MENOPAUSE AND YOUR SKIN 101

MENOPAUSE

Menopause can take a toll on us.  The hormonal shifts have both emotional and physical effects.  Some of it is out of our control, but a lot of it can be managed.

As our estrogen levels drop we notice changes such as hot flashes, changes in our skin and hair, difficulty sleeping, fatigue, irritability and decreased sex drive.  (to name just a few)  As an aesthetic nurse I am frequently asked what can be done to help with some of the skin changes.

Obviously, it goes without saying, that having a healthcare provider to help you manage the medical aspects of “the change” is in your best interest.  HRT (hormone replacement therapy) is a viable option for many of us, but not everyone.  Some individuals may have contraindications for HRT.  If it is an option, estrogen replacement can help alleviate many of the symptoms of menopause.  Each individual has to look at their own medical history and determine what is the best approach for them.

ESTROGEN AND OUR SKIN

As our ovarian function declines,  we lose estrogen production.  A side effect of this is the loss of collagen.  Estrogen helps the body with the production of Collagen I and III.  Additionally, estrogen supports oil gland activity, elastin and subcutaneous fat.  We notice this as we discover our skin thinning, new wrinkles, sagging, dry skin and less volume.  We can provide support to our skin as it experiences menopause related changes.  Here are a few ideas….

  • Eat a healthy diet full of antioxidants. (eat lots of colors!)
  • Try to incorporate soy into your diet.  The isoflavonoids in soy mimic estrogen.
  • Drink plenty of water/stay hydrated.
  • Try to sleep 8 hours a night.  (easier said than done, I know)
  • Wear sunscreen every day, rain or shine!  UV rays break down our collagen.
  • Use a topical antioxidant prior to your sunscreen every day.
  • Utilize a retinol/retinoid (Vit A) product topically at night.  Studies show this helps stimulate new collagen.
  • Utilize peptides in your skin care.  It is proven that various peptides help support the production of collagen and elastin.
  • Use a gentle non-stripping cleanser.
  • Exfoliate your skin.  A physical exfoliant or lighter chemical peel exfoliant.
  • Look for hyaluronic acid in your skin care.
  • Utilize fillers/fat transfers to replace lost volume.
  • If dryness is an issue, make sure your moisturizer is replacing enough moisture so your skin feels comfortable.

There are other issues I hear complaints of related to menopause.  Facial hair growth is a common complaint.  (as estrogen levels drop and our androgen hormones become more dominant)  If there is pigment in the facial hair, laser hair removal is a fantastic option.  If the hair is light or has no pigment, electrolysis is a better option.  There are  also prescription creams that can decrease facial hair growth.

Acne can be a problem that resurfaces at this point.  Again, due to the dominance of androgen hormones our skin can have thicker sebum production.  Retinoids/retinols can be helpful.  For more serious issues your health care provider can help you decide if Spironolactone (a prescription) is an option for you.  The Spironolactone helps suppress the androgen hormones, helping both with hair growth and acne.

Estrogen also helps control our melanocytes.  As we lose the estrogen, hyperpigmentation can become more of a problem.  So, this brings us back to sunscreen and topical antioxidants to protect from UVA/UVB.

For those wanting to go the extra steps to help with collagen production and repair prior damage, there are numerous laser modalities available that make a considerable improvement and difference.  I am currently a fan of  HALO™, IPL’s and Ultherapy®.

I read that we spend 1/3 of our lives in menopause based on the average life expectancy in the developed world.  We can make it feel good and look good ladies!

I’ll finish with a current list of favorites.

SUNSCREENS

The entire line of Elta MD® sunscreens are excellent sunscreen options.

c-e-ferulic

The Skinceuticals line has excellent antioxidants.  Both CE Ferulic® (for drier skin) and Phloretin CF® are great options.

alastin retinol

Alastin® Retinol at night is effective, yet gentle.

Alastin Restorative Skin

The Alastin® Restorative Skin Complex has numerous peptides and antioxidants.  This stimulates collagen and elastin.

Both SkinMedica® and SkinCeuticals offer hyaluronic acid products that effectively boost hyaluronic acid in the skin.

triple lipid restore

SkinCeuticals Triple Lipid Restore is an excellent hydrating cream for those with drier skin.

All of the mentioned products are available at TOC Medical Spa.

We have a sale this month too!

10% off one product

15% off two products

20% off three products

Hope this is a little informative 🙂

 

 

 

 

RESTORING YOUR LIPS

When assessing and treating a patients lips there are several subtle changes that can rejuvenate the mouth area without making the lips look “done”.  Although some patients want much fuller lips, a lot of us prefer subtle changes.

old lips

young lips

lip comparision

As we age our upper lip changes in several ways.  We tend to lose the definition along the vermillion border, the philtral ridge/columns (the vertical columns that start at the tip of the cupids bow and end below the nose) flatten and the space between the upper lip and nose elongates.  Subtle changes can be created with easy injection techniques, including defining the vermillion border, restoring the philtral columns and accentuating the cupids bow.  Restoring the philtral columns frequently make the lip lift slightly.  Filling these columns can return the contours that were likely once there.  Vertical lip lines can be softened as well.  Small amounts of filler can be placed within the lip itself to restore lost volume.  There are many fillers to choose from these days,  giving the patient and provider options, depending on the treatment plan.  Fillers vary in their hyaluronic acid %, viscosity, elasticity and cohesiveness.

