surrounding tissue, delivering unparalleled precision to your aesthetic procedures. This revolutionary technology also reduces recovery time and allows technicians to customize treatments to your individual needs.

AGNES Precision RF is a transformative technology that gives you solutions with the need for surgery. 

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There are nine different types of AGNES Precision RF micro-insulated needles, and each class has a different length of insulation for the corresponding specific use. This versatility and precision make AGNES Precision RF a genuinely innovative and unique device that is able to treat a multitude of areas successfully.

Safe and effective, AGNES Precision RF delivers results that can easily be reproduced on all skin types. Because it is not a laser there are no seasonal or skin type restrictions. The non-surgical procedures are quick (30 mins or less on average), with little discomfort, no downtime, and creates surgical-like results.
​AGNES Precision RF treatments result in immediate and long-lasting results. The innovative approach allows an aesthetician to treat small areas that can not be safely treated with other devices. This includes the face, body, scalp, and neck.

AGNES Precision RF has uses beyond eliminating unwanted fat. It is effective for improving the look and feel of skin texture and for improving the appearance of photo aged skin, acne vulgaris, scars, and striae. Treatments can lift and tighten the skin, smooth wrinkles and fine lines, define the jawline, and improve the appearance of puffy lower eyelid fat pads. Treatments are minimally-invasive with results that resemble those that are attained by surgical facelift. AGNES Precision RF can even treat cystic acne by removing the sebaceous gland improving or preventing acne and blackheads.
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AGNES Precision RF is a transformative technology that gives you solutions with the need for surgery. It is designed for both dermatological and aesthetic treatments. Permanently destroying fat and tightening the skin at the same time.
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Picking a Neuromodulator

1/3/2023

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Choosing The Best Neuromodulator For You

​Injectable neuromodulators are a fantastic solution for dealing with fine lines and wrinkles that can make us look older than we may prefer to look. Understanding and choosing a neurotoxin can be a difficult and overwhelming process that is made much easier with the help of an experienced medical expert like Dr. Doser, DNP, FNP-C.

​Let’s start with what neuromodulators are. First, the clinical definition - “Neuromodulators are an extensive class of exogenous chemical neurological insults that can adversely affect function in both developing and mature nervous tissue.” That description is simultaneously hilarious, boring and terrifying! And it doesn't make much sense, so…. let’s go with the layman’s definition. Neuromodulators are injectable solutions that temporarily block nerve receptors in the muscle, decreasing the depth of lines and wrinkles that form in the face. It also allows for the baby cells that make collagen to start to produce again causing softening over time with regular use.

"Understanding and choosing a neurotoxin can be a difficult and overwhelming process."

​Neurological “insults'' aside, neuromodulators are a large class of chemicals, a few of which can be used safely and effectively for aesthetic purposes. This class of FDA approved cosmetic treatments include Botox, Daxxify, Jeuveau, Dysport and Xeomin. Like everything in our universe, each of these treatments has both its yin and its yang. Dr. Doser has administered all five of these at SkinWise Rx and therefore has a great deal of insight into what works, what doesn’t and which ones she recommends. Dr. Doser no longer injects Jeuveau and Xeomin because there are better products available, so let’s just talk about the ones she likes and recommends.
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Daxxify

Daxxify is the newest neurotoxin on the block. Daxxify is in fact a new class of neurotoxin whose effects have been shown to last two to three times as long as other available neurotoxins. It shows very promising results. In clinical trials Daxxify was shown to last as long as 6 to 9 months. And longer lasting results means fewer trips to the clinic. Being that it is the newest FDA approved neurotoxin, there is not a lot of data to compare it to brands that have been around for decades.

Botox

Botox is the most well known, because it was the first neurotoxin approved by the FDA for use as a cosmetic treatment. It is the #1 selling U.S. treatment with more than 100 million vials sold and has been proven safe and effective in nearly 5,000 clinical trials. That’s a heck of a track record, don’t cha know. Botox is a good treatment that gets the job done, consistently, but that doesn’t mean it’s the most effective or longest lasting. With Botox you may not see results for up to 5-7 days. 
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Dysport

Dysport is one of the neuromodulators that has been around the longest and has many years of worldwide clinical use. It has been proven safe and effective. Dysport promises quicker, more natural looking results that last longer than most neuromodulators. This is precisely why this is one of Dr. Doser's most commonly recommended treatments. 
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What Is Buccal Fat Pad Removal Surgery?

12/18/2022

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What Is Buccal Fat Pad Removal Surgery?

"Buccal fat pad excision, commonly known as buccal fat removal surgery, is starting to trend a bit, or at least causing a stir in the algorithms. It is a surgical procedure that is gaining popularity with some stars in Hollywood. "Surgery" and "trend" are often two words that should give us pause when used together. We will get into the reasons for that in a bit, but let’s first start with explaining what buccal fat is and why someone would want it surgically removed.

"Surgery" and "trend" are often two words that should give us pause when used together. 

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In our cheeks we have what is called a buccal fat pad. It lies between the cheekbones and jaw bones. For some of us it can be quite thick and provide a cherubic look. For others it can be the opposite. Very thin buccal fat pads can give a gaunt look. From time to time this gaunt look comes back into fashion. 

The buccal fat pad can be altered via a combination of aesthetic contouring of the facial skeleton, facial liposculpture, and/or cervicofacialplasty. These procedures can make subtle to dramatic changes to one's face. Removal of fat can help draw the cheeks in giving desirable definition to the jaw line. It is a relatively quick procedure that can be accomplished under local anesthesia however, it isn’t reversible.

Buccal fat pad excision is not reversible.

That may sound well and dandy, however, there are many issues that come along with a procedure like this. First and foremost, surgical procedures carry a certain amount of permanence. If you are unhappy with the results or trends change, reversal of the procedure more often than not requires further surgical procedures.

Additionally, our bodies do not stay the same as we age and surgical procedures that we had when we were younger will not look the same. As we age collagen, fat, muscle and bone are lost from the face. The most common areas are the temples, brow, lips, and cheeks. When the cheeks sag, it makes the smile lines and tear troughs deepen. Fat and bone will also migrate to different parts of the face drastically changing its shape. As these inevitable steps of aging occur the results of previous surgical procedures will change. ​

The buccal fat pad naturally disappears as we age. If fat from the pad is removed it can cause one to look prematurely aged and can even distort the face.

The buccal fat pad is one of those things that naturally disappears as we age. If fat from the pad has already been removed it can cause one to look prematurely aged and can even distort the face. Attempting to get a more well defined jawline by having buccal fat pad excision in our twenties could result in additional surgeries to replace the fat with implants, or years of injecting dermal fillers. 

Dermal filler injected along the jawline or cheeks can create the same desired definition without the permanence or the price tag of surgery. The temporary nature of dermal fillers make them a great way to test if you are going to like the way you look.
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Hyaluron Pens

11/28/2022

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FDA Issues Stern Warning

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​In a recent safety warning issued by the FDA they state "Many of these over-the-counter fillers are meant to be used with at-home injection devices, none of which have been OK’d by the FDA. [these devices] use high pressure rather than needles to force facial or lip fillers into the skin. The hand-held devices are marketed under names like Hyaluron Pen and Hyla-Pen, and using descriptors like microinjectors, noninvasive injection pens, noninvasive nebulizer syringes, high-pressure pens or sprayer pens."

It is extremely dangerous to purchase over-the-counter fillers and even more dangerous to have them injected by a non-licensed individual.

It is extremely dangerous to purchase over-the-counter fillers and even more dangerous to have them injected by a non-licensed individual. There are nerves and blood vessels in the face that, when damaged, can cause paralysis or necrosis. The only fillers cleared by the FDA should be injected and must be injected with a needle or cannula by a licensed healthcare professional. 

The FDA states "The unregulated fillers and devices have been linked to serious adverse events, including permanent damage to the skin, lips and eyes."

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American Society for Dermatologic Surgery (ASDSA) has also issued a patient safety alert regarding self-injecting hyaluron pens after videos surfaced online of children/teens buying and injecting themselves and others. The ASDSA stated that “Facial injections require an in-depth knowledge and expertise of anatomy and, when left to untrained consumers, pose the risk of serious injury.”

Unapproved fillers are often manufactured in foreign countries that do not do an effective job of regulating the manufacturers of these medical products.

​It’s not just the delivery system that is dangerous. Unapproved fillers are often manufactured in foreign countries that do not do an effective job of regulating the manufacturers of these medical products. Ingredients can be contaminated with dangerous chemicals, made in unclean environments or even cut with other dangerous ingredients to reduce cost. Once injected these inferior products can cause infections, severe reactions, and even necrosis. These conditions can cause permanent damage and some injected products must be removed surgically. When self-injecting the consumer rarely has a way of knowing if the product they are injecting is genuine or safe. Unfortunately, most of these products are often discovered when clients begin reporting adverse effects from the contaminated or poor quality products. Further, there is little recourse with the manufacturer and little may be done to prevent them from continuing to sell their products.

