Tuesday, October 1, 2013

Start Aesthetic and Anti-Aging Medicine Early

Our skin reflects cumulative damage from the sun and the environment and belies our general health. Underlying undesirable changes in the skin are some preventable changes in skin metabolism. The skin renews itself every four to eight weeks as new cells are generated in the deep layers. These new skin cells mature and migrate to the surface, where they are soon ready to slough off. The sloughing off is a signal to the deep layers of the skin to begin the process again, and new skin cells are created and sent the surface. As we age, this turnover of our skin cells slows, and can cause a dull, coarse appearance. Another common change seen in aging skin is a decrease in collagen and elastin production. Since collagen and elastin are important for the structure and elasticity of the skin, the loss of these two proteins causes wrinkling and sagging. Anything we can do to increase skin cell turnover and collagen and elastin production will help the skin appear more youthful and will improve the health of the skin. There is good evidence that rapid skin cell turnover via exfoliation reduces the risk for skin cancer.

The trend in aesthetic medicine and cosmetic procedures is to start non-invasive procedures early in order to keep the skin healthy and prevent some of the undesirable changes that occur as we age. One of the most popular treatments at Youthologie is Laser Genesis, which is a comfortable laser treatment that stimulates collagen production. The result is smoother, tighter, younger looking skin with less sun damage. The same treatment improves scars and prevents acne breakouts, and there is no downtime or recovery time. Patients are able to resume normal activities immediately.

Another important tool in anti-aging medicine is bio-identical hormone replacement. This is the use of hormones that are the same as those made by the human body to replace the normal decline in hormone levels that occurs as we age. It is said that we age because our hormone levels decline.  Generally, the hormones being replaced are the sex hormones estrogen, progesterone and testosterone. However, another hormone that commonly becomes deficient with increasing age is thyroid hormone. Every tissue and organ in the body has receptors for hormones, so they have a global influence on virtually every bodily process.

The goal of anti-aging medicine is to live a full, healthy, and happy life for as long as possible and to prevent the common diseases and disorders that typically increase with age. The big killers and disablers are heart disease and stroke, cancer, Alzheimer’s disease, diabetes, and, for women, osteoporosis (cause of hip fractures) and macular degeneration (cause of blindness). All of these conditions are at least somewhat preventable. It is possible to assess our risk for disease and prevent it through changes in lifestyle and nutrition and the use of bio-identical hormone supplementation.

There is widespread misplaced fear and misunderstanding regarding hormone replacement therapy. Bio-identical hormone replacement therapy (BHRT) differs significantly from hormone replacement therapy (HRT), as the latter uses synthetic hormones. Many women stopped using HRT on the advice of their doctors when the Women’s Health Initiative study was discontinued prior to its scheduled completion due to the finding of an increased risk for heart attack, stroke and breast cancer associated with synthetic hormone therapy. This risk is not seen with BHRT. 

One difference between bio-identical hormone replacement and synthetic hormone use is that bio-identical hormones are familiar to the body. The body has the enzymes necessary to metabolize hormones that are identical to those created by the body. As a result, the hormones are present for a only few hours, just as when the body manufactures its own hormones. Because synthetic hormones are unfamiliar to the body and the body does not have enzymes to metabolize them, they can remain in the body for months. This means there is a prolonged period of time during which all tissues of the body are influenced by these hormones. Another example of how BHRT differs from HRT is in the use of progesterone. This natural hormone has a protective effect on breast tissue and helps to prevent breast cancer, whereas progestin, the synthetic substitute often used, does not have a protective effect on breast tissue. 

 For more information about aesthetic and anti-aging medicine, contact Youthologie at 919-847-1495 or email lisa@youthologie.md, or visit our website www.youthologie.md.


Tuesday, November 13, 2012


Lips.  They occupy a position in the central column of the face.  They are used for expression in so many ways—not just for talking, but for smiling, pursing, frowning, and tightening.  They are sensual and are an instrument for enjoyment—food, drink… kisses. 

When we are engaged in conversation with another human they are mainly observing our eyes and lips; they are mainly looking at that central column of our face.  For this reason, subtle changes to the areas of the eyes and lips have major impact on our appearance in general. 

As we age, we make less collagen in the skin everywhere, which decreases the structural support of the skin, allowing skin to sag and wrinkle.  In the area of the lips and philtrum, collagen loss means volume loss.  The entire area around the mouth loses volume and becomes more recessed.  Anti-aging maneuvers are often all about collagen building, or structural enhancement, or volume enhancement.  This can be achieved by stimulating and increasing our own collagen production or by adding structure and volume by using an injectable filler, or even by surgically implanting a shaped object (although this has largely fallen out of favor for the lips, thank goodness.) 

Youthful lips are full, sensual lips that are smooth and “juicy” (plump) looking.  Thin, tight lips are a reliable sign of anger. Most people do not want to appear angry or upset when they are not—this is not considered beautiful.  What can we do about it?  There are some lip products that stimulate collagen production; exfoliating peels and laser treatments can be used to increase collagen production; but one of the easiest, quickest  and most effective ways to enhance the lips/philtrum area is with the use of injectable fillers.  This results in a soft and natural appearance to the lips that is long-lasting, semi-permanent or permanent, depending on the filler chosen.  Small changes to this area can greatly enhance the youthfulness of the entire face. 

