Intraceuticals Oxygen Facial treatments utilize refined Hyperbaric Oxygen to promote the delivery of treatment specific solutions to the skin. The serum applicator creates a hyperbaric pressure bubble to initiate osmotic hydration and ingredient delivery.
Intraceuticals revolutionized the use of multi-weight Hyaluronics as both exceptional hydrator as well as an effective delivery system. The patented 3-step hyaluronic layering combines 3 specific combinations of hyaluronics, which work together to provide perfect hydrodynamics.
1) Low Molecular Weight Hyaluronic Acid – small, fast and easily absorbed to deeply hydrate skin.
2) High Molecular Weight Hyaluronic Acid – draws moisture from the air and binds moisture to skin.
3) Hyaluronic Polymer – a longer lasting form that works on the surface to seal in hydration and maintain infusion results
Oxygen Facials Options
There are a variety of Intraceuticals Oxygen Facial treatment that may be used to fit individual needs. Treatments may be “boosted” with collagen, vitamins and antioxidants or upgraded to include an Atoxelene targeted treatment for lines. In a clinical setting treatments are often customized by adding an enzyme treatment, mild peel, derma planing or microdermabrasion for exfoliation. Oxygen facial treatments are also excellent in conjunction with skin tightening treatments such as Forma or ReFirm .
Ultimate in hydration, the rejuvenate serum is formulated with hyaluronic acid, vitamins A, C, E and antioxidants to lift tone and hydrate skin. Appropriate for all skin types, and excellent as part of a skin recovery program after chemical peels, non-ablative laser resurfacing and IPL.
Combines botanical brighteners and super concentrated vitamin C to brighten and balance uneven skin tone. Leaving skin more luminous, toned and radiant.
Refine the appearance of problem prone skin. Formulated with salicylic acid, vitamin C and chamomile extract to reduce irritation and clarifying pores. Ginger root extract reduces redness and calms irritation.
Amino acids instantly firm, lift and plump, reducing the appearance of fine lines. This targeted treatment may be added to Rejuvenate, Opulence or Clarity Sensitive Treatments. This treatment does require additional time,and is and additional cost.
Rejuvenate +Booster Treatment
Enhance your Rejuvenate treatment results with your personally prescribed Rejuvenate Booster+ Treatment. There is typically an additional charge for boosted treatments and additional time may be needed.
Collagen – collagen building peptides to promote skin renewal and rejuvenation
Vitamin C+3 – Three forms of Vitamin C work together to smooth, strengthen and promote healthy glow
Vitamin A - Helps promote skin elasticity while clarifying and refining skin appearance
Antioxidant – Revitalize and balance dull and stressed skin with natural super fruits from Australian Rainforest.
Add A Mask!
Super hydrators Hyaluronic Acid and brown algae provide a burst of hydration, to hydrate and soften the lips and skin surrounding mouth, defining the lip line. The Intraceuticals Lip masks may be added to an oxygen facial or purchased for at home use.
Hydrolysed plant proteins helps to soothe and hydrate and tighten tired, puffy and overworked eyes.The Intraceuticals eye masks may be added to an oxygen facial or purchased for at home use.
Aesthetics is a branch of philosophy that explores and studies the nature and form of beauty, along with the creation and appreciation of beauty.
An Esthetician is a skin care specialist, that has been formally educated and trained in skin health and beauty. To become an Esthetician, one must obtain a specific amount of credit hours, typically around 600. Educational requirements, rules and regulations do vary by state. After graduating, an Esthetician will need to pass state board exams, which include a written and practical exam, to obtain a license. An Esthetician may work in a salon, spa, private studio, on location, med-spa or in a medical practice such as dermatology or plastic surgery. An Esthetician may also work as a makeup artist, as an educator or in sales. Many Estheticians obtain additional degrees, certifications or training. This may include things like laser certification, cosmetic tattooing, lash extensions, electrolysis, massage therapy, nursing, oncology esthetics, and holistic approaches.
Estheticians typical provide treatments such as facials, chemical peels, hair removal, makeup application and some body treatments. Estheticians may also be referred to as a facialist, because they specialize in facials. Estheticians are the go-to people when choosing skin care products, they study ingredients and skin care products extensively and can create a complete skin care regime appropriate for your skin. Although an Esthetician is trained to recognize some skin conditions, they do not diagnose or treat medical skin conditions. Many skin lesions closely resemble each other and need to be diagnosed by a dermatologist. Conditions like eczema, psoriasis, allergies or skin cancers, require medical attention.
Esthetician or Aesthetician
Esthetician and Aesthetician may be used interchangeably and both are correct, however the spelling on a license may differ by state. In Arizona, my license reads “Aesthetics” while my text book is Esthetician. Generally, the Esthetician spelling is used when describing someone who works in a spa environment, while Aesthetician is used to describe someone who works in a medical environment. There is no solid rule on which spelling must be used, both are correct.
The term “Holistic Esthetician” is not recognized by the State Board of Cosmotology as a specific license, it does however describe an Esthetician who uses a holistic approach, emphasizing the importance of the whole person, including mind, body and spirit. Holistic esthetics is typically associated with treatments and remedies that are more natural or integrative alternative therapies. Holistic Estheticians usually work with products that contain natural and/or organic ingredient. Some schools offer specific holistic-based esthetician training programs, however there is little difference compared to a general esthetician training, so many Estheticians opt for post graduate holistic eduction and may even obtain a Holistic Skincare Practitioner Certification. There are plenty of Estheticians who do not specifically identify themselves as a holistic provider, but incorporate some holistic approaches.