Having your procedure performed by an ethical injector gives you the option to have your hyaluronic acid (HA) lip fillers reversed if you're not happy with the results. An ethical injector will not attempt to reverse an injection if they don’t know exactly what product was injected in the first place because they are unable to predict what the results might be. This unfortunately means that someone who used a hyaluron pen and is unhappy with results are very likely to have surgical removal as their only option.
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If you received more HA filler than you expected, aren't happy with the appearance of your lips or the results were uneven or lumpy you don't have to live with the results until the filler naturally dissolves in 3-18 months. HA Fillers can be fully or even partially dissolved by an experienced injector. Injections of hyaluronidase can fully dissolve HA fillers if you aren't happy with your results. Hyaluronidase can also be used to partially dissolve HA fillers to even out asymmetrical or lumpy results or to just reduce size if you feel your injections made your lips too full.

Dr. Doser, DNP, FNP-C, is a nurse practitioner with a clinical doctorate, the highest clinical degree given in her profession.

Dr. Doser echoes the FDA and ASDSA's warnings and highly recommends that any type of medical cosmetic procedure only be administered by a medical professional. When considering an aesthetic medical procedure, first and foremost, you must be able to trust your injector.

Dr. Doser, DNP, FNP-C, is a nurse practitioner with a clinical doctorate, the highest clinical degree given in her profession. Since 2005, she has excelled in the healthcare profession as an educator, nurse practitioner, and lead clinician. Her specialties include aesthetic rejuvenation, high-risk obstetrics, women's health, and urgent care.

Dr. Doser has traveled the United States training physicians and nurses on proper injection techniques and the nature of adverse events for Galderma Laboratories and has served as a subject matter expert in the areas of neuromodulators, fillers, and collagen stimulators. She has been featured on Oregon's KOIN Channel 6 News, offering her expert opinion on skin care and various health topics.
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Is Toothpaste An Effective Acne Treatment

11/21/2022

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Is Toothpaste An Effective Acne Treatment?

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Acne is the most common skin condition affecting nearly one of every six Americans.

​The most common skin condition affecting Americans is acne. That’s probably not surprising to hear. I mean, we’ve pretty much all had acne. More than 85% of us experienced acne as teens. If you’ve perhaps sold your soul to be a member of the other 15% then this blog isn’t likely for you (though you might find my FDA rant useful).

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For a significant number of people acne unfortunately doesn’t end with the teen years. Many continue to suffer the effects of acne well into adulthood. If you're suffering from adult acne it's important to know that it is treatable and you are not the only one. It affects nearly one in six people in the United States. While adult acne in women is more common, adult acne in men tends to be worse.

Acne is the most common skin condition affecting nearly one of every six Americans.

Unfortunately, left untreated acne outbreaks can lead to scarring. Scarring can be treated and improved but it's ultimately best to treat the acne before scarring occurs,  if possible. Treatments can vary from OTC products for mild cases to prescriptions and laser treatments for severe acne. 

One ‘hack’ that still manages to make the rounds (thanks to social media) is applying toothpaste to zits. The root of this comes (mostly) from the past. Toothpastes and soaps used to have an antibacterial ingredient called triclosan that was effective at preventing plaque and gingivitis. Triclosan was likely effective in reducing mild acne caused by bacteria. However, as it turns out, triclosan is probably not safe and for the most part no longer used in toothpaste. I say ‘probably not safe’ because it was banned for use in soaps but not toothpaste. 

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That’s a bit of a head scratcher, innit? Here’s why the FDA would ban something in soaps yet claim it’s safe to put in your mouth and likely swallow some of it: The FDA doesn’t do its own testing. The FDA relies on the corporations making fistfuls of money selling dangerous products to provide them with evidence that their products aren’t dangerous. Spoiler alert - The corporations weigh how much money they can make against how much the lawsuits will cost them, rather than by how many people will be harmed by unsafe products. Fun fact! It took more than 80 years from the time we knew that asbestos, mercury and lead were harmful until they were banned. In this case the FDA asked Colgate to prove that a chemical that isn’t safe for external use is safe for internal use, and *feigned shock!* they did. Ok, getting off my soapbox now.​

Fun fact! It took more than 80 years from the time we knew that asbestos, lead, and mercury were harmful until they were banned. 

With the exception of one brand of toothpaste, triclosan no longer is used in toothpaste. Triclosan was likely the only real benefit of putting toothpaste on acne. Unless you are using that one brand of toothpaste you aren’t likely to get that benefit.

There are, however, many other reasons not to use toothpaste on acne. Most toothpastes contain either alcohol, hydrogen peroxide or baking soda. Though good for cleaning your teeth they can cause your skin to be dry, red and flakey. Thankfully, there are many very effective options for treating acne today and we don’t need to rely on wive’s tales or hacks.
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Lash Serum Danger

11/7/2022

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Lash Serum Danger

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When I was five I was told every Sunday by the ladies at church how gorgeous my thick, beautiful, long eyelashes were. I hated hearing that! So much so that one day after church I grabbed a pair of scissors and I cut my upper eyelashes off. I do not recommend it. When I would rub my eyes my now stubby eyelashes would go inside my lower eyelid and poke it. I was a farm kid with hay fever and other airborne allergies so I had to rub my itchy eyes a lot. It was a valuable lesson that I have never forgotten.

"Not everyone is blessed with the stunning lashes I had as a five-year-old and might find it blasphemous that I would cut them off."
Dr. Doser's Little Brother

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​Not everyone is blessed with the stunning lashes I had as a five-year-old and those that aren’t might find it blasphemous that I would cut them off to spite my face, so to speak. Those of you who are unhappy with the lashes that DNA dealt out have some options for making your lashes longer, thicker, and stronger. There are tricks, viral hacks, vitamins, serums and cosmetics designed to do the trick. Unfortunately, most of those either don’t work, look fake, or are simply a façade for real lashes.
One of the options that has pretty impressive results and is growing in popularity is growth factor lash serums that help promote lash growth. There are a few FDA approved lash serums, but that doesn’t mean they are either safe or effective. So choose wisely as the side effects can sometimes be extreme and irreversible.

Choose your lash serum wisely as the side effects can sometimes be extreme and irreversible.

Many years ago it was discovered that a component of a glaucoma drug had an unexpected external benefit that resulted in longer, thicker and stronger eyelashes. Called Prostaglandin analogues (PGAs), this class of drugs was modified to be used as an agent to promote lash growth in the beauty industry. But every yin has a yang, and the side effects of this drug could be irreversible darkening of the iris, darkening of the periorbital skin, periorbital hollowing, and volume loss in the periorbital fat pad. 

Recent studies have shown evidence that use of Latisse, a hormone hair growth promoter which uses PGAs to grow lash hair, can result in permanent fat loss around the eyes causing a sunken appearance of the eyes as well as irreversible displacement of the eye. ​​​​​​​​Known as enophthalmos, it literally means that the eyeball is displaced in the orbital socket. Some of these side effects began to occur as early as one month after beginning treatment.

Although Latisse is intended for topical use it stands to reason that it can enter the eye and cause similar changes. ​​​​​​​​

SkinWise Rx recommends and exclusively uses AnteAGE lash growth serum because it doesn't contain PGAs

SkinWise Rx recommends and exclusively uses AnteAGE lash growth serum because it doesn't contain PGAs and thus won’t result in fat loss around the eyes, enophthalmos, or periorbital hollowing. Anteage's unique serum contains twelve hair growth factors - including hyaluronic acid - and is free of parabens, prostaglandin, and fragrances. ​
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RHA Density

10/31/2022

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Introducing RHA Density

SkinWise Rx is one of the first clinics in the U.S. to offer RHA Redensity™ dermal filler.