The fillers can better delineate the outline of the lips, create greater smoothness to the lips, and increase the volume of the lips.  Another effect noticed by patients after lip enhancement is that they have more freedom in the type of lip make-up they can use.  Before lip enhancement many have stopped wearing strong, bold colors of lipstick, as well as minimal lip gloss looks because of lipstick “bleeder lines” and because their lips appear small and anemic.  Once the clock has been turned back and lips are fuller, better defined and poutier, patients can wear any type of lipstick effortlessly. 

Many different fillers are commonly used for lip/philtrum enhancement, but only Restylane is FDA approved for use in the lips as of late 2011.  Our favorite material for lip enhancement at Youthologie is Silikon 1000.  This is a medical, sterile, non-reactive, non-allergenic permanent injectable filler that is clear in color and becomes incorporated into the tissues where it is injected.  It has a very soft and natural appearance, and can be used in small increments; so that there is a gradual building of the lip/philtrum structure over time until the desired effect is achieved.   I have been using this material for lip enhancement since 1999, and I have never seen a complication with it, nor have I ever had an unhappy patient.  The only complaint is usually, “I want more!”  It is very common for patients to undergo 2 or 3 sessions as they proceed with caution and gradually create the lips they have always wanted.  Your perfect lips are yours forever! 

Saturday, July 21, 2012


We happen to be working with Plum District this month (July 2012)—the online deal purveyor “for moms, by moms who know”; so watch our FaceBook page and be on the lookout for our emails ‘cause we’ll let you know when our special is running.  We are offering an introductory Vibradermabrasion treatment at 50% the normal pricing, so I thought I would write a little about what Vibradermabrasion is and what it does for your skin.

Vibradermabrasion is considered to be a type of microdermabrasion, but it is so radically different from other types of microdermabrasion as to be almost a totally different treatment.  All microdermabrasion treatments are exfoliating, and the older, more dated versions exist in two forms.  Either they are performed by a sort of dremel like tool that is used on all comers (after a dunk in some disinfectant, at best) or by a sort of sand blasting of aluminum crystals against the skin.  The obvious problem with the dremel type tool is that it is very porous and users are likely sharing some DNA with the previously treated users.  The problems with the sandblasting tool are many; the crystals often get in the eyes and up the nose of users and have been shown to become embedded in the skin, which makes it impossible to follow the treatment with any sort of laser or IPL treatment, difficult to follow with a facial, infusion or mask and allows aluminum, a known neurotoxin, to effect the brain of users.  Another problem with both of these tools is that because the surface area of the treatment device is small, the treatment often takes a fairly long time, it can be uncomfortable, and it often leaves the skin with “streaks” of treated areas, which results in a clawed look. 

Vibradermabrasion uses neither of these two imperfect technologies.  Instead, each user has their own dedicated paddle that is made of surgical steel, which is inert and will not leave deposits in the skin.  No other person uses that same paddle; everyone has their own.  Vibradermabrasion achieves exfoliation by the polishing motion of this paddle against the skin, and the surface area of the paddle is large enough that the treatment is relatively quick and efficient, never looks streaky and leaves the skin looking smooth and polished, both to the naked eye and microscopically.  The strength of the treatment is adjustable, so that the experience is customized for each individual user; and the treatment is pleasant and relaxing.  Other treatments such as laser, IPL, facials, etc. can be performed immediately following Vibradermabrasion; and, in fact, are enhanced by preceding the treatment with Vibradermabrasion.

What, exactly, makes exfoliation such a desirable treatment?  First of all, it removes the dull, coarse layer of dead skin at the surface of the skin; so immediately the skin looks brighter and more luminous.  This action also stimulates new skin cells to be created and increases skin cell turnover.  New skin cells are desirable because they are younger and healthier, which will be reflected in their appearance; and they are better at most functions such as producing collagen (more on this in a minute) and protecting you from sunburn and skin cancer.  Studies have shown that regular exfoliation reduces the risk of developing skin cancer.  Exfoliation also has a sort of deep cleaning type effect on the pores of the skin, and so is often helpful for controlling acne breakouts.  Its exfoliation effects also make Vibradermabrasion a great treatment for keratosis pilaris (red bumps on the upper arms or thighs).

All of this is great, but the genius and unique part, the really cool part of vibradermabrasion is, in addition to the exfoliative effects of the treatment, vibrational energy in the 80-180 Hz range is applied to the skin throughout the treatment. This results in an immediate documented increase in blood flow to the skin, which allows greater oxygen and nutrient delivery to the skin and a delayed documented increase in the collagen content of the skin.  Why would you want more collagen in the skin?  Many of the unwanted changes of aging and photodamage (damage from sun exposure) such as fine lines, wrinkles, sagging, and draping result from a decrease in collagen, so an increase in collagen in the skin is always part of the anti aging strategy. 

Vibradermabrasion can be performed on any area of the body.  It is commonly used in the areas of the face, neck and chest—a series of treatments is transformative and can be followed by regular maintenance treatments. 

Below I have included a list of FAQs.