When assessing and treating the lower lip there are several changes that can have a nice impact,  other than just looking fuller.  Again, the vermillion border can be defined and fine lines can be corrected.  The oral commissures, which tend to turn down as we age, can be turned back up with filler placement techniques.  Volume restoration can be completed to obtain the desired effect.

The ideal balance of upper lip to lower lip is 1/2 to 2/3’s.  This does vary individually and you and your provider can decide the best proportions for you.

In addition to fillers, small doses of Botox® or Dysport® can be utilized to relax muscles in this region of the face.  If a person tends to purse their lips  Botox® or Dysport® can be used in the muscle surrounding the mouth (the orbicularis oris) to minimize the pursing.  This injection technique also tends to roll the upper lip up and out slightly, making it appear slightly fuller.  Additionally, for a gummy smile,  an injection a little higher (closer to the nose) in the upper lip can relax the muscle that lifts the lip up.  This injection prevents as much gum tissue from being exposed with animation.

Another placement of Botox® or Dysport® that can help in the lower face and lip area is treating the depressor anguli oris ,(DAO) which, in some individuals, pulls down the sides of the mouth.  Very small doses are utilized in these muscles to help minimize the appearance of frowning.

As with all facial injections, make sure your provider has a thorough understanding of facial anatomy.   Ask if there is an “emergency kit” for injectables in the clinic.  (a kit containing an enzyme to dissolve filler, should it be required)

Do not worry that having injectables in the mouth area will leave you with unnaturally big lips. (which we have all seen) If you and your provider are on the same page, you can obtain a natural restoration of the volume and definition you once had.

 

VYCROSS TECHNOLOGY

 various vycross

It has been a while!  I hope everyone had a good summer and that the new school year is off to a good start!

I thought I would do a quick blog on some of the newer HA (hyaluronic acid) dermal fillers that have come on the market.  As an injector I have been utilizing Allergan’s offerings with Vycross® technology.  These products inject very smoothly, have good malleability and moldability and tend to create less swelling for my patients. (not ZERO swelling, but less)   As an injector it makes my job easier and for my patients the treatments are well tolerated.  Additionally, the product lasts longer due to Vycross® technology.

The Juvederm® family of products have been available for a number of years.  Juvederm Ultra® XC and Juvederm Ultra Plus® XC utilize hylacross technology, the predecessor to the newer line of products.   Vycross® technology blends different molecular weights of hyaluronic acid and have enhanced cross linking to increase the duration of the product in the dermis.   The newer products, Juvederm Voluma®, Juvederm Vollure™ and Juvederm Volbella® have given injectors and patients more options to choose from.

The products have differences which make them suitable for different areas of the face.  Voluma® has 20 mg/ml of Hyaluronic Acid, tends to be very cohesive and is frequently utilized in the mid face to replace lost volume and to create lift.  Vollure™ has 17.5 mg/ml of Hyaluronic Acid and tends to be much less cohesive than Voluma® and works well in areas where finer correction or more subtle volume is desired.  Volbella® has 15 mg/ml of Hyaluronic Acid and works well in fine lines, such as perioral lines (smoker lines).  Volbella® smooths very easily once injected.  In general, the less the HA concentration the softer and smoother the product.   You and your provider can determine which products to use to achieve your aesthetic goals.  It may be that you can benefit from several of the products.

vycross face

All of the products mentioned have 0.3% lidocaine added to make the injections less painful.  I also pretreat with topical numbing and use ice during the treatment.  There are also occasions when a 2% lidocaine dental block is helpful.  For example, lip injections.

The duration of the products varies patient to patient and the companies literature tends to promise more than it can deliver.  BUT, I do find these products are outperforming their predecessors and longevity has improved.  All of the HA fillers have a good safety record and have minimal side effects.

 

DON’T BE SCARED

injection

I received an email from a client this weekend referencing an article which ran in the New York Post on July 7th.  She asked, “Should I be scared?”

The article, “Doctors warn popular cosmetic procedure may cause blindness”, written by Rebecca Sullivan, addresses some of the worst, and rarest, complications with injectable fillers.

One of these very rare complications is blindness.  There have been approximately 100 cases documented of blindness related to the injection of  dermal filler world wide.  These cases, statistically, are extremely rare.   The incidence has been highest when injections have been performed deep in the glabella area.  (between the eyes)  There have also been cases involving injections into the nasolabial folds and the nose itself.  When filler is injected deeply it can be introduced to one of the facial arteries and then can make its way to the retinal artery, resulting in blindness.  Blindness has not been reversible in the documented cases.  This rare adverse event has been reported with the injection of autologous fat and dermal fillers, such as hyaluronic acid fillers.  (Restylane®, Juvederms®, for example)   The occlusion of an artery can also cause soft tissue damage or tissue death (necrosis) . Although, still very rare, there have been more cases of this adverse event reported than blindness.  Infections have also been reported and are also very unusual.

