So what 5 things to do?

1.  SUNSCREEN.  Not going to go on and on about this one.   You know it is good.  SPF 15 or 30.  Daily.  I don’t care if you aren’t outside a lot.  If you live in the Bay Area, you get tons of sun.  Sun is one of the most damaging, aging things you can do to your skin.  It will make you look old and wrinkly.  Block it.

2. DON”T SMOKE.  I won’t go on and on about this one either.  Smoking damages your skin.  It has toxins, it reduces blood flow, it causes little lines around your mouth.  The effect of it won’t show for years, but when it does it hits like a brick wall.  You can never fully reverse the damage smoking does.  So don’t do it.  It will make you look old and wrinkly.

3.  EXFOLIATE.  Cleaning your skin well is a must.  It will keep your skin healthier, remove all those bad things in the environment, reduce your pore size, and help your products work better by penetrating more.  You can use a chemical exfoliant (like my lovely glycolic acid pads!) or a mechanical one (like the clarisonic). 

4.  ANTIOXIDANTS.  These are products which help repair the damage to your skin.  Think of them as little doctors running around your skin fixing the injured cells.  Don’t buy over the counter products.  They are not the same strength and tend to cost as much.  Buy from a MD.

5.  VITAMIN A products, like Retin A and retinol.  This is still the gold standard for reversing damage in the skin.  I have tons of information on the subject.  If you don’t tolerate full strength Retin A, retinol is a good alternative.  Don’t do over the counter products- they don’t have the same strength medical grade products do.  Also, if you are within six months of trying to have a baby, you need to stop these products.  They are NOT safe during pregnancy and breast feeding.   

Dr. Zein Obagi started the line in Southern California years ago.  As this article in Plastic Surgery Practice states “For 25 years … he has written and rewritten the book on healthy skin.”  He does not judge skin based solely on the Fitzpatrick System (looking at white to black skin, and judging it on how it responds to UV light). 

He instead wants to base classification of skin based on a more “clinical classification” looking at five things:

• color
• thickness
• oiliness
• laxity
• fragility

He describes life stages of the skin: 

• Under age 10.  Properly clean and hydrate your skin.  Apply sunscreen.  He recommends antioxidants to prevent early damage from free radicals (**I am not sure how I feel about this.  I don’t know any research has been done on safety of antioxidants in young children.  Remember whatever you put on the skin can be absorbed through the skin. But I think it is an interesting concept and makes sense.)
• Age 10, the skin needs to be cleansed properly. If there are issues with sebum production (ie acne), you need to cleanse with a specific cleanser for oily skin and do a nonirritating scrub to prevent whitehead formation.  He recommends an astringent to decrease the sebum deep in the pores.  If needed, he also recommends hormone balancing.  The best you can do with acne scarring is to PREVENT it.
• After age 25:  He calls this the “inactive phase.”  Most cells making collagen and elastin become lazy.  This leads to aging.  So we should stimulate these cells.  The most effective agent to do this is Vitamin A- Retin A and retinol.  I agree with this statement.  Retin A products are well studied, their positive effects on the skin are well known, and it has been the workhorse of skin care for 20+ years.  I carry both Retin A and retinol in my office.  ***These products are NOT safe during pregnancy or breast feeding.  So if you are starting to think of babymaking, stop these 6 months before you start trying for your baby.

Other interesting pearls…

97% of the public gets skin care products from department stores and not physician offices.  This number surprised me.  The cost is usually similar (and for my personal line, my products are sometimes less).  Don’t pay for advertising and packaging.  Get a medical grade product.

Guidelines and safety in our industry:  He had an entire page dedicated to “unqualified doctors doing procedures.  We have board certified doctors who have worked hard in their training and worked hard to get the best results.  And we have a lot of other doctors who are not as well trained, who are doing it just for the money.  The dilemma is very big.  I think the future is not in creating more devices.  It is to create guidelines, to create standards. … I think the consumers really need to do their homework and go to board certified specialists and ask for a second opinion on a procedure.”  I agree. 

But it, like so many things which help your appearance, needs to be done on a regular basis.  Each kit costs $75-100,  (EXCEPT FOR NOW AS I AM DOING MY BUY ONE GET ONE FREE SALE!!!!) and if you use one kit a month, for a year… well that gets pricey.  So the real question is- what can you do to extend the effect? 

• You need to build them up.  So you should do it full time for two months. 
• Then you can go on “maintenance” which is every other or every third day
• I have heard from patients (**this is not the official recommendation**) that using a different eyeliner brush helps extend the material
• I have also heard from a reputable source that they think the key is 4 kits a year after your initial 2 month daily routine.

Hmmm.  4 kits?  We spend so much on mascara and eyeliner and shadows.  And if you are doing the fake lashes then you are spending even more.  The results with latisse are fantastic for most of my patients.  So if you are looking to have lovely lashes for the new year … HO HO HO?  Maybe Santa can slip these into your stocking last minute?  Or a little gift from you for you.  Happy new year? Here’s looking at 2012 with lovelier lashes??

 (My latisse special is 2 boxes for $100, which is cheaper than I can buy it- I can do it through a grant, and the boxes all expire in 2013.)

So stock up quickly.  When they are gone, they are gone.  Office is open the week between Christmas and New Years…

oh my.

They don’t know what this person was injecting, but being a foreign substance, it 1. got infected and 2. the body didn’t like it so it spit it out. 