What is Vibradermabrasion?
Vibradermabrasion is an advanced form of dermabrasion or microdermabrasion that also offers an infusion system to enhance absorption of topical treatments.  The Vibraderm system uses a set of paddles that are unique to each patient, so there is no shared surface between patients.  The paddles are made of stainless steel and plastic.  There is a gentle scrubbing motion that provides a complete and uniform removal of the stratum corneum (the top “dead” layer of skin) while at the same time delivering vibration, which enhances the circulation and oxygen and nutrient delivery to the skin.  The system is also capable of Vibrafusion, an enhanced delivery of topical compounds into the skin; deeper into the skin, at a faster rate, with increased absorption.  The absorption of topical compounds is increased by an estimated 500% using Vibrafusion.
What can Vibradermabrasion treat?
Vibradermabrasion is used as an in-office exfoliation technique that increases cell turnover, collagen production, and skin circulation/oxygenation that ultimately results in smoother, healthier more polished looking skin.  It is also used for Vibrafusion to drive beneficial topical compounds deep into the skin where they can have a greater effect.
How does Vibradermabrasion work?
Vibradermabrasion works by the use of an abrasive stainless steel paddle that “scrubs” the skin in a gentle back-and-forth motion in combination with vibration.  Each patient has their own steel paddle, which can be used many times.  Each paddle also has a pebbled plastic side that is used in the same fashion for Vibrafusion (infusion of topical compounds.)

Indications for treatment with Vibradermabrasion:
Vibradermabrasion is used cosmetically for the treatment of variations in skin pigment, scarring from acne or other injury, coarse or dull skin, enlarged pores, thinning of the layers of the skin, fine lines and wrinkles, loss of collagen and elastin and other evidence of sun damage.  Vibradermabrasion increases results from laser and IPL treatments, chemical peels, facials, and levulan treatments.  Vibradermabrasion is also a valuable tool in preventing acne breakouts and in eliminating keratosis pilaris.
Indications for Vibrafusion:
Vibrafusion is used to enhance the absorption of compounds such as hydrating compounds, moisturizing compounds, hydroquinone for pigment correction, collagen stimulating compounds, and many others.
Who should not have treatment with Vibradermabrasion or Vibrafusion?
Vibradermabrasion is gentle enough to be performed on almost everyone.  It should not be performed in an area with an open wound or a recently healed wound.  Any restrictions that apply for topical compounds would also apply when used with Vibrafusion.  For example, pregnancy would contraindicate the use of tretinoin topically with or without Vibrafusion.
What is treatment with Vibradermabrasion like?
The treatment is performed in the office, and is quick and comfortable.  There is an enjoyable and gentle massaging or “buzzing” sensation as the treatment is performed.  The strength of the treatment is adjustable, and so is customized for the comfort of each individual.   Vibradermabrasion can be performed on any area of the body, but is commonly performed on the face, neck and chest areas.
Will there be restrictions after treatment with the Vibraderm system?
There are no special restrictions after treatment with the Vibraderm system.  Restrictions that apply for topical compounds would also apply when used with Vibrafusion.  For example, use of tretinoin topically is photosensitizing and precludes sun exposure with or without Vibrafusion.  It is fine to exercise or wear make-up immediately following treatments.
How quickly will I see results?
There is an immediate, more smooth and polished look to the skin.  Within 2 to 6 weeks, the skin will show evidence of increased collagen production.  A good skin care program at home will enhance the results.
Are the results permanent?
Typically, a series of 6-10 treatments are performed every 1-4 weeks for maximum improvement, and results last 3-6 months.  Maintenance treatments are usually performed once every 1-3 months following the completion of the initial series.  It is safe and gentle enough to be performed every week for the rest of your life! 
What are the risks, potential complications and side effects of Vibradermabrasion?

·         Mild swelling or redness of the skin immediately following the treatment, but generally no downtime
·         Hypersensitivity to the treatment or to a topical compound
·         Allergic reaction to a topical compound
·         Tickling sensation or sneezing with treatment of the nose

Monday, May 2, 2011

Take a Sec (S.E.C.) to Understand the Elements of Good Skincare

Our entire “suit” of skin replaces itself approximately every 6 weeks. It does this by sloughing off old, dead skin cells on the surface of the skin, which stimulates the production of new skin cells in the deep layers of the skin. The new skin cells then undergo some changes as they migrate gradually to the surface of the skin. Once the skin cells reach the surface of the skin they are then in the category of old, dead skin cells, and they are ready to slough off. This process, known as skin cell turnover, slows down as we get older; so that the old, dead skin cells accumulate at the surface of the skin making the skin look dull and coarse. Newer skin cells are not as rapidly or frequently produced and skin loses the healthy glow it once had.

As we age many other undesirable changes begin to occur in our skin unless we take the time to encourage our skin to remain healthy. Because skin is the largest organ in the body, keeping it healthy makes a big difference in how we look and feel. Along with the slowdown in skin cell turnover there is a decrease in the production of collagen and elastin, two of the proteins that give skin its shape and elasticity. Loss of collagen and elastin leads to sagging and wrinkling. The decrease in skin cell turnover also means the skin heals more slowly and does not protect itself as well from damaging sun rays. There is a decrease in production of glycosaminoglycans (GAGS, for short) such as hyaluronan which bind water and give our skin plumpness or juiciness. Hyaluronan also participates in tissue repair and hydrodynamics, as well as migration and proliferation of cells. This extremely important polysaccharide acts as a free radical scavenger and drives collagen formation. Two of the most damaging influences for our skin are UV or ultraviolet light (sun and/or tanning bed exposure) and tobacco use (smoking). Both of these environmental exposures accelerate the changes of aging in the skin. Prolonged UV exposure creates additional signs of aging in the skin such as age spots, diffuse uneven pigmentation, spider veins and eventually dermatoheliosis or photoaging, a term usually describing the leathery, pebbly texture of skin that has been chronically and extremely damaged by the sun.