​SkinWise Rx has placed its first order of RHA Redensity™! We are proud and excited to be chosen as one of the first clinics in the U.S. to offer the first and only FDA-approved dermal filler designed for injection into both the superficial dermis and dermis to treat moderate to severe dynamic perioral rhytids (smile and laugh lines around the mouth).
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The area around our mouths is the most dynamic area of the face due to our vast amounts of laughing, smiling, eating, and talking. Dynamic lines, or expression lines, are caused by repetitive muscle movements we use to make different facial expressions. The muscles in this region are flexed and stretched thousands of times every day and are therefore subject to more complex and dramatic changes as we age. These movements coupled with a loss of elasticity, create dynamic wrinkles and folds in the skin around our mouths. We also have to deal with bone remodeling in this area as we age. Bone remodeling is the process of bone and fat deteriorating in one area and reaccumulating in another, ultimately changing the structure of the face. These wrinkles and folds can be difficult to treat because dermal fillers may cause the area to appear stiff or unnatural when the face moves.
RHA Redensity is different from any other dermal filler currently available. It is specifically designed to be resilient enough to adapt to your facial movement, which can provide a more natural look both at rest and while your face is in motion. RHA Redensity has been designed to resemble the natural hyaluronic acid that the human body produces. The natural hyaluronic acid in your skin helps provide moisture, volume, and structure to your skin. Over time, your skin produces less hyaluronic acid. The exclusive manufacturing process helps preserve the natural structure of the hyaluronic acid, allowing it to more closely resemble the natural hyaluronic acid in your skin. It is well suited for addressing Lip lines, Marionette lines, lipstick lines and smoker lines. 
RHA Redensity last considerably longer than other dermal fillers - up to 15 months!
Because RHA Redensity’s unique formulation is similar to naturally occurring hyaluronic acid it isn’t metabolized by the body as quickly as other dermal fillers and lasts considerably longer - up to 15 months! In comparison, most dermal fillers only last about six to nine months depending on your metabolism.
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SkinWise Rx is extremely pleased with the results that can be achieved with the RHA collection and are excited to introduce you to the newest member of the collection.
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Scar Treatment

10/20/2022

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Scars - Love 'em or Treat 'em?

Scars - We've all got them and we all feel differently about them. They can be a badge of honor or the bane of one's existence.

Scars may remind us of how strong we have had to be to overcome serious injuries or illness or the fortitude it takes to get through a difficult pregnancy. They often can be the source of great stories that involve epic adventures or monkey knife fights. Often they are unwanted reminders of domestic violence, service in wars or the simple fact that the human body is fallible, fragile, and too often frail. How you got your scars and how you feel about them can be deeply personal. At SkinWise Rx we will celebrate with you the scars you are proud of and treat those that you would like to wish away.

Scars can be as different as snowflakes and have to be treated uniquely. 

Scars can be as different as snowflakes and have to be treated uniquely. There are many treatments/combinations of treatments that can be used to address unwanted scars. The combination of your age, the scar's age, its size, skin type, and scar type all affect how a scar should be treated for best results.
Silicone gel sheeting has been used for first-line scar treatment for more than 30 years. Over the decades products have continued to improve, reducing costs and providing improved results. So much so that topical silicone gel products are overwhelmingly the preferred and recommended treatment for early scar management and the prevention of abnormal scarring.

Exactly how Silicone Gel Sheeting works to improve scars is still being discussed and disputed in the medical field, what no one is arguing is if SGS works. "SGS improves hypertrophic scars, keloid development and recovery." It is generally believed by the medical community that SGS keeps the wound hydrated and closes off the blood vessels in the area suppressing the creation of scar cells.

​Silicone Gel Sheeting improves hypertrophic scars, keloid development and recovery.

Silicone gel sheets are noninvasive and can easily be applied at home by the patient. For best results SGS should be worn daily for approximately 6-12 months. At that point other scar therapies can be considered.
For minor scarring, chemical peels can be an effective and relatively inexpensive solution with little downtime. Chemical peels remove the top layers of skin causing the body to generate new skin and collagen which helps fill in superficial textural changes. This smooths and tones skin and decreases discolorations.

For more severe scarring, your options include radiofrequency (RF) microneedling and laser resurfacing. RF microneedling is a minimally invasive treatment with little downtime. Using heat and small needles, RF microneedling breaks up the scars and encourages new skin and collagen growth improving texture and pore size. Three to four treatments are typically necessary to achieve desired results.

SkinWise Rx offers several procedures for the treatment of scarring

Ablative laser resurfacing is more invasive and has a 7-10 days downtime. Depending on the severity of scarring, laser resurfacing may be the most effective treatment. Laser resurfacing removes the damaged layers of skin which generates new skin and encourages collagen remodeling resulting in smoother and brighter skin. This also takes a series of 2-4 treatments.
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The scarring caused by severe acne can be treated as well. SkinWise Rx offers several procedures for the treatment scarring depending on the type and severity. Know that acne scars vary from rolling, boxcar, icepick, and atrophic. Many of these types will be present in a single area of concern. Acne scar treatment is never one and done. It takes a series to lessen the impact of permanent damage.
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Filler reduction or dissolution options

10/5/2022

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Lip fillers don’t have to be semi-permanent. If you are unhappy with the results of your injections they can likely be reversed.

Recipients of dermal fillers can sometimes be displeased with the results. Inexperienced injectors can often inject too much filler or not place it evenly or accurately. Just as often, a recipient may just decide that filler wasn’t the solution they were looking for. 

Perhaps you are in this boat and have received more HA filler than you expected, aren't happy with the appearance of your lips, or the results were uneven or lumpy. The good news is you don't have to live with it until the filler naturally dissolves in 3-18 months.
HA Fillers can be fully or even partially dissolved. 
HA Fillers can be fully or even partially dissolved. Injections of hyaluronidase can fully dissolve HA fillers if you aren't happy with your results. Hyaluronidase can also be used to partially dissolve HA fillers to even out asymmetrical or lumpy results or to just reduce size if you feel your injections made your lips or other features too full.

Unfortunately, if you’ve chosen the longer lasting and more permanent non-HA fillers such as Sculptra, Aquamid, or Bellafill, your options are fewer and much more difficult.  Hyaluronidase can not be used to reverse the results of these non-HA dermal fillers. If you are unhappy with non-HA filler results your best option is to consult a reputable cosmetic surgeon. They may be able to even out or even remove the filler, however at considerable cost.
If you have had injections from a disreputable injector your options are likely limited to a cosmetic surgeon.

Additionally, if you have had injections from a disreputable injector your options are also likely limited to a cosmetic surgeon. These injectors who literally order their products illegally from China via Alibaba. China and many other foreign countries do not do an effective job of regulating the manufacturers of these medical products. These products may be contaminated with unknown substances or can even be mislabeled. It is unsafe to you to attempt to reverse the results of an unknown injectable.

SkinWise Rx cannot stress enough the importance of making sure your injector is both licensed and experienced. An experienced injector is not likely to make mistakes that produce uneven or overdone results. An ethical injector will only use FDA approved and regulated products and will advise you to try reversible HA fillers before trying the non-HA fillers.

Dr. Doser is a Doctor of Nursing Practice (DNP) and a Board Certified Family Nurse Practitioner( FNP-C). She earned her DNP from Oregon Health Sciences University in Portland, Oregon, one of the top medical schools in the nation and renowned worldwide for training in primary care. In addition to her extensive and impressive education Dr. Doser has 13 years of experience in the field of aesthetic medicine.
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Daxxify - A New, Longer Lasting Tox

9/15/2022

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Daxxify - Coming Soon To SkinWise Rx

The FDA recently approved Daxxify by Revance for temporary improvement of moderate-to-severe glabellar lines in adults. Daxxify is the first genuine neuromodulator innovation to the Aesthetics marketplace in more than 30 years.
 

SkinWise Rx is excited by this innovative new product and we are extremely confident in the safety and efficacy of Revance products. Daxxify is being given a carefully planned launch. It will only be going to Revance Aesthetics elite practice partners, like SkinWise Rx. We will be among the very first clinics in the state of Oregon to carry Daxxify!

Daxxify is an injectable toxin, or neuromodulator similar to Botox, Dysport, Xeomin, and Jeuveau. But Daxxify is, in fact, a new class of neuromodulator whose effects last two to three times as long as current neuromodulators. In clinical trials Daxxify’s results were shown to last as long as 6 to 9 months!! Longer lasting results means fewer trips to the clinic!

Glabellar lines are those two vertical lines that appear on the forehead between our eyebrows when we frown or focus. They are also referred to as the 11s due to their similar appearance to the number 11. By injecting Daxxify into the underlying muscles of the forehead they can be relaxed, smoothing the skin between your eyebrows that create these deep, undesirable lines.

And even more good news, Daxxify is free of animal products because it’s made from amino acids. It’s also been approved for a wide-variety of off label uses such as treating migraines, excessive sweating, TMJ and even urinary incontinence. 

Follow SkinWise Rx on Instagram, Facebook, TikTok or sign up to get our newsletters and you will be the first to know when we receive our first batch of Daxxify and will begin scheduling appointments.

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Beauty and the Bees

3/19/2021

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​Propolis has been used for centuries to heal burns, cuts and other wounds and to protect the skin. It’s known to be beneficial for treating scars and has been used to improve skin texture damaged by acne scarring.