There are more and more of these cases popping up: a NY woman injecting free silicone, the Florida injections of super glue, tire sealant, and cement.   I don’t have a lot of patients seeking to enhance their bottoms.  If you want a larger or curvier bottom, the best way in my opinion to get more curve is to 1. take down the surrounding areas like the love handles and outer thighs using liposuction, to help define the buttock area more, and 2. fat graft into the buttock to give more volume.  (This is a surgical procedure, and in my view should be done by a board certified plastic surgeon well versed in liposuction and fat grafting.) 

I cringe when I read these stories.  I get these hotel room, back room injections are cheaper.  But are they?  When you get infections and ER visits and operations to try to fix things… and the likely irreversible scarring and disfigurement which comes with it…. I don’t understand.  In this age of computers and information, please do your homework. 

• Safe surgeon.  Look at their credentials and training.  Research them.
• Safe technique and substance.  Research it.  Free silicone has issues which are well known.  And who would ever think cement and tire sealant are good things to inject?
• Safe place. When doing a large scale injection, you need sterile technique.  Otherwise you can get infections. 

http://abcnews.go.com/GMA/WaterCooler/wireStory/nc-woman-charged-buttocks-injections-bad-15114376

Monday, December 12th

• Spend $350 and
• join or are a member to their “inner circle program”
• For purchases made between Dec 1-14. 

Stock up! If you purchase the Nuderm line, you would qualify.  Need elastiderm? Retin A? Clear? A travel Nuderm? If you are thinking of a blue peel, you start by prepping your skin with the NuDerm line. 

Go to www.obagi.com/ic for more information.

So starting today, you get a free latisse when you buy one.

For anyone who knows anything about this, you can’t beat this deal.  This is real latisse.  Expiration dates are in 2013.  So stock up.  Buy Christmas and Hannukah presents.  Stimulate the economy.  Put some away for a rainy day.  Give yourself a little present.

Quantities are limited.  So come in soon.

And have lovely lashes all year long….

Doing a special for youon botox.

Monday December 12.

All day.  $50 off one area, $100 off two. 

Treats and fun things as well.  The season of giving is upon us.  And I am thankful, so I want to share.  I will also be posting lovely little things on my facebook site, so check it out and become a fan! (if you are not doing so already).  http://www.facebook.com/laurengreenbergmd

For those patients who do the HA fillers (hyaluronic acid fillers like Restylane, Perlane, and Juvederm) and for those who do Botox, you are low risk. 

But this idea of biofilm may explain why people have delayed  issues with long acting fillers.  Free silicone was used by some doctors in the early 80s to treat acne pit scars and other issues.  It stopped because of issues. What you saw years later was the silicone encapsulated and became a hard little ball. These balls would spit out as well. Why?  Some of this hardening and forming little balls may have been due to inflammation and scar. 

But a new theory is this may be due to biofilm.  The idea is the biofilm leads to more inflammation and perhaps a low grade infection.

At the TIPS meeting in San Francisco, June 2011, I heard a talk about biofilm and fillers.  It is rare to see someone symptomatic with this.  The speakers said higher risk products were:

• volumizing
• long lasting (last more than a year)
• mass volume
• foreign bodies, which cause a capsule response (like artefill and free silicone)
• immunosuppressed patients
• acne / sebaceous patients

So the higher risk products would be Radiesse, Artefill, Sculptra, and any “permenant” foreign filler (not fat).  For my patients, the largest risk would be in Sculptra patients.  What can you do? 

• Avoid make up before and after the injection for 8 hours
• Avoid injecting in the lips (which we do not do with Sculptra)
• Do not do injection if you have an active acne infection
• Good skin prep
• Consider an antibiotic prophylaxis before doing any major dental work or cleaning

If anyone has swelling, redness, or any odd reaction after injection, please see your doctor immediately.  Of note, this reaction is rare and will be delayed.  In this talk at the TIPS meeting they described it as happening a year out.  This is new information, but one to be heeded.  I had a patient who had an odd swelling episode months after her last Sculptra injection.  She had Sculptra for over two years with three prior injections with no issue.  When she got this odd swelling, she had no fevers, no elevated white count.  But she had facial swelling that came on quickly and left quickly after a few days.  It puzzled all the doctors around her. 

Education and Prevention: It is part of why I went to this talk, and I will incorporate what I have learned.  Though this is rare, as long acting (more than one year) filler use grows, safety is key.

Sign me up!

So the product and the science behind it make sense to me.  I discussed it with them, we had meetings and evaluations, and I was chosen as one of the 15 sites they are using for the next phase of their trial.

What is it? Silicone gel sheeting

How does it work? Remember the three keys to bad scar are 1. genetics, 2. inflammation, 3. tension.  It works to reduce inflammation and tension.

What are the risks?  Likely incredibly low.  Silicone gel sheeting has been used for a long time.  This product is novel in how it works to reduce tension.

Can I buy the product? Not yet, but the hope is you can in the future.

Who can be part of the study?  There are many criteria, but it is for women who are doing full abdominoplasties with a participating surgeon.  (Mini tummy tucks, Wedge tummy tucks, etc are not included.)

For more information, you can go to their webpage: http://www.neodynebio.com/index.html

I will be offering it to my full abdominoplasties if they meet criteria.  Inclusion in the study is absolutely optional.