Unfortunately, the damaging effects of sun exposure do not really appear until 10-20 years into the exposure. This can make it difficult to convince a person in their 20’s that tanning will eventually result in some very ugly and unhealthy skin changes. It is often difficult to convince a person over 40 that it is the sun that has caused all of the changes they would now like to improve. I tell my patients that using really good skincare products, consistently, every day, at home is the most cost effective way to begin their journey to healthy skin. Any other treatments or procedures they choose to do will be far more effective if we prepare their skin with good skincare.

There are basically 3 elements of good skincare that everyone can incorporate into their daily routine. We use the S.E.C. acronym and advise taking a sec to improve the health of the skin twice a day.

S is for sun protection. This is an absolute must if you are serious about maintaining healthy skin. It does mean using a sunblock every day (yes, winter too—have you never gotten a sunburn in the snow?); but this is really only meant to protect you during brief forays into the outdoors, such as walking from your house to your car. When you are spending an extended period of time outdoors (walking, gardening, attending a sports event, etc.) you actually need to cover your skin with protective clothing and provide your own shelter in the form of a large-brimmed hat or parasol (no, a baseball cap is not good enough for obvious reasons—it only shades about 25% of your head and neck and exposes your vulnerable ears). The argument I usually hear in favor of sun exposure is the need for vitamin D. Vitamin D is an extremely important vitamin produced in the skin in UV light that actually behaves as a vital hormone (see previous vitamin D blog), but here’s the thing: you cannot get enough sun exposure to create adequate amounts of vitamin D in your system without damaging your skin. Normally I am all for living like a caveman or caveperson, but not in this case. Cave people had an intact ozone layer to protect them, which we do not; and cave people died by the time they reached the age of 35, which we do not. It is best to simply take your vitamin D3 as a supplement, at least 5,000 u per day as an adult, and avoid the damaging rays of the sun.

If you do nothing else, an increase in sun protection will improve your skin.

E is for exfoliation. This is a term given to the act of removing the outer layer of coarse, dead skin cells and is usually done mechanically or chemically. Mechanical exfoliation is simply performed by abrading the surface of the skin in a gentle manner. Methods of mechanical exfoliation include washing with a loofah or buffing pad, washing with scrubbing granules, or using a microdermabrasion device. Chemical exfoliation is performed by applying an agent that loosens and removes the surface skin cells. Alpha hydroxy acids (AHAs) are commonly used for exfoliation. All of the AHAs are derived from natural substances such as fruit, nuts, or milk. The most effective AHA is glycolic acid, derived from sugar cane. Glycolic acid is the smallest molecule in the AHA category, which allows it to penetrate more deeply into the skin for greater effectiveness. In a glycolic acid solution, the pH or acidity of the solution and the concentration of glycolic acid determine how strongly the solution interacts with the skin.

Whatever method of exfoliation is chosen, the end result is that the gentle removal of the outer layer of coarse, dead skin cells stimulates the creation of new, fresh skin cells in the deeper layers of the skin. There is an increase in skin cell turnover, so that more new skin cells are coming to the surface of the skin. Consistent, daily exfoliation means that new skin cells are constantly being sent to the surface of the skin. Why is this a good thing? Because new skin cells are better at making collagen and glycosaminoglycans, and new skin cells are better at protecting you from damaging UV rays. In fact, regular exfoliation can decrease your risk of skin cancer.

My personal favorite methods of exfoliation include use of Rx Systems glycolic acid wash and cream because this line has a lower pH (more acidic) and includes alpha lipoic acid, a very potent antioxidant (see previous antioxidant blog) that has even more protective effect versus UV rays; use of the Clarisonic device for cleansing because the brush is gentle and nonabrasive yet the sonic energy applied to the skin is super cleansing and stimulating; and the occasional (monthly) treatment with an in office glycolic or combination chemical peel (see previous chemical peel blog) alternating with treatment with vibradermabrasion because this is the absolute best of the microdermabrasion world (each patient has their own treatment paddle made of surgical steel and the polishing effect of the paddle is enhanced by the application of vibrational energy for maximum skin transformation.)

C is for collagen stimulation. As I noted above, many of the more undesirable changes of aging in the skin involve a decrease in the amount of collagen produced by the skin. Therefore, when addressing fine lines and wrinkles, enlarged pores, and sagging or draping of the skin it is all about the collagen. Regular exfoliation will have an effect on collagen production, but we can do better still.

If you are young and relatively line-free you can get by with a low level collagen stimulator for maintenance and prevention such as vitamin C serum. My personal favorite is the Rx Systems vitamin C serum because it is packaged in such a way as to prevent contact with air and light until you actually use it. This is advantageous because the exposure of vitamin C serums to air and light not only begins the breakdown of the vitamin C; it actually creates free radicals that are harmful to the skin (see previous antioxidant blog.) Vitamin C applied to the skin also helps to prevent skin cancer.

The most powerful of the collagen stimulating topicals are the retinoids, or molecules related to vitamin A. I love the retinoids because they do so many things for the skin. They reverse sun damage, they stimulate collagen and so are anti-aging, they are anti-acne (and let’s face it, many of us fight both acne and lines), and they take any other product you use with them deeper into the skin. My personal favorite is Retrinál from Avene because it is a top performer when it comes to collagen stimulation, but does not have many of the undesirable side effects of the other retinoids such as redness and peeling with regular use and sun sensitivity, making it OK to use year round.