We’ve known for decades the importance of our friendly neighborhood pollinator on our food supply - the unassuming honey bee. But more recently we’ve begun to discover significant biological benefits of honey, beeswax, pollen, venom and propolis, many of which are very beneficial to the skin. WARNING - THOSE WITH BEE ALLERGIES SHOULD AVOID USING BEAUTY PRODUCTS CONTAINING BEE PRODUCTS UNLESS DOING SO WITH THE ADVICE OF THEIR DOCTORS.

WARNING - THOSE WITH BEE ALLERGIES SHOULD AVOID USING BEAUTY PRODUCTS CONTAINING BEE PRODUCTS UNLESS DOING SO WITH THE ADVICE OF THEIR DOCTORS.

Recent clinical studies have shown that bee venom can reduce the appearance of wrinkles in the skin. Bee venom serum applied to facial wrinkles showed a reduction in wrinkle count, depth and total area. The specific mechanism that caused bee venom to contribute to a reduction of wrinkles is currently unknown, however it is believed it is a combination of anti-inflammatory properties, antiseptic properties and its ability to reverse UV damage.
Propolis has been used for centuries to heal burns, cuts and other wounds and to protect the skin. It’s known to be beneficial for treating scars and has been used to improve skin texture damaged by acne scarring. Propolis can decrease inflammation and is used to treat eczema, psoriasis and has even been used to reverse the effects of UV damage to skin.

It should be noted that products made from bee products are not vegan. Further, bees use propolis to construct their hives. Harvesting propolis can cause damage to the hive and the bees and is therefore not a sustainable practice.
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Tech Neck. What is it and what do I do about it?

2/13/2020

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Dr. Lani Doser explains tech neck prevention and treatment

Tech Neck

Tech neck is a relatively new term for a condition that is becoming exceedingly more prevalent in our tech dependent society. Many of us spend hours everyday bent over ill-placed computers or scrolling the "Black Mirror" causing the delicate skin on our necks to form creases where it folds. 

"The more time we spend bent over our devices, the more the neck ages. The symptoms of tech neck can be aches, stiff neck, and WRINKLES on the front of the neck."
​Dr. Lani Doser, DNP

According to data by Pew Research Center, 88% of women between the ages of 30-49 own a smartphone. And that number is even higher for those between 18-29. Moreover, an Asurion Insurance survey showed Americans check their phones an average of 80 times per day or every 12 minutes while awake!⠀⠀⠀⠀⠀⠀⠀⠀⠀
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The more time we spend bent over our devices, the more the neck ages. The symptoms of tech neck can be aches, stiff neck, and WRINKLES on the front of the neck.​

"The remedy for tech neck is NOT throwing away your phone. It’s getting treated when you recognize the first signs." 
​Dr. Lani Doser, DNP

The remedy for tech neck is NOT throwing away your phone. It’s getting treated when you recognize the first signs. 

So, what can be done other than switching to a rotary phone? Step one is to modify your behavior to help prevent the signs of tech neck. Spend less time staring at our cellphones and tablets and adjust your work monitor so that the center of the screen is eye level. And listen to your mother - "Sit up straight."

Once you've addressed the causes of tech neck, visit SkinWise Rx for a consult. ​At SkinWise Rx we can look at your nonsurgical options and give you experienced and educated recommendations. 

Depending on the area and severity of symptoms, toxin injections such as Botox or Jueveau will help. And laser treatments (Lutronic Genius), fractional resurfacing (Erbium YAG Laser or Er:YAG), and/or dermal fillers like Juvederm or Restylane all have unique benefits to address the signs of Tech Neck.
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January 30th, 2020

1/30/2020

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Prejuvenation is a term that has suddenly thrust itself upon the aesthetic world. But what is prejuvenation? And why is it important?

“There are two types of aging: Intrinsic, which is inevitable thanks to our DNA, and extrinsic which is brought on by exposure to environmental factors.”
Dr. Lani Doser, DNP

Prejuvenation is addressing signs of aging BEFORE they become a problem. The goal of an aesthetician is to prevent signs of ageing before they occur rather than correcting them once they appear. 

Dr. Lani Doser, DNP tells us, “There are two types of aging: Intrinsic, which is inevitable thanks to our DNA, and extrinsic which is brought on by exposure to environmental factors.” Extrinsic factors, which are typically avoidable, include sun/UV damage, smoking, poor diet, lack of sleep, etc.
​

Preventative steps - “Your body is a temple. Treat it as such.”

The first step in prejuvination is prevention - Avoiding the extrinsic factors that can cause aging. 

Avoid the sun
The most effective action one can take is to wear sunscreen daily and apply it frequently throughout the day. Wearing a hat and sunglasses and avoiding direct sunlight will reduce the amount of UV damage to the skin. 

News flash: Smoking is bad, mkay?
We are well beyond having to inform people that smoking causes premature aging and will very likely kill you. You already know it. So let’s not beat that horse anymore. However, many people are under the impression that vaping is a good alternative. It isn’t. As with cigarettes, nicotine dries the skin causing premature wrinkles as well as retarding the body’s ability to heal itself.

Maintain a low-fat diet high in antioxidants
Antioxidants inhibit oxidation which causes damage to skin cells. A diet high in nuts, beans and fresh fruits and vegetables (especially those high in vitamin C) helps prevent oxidation, thus keeping your skin cells healthier. Further, switch from foods high in saturated fat to foods with plant-based healthy fats (avocados, coconut oil, nuts, flax). Foods high in saturated fat are common contributors to acne and the subsequent scarring. 

Get adequate sleep
During sleep the body puts its energy into healing itself. Lack of adequate sleep or disruptive sleep prevents the body from entering this healing stage and cell damage accumulates.

"Bone remodeling is the process of bone and fat deteriorating in one area and reaccumulating in another, ultimately changing the structure of the face."
Dr. Lani Doser, DNP

Step two is treatment.

The signs of ageing are no secret to medical professionals. Bone remodeling and UV damage are two of the biggest culprits. As we age bone slowly moves from places we are used to seeing and some is redeposited in new places. Our muscles are no longer able to rely on the support from this bone causing sagging and wrinkles. Injectable fillers are simple and effective way to add volume to these areas of the face. Regular toxin injections such as Botox, Jeuveau, and Dysport can help delay the deep glabellar lines (the 11s between the eyes) and crows feet from forming. In addition, there are many procedures such as microneedling, HiFU and laser therapies that will help encourage new collagen growth creating volume and filling out fine lines and wrinkles.

Thanks to new technologies, UV damage can now be seen before it is visible to the naked eye. IPL, LaseMD and ErbYAG can all be effective treatments to address UV damage before it becomes a problem as well as improving the tone and texture of your skin. ​

​The bottom line on prejuvination is that signs of ageing become far more difficult to address as time passes. Begin a skincare routine and address aging early with preventative steps and treatment for best results!
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January 16th, 2020

1/16/2020

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Beauty is in the eye of the beholder, as the saying goes. Yet, a new and bizarre beauty trend is testing the validity of that adage. 

"You should seek a clinician with a similar look as yourself. If they aren’t willing to do it to themselves you shouldn’t let them do it to you.” 
Dr. Lani Doser, DNP

“Devil lips” are trending on social media and the reception has been mixed. Some people find them interesting and intriguing and many others are shocked and disturbed. However, medical professionals are chiming in with warnings about duplicating the curious look.

Essentially, having this type of procedure is akin to bending your elbow backwards - Can you? Sure. But you really, really shouldn’t.

“The damage inflicted to achieve this look may be irreversible.” Dr. Lani Doser states. “It’s definitely semi-permanent and this look likely cannot be achieved using a reversible filler. I don’t know of a dissolvable filler that can create that type of structure.” Essentially, having this type of procedure is akin bending your elbow backwards - Can you? Sure. But you really, really shouldn’t.

​This procedure could cause vessel occlusion, scaring, and infections. Further, changing the border of the lip can permanently distort it. Even with semi-permanent fillers it is unlikely they will wear off symmetrically leaving you with distorted and lumpy lips.

Given the high likelihood of permanent damage, the ethics of performing such a procedure must be posited as well. Dr. Doser says "You should seek a clinician with a similar look as yourself. If they aren’t willing to do it to themselves you shouldn’t let them do it to you.” 
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January 10th, 2020

1/10/2020

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The following blog post was written by a client of Dr. Doser's and has been reprinted here at her request.
​“If you squint like that, you’re going to get wrinkles,” my mother would say to me from the time I was in elementary school. The amblyopia and light-sensitive, far-sighted eyes led to the brow-furrowing habit that never abated due to the fact that I like being able to see. Glasses helped me see but didn’t stop the squinting habit – even when I do remember where I left them.

