TRIA AGE DEFYING LASER

One of my favorite new at home treatments is the Tria® device.  The Tria® is the only FDA-cleared at home laser.  It is a fractionated non-ablative laser in a small hand held device which creates microscopic zones of cellular disruption. (or micro injuries) This stimulates the bodies healing response, ultimately creating new collagen and elastin.  Over time skin appears smoother and hyperpigmentation (freckles) fades.  The microchannels in the skin also allows active ingredients to penetrate more effectively allowing the skin to absorb up to 17 x’s the amount of, for example, antioxidants.  We sell the device with both C E Ferulic® and Resveratrol B E (both Skinceutical® products) to help our clients receive the most from their Tria® and antioxidants.

The Tria® sits on a charger when not in use.  When you are ready to treat yourself simply cleanse your skin and treat your face as instructed.  There are three levels of treatment and the company recommends starting on level one and slowly working up to level 3.  I recommend NOT going home and treating your whole face on level 3 (which I did) right out of the gates because it is uncomfortable and you look like a tomato afterwards.  You definitely feel it working!  Gradually working your way up to level 3 is best as it allows you to acclimate to the laser.  Over time a treatment on level 3 is not uncomfortable at all.

I tell my clients that it is a great tool to have in your tool belt at home as it gives you an opportunity to stimulate collagen effectively.  It is perfect for at home maintenance.  The Tria® is similar to a Fraxel laser treatment, only much less aggressive.  With a typical in office treatment with a Fraxel you have approximately 25-30% of your skin treated.  The Tria® is affecting approximately 1% of your tissue with a treatment.  But you can imagine over time how this could really make a difference.    Once on level 3 each treatment takes about 5 minutes.  Quick and easy!

For those of you more familiar with laser technology, the Tria® is a diode 1440 nm device.  It has a 12 mJ output with a depth of penetration up to 350 microns.

THE NEXT CHAPTER ON SKIN CARE: GROWTH FACTORS

When I do a skin care consult I generally have 4 topics.  Sunscreen, antioxidant/vitamin C, retinol/retinoid and growth factors.  I consider the first three no brainers.  I consider growth factors a nice addition, but a luxury as they tend to be quite expensive.

Products with growth factors can have benefits for aging skin.  I will refer to the two growth factor products I have the most experience with, SkinMedica‘s TNS and Neocutis‘s BioSerum.

TNS Recovery Complex, or Tissue Nutrient Solution, is a combination of growth factors and other skin benefiting ingredients.  Consider it a nutrient rich broth for the skin.  The growth factors are proteins we lose with age and by using a serum to replace them, theoretically, gives your skin support to renew itself.  With time it improves the appearance of fine lines and wrinkles, skin tone, texture and resiliency.  The cell “bank” for this serum is in Houston, Texas and  the original cells were derived from human cells.

TNS also comes in a product called TNS Essential Serum which is a dual chambered product.  One side is TNS Recovery Complex while the other side is a combination of antioxidants, peptides, arbutin, (which helps minimize hyperpigmentation) and hyaluronic acid. (which helps lock in moisture) This product takes two steps down to one by combining the ingredients.

BioSerum, PSP (Processed Skin cell Proteins),  is made in Switzerland and also sources the cells from a cell bank where the original cells were harvested from human tissue.  Their serum was originally made to minimize the formation of scars with wound healing and burns.  Cosmetically, like TNS, it supports the skin in cell renewal, minimizing the appearance of lines, wrinkles and overall skin texture.  BioSerum also contains vitamin C, hyaluronic acid and peptides.

Both lines give immediate results due to the level of hyaluronic acid in the products as it gives skin plumping almost immediately.  The real results are 3 months down the road.

Both lines have numerous products with their respective growth factors in the products in addition to the serums which have the highest percentage of the proteins.

There are other growth factor products on the market.  Some are derived from nonhuman cells and I am not as familiar with the science behind these products.

Growth Factors are not to be confused with stem cells.  Stem Cell therapy is another topic.

I have heard some concerns in the industry that the growth factor products can also stimulate the overproduction of “bad” cells, such as skin cancers. There is no real research or well controlled studies to help answer this concern one way or the other.  My personal answer is if you have had a history of skin cancer, I would not use growth factors.

