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.
​

Time for some straight talk on filler. I get questions from clients daily and most have the same concerns and fears. Do these top 5 resonate with you?

1. It's too expensive. There are many dermal fillers available now and the more on the market, the better for you. My favorite is FDA approved new comer is Versa made by Prollenium. It is super smooth, moves dynamically, causes little swelling, and is significantly less expensive than my other fillers. I love this affordable, elegant hyaluronic acid dermal filler.

2. It is too painful. There are many options for controlling and reducing pain. Skinwise Rx offers topical anesthetics, regional nerve blocks, and nitrous oxide for pain management if anxiety or fear are obstacles. Look for an injector that cares about your pain, not one that flippantly says, "Injections ARE painful." I care, am gentle, and take extra time for your comfort.

3. I'll have to miss work. Redness and bruising can happen. I reduce the occurrence of these by using a Cannula, a vein viewer that allows me to see areas that should be avoided. Additionally, I always use the smallest needles possible to reduce downtime. Make up can be worn the next day. Most clients go directly back to work the same day or are injected on a Friday so that they can recover over a weekend. There will be soft swelling that mostly relieves (approximately 80%) in 3 days. Many actually enjoy the swelling and miss it when it is gone.

 4. I'll look too fake. Choose an injector that embraces your aesthetic. Check their before and after pictures on their Instagram. Does anyone look too augmented? Too feline? Does the injector not appear how you would like to present yourself? If so, use caution. Talk about the photos you like and the ones you don't. Be specific and realistic. You cannot become too augmented with fewer than 5 syringes. 

5. It's unsafe. This is a good reason to get injected by an educated, experienced, ethical and licensed injector. Look for cleanliness. Don't use an injector that will split an opened syringe with a friend. It's illegal, unsafe, unethical, and made for single use. Licensure and education help to narrow the field. This does not guarantee a good injector, but decreases the number you consider. It denotes your injector did additional effort on your behalf. Did they mail away for a certificate or go to school specifically to learn the art? Did they pay additional money to register nationally and statewide? Are they being governed by any bodies to serve ethically? If you have many previous facial surgeries, anaphylactic allergies, or extreme fear; choose to be injected by a board certified plastic surgeon or dermatologist. Use care and research your injector. 

​How to make Dysport or Botox last longer? How long does it last for you? Do you think it is related to the injector or to your habits?

Some theories exist on rapid metabolism. For example, if you are exercising a lot or really physical for your job (armed forces, police, firefighting, flight nursing, professional athlete, etc.) you have more potential to metabolize medication faster (same with being very thin or having a rapid metabolism). If you are training for a marathon, triathlon, or Hood to Coast; expect to go through units more rapidly. During this time you may need to be injected more frequently.

As you age, you may need more units. BotulinumtoxinA may not work as well over time and you may become more resistant to its effect over time. If this happens, consider increasing your original dose or trying a different brand. Tell your injector if you are not getting the longevity you have had in the past. Together, troubleshoot what is happening. You should get your records from past injectors to see if the injection pattern and dose is the same as 10 years ago. If it is the same as 2008, you may need to change it up.
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As to what YOU can do, one review article in Dermatological Surgery (2018 Feb, p249-260) discusses the myths and reality of neuromodulators. The main truths according to authors Dover, Monheit, Greener, & Pickett are:

1. Neither Dysport or Botox are superior in effect.
2. Protein load does not increase "spread" in Dysport.
3. The amount of fluid used for reconstitution does not influence treatment effect.
4. Icing before and after injection may decrease efficacy
5. Exercising the muscle for 2 hrs daily until the height of effect increased duration.

Lastly, according to a study in 2012, taking oral zinc with a phytase enzyme four days before injection and the day of injection can increase, by a few weeks, how long neuromodulators last (JDD, 2012 Apr, 507-511) and speed up how quickly they take effect. This study has not been replicated.

How long does your Botox/Dysport/Xeomin typically last? Do you think duration is based on your injector or on your habits?


#botox #dysport #xeomin #toxin #wrinklecare #portlandoregon #pdx #swportland #lastlonger #neurotoxin #injectables #fillers

Jennifer Aniston has become a spokesperson for Shire Pharmaceuticals speaking about her struggle with dry eyes. This is a common condition that effects 30 million Americans. It can be caused by many things including genetics and surgery.