Medical Aesthetician and Laser Technician
An Aesthetician that works in a medical environment may have additional training or certifications, they may be referred to as a Medical Aesthetician, Paramedical or Clinical Aesthetician, Master Aesthetician or Aesthetician, CLT (Certified Laser Technician) or CMLT (Certified Medical Laser Technician).
Although the terms Medical Aesthetician and Paramedical Aesthetician are used to describe an Aesthetician who works in a medical setting, these terms are usually not recognized by most state boards and do not necessarily guarantee that a provider has met any additional requirements. A “Master Aesthetician” is generally someone who has obtained additional training and credit hours to include laser treatments and aesthetic treatments typically offered in a medical setting. Some states like Utah offer a Master Aesthetic license after completing 1200 credit hours plus additional apprenticeship hours. The majority of states, including Arizona require formal training and additional credit hours to obtain a Laser Technician certification through the state Radiation Regulatory Agency. This requires a minimum amount of credit hours to include didactic and practical hands on training. Usually, specific training and additional hours are required for each modality added to your certification. Laser technicians must work under the supervision of a medical director. In California a laser technician must be an RN or PA and in New Jersey only a Medical Doctor may perform laser treatments.
A Career in Aesthetics
If you are considering a career in the aesthetic industry, research the requirements required by your state. Do a little self-reflection and consider what aspect of the aesthetic industry you feel most passionate about and what things you might want to avoid. For example, if you can’t handle the sight of blood you probably shouldn’t work for a plastic surgeon. If your a “Little Miss Chatterbox” like myself, you should avoid the tranquil day spa. Are you obsessed with make-up, does your heart drive you to work with cancer patients, do you take a holistic approach to life, are you a social media genius or do you have the talent to be an educator. Would you prefer to work in a luxury spa environment, a medical practice, work in management or work as a sales representative. Do you have the discipline to be self employed or the entrepreneur spirit it takes to open your own spa or create a new product. Maybe your a trail blazer, who will create your own niche in the market. Evaluate the job opportunities in your area and inquire about the qualifications employers look for. Not everyone who goes to esthetic school will find success in the industry, but there are ever-growing possibilities. Consider Anastasia Soare, a woman who came to America and took a “waxing job” as an Esthetician. From her brow-shaping method, she built the global beauty empire Anastasia Beverly Hills.
Choosing an Esthetician
Not all Estheticians collectively agree on the best products, treatments or approach, so you should look for an Esthetician that fits your personal goals. If it is important to you, to have an all natural approach, then look for an Esthetician that is like minded. If you want to relax and be pampered in tranquil ambiance, then you may prefer a day spa setting. If you are seeking corrective or more aggressive result focused treatments, then a med-spa or medical practice may fit you best. When selecting an Esthetician, be sure to ask about there experience and training. What ever your goals and personal style is, there is an Esthetician for you.
The use of makeup may be prohibited or restricted after a cosmetic procedure or skin treatment such as laser resurfacing, fractional laser or chemical peels. Pure mineral cosmetics are recommended after cosmetic procedures, it may be worn sooner than traditional makeup and in many cases may be worn immediately after your procedure.
Get Your Post Procedure Cosmetics Before Your Procedure
It is best to be color matched before your procedure, as you may be pink or red after your procedure and not get an accurate match. You may schedule consultation with an aesthetician prior to procedure to be color matched and help you prepare for your procedure. If you purchase a mineral powder outside of your providers clinic, bring it with you to your consultation to verify that is okay to use after your procedure.
Pure Mineral vs Mineral Based
Ensure your mineral makeup is pure mineral and not just a mineral based makeup, which may contain ingredients such as talc or preservatives, that are contraindicated after certain cosmetic procedures. After resurfacing treatments, it is not recommended to use products that contain certain oils, chemical, fillers, preservatives, FD&C dyes or talc. Most cosmetic powder contain about 50% – 80% talc, which will exaggerate peeling or further dry skin after cosmetic procedures. Many aesthetic practices, cary lines like Jane Iredale that are a pure mineral makeup. Jane Iredale products use the highest quality ingredients available, pharmaceutical grade and certified organic. Most products are vegan and gluten free and are all are certified cruelty-free. Other options include, bareMinerals and Young Blood cosmetics.
Always Buy From An Approved Provider!
I can not stress how important it is to purchase your products from an approved provider. It is tempting to purchase products online for the convenience and sometimes discounted price, but this comes at a risk. Manufacturing and selling counterfeit cosmetic and healthcare products is an industry in itself. Often counterfeit products contain ingredients that are harmful, or at best useless. There is also an industry for people who are “dumpster divers” that will pull products that have been discared by vendors and sell them on line. It is not worth compromising your results or risking your health. Counterfeit products are not just found online, they are also found in popular stores and in some cases even salons. The best way to be sure you are getting authentic product is to go to the products official website and use your zip code in the “find a store” or “find a provider” area provided.
I usually recommend a mineral powder rather than liquid minerals after resurfacing treatments, because it is the easiest to apply without much blending and doesn’t require any rubbing or tugging on the skin. Many liquid minerals cosmetics contain ingredients that are not recommended immediately post procedure, so be sure to check the ingrediants.
Hydration Spray: Look for a hydration spray that uses natural ingredients to calm, nourish and hydrate skin. Hydration spray is used to set minerals and help to conceal pores and fine lines . You may spritz your face with hydration spray as often as needed to hydrate skin feels tight or dry. *Hydration spray is strongly recommended for anyone undergoing laser resurfacing treatment.