I have used both TNS and Bioserum over the years and have noticed improvements in the fine lines around my eyes and overall tone of my skin.  I can not say which is more efficacious.  I can say that the TNS has a strong smell which takes some acclimating to.  The Bioserum is free of any strong odors which some people would want to consider.

SKIN CARE-THE BASICS

There are so many skincare products out there!!!! It is seriously overwhelming.   AND a huge $ making industry.  There are a lot of products which are, essentially, just emollients.  Finding which products really are worth spending your money on is a worthwhile venture.  Knowing what the active ingredients in the products are and what they do for you is a good lesson.  Here is a summary based on the last 10 years of working in the skin care world.

1) SUNSCREEN

If nothing else, wear sunscreen every day, rain or shine.    Not only does it help prevent the aging effects we see after years of not wearing it, it helps prevent skin cancer.  “An ounce of prevention is worth a pound of cure” is so true in this case!  Not all sunscreens are created equally.  Ideally your sunscreen has zinc or titanium dioxide as these protect you better for longer.  The chemical agents, such as octinoxate, become less effective (or ineffective) after 60-90 minutes of sun exposure.  Zinc and titanium can give you all day protection as long as you do not swim or sweat them off.  These days so many lines of sunscreen utilize micronized zinc which is actually cosmetically elegant, not at all like the zinc of the past which created a lot of white noses at the pool.  The percentage of zinc or titanium also plays a role.  For instance, ideally the percentage of zinc is 7-10% for superior protection.

2)VITAMEN C/ANTIOXIDANTS

Topical Vit C  has been proven to provide additional UV protection and help fight off free radicals.  It also helps stimulate collagen and elastin, fade hyperpigmentation and reduces fine lines and wrinkles.  When used in conjunction with other topical antioxidants these benefits increase as the antioxidants work synergistically together.  Typically, these products are pricey as a stable form of Vit C is  expensive to manufacture.  However, it is money well spent.  Just adding a good topical antioxidant and a good sunscreen to your routine will pay off.  I would even recommend taking a before and after picture.  (for example at 3 months, 6 months and 12 months)  You will see improvements!

3) RETINOIDS OR RETINOLS

These have been around for years.  Because they work.

Originally used for acne these topicals have proven anti-aging benefits.

Retinols and retinoids are Vit A derivatives and when used topically increase cellular turnover.  They also stimulate collagen.  Over time they minimize the appearance of lines, hyperpigmentation, enlarged pores and rough skin texture.  They can be drying initially so your provider may recommend easing in to your application schedule.  For instance, I often recommend twice a week for two weeks, 3 times a week for two weeks, every other night for two weeks and then every night if tolerated.

Adding these three products to your skincare is worth it.  There are studies proving it.  You gotta love the skin your in:-)

RELAX

Botulinum  has been utilized both medically and cosmetically  for years to relax muscles.

Cosmetically, the botulinum products include Botox, Dysport and Xeomin.  These products temporarily relax the muscles helping to create fewer dynamic lines.  Commonly treated areas in the upper and  mid face are frown lines, crows feet, forehead lines and bunny lines on the nose.

Commonly treated areas on the lower face are upper lip, (smoker lines) chin, (orange peel) downward turn or pull of mouth (depressor anguli oris or DAO muscle)  along the jawline to help define the jaw (Nefertiti lift) and the platysmal bands in the neck.

You and your provider can determine your goals and decide the best treatment plan.  The provider will have a good understanding of which muscles lift and which muscles pull down allowing for the treatment to have a lifting effect where desired.

The treatment itself involves a series of injections into the muscle with a very fine needle.  Generally your provider will offer numbing cream or ice to minimize any discomfort.  You will be asked to stay upright for 4 hours after your treatment and to avoid vigorous activity/exercise,

Common side effects of treatment are bruising and swelling.  Less common side effects are ptosis of the eyelid, (drooping lid)  headaches, injection site discomfort and heavy brows.  It is possible to have an allergic reaction as well.  There are more serious side effects which have been observed with the use of these products medically as the dosing can be 20-25 x’s more than with the cosmetic uses.