There may be a need for a fourth element of good skin care if you have pigment issues. If you have freckles or solar lentigos (superficial depositions of darker pigment indicating your skin is very sun sensitive) or if you have what is known as actinic bronzing (pigment variability with both dark and light spots from chronic sun exposure) you will want to include a lightener twice a day to encourage pigment evening and extra attention to sun protection. I have my personal favorites here as well—for a lightener with hydroquinone I like Blanche from Neocutis and for a lightener without hydroquinone I like Vibrance from Vivité by Allergan.

It may sound like a lot of effort, but taking a S.E.C. to improve your skin twice daily and maybe even adding in an office procedure once a month or so will result in skin that is healthier and skin that looks healthier. Your skin will have fewer lines and will be tighter, the pigment variations will be improved and your skin will have a new luminescence or glow.

Additional recommendations:
Use a good eye cream twice daily.
Consider a good lip treatment twice daily.
Don’t forget the neck and décolleté!

Monday, March 28, 2011

Chemical Peels

Chemical peels are an immensely popular cosmetic procedure with total chemical peel procedures done in 2009 amounting to 1,142,949 peels of varying types. Chemical peels are also known as chemexfoliation or derma-peeling, and are a technique used to improve the appearance of the skin. In this treatment, a chemical solution is applied to the skin, which causes it to react and eventually flake or peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin also is temporarily more sensitive to the sun. Even if the flaking or peeling reaction is not seen, the skin still benefits through skin cell turnover, the surfacing of new skin cells that are better at creating collagen, better at regulating pigment, and better at protecting from skin cancer.
Chemical peels are said to have been used since ancient times, notably in Cleopatra’s Egypt women used goat’s milk or soured goat’s milk, as well as fermented grape peels on their skin. This makes sense as the lactic acid in the goat’s milk is even now considered a hydrating agent, and the resveratrol found in fermented grape skins is currently a very hot topic as an anti-aging molecule.
Some of our more modern peels were not discovered or invented until the 19th century. Two of the earliest chemical peels were phenol and trichloracetic acid, which were very powerful. Increasingly, the trend in peels is to use less aggressive, less powerful peels, in a series, to achieve good results and avoid potential undesirable side effects. Where deeper effects are wanted, currently lasers are used because of their greater precision.
What conditions are treated by a chemical peel?
Chemical peels can be performed almost anywhere on the body and are commonly performed on the face, neck, or hands. They can be used to:
Reduce fine lines under the eyes and around the mouth
Treat wrinkles caused by sun damage
Improve the appearance of mild scarring
Treat certain types of acne
Reduce age spots, freckles, and dark patches called melasma
Improve the look and feel of skin that is dull in texture and color
Who Is a Good Candidate For a Chemical Peel?
Generally, fair-skinned and light-haired patients are ideal candidates for chemical peels. Darker skin types may also have good results, depending upon the type of problem being treated. However, the risk of an uneven skin tone after the procedure is increased. Sometimes pre-treatment with a lightening agent can help reduce the risk of post inflammatory hyperpigmentation in darker skin types. There are also more gentle peels that do not carry any risk for darker skin types.

Is it safe to have a chemical peel during pregnancy?

Some peels are safe during pregnancy. Usually the peels that are safe during pregnancy are milder and less penetrating, but still beneficial.
How is a Chemical Peel performed?
During a chemical peel, a chemical solution is applied to the skin and allowed to soak in. It may or may not require neutralization. Over the next 1 to 14 days, depending on how deeply the chemical penetrated the skin, the skin flakes or peels off. This procedure destroys parts of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents.

The types of chemical peels differ based on how deeply the chemical penetrates and what type of chemical solution is used. Factors that may affect the depth of a peel include the acid concentration in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels result in more dramatic effects as well as higher risks, increased pain, and longer healing time.

When will the results of a peel be evident and how long will the results last?

There may be an almost immediate glow to the skin, followed by a period of flaking or mild dryness for a few days to a week. Once the flaking stage is over the skin is softer, smoother, clearer and more even in tone. A series of peels will be additive in effect. Depending on how deep the peel is or how many peels in a series have been done, the effects can last anywhere from 6 weeks to 4 months.

What type of care does the skin need after a peel?

The number one rule after a peel is no sun exposure, so sun block should be worn every day, extended time in the sun should be avoided and a hat should be worn when outdoors in the daytime. The skin will require extra hydration, so a good moisturizer twice a day can be helpful. Avoidance of any aggressive treatments or products for 2-5 days after a peel will allow the necessary healing to take place.

How often can peels be done?

Depending on how sensitive the skin is and how rapid the recovery is, a peel can be done every 2-6 weeks in an initial series. Once the initial series is complete, a maintenance peel can be done every 1-4 months.

Can peels be done with other treatments?

Peels can be done with other treatments or alternated with other treatments. Commonly a mask is applied immediately following a peel for increased effect; the peel allows greater penetration of the mask. Also, peels are often alternated with treatments such as vibradermabrasion (a skin polishing treatment combined with vibrational energy) or collagen stimulating laser treatments.

In summary, there are a variety of types and strengths of peels. One treatment will improve the skin, but a series of peels will create much more improvement. Appropriately chosen peels can be performed safely for all skin types and conditions. Expected results are softer, smoother skin with more even tone. Peels can be combined or alternated with other treatments for even greater effect.