​"I’m the natural girl – the hippie chick minus the patchouli and comestibles. Keens, no bangs, hair down, casual."

I’m the natural girl – the hippie chick minus the patchouli and comestibles. Keens, no bangs, hair down, casual. I’m not a stunner but I mostly feel okay with how I look. Consideration for my appearance has waxed and waned with how I felt about my weight and how much emotional, financial, and logistical bandwidth I had left after homeschooling two girls, having three more babies, running a business with 25 employees, and hosting a weekly home group.

"I had noticed that when I took pictures over the last couple years (I am 47 now), I looked old. No position could make the wrinkles disappear."

The thought of having medical aesthetic work done never really occurred to me before recently. I had noticed that when I took pictures over the last couple years (I am 47 now), I looked old. No position could make the wrinkles disappear. They exist no matter the cream I use, smile I modify, or facial gymnastic I try to execute for the sake of the camera. People would ask me why I was scowling, and I’d say I’m just squinting because of the light. My mother always said I looked tired. I notice that the eyes of men don’t stay like they used to. These are hard things. I try to face them directly and always with humor, but the sense of being looked over and not feeling as desirable weighs on me. 

Recently I found out that a couple of my friends, who look fantastic, have been having Botox injections for a couple of years. My first thought was, “That’s so shallow!” That was followed not long after with, “Hey, if they are doing it, maybe I should / could / will think about it.” Notably, these are not shallow women. They work for highly competitive companies in highly competitive industries. They are caring, involved women. I had no idea that they had been having work done except that they don’t look tired. 

"Would I like the look? Would I still be able to express myself? How would my family and my children feel about it? Was it a slippery slope of vanity and inauthenticity?"

My friends’ use allowed me to explore the idea more deeply. I pondered how this would effect me as much emotionally as physically. Would I like the look? Would I still be able to express myself? How would my family and my children feel about it? Was it a slippery slope of vanity and inauthenticity? I finally wrestled with the answers to these questions, which allowed me to choose my next step. I was unhappy with my current look. Judging by my besties, I was going to like the softening of my wrinkles and it would look natural, not artificial.  I had not noticed an inability for them to express themselves. I would still be able laugh, smile, inflect, and wink; they certainly did. Legitimately, my family and children would ask the same questions that circled my brain. 

"As much as I thought a good pantsuit would help me out, I realized that Botox should no longer be considered frivolous or vain. How useful are heels? They serve me no purpose. They are painful and I would rather wear Keens... I am competing in a tech-heavy industry against women half my age. Remaining brilliant but aged, regardless of how okay I was with it, was not going to help me find employment."

What finally pushed me over the edge was a need for a job. It is known that beautiful people get hired, earn more money, have more power, have better mentors, get promoted more often, and that even doe-eyed babies look at their faces longer (Bennett, Newsweek, Jul 19, 2010). I will be looking for employment soon armed with a second degree and an additional social media marketing certification. As much as I thought a good pantsuit would help me out, I realized that Botox should no longer be considered frivolous or vain. How useful are heels? They serve me no purpose. They are painful and I would rather wear Keens but they are not appropriate for a professional interview. My same acceptance of heels for work would play into my acceptance of help to create a refreshed and natural exterior. My reality is truly ugly. I am competing in a tech-heavy industry against women half my age. Remaining brilliant but aged, regardless of how okay I was with it, was not going to help me find employment. It was time that I sought treatment, not to become a supermodel, but to keep me viable in a biased, complex, and uncompromising work force.
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December 27th, 2019

12/27/2019

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"It won’t work"
FALSE. Studies show that it can produce results similar to ablative laser resurfacing at a lower cost, less pain, less side effects, and a 1-3 day recovery time. It can be used for wrinkles, thin skin, UV damage, hyperpigmentation, scarring, and loose skin. All forms of skin rejuvenation consist of microinjuries through chemicals, as in peels; heat, as in lasers; and now needles. All of these methods cause new beautiful skin to develop.

​"It is going to hurt
"
FALSE. This may be true at other locations but not at SkinWise Rx! Our medical experts will thoroughly cleanse your skin using microdermabrasion to remove dead skin cells and prepare the epidermis. Next, a layer of anesthetic cream is applied to numb the skin and make the therapy comfortable. After about 20 minutes the patient is ready for treatment. 

"​This treatment is ideal if you have serious worries about aging, scarring or discoloration, as there really is a noticeable improvement."
Dr. Lani Doser, DNP

"I can’t. I am on Retin A"
FALSE. The skin needs to be free of Retin A products for only 12 hrs prior to treatment. Unlike peels you do not have to discontinue your tretinoin or adapalene products for two weeks. You stay off of active skin care products for 3 days after treatment. You can resume your regular skin care after 3 days. 

"I can’t have lasers, so I can’t microneedle"
FALSE. Microneedling works with all skin colors from white to black. You will be quite red post-treatment like a severe sunburn. We will apply Epionce Medical Barrier Cream to help the skin heal. Your skin may have a slight sting when the anesthetic wears off and you can use cold compresses and take Acetaminophen/Tylenol for it. We apply sunscreen at the office. No sun exposure or active skin care products (acids or items that sting or burn) for the next 3 days. 

"I won’t have immediate results"
FALSE... & TRUE. Usually by day three you start to see some skin changes but know this is a cumulative treatment. It is recommended to undergo at least four sessions, once every four weeks, for best visible results. Do not expect immediate results; smooth flawless skin is a slow and gradual evolution. 

Who should use microneedling? 
This treatment is ideal if you have serious worries about aging, scarring or discoloration, as there really is a noticeable improvement. We do not recommend microneedling if you have minor skin concerns that could be addressed through less invasive methods like using carefully selected skin care products.
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December 18th, 2019

12/18/2019

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What exactly is a stretch mark?

A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin, which support our skin, to rupture. As the skin heals, stretch marks may appear. Not everyone develops these narrow bands on their skin. Fluctuating hormone levels seem to play a role. You may also have a higher risk if people in your family get stretch marks.Stretch marks fade with time; however, treatment may make them less noticeable more quickly.

"In-office procedures have proven more effective at reducing the visibility of stretch marks than creams, lotions, and gels."
​Dr. Doser, DNP

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If you develop stretch marks, you’re most likely to do so during these times:
  • Growth spurts that happen in puberty
  • Pregnancy
  • Rapid weight loss or gain
  • Weight training when you have rapid muscle growth

Applying a corticosteroid to your skin for a long time can also cause stretch marks. If you have Cushing’s disease or Marfan syndrome, you may see stretch marks.

When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color. Early stretch marks may feel slightly raised and can be itchy. In time, the color fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you often feel a slight depression.​​


​What can get rid of stretch marks?

Like any scar, stretch marks are permanent, but treatment may make them less noticeable. Treatment can also help alleviate the itch. If you’re pregnant or breastfeeding, check with your doctor before treating stretch marks. Some products contain ingredients, such as retinol, that can harm your baby.
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​It’s important to understand that no single treatment works for everyone — and many products don’t seem to work at all. Here’s what researchers have discovered about the many treatments for stretch marks.​

"Like any scar, stretch marks are permanent, but treatment may make them less noticeable. Treatment can also help alleviate the itch." 
Dr. Doser, DNP

Procedures that dermatologists perform

Dermatologists use the following procedures to make stretch marks less noticeable, but none of these can get rid of stretch marks:
  • Chemical peel
  • Laser therapy
  • Microdermabrasion
  • Radiofrequency
  • Ultrasound

To give you the best results, your dermatologist may use more than one procedure. For example, your dermatologist may treat you with radiofrequency and a pulse dye laser.

​With all procedures, side effects are possible. In the skilled hands of a board-certified dermatologist, side effects tend to be minor and temporary. It’s common to have some redness and swelling after a procedure. The redness and swelling tend to disappear in a few hours or days. A dermatologist can tell you if any of these treatments would be suitable for you, given your health, age, and how long you’ve had the stretch marks.
​

​Stretch mark creams, lotions, and gels:

Researchers have studied many of the creams, lotions, and gels sold to treat stretch marks. While no one product seems to help all of the time — and some don’t seem to help at all — researchers have discovered some helpful hacks.

If you want to try one of these creams, lotions, or gels to fade stretch marks, be sure to:
  • Use the product on early stretch marks. Treatment seems to have little effect on mature stretch marks.
  • Massage the product into your stretch marks.Taking time to massage the product gently into your skin may make it more effective.
  • Apply the product every day for weeks.If you see results, they take weeks to appear.​


​​Home remedies

In studies, popular home remedies have not worked. Researchers found that none of the stretch marks faded when people massaged almond oil, cocoa butter, olive oil, or vitamin E into their stretch marks.
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Tanning cannot get rid of stretch marks. When you tan, stretch marks become more noticeable because they don’t tan.
​

Self-tanner

While tanning can make stretch marks more noticeable, a self-tanner can camouflage stretch marks — both early and mature ones. A self-tanner cannot get of rid of stretch marks.