Lips may become dry after treatment and should be protected from UV rays. Jane Iredale Lip Drink SPF 15 is a color less lip balm that moisturizes and protects lips. It does not contains petroleum-derived products that dry out the lips. Lip Drink offers broad band UVA/ UVB protection, made with an 8% edible zinc oxide and antioxidants green tea extract, Vitamin E and C to protect your lips. * Recommended by the Skin Cancer Foundation.
Lipcolors and Lipsheres are hydrating, do not contain chemical dyes or preservatives and made with edible zinc oxide to protect your lips.
Eyes: Look for a mascara that is hypo-allergenic, mild and conditioning and does not contain lacquers,shellac or petroleum based products. If you have had the area around your eyes treated, look for pure mineral eye shadows that are highly pigmented and do not contain chemical dyes or preservative that may cause irretation.
There are countless skin care products available to treat skin discolorations known as “hyperpigmentation”, such as brown spots and melasma. There is also just as much confusion and misinformation, surrounding topical Hydroquinone and Non- Hydroquinone products. The fact is they are both necessary, as each have a place in correcting and maintaing pigment irregularities.
I am a proponent for Hydroquinone and for good reason, when used correctly it is arguably the most effective topical for treating hyperpigmentation. I am also a proponent for Non-Hydroquinone skin brighteners, because I do not support using Hydroquinone indefinitely without pulsing on and off.
If you understand how hyper pigmentation occurs, you are better able to understand how to treat it. The process of producing pigment (melanogenesis) is complex, with many process, so I am giving the short version. When the skin has hyperpigmentation, it means that, there are melanocytes that are over producing melanin (pigment) AND that those pigment cells are not being evenly distributed to the skin cells called keratinocytes.
Something must first, trigger the increase of tyrosinase activity, this can be sun exposure, hormones or inflammation. Tyrosinase is an enzyme in the skin that controls the production of melanin. One of the main goals in treating hyperpigmentation is to inhibit the tyrosinase, so that it will not trigger the overproduction of melanin (pigment). Products that aim to do this use ingredients that we call “tyrosinase inhibitors”. Hydroquinone is a strong tyrosinase inhibitor, however there are also non-hydroqinone tyrosinase inhibitors that are effective.
Hydroquinone is a strong tyrosinase inhibitors and very effective at treating hyper pigmentation. There is concern, however that with extended use the skin may become resistant to the effects. This is why it is important to use hydroquinone under professional guidance. The general idea is to maximize correction, before you build resistance. Many dermatologists and skincare professionals are now recommending pulsing on and off hydroquinone. If you are using or plan on using hydroquionone products, I recommend you read “Hydroquinone: What you need to know, to maximize it’s benefits and prevent resistance”.
When you are pulsing off hydroquinone, you may want to use a non-hydroquinone skin brighter. Look for a brightener with tyrosinase inhibitors. Ideally, non-hydroquinone skin brighteners should be formulated with a combination of ingredients that will have an effect on the various stages of melanogensis (the formation of pigments). Antioxidants and exfoliants play a role in melanogensis and should be part of a skin care regimen, along with a tyrosinase inhibitor. I am including a short list of some commonly used ingredients in Non-hydroquinone brighteners.
Non-Hydroquinone Lighting/ Brighting Ingredients
Arbutin (Bearberry Extract)
Licorice Root Extract
Hydroxyphenoxy Propionic Acid
For best results begin by preparing your skin to best absorb the topical products you are using, this is done by properly cleansing and toning skin. Topical antioxidants and a broad spectrum SPF, are a MUST, because they help block the effects of “triggers”. We also recommend some type of chemical exfoliant, such as glycolic or lactic acid. These help by exfoliating melanin filled skin cells from the surface, which accumulate and cause pigment to be more dense, making it look darker. Retinoids such as tretinoin (Retina-A) work by inhibiting the transfer of pigment to skin cells, this blends pigment for even skin tone. Retinoids also work as a tyrosinase inhibitor. Finally, if you are not seeing the results you want with topical products alone, consult with a skin care provider to discuss which treatment options are best for you. Typically, we recommend chemical peels or PhotoFacials (IPL or BBL), depending on skin type and conditions being treated.
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In the world of medical aesthetics, hydroquinone is often a necessary part of skin care. It is the gold standard for treating dark skin irregularities known as hyperpigmentation. As effective as it is, there is a rising concern regarding the number of people who are using hydroquinone incorrectly, without on going professional guidance. Many of those who are using hydroquinone do not understand the risk of hydroquinone resistance or how to properly use it, as to enhance efficacy. It is important to use hydroquinone in a way to maximize it’s benefit, before the skin builds a resistance and how to properly transition off, to reduce incidence of rebound hyper pigmentation. Always seek a professional guidance before starting or continuing hydroquinone use. It should be used only under the strict supervision of a professional.
Why do we need Hydroquinone?
Hydroquinone is the single most effective topical ingredient for treating skin discolorations. Skin discolorations can include sun spots, Melasma and Post Inflammatory Hyperpigmentation (PIH), pigmented acne scars. When the skin is inflamed it can respond by over producing melanin, this inflammation can come from acne, injury, surgery or aesthetic procedures such as laser or chemical peels. UV exposure and hormones can also induce skin discolorations. In the world of medical aesthetics we are really dependent on the ability of hydroquinone to quickly correct hyper pigmentation. There are non-hydroquinone skin brighteners that are very good products, however they are not as effective as hydroquinone. That does not mean that botanical lighteners do not have a place, as you will learn, both hydroquinone and non-hydroquinone brighteners are important.