For people that get cosmetic treatments, it can be caused by a multitude of options. Items like false lashes, lash extensions, mascara, eyeliner, and make up can be irritating. Botox, Latisse and lash growth serums are also a culprit. Any eye surgery can create this condition (Lasik, blepharoplasty). If you are using eye drops daily or even hourly (Aniston reports using drops multiple times in an hour), seek help.

There are options that can lessen the symptoms. Instead of taking a nip of the "V" (visine, LOL), go see your ophthalmologist. Eye doctors can suggest ways to reduce this constant pain and irritation. Jennifer Aniston is hoping to create more awareness with a campaign called myeyelove.com sponsored by Shire. Consider taking a look.

For myself, because I am not ready to stop make up or Latisse, I use over the counter Genteal eye gel for severely dry eyes. It is soothing and can be used at morning and at night. It is my go to daily, I don't have to use drops during the day, and it doesn't make my eyes blurry after I use it. So for those of you bleary-eyed from hump day, make an appointment and be seen. You don't have to put up with dry, irritated eyes. Jennifer says so.

Jada Pinkett Smith claims she has the νagina of “a beautiful peach” after undergoing νaginal rejuvenation treatments to resolve her bladder problems. The 46-year-old actress, who is married to Will Smith, revealed the news on a recent episode of her Facebook series Red Talk Talk, during which she and mother Adrienne Banfield-Jones, 64, visit the Vitality Institute of Agoura in Los Angeles, Calif., where Pinkett Smith had previously undergone treatment (Pinkett Smith’s 17-year-old daughter and co-host Willow Smith was not present). 


“A lot of women focus on keeping [the νagina] healthy for sex and pleasing man,” Pinkett Smith says, to which her mom adds, “But you gotta do it for yourself.” The pair, who admit that νaginal rejuvenation is a “sensitive topic” due to cultural shame surrounding age, met with owner Kelly Rainey, who explained that the 5-year-old process is ideal for women who want to improve dryness, their cosmetic appearance, painful sex, and stress incontinence (a condition that causes a person to accidentally urinate with physical movement).

During the procedure, an instrument called the “UltraFemme 360″ is repeatedly inserted into the νagina. “It introduces heat which stimulates cellular turnover which makes you feel younger again,” Rainey told the mother and daughter of the radiofrequency process. “And it gets tighter and nicer and functions like it did when we were back in our twenties.”



VAGINAL REJUVENATION 101
Jada and Gammy embark on a very personal journey to a clinic that specializes in vaginal rejuvenation. Gammy is skeptical of the newfangled technology, but Jada has a different point of view.Posted by Red Table Talk on Friday, June 15, 2018

-Article by Elise Sole' published in Yahoo Lifestyle.

The weather's here! Sun is out and spots return. Oy, One hour of sun, even with sunscreen, can trigger hyperpigmentation in those with a history of sun spots. I have many happy clients (like above on Obagi NuDerm (before-left and 9 weeks-right).

I reached out to Obagi NuDerm to find out: Can Obagi NuDerm be used in the summer?Here are the answers:

"Absolutely!  In fact, it is especially important to use your Nu Derm products during the summer when sun exposure is at its highest and skin’s susceptibility to sun damage is at its peak.  If there was ever a time to correct and protect your skin with Nu Derm, SUMMER is that time!"

One of the misconceptions regarding tretinoin is that it thins the skin and makes skin more susceptible to sun burn.  Experts would disagree!  Although this can appear true during your skin’s initial adjustment period (as skin can experience redness, sensitivity and irritation),  with continued use of tretinoin, the epidermis is actually thickened and strengthened. While your skin is adjusting to your retinoic acid/tretinoin – as ALWAYS -  it is important to use a SPF like one of your favorites from Obagi’s Sun Shield line that includes Sun Shield MATTE or Sun Shield TINT, available in Warm or Cool tint.  With proper protection, you can experience the benefits of great skin care, all year long. 