​
​Prescription medicine you apply to your skin

In studies, two ingredients seem to offer some relief:
  • Hyaluronic acid
  • Tretinoin

In two large studies, applying hyaluronic acid to early stretch marks made the stretch marks less noticeable.

Tretinoin is a retinoid, which may also make early stretch marks less noticeable. In one study, people who applied this prescription cream every night for 24 weeks had less noticeable stretch marks. Those who didn’t apply the cream saw their early stretch marks grow. Other studies have found similar results.

Retinol, another type of retinoid, may also help fade early stretch marks.
​

Can anything prevent stretch marks

Short answer: Maybe.

Researchers have discovered that many remedies said to prevent stretch marks don’t actually work. In studies, neither almond oil, cocoa butter, olive oil, nor vitamin E prevented stretch marks.

Other ingredients may work. Researchers have found that products containing centella or hyaluronic acid may help prevent stretch marks. Centella is an herb, and our skin naturally contains hyaluronic acid.​


​When to seek a dermatologist’s expertise

Stretch mark treatments that you can buy at a store or online can be expensive. If you find yourself spending a lot of time and money without getting any results, seeing a board-certified dermatologist can be helpful.

The in-office procedures have proven more effective than the creams, lotions, and gels. Dermatologists can also tell you about any new product or procedure that may help.

Images
Image 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Image 2 and 3: Getty Images
​


References
Hague A and Bayat A. “Therapeutic targets in the management of striae distensae: A systematic review.” J Am Acad Dermatol. 2017;77(3):559-68.
Stier MF and Hirsch RJ. “Rejuvenation of scars and striae.” In: Hirsch RJ, et al. Aesthetic rejuvenation. McGraw Hill Medical, China, 2009:224-9. 
Ud‐Din S, McGeorge D, et al. “Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae. J Eur Acad Dermatol Venereol. 2016; 30(2): 211–22.
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December 12th, 2019

12/12/2019

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1. Start with one product. Using several anti-aging products at the same time can irritate your skin. When you irritate your skin, signs of aging become more noticeable.
2. Test the product before applying it to your face or hands. Even hypoallergenic products can cause a skin reaction. To test a product, apply a small amount to your inner forearm. Repeat this twice a day for four to five days. If your skin looks normal — free of redness, itch, and other reactions — you can apply it to your face and other skin.
"Stop using a product that stings, burns, or tingles. These sensations mean that the product irritates your skin. Irritated skin looks older. If you are using a product prescribed by your dermatologist, ask if this should be happening before you stop using it. Some prescription-strength products will burn or sting."
Dr. Lani Doser, DNP
3. Continue using, if you want to continue seeing results (except in the case of adverse reaction). People often stop using a product once they see results.
4. Follow directions. Some products contain active ingredients that can cause problems if you apply more than directed. You could end up with clogged pores, blotchy skin, or excessively dry skin. Read the instructions, and use as directed.
5. 
Give the product time to work. A moisturizer can plump up fine lines in a few days, but most products take at least six weeks to work. Sometimes it can take up to three months. Be patient and give the product time to work.
6. Protect your skin from the sun. Sun protection helps to reduce signs of premature aging on your skin. It also allows your skin to repair and renew itself and reduces your risk for getting skin cancer.
7. Use moisturizer. Moisturizer traps water in your skin. This extra moisture can help reduce the appearance of fine lines and brighten your complexion.
8. Forget about tanning. Tanning speeds up signs of aging on your skin. Tanning can lead to premature wrinkles, age spots, and other unwanted signs of aging.
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December 06th, 2019

12/6/2019

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Laser services and skincare treatments to address Anti aging
We all know that as we age our bodies begin to show their wear. Our metabolism slows, our skin loses its elasticity and wrinkles begin to crop up where they never were before.  While we all have our own ways of coming to terms with our mortality and the aging process, no one wants to look older than they are.   

That’s why we’ve come up with a list of the top 6 body parts that show their age first and what you can do to optimize these spots, delaying their decay and giving you a little more staying power.

Whatever problem area you wish to target, anti-aging always starts with anti-inflammation – which means a good diet, good sleep, plenty of movement in your day and regular hygiene. 
Dr. Lani Doser, DNP


​Hair

Hair has always been a major tell when it comes to age and not just because those nasty grays are taking root. Those are easily washed away with a color boost from specially formulated hair dyes. But even if your color is youthful, your hair thickness and moisture can be a dead giveaway. Not only does hair lose its pigment as we age, it also becomes thinner and more dry and brittle. Platelet Rich Plasma (PRP) therapy is an excellent treatment for increasing the number of follicles and restoring your hair's thickness.

Years of sun exposure, color, straightening, curling and styling have wrecked havoc on your follicles.  Eating a healthy diet rich in protein, omega-3 fatty acids, and dark green vegetables for vitamins A and C, as well as zinc packed nuts will help love your hair (and the rest of your body) from the inside out. Remember that over washing and sun exposure can age hair prematurely. Getting deep conditioning treatments can help keep hair healthy and strong. Use a mineral sunscreen on your part.​


​Hands

Hands are one of the first signs you’re aging. This is because the skin on your hands is thinner, more exposed and over worked than any other body part. Sun damage makes its mark here, which is why applying sunscreen to the backs of your hands, on top of a good quality hand cream, at least once a day, is crucial. At night, keep your mitts moist with thicker overnight creams and a pair of moisturizing gloves to keep them soft, supple and younger looking. For sun spots, turn to IPL (Intense Pulsed Light) laser treatments, simple, safe and cost effective, IPL will help you erase years of sun damage and renew your hands’ youthful appearance.


​Face 
​

Sun spots​ and freckles don’t just appear on your hands as you age, dark spots can also show up on your face as you grow older. In addition, you’ll be battling volume loss in the cheek and temple areas and wrinkles, especially forehead and frown lines.  No matter which of these issues you’re battling, there’s something you can do. 

Obviously, a good diet rich in whole foods and packed with protein and vegetables is great place to start, as is a great skin care regimen – proper cleansing, toning and hydration of your delicate facial skin. Plenty of rest will ease inflammation in the body and slow the aging process.  But if age spots and wrinkles have already set up a home base on your face, here are a few things you can do to turn back the clock without looking plastic:

  • Battle forehead lines and frown lines with Botox
  • Cheek and temple volume loss can be plumped up again with dermal filler 
  • An IPL photofacial is perfect for renewing sun damaged skin 
  • Our exclusive Genesis V by Cutera™, a non-invasive laser technology, is a powerful anti-aging tool that naturally and effectively treats fine lines, wrinkles, and diffuse redness and scars.  By gently heating the dermis well below the skin’s surface, Genesis V Rejuvenation Therapy improves the appearance of wrinkles through collagen stimulation. Laser light also reduces redness and stimulates collagen regrowth, assisting in skin tightening. ​


​Eyes

The windows to your soul, your eyes, can give away your age in less than a blink. That’s because tear troughs, crow’s feet, dark circles and blepharoptosis (drooping eyelids) are all serious markers of age.  A good skin care regimen, including specially formulated eye creams (look for those with vitamins C and E), work well here to keep things moist, but a Botox browlift, dermal fillers and laser treatments can be your best friend when thinking about rejuvenating the skin around your eyes.  The treatment you choose will depend on your skin type and your unique aging profile. Our medical professionals here at SkinWise Rx can help you customize a treatment plan.


​Mouth

Smiling can be your best beauty accessory. Smiles are contagious – they make a great first impression and let people know you’re friendly and approachable.  But now, a recent study published in Psychology and Aging, shows that a great smile can make you appear younger than you actually are, by at least a few years.  But what if your pout has begun to pucker? 

Lip lines, loss of lip volume, marionette lines and yellowing teeth can all age your grin, making you look older. Keep your smile sparkling with regular dental hygiene, maintenance and teeth whitening. Botox and injectable dermal fillers can help plump a pout, decrease a grimace and smooth whistle lines.


​Neck

The dreaded turkey neck waddle, deep creasing on your neck and fine lines, skin tags and spots peppering your décolletage  (the area of a woman's body that is exposed when a garment with a low neckline is worn) can all tip people off to your age.  The skin on your neck is thin, thinner than your face, which is why you need to be sure to take good care of this delicate area.  Preventative measures include a good skin care routine, proper moisturizing and UV protection can go a long way to keeping your neck and the often forgotten décolletage looking supple and young.