Friday, May 7, 2010

Notes on the Food Revolution

Lately my mind has been on the perpetuation or should I say perpetration of an unhealthy diet and lifestyle on the children of America by the public school system. I’ve been watching Jamie Oliver’s Food Revolution on TV. For those who don’t know, Jamie Oliver is the bloke from Essex who starred in the British TV show The Naked Chef and who has now made it his mission to bring healthy eating to America’s school children. His Food Revolution was filmed in Huntington, West Virginia, reportedly the unhealthiest city in America (although, as you’ll see on the show, there are those who resent that label.)
Jamie begins by starting with a single school and campaigns to bring in fresh food, cooked on the premises every day that contain fruits, vegetables, and good quality protein. In addition, he is trying to decrease the amount of fried food, processed food and sugar offered to the students. These are relatively simple and modest goals, and you would think most people would easily see that these are valuable goals. I mean, he’s not even suggesting the food be organic (which would offer more vitamins and minerals per pound of food, but would be more expensive.) One of the remarkable aspects of the program is how difficult it is to achieve these very simple and admirable goals. Another remarkable aspect of the program is that when given a choice, the students choose Jamie’s food over the usual non-nutritious fare. The parents are often more of an obstacle than the children.
Huntington got its unhealthy reputation by 1) being located in West Virginia which has the most per capita obese citizens in the nation and 2) by having the most per capita obese citizens in the state. These statistics vary from year to year, so it is not always West Virginia in the lead; but those states that have a large percentage of the population suffering from obesity also have a large percentage of the population suffering from diabetes, heart disease, and a host of other diseases. Jamie has some very poignant interviews with some of the people of Huntington who have been quite negatively affected by obesity, either their own or that of someone they love.
Another place where you can learn about Jamie’s Food Revolution is on his website www.jamieoliver.com where you can join over half a million Americans in signing a petition that states:
I support the Food Revolution. America's kids need better food at school and better health prospects. We need to keep cooking skills alive.
The petition is mainly to make a point to President and First Lady Obama that this is an issue that Americans really do care about.
The website has tons of recipes, how to videos and advice for starting a food revolution in your own community. There’s lots of fun stuff for kids—recipes and videos just for them, for example. You see, one of Jamie’s very salient points is that many of the children living in the U.S. today are the third generation of non-cooking Americans. In other words, they have been raised on processed food, fast food, food that contains little to no nutrition, but a great many calories. Nobody in the family actually cooks, and consequently kids grow up not learning how to cook.
If you don’t have time to watch a full episode at http://abc.go.com/shows/jamie-olivers-food-revolution
you also have the option of watching Jamie do his TED talk at http://www.ted.com/talks/lang/eng/jamie_oliver.html which is also quite good. One of the most amazing things Jamie shows is a group of children who cannot identify (pardon the pun)garden variety vegetables. If they don't know what it is, do we really think they're gonna eat it?
If you don’t know by now we ARE what we eat, we ARE what we drink, we ARE what we breathe and we ARE what we do for ourselves. And as Jamie points out, most of the diseases that kill us are diet related and completely preventable. We should make an effort to spare our children. At the very least we should sign Jamie’s petition. And we should tell our friends to sign Jamie's petition.

Tuesday, January 5, 2010

Defy the Aging Process in 2010

Time moves in only one direction. Until we can time travel we will inevitably age chronologically, but does that mean we must age biologically?

There are certain aspects of a Healthy Lifestyle that are well publicized, notably fitness or regular exercise and diet or nutritional optimization; and by now there is no doubt that smoking is associated with a variety of health problems. No one who is serious about health and self-love can continue to smoke. This article will highlight maneuvers to combat the common disabling conditions of advanced age and will include some of the lesser known and more interesting facts regarding a healthy lifestyle and how it can help you defy the aging process.

Aging, as it turns out, is not perfectly understood. There are many theories about why aging occurs and what processes take place. Certain cultures seem to support a lengthy and functional life, but there is much left to learn. Aging is a multifactorial process.
Most people would like to avoid the disabilities that make advanced age unpleasant and expensive such as heart disease, stroke, cancer, Alzheimer’s dementia, diabetes, arthritis, osteoporosis and bone fractures, loss of mobility and loss of sight or hearing.

Current theories of aging fall into two main groups: the idea that we have a finite number of cell divisions available to us or a predetermined lifespan and the wear and tear theories that suggest that environmental damage to our systems gradually cause things to go awry.

The predetermined lifespan theories include the idea of genetic regulation of lifespan and the activation of transcription factors that affect metabolism, cellular energy, and the dynamic balance between cellular damage and repair. Also in this group of theories are proposals that the length of chromosomal end-caps called telomeres determine the number of cell divisions; another part of the concept of replicative senescence. Telomerase, an enzyme that functions in the repair of telomeres appears to be very important in determining lifespan. Neuroendocrine dysfunction is the decline in function of the neuroendocrine axis (brain, nervous system, endocrine glands) that results in a predictable decrease in hormonal output. Declining hormones lead to many changes of aging such as a decrease in muscle mass, decrease in immunity, impaired glucose metabolism, decrease in the sense of well being and disrupted sleep patterns.