Resistance to Hydroquinone
Hydroquinone works by inhibiting tyrosinase, which is necessary for melanin production. It is believed that with extended hydroquinone use, the skin will compensate by increasing tyrosinase. This would causes the skin to become resistant to the effects of hydroquinone. When the skin becomes resistant to the effects of hydroquinone it will quit improving the hyper pigmentation. To prevent building resistance, it is not recommended to continue use for extended periods of time with out cycling off. It is usually recommended to cycle off hydroquinone after about 4-6 months. If needed, hydroquinone may be resumed after about 2 months. If you stop hydroquinone “cold turkey”, there is a risk of rebound pigmentation. To prevent rebound pigmentation, it is generally recommended to transition your skin off. While transitioning off and breaking from hydroquinone, continued stimulation with a retinoid is beneficial. When it is time to transition off your hydroquinone, you may begin to incorporate a non-hydroquinone skin brightener. There are several professional products that may be recommended. Exact regimens will vary individually, depending on skin condition and any skin treatments, such as laser treatments or chemical peels, that are planned. Do not attempt to cycle off hydroquinone without professional guidance!
Maximize Hydroquinone Effectiveness
When using hydroquinone to treat hyper pigmentation, the goal is to correct the condition before the skin builds resistance. In order to maximize effectiveness, we need to use a high quality hydroquinone product in the appropriate dosage, along with products that optimize penetration, assist in correction and protect from exacerbating factors.
We want to use enough of hydroquinone to reach correction, so a skin care professional needs to show you how to measure your hydroquinone and give you a time frame that you should expect to run out of product. Using hydroquinone every morning and night is a common protocol for treating facial skin.
We want the hydroquinone to have optimal ability to penetrate and work. Prepare the skin by cleansing with an appropriate cleanser. This would exclude anything that does not sufficiently clean the skin or leaves any occlusive film, this could inhibit product penetration. For this reason, I generally do not recommend cleansers like CeraVe or Cetaphil. Anything that is too harsh or active, should also be avoided, as we do not want to induce any unnecessary inflammation or irritation. After cleansing, an appropriate toner should be used, this will restore the skins PH balance after cleansing, preparing it for corrective skin care products. (astringent is not toner). Hydroquinone should be applied after toner, unless you have been instructed to use a Vitamin-C serum or other corrective serums. Always, confirm with your Esthetician or provider, the order your products should be applied.
When Hydroquinone is used with a mild exfoliant and Tretinoin (Retin-A), the pigment will be more evenly distributed. The goal is not just to suppress the production melanin (pigment), it is to have even distribution of the pigment. When the skin has hyper pigmentation, the melanocytes are not functioning properly. Not only is there an over production of melanin, but the pigment is not being evenly distributed to skin cells called keratinocytes. When Hydroquinone is used with Tretinoin, it works to evenly distribute the pigment. A mild chemical exfoliant will enhance the process by increasing the skin cell turnover. It is important that the exfoliant be appropriate to your skin type and personal skin care regimen, to reduce risk of any unnecessary inflammation. Here is the icing on the cake, tretinoin will also treat acne, increase collagen production in the dermis, as well as glycosaminoglycans such as Hyaluronic acid that bind to water and improve skin moisture. There is also evidence that tretinoin may positively effect gene expression in the skin. – Yes, please! I want all of that.
Sun protection is important for several reasons. 1) UV exposure stimulates the production of melanin, while hydroquinone is working to suppress it. It literally, defeats the purpose of using hydroquinone, if you do not have proper sun protection. 2) Hydroquinone, tretinoin and exfoliants can all cause photosensitivity of the skin. 3) Heat, including heat from the sun dilates capillaries in the skin and induces inflammation, which can exacerbated pigmentation problems. 4) UV exposure causes skin discolorations, free radical damage and breaks down collagen and elastin.5) UV rays damage DNA and causes skin cancer, and melanoma can be life threatening.
Your sunscreen should be an SPF 30 or higher and should have zinc oxide. Zinc Oxide can help by blocking some of the UV induced heat, that contributes to inflammation and exacerbates hyper pigmentation. Zinc also provides broad spectrum protection from UVA/UVB rays without the irritation occasionally seen with chemical sunscreens. Professional zinc products are more elegant and will look better on the skin. Using a moisturizer, BB Cream or cosmetic with an added SPF, is not enough. It is important to have an actual sunscreen, with high broad spectrum coverage. Sunscreen should go on after any moisturizer, it is the last thing you put on, but before makeup. Sunscreen needs to be used EVERY day!
Topical antioxidants are useful for many reasons, but in regards to skin discolorations we especially like topical Vitamin-C. First, Vitamin-C reduces oxidized dopaquinone, which helps further brighten the skin. Perhaps, more importantly, Vitamin C helps to reduce inflammation in the skin that can cause or exacerbate hyper pigmentation. Some antioxidants, including Vitamin-C also have photo-protectant ability, enhancing the effectiveness of sunscreen. They works by neutralizing the UV rays, rather than reflecting or absorbing UV rays like a sunscreen, so use them together to maximize your protection. We recommend using an l-ascorbic acid form of vitamin c, in serum form. A quality l-ascorbic acid, needs to be packaged in a glass bottle with a glass dropper, the bottle should be dark to reduce oxidation of the product.