Nonsurgical treatment possibilities to tighten the skin in this area include High Intensity Focused Ultrasound (HiFU) and Radiofrequency Microneedling (RF Microneedling), Intense Pulse Light Treatment (IPL), LaseMD, Kybella injections. Finally a necklift procedure for those with gobblers –if you’re willing to go under the knife.

Whatever problem area you wish to target, anti-aging always starts with anti-inflammation – which means a good diet, good sleep, plenty of movement in your day and regular hygiene. 

​Keeping your skin properly cared for will go a long way in keeping it in tip top condition. If you still want a little non-surgical help, SkinWise Rx is here to help. Call our office today (503.964.5334) to schedule your FREE consultation and let us help personalize your anti-aging skin care plan today.
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November 27th, 2019

11/27/2019

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Botox Dermal Filler IPL
Dr. Doser's Top 3 Cosmetic Treatments for the Holidays
The holidays bring all kinds of stress, including the anxiety of seeing family and friends again after what may have been a long separation. Sure, you miss them but let’s face it – those closest to us can oftentimes be the most critical as well.  

Which is why now is the perfect time to make sure you’re looking your very best for those long awaited reunions that holidays bring. Naturally nobody wants to show up to that big event looking plastic or unnatural. So what procedures will give you the most dramatic results in the shortest amount of time – without leaving you looking unreal?

Refresh your look with these 3 cosmetic treatments ​

For those wanting to look and feel their most confident this holiday season, there are three minimally invasive procedures that consistently provide great, natural looking results, with little to no downtime. 

In fact, for most, results will take effect immediately to 10 days after your procedure and leave you looking refreshed, just in time for that first welcome hug and the requisite once over.
​

IPL

Intense Pulsed Light treatment, sometimes referred to as a photofacial or photo rejuvenation, is one of most effective, non-invasive treatment you can have to revive the healthy look and feel of your skin. 

Not only does IPL help repair some forms of sun damage and hyperpigmentation, it also improves tone and smooths the epidermis by stimulating new skin growth, providing a more youthful, healthy appearance overall.

IPL clinicians evaluate your skin and then customize your treatment to include the selection of an optimal wavelength to deliver intense broad-spectrum pulses of light, targeting the hemoglobin and melanin in your specific skin tone and condition. 

When these targeted areas absorb the light, they darken and the surrounding skin may appear pink. This effect can last anywhere from just a few hours to a few days. These newly darkened spots eventually flake off and fade, disappearing as a result of the body’s own natural rejuvenation response, revealing healthy fresh looking skin. 

IPL works optimally on light-to-medium tone skin and is best embarked on during the cooler, more overcast months, as patients receiving IPL must avoid the sun (as well as artificial tanners) while undergoing treatment. IPL is used to treat the following issues:

  • Rosacea
  • Hyperpigmentation
  • Dilated blood vessels
  • Broken capillaries (telangiectasia)
  • Sun damage like sun and age spots
  • Fine lines and wrinkles


​Dermal Filler

A lesser-known part of the natural aging process - volume loss - is often seen in populations over age 40. By this point, most people have marked facial volume loss, causing them to notice a reflection that appears haggard or worn.  This is because volume loss occurs not only in the skin, reducing firmness and elasticity, but also in the muscle and even bone. The overall effect on your face is that it leaves eyes slightly sunken looking, cheeks hollow, and mouths turned down.

But volume loss is easily and safely overcome in the hands of an experienced, educated clinician. In fact, we believe the use of dermal fillers are as much an art form as they are a skill – that is, if you want your results to appear natural looking and serve as a subtle enhancement without the dreaded mask-like appearance that can happen in the hands of someone with less restraint and experience. 

Dr. Lani Doser, DNP (a doctorally trained nurse practitioner) is an experienced, highly trained injector with a reputation for refreshed, natural looking results.

It’s important to note that dermal fillers have been vigorously tested for safety and quality here in the U.S. and typically take no more than an hour to achieve desired results.


​Botox

Botox is neuromodulator used to relax creases and frown lines in the face.  This simple, non-surgical treatment temporarily smoothes moderate to severe frown lines, “crow’s feet,” and other facial lines and creasing usually in the upper regions of the face in people ages 18 to 65, through the use of injection. 

A typical treatment delivers very low doses of Botox, administered through injection, directly to the muscles responsible for those frown lines. This neuromodulator works by blocking the transmission of nerve impulses to the injected muscles reducing the activity that results in the formation of frown lines and other crease-making facial expressions. This makes Botox ideal not only for treatment of existing conditions but also for the prevention of future lines and creases.

Best of all, treatments usually take only 10-20 minutes with little to no recovery time necessary afterward and the effects, when applied properly, will leave you looking subtly refreshed but not radically altered. You may continue to see marked improvement to the treated areas, with lines improving even up to one month, and results lasting up to 4 months. 
​
Armed with these fast-acting cosmetic procedures, you can head into the lion’s den of the holiday season looking and feeling great, as you put your best face forward.

Happy Holidays!

​Dr. Lani Doser, DNP
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November 22nd, 2019

11/22/2019

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1. Wrinkles, age spots, skin changes

WHY: Accumulated sun damage can cause the skin cells to age, to pigment irregularly, and to wrinkle with lines that stay after movement. Even the support structures of the pores can enlarge causing them to sag and look wider. 

​TREATMENT: Epionce Lytic Tx will help shrink pores and retexturize skin.  Intense Defense Serum has 3 types of vitamin A to freshen skin and lighten spots. Eminence bamboo firming serum also has botanical vitamin A and causes freshening and external tightening. Avene Retrinals (retinaldehyde) inhibits melanin (that makes age spots). It can also change the DNA of the cell to help with wrinkles and sagging. IPL will reduce mottling on the chest or face. Facial peels can also freshen, lighten, and reduce acne as well as exfoliate the skin. Microdermabrasion can help exfoliate pores to clear blockage and make them look smaller.

Sunscreen by Eminence or Epionce will keep away sun damage if you wear it, even on cloudy days, and reapply throughout the day (on hands and chest too).

"Sunscreen should be your BFF! Use it everyday and in the future you will look back and say 'Thanks Me!'."
Dr. Lani Doser, DNP

2. Facial Volume loss

WHY: With age; collagen, fat, and bone are lost from the face. The most common areas are the temples, brow, lips, and cheeks. When the cheeks sag, it makes the smile lines and tear troughs deepen. Lips lose definition and lipstick will bleed into lip lines (even if you never smoked). Deep temples can make you look skeletal and eye brows can drop. (Link FILLERS blog).

TREATMENT: Avoid rapid weight loss diets that will reduce your skin’s elasticity and make it sag, wear lip-gloss at the center of the lips, and apply highlighter to the apples of the cheek with contour/bronzer under the cheekbones. Consider facial fillers such as Radiesse or Juvederm to fill depressed areas for 6 months to 2 years.

3. Veiny and spotted hands

WHY: Hands appear veiny due to the same reason that the face loses volume. The hands have lost bone, fat, and muscle. The spots occur because of accumulated sun damage.

TREATMENT: Isometric exercises of the hands could build stronger muscles and appear less sunken. Retin A cream on the hands will help reduce aging pigmentation, fine lines/wrinkles, and rejuvenate the skin (see recommendations above on 1). Calcium supplementation will help with bone loss. IPL can greatly reduce age spots. Dermal fillers such as Radiesse can plump the hands again.


"Remodeling is the process of bone and fat deteriorating in one area and reaccumulating in another, ultimately changing the structure of the face. "
Dr. Lani Doser, DNP

4. Sparse eyelashes and eyebrows

WHY: While testosterone causes men’s eyebrows to grow wild as they age, women’s brows thin after years of plucking and waxing. Eyelashes bear much assault over years with repetitive mascara, curling, and make up use. Many times make up is applied and left on over night. 

TREAT: Clean your eyelashes gently. Use a make up remover designed to take off mascara and do not rub.  Consider eyelash conditioners. A known eye lash grower is FDA approved Latisse with consistent results.