What the EXPERTS are saying:

Suzan Obagi, MD, Associate Professor of Dermatology and Associate Professor of Plastic Surgery, Director, UPMC Cosmetic Surgery and Skin Health Center, University of Pittsburgh Medical Center hears this question a lot:
 
“Many patients ask if they should take a break from using their skincare products during the summer months.  This stems from concerns with sun exposure and increased outdoor activities.  However, I have oftentimes found that patients that need the NuDerm product line most are those with pigmentation issues such as melasma or post-inflammatory hyperpigmentation.  These are conditions that typically flare and worsen during hot, sunny weather.  In order for patients to have adequate control over these conditions, I recommend that they continue to use their NuDerm products as instructed.  This goes hand in hand with sun avoidance during the peak hours of 10 am to 2 pm, wearing a hat when outdoors, and reapplying their sunscreen after sweating, swimming, or every 2 hours while outdoors.  Furthermore, while ultraviolet ray B (UVB, the burning ray) increases during the summer, UVA (the aging ray) remains constant all year.  Therefore it is imperative to use a daily, broad-spectrum sunscreen such as Obagi Sun Shield, either tinted or untinted, daily.  I recommend it even while driving or working under fluorescent lights, as these are sources of ultraviolet light exposure that most patients do not realize.”

Doris Day, MD, Lenox Hill Hospital in New York City, clinical associate professor of dermatology at the New York University Langone Medical Center, awarded Dedication and Excellence in the Teaching of Dermatology. According to Dr. Day with regard to retinoid usage and sensitivity: 

"This is one of the biggest retinoid myths," says Doris Day, MD, (a tretinoin user herself). "The ingredient itself is sensitive to sunlight, which is why you should apply it before bed at night. A retinoid shouldn't make your skin any more vulnerable to UV rays than it would be after buffing away dead skin with a face scrub. Summer is actually a good time to start a retinoid: Humidity makes your skin less likely to dry out as it adjusts. Of course, apply sunscreen (SPF 30, at least) as diligently as you always do."

Is there anything extra I can do to protect my skin during the summer months when sun exposure is at its peak?
 
In addition to using a sunscreen, incorporate a topical antioxidant into your morning skin care routine. Antioxidants help in the fight against free radical and sun damage.  They help stabilize collagen, which helps reduce the aging effects the sun inflicts on our skin. Vitamin C in the form of L-ascorbic acid is believed by many experts to be the most stable and effective in protecting skin.  Obagi Medical offers a full portfolio of vitamin C (l-ascorbic acid) products:  Pro C formulas 10%, 15% and 20% as well as Pro C Peptide Serum, C Exfoliating Day Lotion and Pro C Suncare SPF 30, all of which contain vitamin C.  Apply a few drops, first thing in the morning, after cleansing and toning. (Be careful to avoid the eye area if you’re using Elastiderm Eye Cream as Elastiderm contains a copper peptide which neutralizes the benefits of the copper and C when the two ingredients come into contact.) 

Stopping your Nu Derm products in the summer increases the chance for you to receive additional, untreated photo damage -  the very thing we are trying to correct and avoid! During the summer months, it is important patients continue use of their Nu Derm System of products keeping pigmentation in check (as well as improving texture, tone, and laxity issues.) Confidently enjoy Nu Derm and wonderful skin all year long!

​Many aesthetic clinics are the same: cookie cutter reflections of each other. Websites are replete with models looking wistfully, usually half-dressed, showing airbrushed appendages and perfect teeth. Instagram is filled with perfection that is not real life. How can you pick your injector when most use stock photos from the aesthetic companies? Here are some tips:

1. Look for organic photos that are usually watermarked. Photos of their kind and generous clients - real people - allowing their before and afters to educate you.

2. Ask if your injector is staying current and relevant. Do they belong to a journal club, do they participate in local and national education, do they have a special certification or licensing? Are they participating in round tables or case review panels? Do they have colleagues that are willing to advise them? Do they seem like a lone horse? Are they humble? What journals do they normally read, what was the last aesthetic journal article that struck them, are they participating in research, are they local or national trainers, are they speaking on podium?

3. Do they have issues with their licensing or board certification?

4. Check reviews, knowing they can include effusive staff and angry or unusual reviewers.

5. These are the tells of a caring provider. Do they use anesthetics (numbing cream, laughing gas, dental blocks) to benefit their patients? (This can be expensive without recouping the loss but shows compassion). Do they use a veinfinder to avoid vessel occlusion, bruising, and swelling? (AccuVein pictured here and arriving at Skinwise on Friday.) How often do they use cannulas for less pain, bruising, swelling, and greater safety? How are they cleansing the skin and lowering the possibilities of infection or biofilm.