Not all skin care products play well together and there are some skin care products that may be contraindicated to your personal skin care regimen. For example, you should not use any product that contains benzoyal peroxide with products that can oxidize, such as Hydroquinone and Vitamin-C Serums. Always inform your Esthetician or skin care provider of the products you are using, and do not add anything new without having it approved first.
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Décolletage is what we call the neckline, or more specifically the area made up of the neck, chest and cleavage. If we neglect this area between our face and breasts, it is sure to age us. Although we can cover up our décolletage, we would certainly be limiting our style and where is the fun in that.
The décolletage is a special concern, because it tends to suffer more sun damage than other areas and women also tend to develop lines between the breast while sleeping on their side. Luckily, there are plenty of options to improve this area, but we have to be patient as correction for non-facial skin is much slower than it is when treating the face. When we treat the décolletage or any non-facial area, we need to treat more conservatively and thus, more often. The skin cell turn over for non-facial skin tends to be slower, so this means the recovery process will take longer, which will require more time spaced between treatments. When treating the décolletage you should treat early and often. Slow and steady wins the race.
When it comes to skin care and anti-aging, the best approach is a comprehensive one. One treatment does not necessarily replace the other. Your skincare provider should work to help you understand which treatments are best for you and the time line that treatments may be done. When budget is a concern, you will need to decide which concerns are a priority for you.
Topical Skin Care
The first step is to use effective skin care products on your neck and chest, every morning and every night, just as you would your face. Most of the skin care products that are used on the face, can also be used on the chest. Some topicals, such as hydroquinone and retinoids need to be used less frequently on non-facial skin to avoid irritation. Some products should be used daily, such as topical antioxidants and an SPF 30 or higher. There are some great products formulated specifically for the neck and chest. Revision skin care formulated Nectifirm for firming the neck and décolletage. NIA 24 Sun Damage Repair for Décolletage and Hands, is formulated with patented Pro-Niacin to repair damaged skin. Consult with your Esthetician, to determine the appropriate protocol for you.
Treatments that use Intense Pulsed Light work to treat brown spots and redness. There is also research to suggest that ongoing treatments will positively effected gene expression in the skin to mimic that of a younger person. Generally a series of 3-5 treatments are recommended, scheduled 3-4 weeks apart. For enhanced results Levulan may be applied prior, this is known as PhotoDynamic Therapy.
Medium depth chemical peels that reach the papillary dermis or upper reticular dermis, such as the Obagi Blue Peel or ZO controlled depth peel will improve skin discolorations, improve texture, laxity, lines and stretchable wrinkles. A medium depth peel on the chest, may take up to 14 days for peeling to be complete. On the up side, peels on the face generally do not look bad during the peeling phase and are easy to tolerate. These peels can be done as often as 4 times a year, however I find that once a year is optimal when combined with other treatments.
Ultherapy is the treatment of choice for the lines that develop between the breasts. Ultherapy works at a deeper level than any other non-surgical treatment, to lift and tighten skin. Ultherapy uses focused ultrasound to target deep into the dermis and even the top of the muscle. Like many other aesthetic treatments, Ultherapy works by creating a wound healing response, but because the targeted areas are at a deeper level we see more tightening and lifting. The increased collagen production in the treated area, can be seen a year post treatment. Most people should plan on repeating this treatment once a year, although younger patients may be able to stretch it out to every two years. Those with advanced photo damage, or who desire more improvement may choose to repeat the treatment in six months. Pain medication may be prescribed, in which case you will need to arrange for someone to bring you in to your appointment and take you home.
Non facial skin does not respond well to “full coverage” ablative laser resurfacing. Non-ablative or sublative fractional resurfacing treatments, such as E-Matrix or Fraxel are more appropriate for treating non-facial skin. These treatments reduce lines, wrinkles and smooth skin texture. Like many other aesthetic treatments, fractional lasers work by creating a wound healing response in the skin, that stimulates the fibroblast in the skin to up regulate the production of collagen. Because laser treatments create heat, we appreciate a different type of wound healing response than we do with other treatments such as chemical peels, micro needling, which is why we see the up regulation of collagen for longer periods of time post treatment.
Fractional lasers generally work in the deeper layers of the skins dermis, an area which is not effected by chemical peels or IPL treatments. The frequency and number of treatments will depend on the level of treatment performed, level of correction desired and condition of skin.
Micro-Needling Collagen Induction Therapy
Aesthetic professionals use micro-needling pens such as the Eclipse or Dermapen, to deliver tiny needles into the epidermal and dermal layers of the skin creating micro-injuries. This begins a natural wound healing or renewal process that will stimulate collagen production in the treated area. There is little to no down-time, and it is surprisingly comfortable. Although, micro needling treatments do not deliver the same level of correction to skin texture as fractional lasers, they are the treatment of choice for scars and stretch marks. Micro-needling is also a good option for early intervention or in between other aesthetic treatments.
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Ultherapy has become a popular anti-aging treatment for those looking to tighten, lift and avoid the thin skin associated with aging. The common question with any aesthetic treatment is “how long the effects will last” and with Ultherapy, the answer is a long time.
How Does Ultherapy Work?
Ultherapy is the only device that is cleared for skin tightening and lifting. It uses focused ultrasound to precisely target and treat tissue at three levels, the Superficial Dermis, Deep Dermis and most importantly the SMAS which is at the top of the muscle, all while leaving the surrounding tissue intact. We are not able to treat all these areas with chemical peels, micro-needling or even other devices such as lasers or Radio Frequency. So basically…. this is as good as it gets with the exception of surgery.