You can minimize the side effect of bruising by avoiding medications or supplements that thin your blood for 4-7 days prior to your treatment.  (aspirin, ibuprofen, fish oil, etc)

Women who are pregnant or breast feeding should not receive treatments.  Of note, people with egg allergies should not receive Botox and people with milk protein allergies should not receive Dysport.  This is due to the possible presence of certain proteins.  Xeomin does not have proteins attached.

If treated with any of the botulinum products one waits up to 2 weeks to see the full effect of the treatment.  It generally takes 7 days (on average) for the product to start relaxing the muscle.  Your provider may want to see you for a 2 week follow up, especially if it is your first treatment.

FACIAL FILLERS

There are numerous injectable facial fillers to help restore volume and symmetry to ones face.  These fillers can be used to restore volume to facial folds, lips, cheeks temples, tear troughs as well as along the jaw line and chin.

The most popular and familiar fillers are hyaluronic acid (HA) fillers.  These include Restylane, Perlane, Restylane Silk, Juvederm Ultra, Juvederm Ultra Plus, Voluma and   Beletero.  Hyaluronic acid is a naturally occurring sugar we  have in our skin that helps it maintain volume.  These fillers are made of synthetic modiphied HA inside an inert clear gel that can be injected wherever volume is needing to be restored.  The particles of HA attract water and maintain volume.  These fillers last anywhere from 6 months to 2 years depending on the filler.  Of note,   HA fillers can be reversed with a product called hyaluronidase if the outcome is undesirable.

Radiesse is a facial filler that is made of calcium particles suspended in a gel which is injected in to areas of volume loss.  The calcium particles promote collagen growth and the volume is ultimately maintained by your bodies own collagen production.  The gel itself breaks down in 3-4 months at which time patients sometimes see a lag in correction until their collagen has grown in.

Sculptra is also used to restore volume using your bodies own collagen production.  It is made of poly-L-Lactic acid.  (PLLA, the same substance dissolving sutures are made of)  Once injected to areas needing volume your body grows collagen around the microscopic particles of PLLA.  This filler generally requires 3 treatments a month apart and then maintenance every 1-2 years as needed.

You and your provider can determine what you are wanting to address and determine which filler/fillers are best suited for your needs.  Once a treatment plan is established you can expect the treatment area to be numbed with either a topical analgesic or nerve block.  Numerous facial fillers now come with Lidocaine mixed in which has made the treatments much more comfortable.  Your provider may mix Lidocaine in with the product if it does not come already incorporated in the syringe.  The injections are done with fine needles or cannulas.

Side effects can include swelling, bruising, discomfort, risk of infection, small lumps and skin discoloration.  In my experience swelling and bruising are the most common side effects lasting 3-7 days depending on the patient.

SCLEROTHERAPY

Let Your Legs Show

Unsightly leg veins trouble many of us.  Women are 3 times as likely to have issues with spider veins and varicose veins then men.  Heredity, pregnancies, prolonged sitting or standing, being overweight and age all play a part in the development of these vein irregularities.

Sclerotherapy, performed since the 1930’s,  is the treatment of leg veins using a solution which is injected in to the vessel with a fine needle.  Polidocanol is a common agent used as is hypertonic saline.  Sclerosing agents damage the inside of the vessel and cause the blood to clot.  The vessels swell and stick together and eventually are discarded by the body.

Women who are pregnant or breastfeeding should not have sclerotherapy.  Other conditions that would  make sclerotherapy an unviable option would include a history of a blood clotting disorder, poorly controlled diabetes or a prior allergic reaction to Polidocanol.

Possible side effects include bruising and swelling at injection sites, skin discoloration,  pain, allergic reaction, ulcers from sclerosant damaging surrounding skin, blood clots and phlebitis.

If you  want to be treated you can expect your health care professional to consult with you and determine if you are a good candidate.  The sessions typically last 20-40 minutes and involve multiple injections with a fine needle.  You will be required to wear support hose for 4-7 days following your treatment.  Heavy exercise is discouraged following a treatment for 1-2 weeks but you will be  encouraged to walk the day of treatment.  You will also be asked to avoid hot showers and baths and long car or plane rides following your treatment.

Sometimes multiple sessions of sclero are required to obtain optimal results.  The sessions are typically spaced 4-6 weeks apart.