Regarding eyebrows, stop overwaxing and plucking. Consider using a trimmer to keep brow hairs intact below the surface rather than removing them by the bulb. If you repeatedly damage hair at the follicle it won’t grow back. Dr. Doris Day, MD, dermatologist recommends taking 5 mg of biotin daily to make hair stronger. Try using eyebrow pencils to fill in sparse brows.
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Winter Skin

11/8/2019

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Winter's in the Pacific Northwest can be harsh to your skin. Dry air, wind💨, and cold 🌡all lash at the tender armor that covers us leaving it dry and cracked. Here are some great home spa tips to help keep your skin in peak condition throughout the winter months! A simple way to remember - Three Ts and two Ds of winter skin care - DTTTD.😜


  1. DOOR closed. Moisturize immediately after showering or bathing with the door 🚪 to the bathroom shut. The additional humidity helps moisturize your skin and good creams will draw water from the air into your skin.
  2. THREE minutes. You only have 3️⃣ minutes to lightly towel off and apply moisturizer. After that the moisture in the skin escapes and cannot be locked in.
  3. TUB creams. To help keep your skin from getting dry with winter ❄ weather, use creams that have to be scooped. They often come in a tub or jar. Do not use lotions from a pump. They have less emollients and often have added alcohol that will actually dry your skin.
  4. Take TIME ⏳to center daily. Try using an app that has you breath, center, or meditate daily. Try it for 7️⃣ days. See if it changes this holiday 🎄 season for you. Studies show that mindfulness, meditation, and yoga are all beneficial for health. It can decrease the sensation of stress, heart 💗rate, blood pressure, and pain. There are many app to try. Dr. Lani uses Relax by Andrew Johnson available at the iTunes store and Google Play. If you are saving for presents, check out free CDs or digital books from your local library. A well known book to promote sleep by Dr. Andrew Weil and Rubin Naiman is available through Multnomah County Library called, “Healthy Sleep: Fall Asleep Easily, Sleep More Deeply, Sleep Through the Night, Wake up Refreshed.”
  5. DON'T skip sunscreen. Even when the days are cloudy ⛅ and you're bundled up from head to toe, wear sunscreen. It protects your skin from aging radiation ☢ that gets through even when the days are dim.


Have a safe, happy, and healthy holidays from the cast and crew at SkinWise Rx! 
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September 28th, 2019

9/28/2019

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​Acne, scarring & Treatments

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"I was first effected by scarring cystic acne when I was 18 years old and going to college. I battled and still war with hormonal acne today. Acne and scarring has a special place in my heart. I know the loss of self-esteem one suffers, the avoidance of any photographs, and the shame I felt. It had nothing to do with my cleanliness or eating chocolate."
​Dr. Lani Doser, DNP

Acne is typically present from puberty until the early 20s but can affect both men and women as late as their 50 and even 60s. In extreme cases acne can be painful, psychologically distressing and even disfiguring. The good news is that both the acne and most scarring caused by acne are complicated to ameliorate but treatable.

For those with more mild cases of acne there are simple preventative steps for preventing breakouts such as to avoid touching the skin, washing before bed, and avoiding sun. Basically, the stuff our parents told us to do. Dr. Amanda Squiers, DNP and Dr. Lani Doser, DNP, would also add other tips such as changing your pillow case nightly, cleansing your make up brushes, and cleansing your phone often. However more severe cases have to be treated with more intensive therapies. In these cases you will want the expertise of a medical professional.

"We also recommend changing your pillow case nightly, cleansing your make up brushes, and cleansing your phone often." 
Dr. Amanda Squiers, DNP and Dr. Lani Doser, DNP

The cause of the tender papules, cysts, and nodules that form deep beneath the skin can be infection or hormonal and can often be treated with prescriptions for antibiotics or birth control. Isotretinoin can also be prescribed to both kill bacteria and reduce the body’s natural oil production. 

The scarring caused by severe acne can be treated as well. SkinWise Rx offers several treatments for scarring depending on the type and severity. Know that acne scars vary from rolling, boxcar, icepick, and atrophic. Many of these types will be present in a single area of concern. Acne scar treatment is never one and done. It takes a series to lessen the impact of permanent damage.

For minor scarring, chemical peels can be an effective and relatively inexpensive solution with little downtime. Chemical peels remove the top layers of skin causing the body to generate new skin and collagen which helps fill in superficial textural changes. This smooths and tones skin and decreases discolorations. Peels can also be titrated to a very small area for icepick scarring. 

For more severe scarring, options include radiofrequency (RF) microneedling and laser resurfacing. RF microneedling is a minimally invasive treatment with little downtime. Using heat and small needles, RF microneedling breaks up the scars and encourages new skin and collagen growth improving texture and pore size. Three to four treatments are typically necessary to achieve desired results.

Ablative laser resurfacing is more invasive and has a 7-10 days downtime. Depending on the severity of scarring, laser resurfacing may be the most effective treatment. Laser resurfacing removes the damaged layers of skin which generates new skin and encourages collagen remodeling resulting in smoother and brighter skin. This also takes a series of 2-4 treatments.

Both Drs. Lani and Amanda have been effected by acne and the scars they leave behind - both physical and emotional. "I was first effected by scarring cystic acne when I was 18 years old and going to college. I battled and still war with hormonal acne today. Acne and scarring has a special place in my heart. I know the loss of self-esteem one suffers, the avoidance of any photographs, and the shame I felt. It had nothing to do with my cleanliness or eating chocolate."

If you have been considering treatment for acne or acne scars and would like more information on the treatment options available to you call SkinWise Rx at 503.964.5334 for a free consultation.
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UNDERSTANDING ISOTRETINOIN (ACCUTANE) AND THE RISK OF DEPRESSION.

7/23/2019

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Acne. For some it’s a small, albeit annoying, part of “coming of age”. For others it can be life-altering, painful and even disfiguring. Patients with scarring inflammatory acne leading to painful nodules and cysts are often desperate for an effective solution and willing to risk the sometimes severe side effects of treatment.

Isotretinoin (the generic name of known brand Accutane) is a form of oral vitamin A. It is an excellent treatment for severe acne symptoms. However, Accutane has been associated with serious mental health side effects including depression. Even after Accutane was discontinued, the association with these side effects has continued anecdotally for patients and prescribers.

​“IF FEAR OF DEPRESSION IS HOLDING YOU BACK FROM ACNE TREATMENT, THEN MAYBE IT IS TIME TO RECONSIDER."
Dr. Lani Doser, DNP

A study recently presented at the annual meeting of the American Academy of Dermatology suggests that patients actually experience LESS depression when being treated with Isotretinoin. The results of the study of 38,000 patients prescribed systemic treatment for acne suggested that patients treated with Isotretinoin were 20% less likely to experience depression than those who were not (under 4% compared to nearly 5% of those not treated with Isotretinoin). 

The study’s author, Dr. Bethanee Schlosser, an associate professor in the department of dermatology at the Northwestern University Feinberg School of Medicine in Chicago, states “Our retrospective, population-based study shows no increased risk of depression in patients taking Isotretinoin, compared to patients with acne but not taking Isotretinoin.” Schlosser suggests that the study’s results highlight what doctors and researchers already knew - that severe acne has a greater impact on a patient’s mood and quality of life and that successfully treating the conditions likely lowers the risk of depression.

Dr. Lani Doser, DNP, says, “If fear of depression is holding you back from acne treatment, then maybe it is time to reconsider. While this medication is a great option for cystic acne, it is not benign for pregnancy. We offer alternatives to Isotretinoin for those not wanting to temporarily block their fertility or have other concerns about Isotretinoin use.”

"Depression is a serious issue that if left untreated rarely goes away. If you are dealing with depression know that it can be treated and there are resources available to help you get treatment. "
​Dr. Lani Doser, DNP

If you are concerned you are suffering from depression please let someone help you. The US Department of Health and Human Services has a 24 hour help line  800.662.HELP (4357).

If you would like more information regarding Isotretinoin and alternitives or would like to schedule a free consultation to speak to one of our medical experts please call SkinWise Rx at 503.967.5334.
​
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  • DermaFrac (Serum Microneedling)
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  • Erbium Yag Laser Treatment | Er:YAG
  • LaseMD Laser Treatment
  • ​Intense Pulsed Light Treatment | IPL
Microneedling, skin care, skin of color expert, lip filler, laser treatment
SkinWise Rx is a top rated skin care and facial treatment clinic throughout the PDX area including Lake Oswego and Portland, Oregon communities. If you're looking to address skincare and facial concerns SkinWise Rx is among the best and if you're from Hillsboro, West Linn, Tigard or Beaverton you're only minutes away. At SkinWise Rx our injectors are experts in providing lip injections and dermal fillers and treating neck fat with our expert Kybella injectors. SkinWise Rx offers several laser treatments including fully ablative Erbium Yag and the less invasive LaseMD laser services. Intense Pulsed Light (IPL) laser treatments is also offered. SkinWise Rx is one of only a few clinics using Platelet Rich Plasma Treatments or PRP treatments in the PDX area to treat hair loss in women and men. When it comes to laser hair removal or laser hair reduction no clinic is better than SkinWise Rx. If you are looking for Radiofrequency Microneedling/RF Microneedling, Mechanical Microneedling, or Serum Microneedling treatments like DermaFrac, Diamond Glow and Tixel treatments look no further. SkinWise Rx is at the top of the list.
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