As we age the processes within the skin begin to slow, our skins fibroblast are more sluggish and we produce less hylauronic acid, elastin fibers become weak, we produce less collagen and our collagen becomes un-organized. This all results in lax skin that is less firm and thinning.
Many of the treatments we use in aesthetics, benefit from the skins wound healing ability. By creating a wound healing response in the skin we stimulate the fibroblast to produce more collagen. The type and length of the wound healing benefits can vary, depending on how and where the “wound” was created. For example a scratch or something like microdermabrasion may only be 14 days of increased collagen production, an IPL / BBL treatment is about 3 weeks, and RF treatments around 6 months. Ultherapy leads to an inflammatory wound healing response which stimulates long-term tissue remodeling and leads to further lifting and tightening. Increases collagen production is seen in skin biopsies 12 months after treatment.
Clinical tightening and lifting can be seen as early as 3-6 weeks,but the most appreciable results are seen at 3 months. The duration of response after a single treatment can be up to 2 years.
Anti-Aging Benefits of Ultherapy Observed in Study
– Increased dermal collagen by over 23.7%, new collagen is organized
– Increased over all dermal thickness
– Increased New collagen Type I (21%-30%) and collagen Type III (48%-68%)
– Increased amount of elastin, elastin fibers are more parallel and straighter
Repeating Ultherapy Treatments
The aging process is continues and regardless of which procedure you choose, maintenance is always necessary. The exact longevity of results with any treatment depends on your body’s ability to produce, maintain and breakdown collagen. The frequency of treatments will depend on age, health, lifestyle, condition of skin, other anti-aging measures taken and desired results. Although one year between treatments is most common, many opt for a second treatment as early as 6 months to boost results.Those who are younger may go as long as 2-3 years between treatments. Ultherapy works best as part of a comprehensive approach to aging, your skin care professional can work to customize a plan for your specific needs.
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Throughout my career in medical aesthetics, Pseudofolliculitis and ingrown hair has been a common concern. Often times it’s men who mistake the condition for acne, other times it’s someone who has had an infection and a doctor recommended they get laser hair removal. The bad news is, that it can be more serious than you might think. The good news is, it can be treated!
What is Pseudofolliculitis?
Pseudofolliculitis commonly known as “razor bumps” or “ingrown hair” is an inflammatory condition in the skin and hair follicle caused by shaving, waxing and ingrown hairs. Pseudofolliculitis can occur anywhere on the body hair grows, however it most commonly occurs on a mans beard and for women on the bikini and underarm area. It tends to be more common in those with curly or coarse hair.
There are two types of Pseudofolliculitis, extrafollicular and transfollicular. Extrafollicular pseudofolliculitis or “razor bumps” occur when curly hair grows back into a hair follicle. Transfollicular pseudofolliculitis or “ingrown hairs” occur when the hair never leaves the follicle, this can happen if the hair grows at an angle. The hair keratin causes inflammation in the skin, usually seen as pustules that look similar to acne.
Concerns and complications associated with Pseudofolliculitis?
Pseudofolliculitis can be painful, embarrassing but more concerning is that it can lead to scars, secondary infection or become abscessed. You may not think that an ingrown hair is a big deal, but it has been associated with serious secondary infections such as MRSA. When there is damage to the skin, it becomes more susceptible to bacteria such as Staphylococcus. It is not unusual for an ingrown hair to become infected with “staph” or become abscessed. In extreme cases, if left untreated staph can lead to a very serious blood infection known as sepsis. These infections can spread and be contagious. If you suspect an infection, you need to seek immediate medical attention.
Laser hair removal remains the best treatment option for Pseudofolliculitis. A series of treatments will be needed, generally spaced 4-6 weeks apart. Another option is to quit shaving, waxing or tweezing and let the hair grow, but if that doesn’t work for you there are some things you can try. When shaving, start with cleansing the area with an exfoliating cleanser that has glycolic acid or some type of an AHA. I also recommend the Clarisonic cleansing brush, which will help to lift the hair. Before you shave place a steamed towel over the area, being careful not to burn your self. For sanitary reasons, I prefer a new razor. Avoid shaving too close, do not stretch the skin or shave against the direction of growth. If you have pustules, you may also be prescribed a topical antibiotic.
Chemical peels and skin care products that contain chemical exfoliant can help with skin discolorations and help to prevent hair from becoming ingrown. - ” the reducing properties of glycolic acid may reduce sulfhydryl bonds in the hair shaft, resulting in straighter hair growth, and thereby may potentially reduce the chance for re-entry of the hair shaft into the epidermis. Salicylic acid peels offer exfoliation and lightening in cases complicated by PIH. Reduced numbers of PFB lesions have been observed with both glycolic acid and salicylic acid peels.” Expert Rev Dermatol. 2009;4(6):595 Dermatologic Conditions in Men of African Ancestry by Marcelyn K Coley, Andrew F Alexis
Laser hair removal for skin of color, is challenging, but possible. If you have dark skin, be sure to find a laser technician that is also a skin specialist and has experience treating your skin type. Your specialist may recommend preconditioning the area prior to having laser treatment, it is important to comply with all instructions. We make these recommendations to prevent you from getting a burn. They may also suggest doing a test spot first to see how you respond to the laser treatment.
Treating the scars
Pigmented scars are the most common and can be treated consecutively with laser hair removal treatments. Pigmented scars can usually be treated with prescription strength skin care products, and chemical peels. Depressed scars require a deep treatment such as micro-needling, fractional laser resurfacing or dermabrasion. It is best to treat depressed or raised scars when the condition is well controlled. Keloid scars are very complicated and need to be diagnosed and treated by a dermatologist. I want to specify that keloid scars need to be diagnosed by a dermatologist, because raised scars are sometimes confused with keloid scars.