This is a beginning list of items to look for and see if they match your wants and needs in a sea of "ticky tacky" injectors who "all look just the same."

​May is Melanoma (actually skin cancer awareness) month. Because it has touched my family irreversibly and profoundly, I want to discuss some thoughtful ways to decrease your risks. First, use sunscreen. Use lots of sunscreen (one ounce or a shot glass or two tablespoons) for the body.

Reapply every 80 minutes when out in the sun. Yes, that often. Use sunscreen that you LOVE and at 30 SPF or higher. There is a current study saying that 100 spf is better for protection than 50 spf. Sunscreen that is practical is sunscreen that you will use. I use Brush on Block everyday before my Jane Iredale powder. I can easily reapply. When we went to Harry Potter world in LA, I brought a SPF make up finisher spray (Topix has a very nice one. I have used SuperGoop's but it can sting around the eyes.) Not only did it work, it was very cooling on the face.

If your shadow is taller than your body, get out. You should avoid midday from approximately 10-11a to 3p. If you are out, sunglasses can protect your eyes (and look posh), a big floppy hat, and protective clothing that has SPF. A less expensive way to get your existing clothing with sun shield, use Rit Sun Guard in the washer with your current clothes.

For my skin of color clients (myself included), I prefer mineral sunscreens. It reflects the sun back without absorption of the sun into my cells (as needed for chemical sunscreen). Less heat means less hyperpigmentation.

Get a skin screen yearly. If anything doesn't look right (ABCDE), get it checked out. If something doesn't heal, make an appointment. Dr Boudreaux, DO, and Dr Matthew McClelland, MD, are wonderful. You get a pleasant visit once a year and can catch anything brewing.

There are some newer sunscreens that have photolyases. There are at least 3 studies and more coming that show protective effects as well as reparative effects to DNA.

https://www.ncbi.nlm.nih.gov/m/pubmed/28329483/

https://www.ncbi.nlm.nih.gov/m/pubmed/26355618/

https://www.ncbi.nlm.nih.gov/m/pubmed/22086236/

Enjoy the sun, Portland, but be careful. And kiss your family and hold them tight.

​The sun has made it's glorious appearance again in beautiful Portland, Oregon. It's a great time to talk about how to care for your skin during sun exposure or exercise.  Exercise is necessary for a healthy body but may run counter to your skin goals. Heat, perspiration, and chafing can cause skin irritation to worsening skin conditions. Showering more can cause dry skin, while not showering, can cause break outs. What to do?
 
Post exercise skin regimens are as important as daily hygiene. Address post work-out breakouts in these ways:

1. Wear clothes that wick away moisture so sweat does not sit on the skin.
   
2. Wear exercise clothing that does not rub or chafe.
   
3. Usually you can wear makeup while you exercise and sunscreen (SPF 30-50, hat and protective clothing if outdoors).
   
4. Shower after working out.
   
5. Wash face with a pH neutral cleanser (Epionce Lytic Gel Cleanser is my favorite). 6. Consider a corrective treatment for your pores like Benzoyl Peroxide or a gentle Retin A.
   
6. Apply a low inflammatory body lotion to reduce irritation and redness (Epionce Renewal Body Lotion, Cerave Itch Relief Moisturizing Cream, Aveeno Eczema Therapy Moisturizing Cream or Cetaphil RestoraDerm Calming  Eczema Body Moisturizer).

 
If you have skin conditions like Eczema, Rosacea, Acne, Hyperpigmentation, and/or Melasma; you may experience worsening. For example, HOT YOGA can increase dark spots due to internal heat just as ultraviolet exposure can. Try to discontinue (or decrease frequency and intensity) anything that raises your core temperature and your red or brown tones. For worsening brown pigment, consider using Obagi NuDerm. For worsening redness or rosacea, consider seeing a dermatologist for topical or systemic treatments. Some gladly pay for rosacea laser work yearly to keep their flush to a minimum.
 
For skin as healthy as your body, get a consultation to talk about a customized regimen. Enjoy spring and summer, safely, with glowing skin. Call 503.246.2227 for a consult.
#sun #exercise #skin #heat #bbloggers