The wear and tear theories include hypotheses of aging that involve ideas of DNA damage and repair and include the concept that oxidation and free radicals, environmental mutating influences and errors in replication cause damage to DNA. The accumulation of mutations leads to cell malfunction and death. Inflammation appears to be involved in all disease processes through the accumulation of AGE or Advanced Glycation End Products, a process by which glucose molecules react with cellular protein to create permanent cross-links that lead to disabling changes. Mitochondria are the energy sources for the cells, and through their energy production and respiration they generate free radicals and ROS (reactive oxygen species) and these molecules cause oxidative damage to mitochondrial membranes and to DNA.

Anti-aging strategies are directed toward extending lifespan or stopping the wear and tear, either by neutralizing oxidative damage, reducing AGE products, replacing missing hormones, providing the nutritional building blocks for good cellular function and maintaining good structural strength. Eventually we will probably be able to make changes in our DNA.

Stress Reduction
Stress is a killer; and worse, stress is extremely aging. Stress can be physical or mental, so anything from an illness to an injury to a highly emotional event can be a source of stress. The human response to stress is an increased production of adrenal hormones including cortisol, resulting in many metabolic changes including impaired glucose metabolism, impaired immunity, and impaired sleep. In addition, all other hormone production is affected and placed in an imbalance. Under the influence of chronic, unrelieved, cumulative stress the adrenal glands become overworked and eventually succumb to adrenal fatigue. Other affects of unrestrained cortisol secretion are slowed protein synthesis (vital for healing and tissue repair), loss of nerve cells and brain damage, bone loss, muscle wasting, increase in abdominal fat, hypertension, hyperglycemia, psychosis and premature aging and death.

Avoiding, reducing or eliminating stress is one of the single most important ways to slow down the aging process. Ways to get rid of stress are avoid negativity and emphasize the positive aspects of life (also known as optimism), maintain close friends, allow whatever happens to be OK (cultivate detachment), participate in leisure activities, take the time to resolve conflicts, seek mental activities to keep the mind active and curious, keep a pet, participate in social activities, get some physical exercise that you enjoy, meditate, perform deep breathing exercises, volunteer, and make sure you have people in your life with whom you can exchange hugs.

Diet and nutrition affect every aspect of our health. What we eat provides the building blocks for our physical structure, as well as all of the functional elements of our bodies. There is vast evidence at this point that the ideal diet is a low glycemic diet. A low glycemic diet includes lean protein, whole fruits and vegetables, whole grains and excludes refined and processed foods.

If you can afford it, organic foods are best. They are higher in nutritional value, containing higher levels of vitamins and minerals, and lack toxic pesticides. Whole foods, as opposed to extracted portions of foods often contain more complete nutrition. One good example is spinach, which we know can help prevent macular degeneration, a very common cause of blindness in older people. It is unknown exactly what compound in spinach is the effective ingredient, so it is necessary to consume the whole food to get the benefits. Raw foods contain more nutrition, so minimal or no cooking of vegetables retains more of the nutritional value of the food. Even meats are better eaten rare or medium as it has been shown that women who consistently eat meats very well done have a higher risk of breast cancer. It is unwise to cook any food in the microwave as most of the nutrition is completely destroyed by this method of cooking.

Fried foods contain trans fatty acids (trans fats) which increase “bad” LDL cholesterol and decrease “good” HDL cholesterol, as well as contribute to type II diabetes and heart disease. Vegetable oils and nut and seed oils used in frying can produce large amounts of free radicals that can damage cells and contribute to inflammatory diseases, cancer, obesity and aging. Fried foods also contain acrylamide, which may be carcinogenic and has been shown to be neurotoxic. Acrylamide is particularly evident in high carbohydrate foods cooked at high temperatures (think French fries.) Olive oil is anti-inflammatory as long as it is not cooked at high heat.

Caloric restriction is the only maneuver that has been shown to extend lifespan. This can be incorporated into lifestyle by fasting for 12 hours (7PM to 7AM) three days a week. The only other molecule that may extend lifespan is resveratrol, found in red wine and available as a supplement.

Broccoli and tomatoes have anti-cancer effects. Many spices (garlic, chili peppers, and curcumin in particular) have anti cancer effects, anti-inflammatory effects, some reduce cholesterol and blood pressure, and some have been shown to reduce the risk of Alzheimer’s Dementia. Foods with high antioxidant contents such as dark chocolate and many berries, especially blueberries, are beneficial in counteracting free radicals and reactive oxygen species.

Taking a multivitamin, multimineral supplement can improve short-term memory, problem-solving ability, abstract thinking and attention span, and immunity. Vitamin A improves immunity and enhances eye health; Vitamin E reduces the risk of prostate cancer, heart attack, stroke and Alzheimer’s Dementia; Vitamin C decreases the risk of heart attack, stroke and cataracts. Vitamins A, C and E are all considered antioxidants and all have been found to enhance eye health and prevent macular degeneration and to reduce the risk of skin cancer. The B Vitamins are important for many cellular functions and especially for neurological function.

Vitamin D is so important it deserves extra mention. Virtually everyone who is not taking a supplement is deficient in Vitamin D. It is difficult to get enough Vitamin D with sun exposure alone, especially in the winter months. People with darker skin color do not make as much Vitamin D in their skin in response to sun exposure and so are particularly at risk for deficiency. Likewise, as we age our skin makes less Vitamin D, so older people are at much higher risk for deficiency. Vitamin D preserves muscle and bone health, and in one nursing home study the sole act of taking Vitamin D reduced the number of falls and the risk of fracture with a fall. Since the risk of osteoporosis and bone fractures is higher for women, taking Vitamin D is especially important for women. Vitamin D prevents multiple sclerosis and is anticancer, antiviral and antibacterial.