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Pay attention! I am about to share the ultimate beauty secret, the secret to anti-aging.
The desire to stay young and beautiful is a natural part of the human psyche and we are apparently willing to pay big bucks to achieve it. Americans spend billions of dollars each year on anti-aging products and services in a desperate search of the fountain of youth. Each new product we try offers a new opportunity to look younger, but they often prove to be nothing more than disappointment in a bottle. So… how can we avoid disappointment and achieve real results? The answer lies with a comprehensive approach. To understand the benefits of a comprehensive approach you should first try to grasp some of the basics of the aging face. After all, if we do not understand the aging process how can we know how to prevent or correct it?
What is a comprehensive approach to aesthetics in relation to the aging face?
Comprehensive Aesthetics uses a variety of treatments and products to cover a large scope of issues associated with the aging face. Aging occurs on many levels of the face, including the bone structure, muscular level, fat or volume distribution and finally the dermal and epidermal levels of the skin. To achieve the most ideal results it is necessary to address the affects of aging at each level, in order to do this a variety of treatments are needed. We also can not ignore the effects of lifestyle and general health, as both play a major factor in aging.
Aesthetic Professionals and Interdisciplinary Collaboration
Aesthetics is a branch of philosophy or science pertaining to the nature of art and beauty. Aesthetic professionals are those whom are specially trained in the art of beauty. Utilizing a full team of medical aesthetic professionals, including a Plastic Surgeon, Dermatologist, Nurse Injector, Estheticians and Certified Laser Technicians, we are able to take advantage of an interdisciplinary collaboration. Each professional possess a special set of skills that contributes to a truly comprehensive approach toward an attractive, youthful face.
Bone adds to the volume of the face and provides structural support to the other layers of facial tissue and skin. As we age there is a significant loss of facial bone which contributes to biometric volume loss. The bones that define your nose, and upper jaw and brow bone recede and the bones of the eye socket gradually widen. The jawbone also recedes and becomes less defined, reducing the angle of the lower jaw. Even the skull shrinks with age, further adding to excess facial skin. The loss of structural support creates noticeable changes in the other layers of tissue, simply put – when the bones that define your face recede your skin begins to droop.
Bad news ladies, we begin to see bone loss as early as our 40’s, where men may not notice bone loss until their mid 60’s. Hormones can play a factor in bone density. As we age bone density can decrease, leading to diseases such as osteoporosis. Your doctor can help you monitor and address issues of bone density loss. Maintaining a healthy diet with enough calcium vitamin D and magnesium can also help prevent bone density loss.
Once bone loss has occurred you can take action with aesthetic treatments. Injectable fillers such as Sculptra can add volume and support for a more youthful and defined face. Sculptra is injected below the skin to correct the effects of fat loss and natural age-related bone loss. A plastic surgeon can also strategically place fat into the face or use facial implants to make up for bone loss.
Below the facial skin and fat, is muscle. The muscle and connective tissue add support to the overlying fat and skin of the face. As our face ages the ligaments stretch and the supporting system begins to elongate causing the face to droop or sag. When the face is sagging due to muscle, this is usually the time for surgical intervention. During a facelift the underlining muscles and tissues are lifted. If you are not ready for surgery, you may consider Ultherapy which does work at the top of the muscle (SMAS) and gives a modest non surgical lift. Keeping in mind that a non-surgical treatment will always provide a non-surgical result. Ultherapy will not remove excess skin or reposition fat pads, but it will tighten skin and provide a modest lift. Ultherapy is perfect for early intervention and probably as good as it gets without surgery.
Muscle contraction can also cause lines and wrinkles. The muscles we use to make expressions become etched in our face over time, this is most noticeable with the vertical lines between our brows commonly referred to as frown lines, as well as crows feet around the eyes and the lines across our forehead. At first these lines are only noticeable with facial movement, but with out preventative action they are constantly visible even without movement (this is referred to as wrinkles at rest). Botox or Dysport injections are used to treat the lines and wrinkles caused by muscle contraction. It is a good idea to consider these types of treatments early on to prevent the lines from becoming “permanent”. Once the lines and wrinkles have become permanently etched into the skin, fillers may be used to lift the area along with laser resurfacing to smooth the skin or in some more severe cases surgery may be recommended.
Fat and Volume Distribution
A youthful face has the right amount of fat in the right places. As we age some areas of the face loose fat while others gain fat. The areas of fat also become farther apart and the fat pads appear as separate structures rather than a smooth continuous layer.
Fat provides support and volume in the face, as we age this valuable fat begins to decrees. Fat loss creates overall volume loss which contributes to folds, lines and wrinkles. The signs of volume loss can be noticed as early as our 30’s and becomes more significant in our 50’s. As we lose fat in our mid face, we begin to notice things like sunken or flat cheeks, heavy lines and folds around the mouth. Volume loss can also be seen around the temples, near the brow bone and under the eyes. When volume is lost under the eyes, it creates a hollow look and dark circles. Injectables such as Sculptra, Juvederm and Restylane can be used to replace volume to the face. Fat injections can also be used as a more long term approach to replace or add volume. Fat transfer or fat injections is a process in which a plastic surgeon removes fat from one area of the body and places it in another. ( How wonderful is that?! )
Fat accumulation is often seen under the chin and along the jawline creating an undefined jawline and the dreaded jowls. Bags under the eyes are also the result of fat accumulating in the wrong area. A plastic surgeon can perform a blepharoplasty to remove the fat bags under the eyes. The jowls and fat along the jawline can be corrected with a facelift as fat pads are repositioned, but if you are not ready for surgery fillers can be strategically injected to help contour the jawline. If you opt for fillers over surgery you may consider adding Ultherapy prior for a modest lift. Again…. a non-surgical treatment will never give a surgical result.
During a facelift the underlining muscles and tissues are lifted, fat pads are repositioned, fat bags may be removed from under the eyes and volume may be added with fat injections as needed and excess skin is removed.
The surface layer of the skin is generally the first place we begin to notice the effects of aging, most of us begin to notice the effects of aging on our skin in our 30’s. As we age our skin has a reduction in collagen production, elastin, hyaluronic acid and skin cell turnover begins to slow. Uneven melanin production and distribution causes dark spots and skin discolorations. We begin to notice more broken capillaries, changes in skin texture, thickness, elasticity and moisture. When we are treating these issues in the skin we must first consider what skin functions are involve and what layer of the skin the problem begins.
The skin can be divided up into three basic layers Epidermis, Dermis and the Subcutaneous Layer (fat). When we talk about skin we are generally referring to the Epidermis and Dermis. The Epidermis is the top layer of the skin and the Dermis is the deeper layer.
Skin cell turnover in the Epidermis
The skin is constantly in a cycle of growth. The cycle of a skin cell is about six weeks, this is the time it takes for a new skin cell to rise to the surface of the skin and naturally slough off. As we age this process slows down and the dead skin cells begin to accumulate at the surface. When this happens the skin will have a dull appearance, rough texture, dark spots will become more dense and appear darker, and lines and wrinkles become more prominent. In addition to all of this, accumulation of skin cells can clog pores causing them to appear larger and lead to acne blemishes. The slowing of skin cell turnover begins in our 30’s, which is a good time to consider a medical based skin care regimen. Tretinoin (Retin-A), Laser and Chemical peels can stimulate skin cell turn over.
As the skin cell turn over rate slows so does wound healing. After an injury the skin takes longer to reepithelialize, meaning the top most layer of skin (Stratum Corneum) is not quickly replaced. This is why many Doctors and Estheticians recommend preconditioning your skin before surgery or skin treatments.
Collagen is important to youthful skin, but as we age collagen production slows down. Loss of collagen causes the dermal layer of skin to thin and reduces the skins ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). This leads to the domino effect, as loss of elastin causes laxity in the skin and reduced hyaluronic acid which cause skin to be dryer, less supple and thinner.
Professional chemical peels, laser and IPL treatments can help to stimulate collagen production. some treatments offer short term improvement in increased collagen production, treatments such as laser resurfacing and Ultherapy offer longer lasting effects. Beyond professional treatments, a skin care program that includes continuous use of Tretinoin (Retin-A), topical vitamin -C and full spectrum sunscreen will help with collagen production. Tretinoin (Retin-A) is an effective way to stimulate collagen synthesis. Vitamin C is nessacerry to produce collagen and it protects skin from both UVA and UVB, by neutralizing the UV rays. Sun exposure degrades collagen so it is essential to use a good sunblock daily. Another tip to prevent collagen loss add a topical Resveratrol to your night time skin regimen.
A melanocyte is the cell that produces melanin (pigment), the melanin dispersed to keratinocytes, giving skin it’s color. As we age the cycle of melanin production and distribution becomes irregular.
As we age there is a reduction in the number of melanocytes. After age 30 the number of melanocytes decline about 6-8% every ten years. As the number of melanocytes decrease skin will become lighter, less even and white spots or patches (hypopigmentation) can be seen.
Browns spots and patches such as melasma, sunspots, age spots and freckles are known as hyperpigmentation. When a melanocyte produces more than normal amounts of melanin the result is hyperpigmentation. Furthermore the melanocyte doesn’t disperse the melanin evenly, so it is presented as dark spots or patches. Hormones and sun exposure are factors in even skin color.
There are many professional skin treatments that address hyperpigmentation, including chemical peels and Photofacial (IPL) treatments, however daily skin care is most important. Daily sun protection is necessary, this is not optional! Products containing hydroquinone suppresses tyrosinase, the enzyme involved in creating melanin. Botanical (plant based) lighteners can also help to suppresses tyrosinase, however alone are less effective than hydroquinone. Tretinoin (Retin-A) is also important, as it will help with even distribution of melanin.
As we age the structural wall of the capillaries (tiny blood vessels) break down which results in broken capillaries. Flushing, redness and broken capillaries are treated with Photofacial (IPL / BBL) and laser treatments. Vitamin C can also help to strengthen capillary walls, I recommend a healthy diet with enough vitamin-C and a daily topical vitamin -C serum. A sunblock with Zinc oxide can further help by blocking some of the heat that causes blood vessels to dilate.
Lifestyle and Health
Our skin is a direct reflection of our health. All the skin care products and treatments in the world can only do so much, it is up to you to be proactive in maintaining your health.
– Work with your physician to maintain your health.
– Maintain a healthy diet with plenty of fruits and vegetables.
– Exercise contributes to a healthy body and hormone levels.
– Sun protection will go a long way to save your skin.
– If you smoke, quit!
– Limit alcohol consumption
– Drink plenty of water
– Get enough sleep
– Try to reduce stress (get a massage, take up yoga, relax)
– Hormones play a role in the aging process. Ask your doctor to monitor your hormone levels and discuss treatment options.
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