Mineral supplements are often overlooked. Many people are deficient in Magnesium, and it is the most common mineral deficiency in women. Magnesium is important for heart health and muscle health and is calming and anxiety reducing. Taken at night it can improve sleep. Zinc is an important coenzyme for all healing and collagen building and enhances immunity. Selenium is an important trace mineral that increases HDL, decreases LDL, decreases risk of certain cancers, and enhances thyroid and pancreatic function.

Probiotics improve immunity and enhance gut health which is thought to decrease the risk of inflammation and autoimmune disorders.

The benefits of regular exercise and activity are numerous. A reasonable and sufficiently active exercise regimen should include at least 1 hour of vigorous or 2.5 hours of moderate activity each week, as well as strength or resistance training for at least 10 minutes, 4 times a week. It is important to enjoy whatever physical activity you have chosen, so that it is easy to continue to include it in your lifestyle.

Regular exercise maintains muscle strength and muscle mass, and bone health. Regular exercise enhances core strength, which maintains balance and prevents falls.

Regular exercise also reduces the risk for Alzheimer’s Dementia, cancer, constipation, adrenal fatigue and sleep disturbances. Regular exercise improves immunity and enhances healing.

7-8 hours of sleep per night are required for optimum health. Sleep abnormalities are associated with depression, weight gain, and increased risk of inflammatory disorders. It is during sleep that we make melatonin, an important intrinsic antioxidant, and growth hormone. When we are asleep and our brains have electrical activity in delta and theta waves we in a very healing place. During sleep the intervertebral discs that act as cushions between the vertebrae are rejuvenated and plumped with water.

Studies have also shown that people with inadequate sleep have higher BMIs (Body Mass Indices) regardless of their caloric intake.

Hormone Health
You do not have to be aging to have a hormonal imbalance. Hormonal imbalance can occur at any age and is often associated with stress. Hormonal imbalance can show up as a wide range of symptoms including cool body temperature, warm body temperature, night sweats, anxiety, dry/brittle hair and nails, weight gain or loss, swelling or puffiness, and a lowered threshold for allergies. It is impossible to tell which hormones are out of balance without doing some tests. Usually the sex hormones, estrogen, progesterone and testosterone, as well as cortisol are checked in saliva samples. Thyroid hormones and related labs are checked in blood samples. Once levels are known, any deficiencies can be supplemented. In the case of the sex hormones, bioidentical hormones are the clear choice for reasons that are too numerous to elucidate here.

Another hormone that is frequently tested at the same time is DHEA-S or dehydroepiandrosterone sulfate, a metabolite of DHEA. DHEA is the most abundant hormone in the body and is involved in the manufacture of the sex hormones and corticosterone. DHEA is present in high levels in the brain, but declines with age along with growth hormone. DHEA supplementation may stimulate growth hormone, enhances the immune response to infection, increases insulin sensitivity, increases muscle mass, and decreases fat mass. DHEA may decrease the risk of cancer, heart disease, Alzheimer’s dementia and osteoporosis. DHEA, when taken as a supplement, is usually taken in small amounts for women (5-10 mg) and higher amounts for men (25-50 mg).

Skin Care/Sun Protection
Essential elements of skin care are regular exfoliation, collagen stimulation, and sun protection. Exfoliation can be mechanical or chemical and will increase skin cell turnover and skin health. Exfoliation also reduces the risk of skin cancer and will help the skin appear fresh and young. Collagen stimulation also helps the skin appear younger by preventing the loss of collagen and elastin that usually accompanies aging.

Ultraviolet or UV light is a mutating influence on the DNA of the skin and is the cause of essentially all skin cancer. It rapidly ages the skin by decreasing collagen and elastin in the skin, which contributes to the formation of fine lines and wrinkles and sagging skin. For adequate sun protection: wear the highest SPF you can afford, wear it all day, every day, and if you plan to be outside for more than 10-15 minutes provide some shelter for yourself (wide brimmed hat, parasol/umbrella, or stand under a structure). Wear sunglasses to protect your eyes from UV light and prevent cataracts.

Teeth/Dental Care
Poor dental health is associated with Alzheimer’s dementia, heart disease, stroke, pneumonia, and early death. Floss and brush your teeth at least 1-2 times daily, use an ultrasonic toothbrush if you can afford it, consider a plaque reducing mouthwash, see your dentist for regular cleaning and check-ups. Your dentist can also do an oral cancer screening.

As previously mentioned, there is no doubt that cigarette smoking is damaging to your health, but did you know that people who live with smokers and have exposure to second hand smoke also have a higher risk of tobacco related disease? There is a higher rate of sudden infant death syndrome (SID) and a higher rate of childhood asthma in households with smokers. Smoking affects the entire family.

Car Safety
Car accidents are the number one cause of death in the group aged 3-33 years old, and are the third leading cause in the group aged 34-44 years old. Crash and rollover ratings can be found at www.safercar.gov to help you find a safe car. Air bags and wearing seat belts prevent neurological injuries, which can be devastating.

So, until such time as we can manipulate our DNA and exchange genes we don’t like for more favorable ones, it pays to be happy; eat and sleep well; drink red wine in moderation; take antioxidants, vitamin and mineral supplements; exercise regularly; protect yourself from the sun; avoid cigarette smoke; take care of your teeth and drive safely!