Just the prospect of any of the above can make someone think twice before pursuing facial injections.  Here are a few pieces of information to put you at ease as a patient.

  • Seek out a provider with experience and an extensive understanding of facial anatomy.
  • Seek out a provider at an established and reputable office, ideally with a physician  on site.
  • Ask your provider if they have hyaluronidase in the office.  This is an enzyme which breaks down hyaluronic acid fillers.  If can be utilized in an emergency, but most often is used in outcomes that the patient or provider want to reverse.
  • Know that the majority of complications (such as swelling and bruising) are mild and self limiting.

Even in the hands of the most experienced injectors, risk still exists.

As a provider:

  • Know your facial anatomy!
  • Avoid deep injections in high risk areas.
  • Have an emergency protocol and kit available should the need arise. (hyaluronidase, nitro paste, ASA)
  • Aspirate before injecting.
  • Inject slowly
  • Only place boluses on periosteum.
  • When appropriate, utilize a cannula, especially in high risk areas of the face.

I have seen several references to this article on social media.  I think it is important to inform the public that facial injections have a long and safe track record.  I think that the article referenced does shed light on the fact that facial injections are not without risk and a patient should be educated and informed.  Choosing a provider wisely is so important.

But, in the right hands, you should not be scared!

 

 

HOW TO COMMIT TO A SKIN CARE REGIME

routine products

We all have the best intentions whether it be related to our diet, exercise program or other goals.  This is about committing to a solid skin care regime.  Just like all other ‘habits’ it can take practice for a new skin care program to become the new normal.   I believe the research shows that it takes 21 days for a new practice to become a habit.  So, how can we make that easier and help insure we will commit?

The easier we can make it for ourselves, the more likely we are to experience success.

First off, decide what your day time skin care should look like for you and what you are trying to target.  Ideally, everyone includes an antioxidant and a sunscreen with zinc every morning.  A night time routine should include a retinol/retinoid and plenty of moisture.  Once you have established which skin care items are going to suite your skin care needs make sure the products are accessible.  It can be easy to want to skip any part of the routine when we are in a rush to get out in the morning or we are exhausted at night.

Have all your must use products easily accessible.  I keep a tray with my current products on the bathroom counter next to my sink.  I am always able to commit in the morning, it is at night, sometimes, when I am exhausted, that I might be less committed.  But once I brush my teeth my products are right there so I rarely skip.

I am a true believer in topical skin care.  I came in to medical aesthetics with pretty sun damaged skin and can honestly say that I turned my skin around.  I once thought tanner was better.  I even used tanning beds back in the day.  Being a pale red head, this was just a bad idea on so many levels.    I believe that what we use topically is a big piece of the “pie” and is worth the money and time.

I tell patients to, at the very least,  commit to an antioxidant, sunscreen and retinol/retinoid.  I am a huge fan of products with multiple peptides these days as well.

Maybe this well help you get on board with a topical skin care routine.

Happy Monday!

 

 

 

DO YOU WANT TO SAVE A LITTLE $ ON YOUR COSMETIC TREATMENTS?

There are several programs offered by the aesthetic pharmaceutical companies that are meant to drive patients back in for additional treatments.  They are effective for the companies AND they save the patient money.

I think it is worth utilizing these programs if you are a consumer as it does save you $ on something you were probably going to do anyway.

bd2

Allergan, the makers of Juvederm®, Botox®, Kybella™, SkinMedica® products and Latisse®, has a program called Brilliant Distinctions®.  You accrue points by receiving treatments with your provider, purchasing skin care, and in the case of Latisse®, filling a prescription at your pharmacy.  You simply sign up at www.brilliantdistincionsprogram.com.  When you receive an aesthetic treatment with an Allergan product remind your provider to issue you points at check out.  When purchasing SkinMedica® products also ask the person checking you out to issue points on your skin care purchases.   Check your account before your treatments to see how many points you have accrued and create a coupon.  The coupon are worth anywhere from $10-$80 depending on what you have accrued.  (I have seen patients have more than $80 in their banks)  Points do expire after 9 months so keep an eye on them.  Brilliant Distinctions® also has an on line mall where purchases from participating retailers can also create dollars in your account.  The list of retailers is extensive and includes many commonly shopped businesses.  Maybe your holiday shopping is going to pay for your next Botox® treatment!

aspire2

Another program, from Galderma, the makers of Restylane® products, Sculptra® Aesthetic and Dysport®, is called Aspire.  Once again, you accrue points as you receive treatments.  Go to www.aspirerewards.com to sign up.  You are also able to accrue points in Aspire by taking monthly quizzes, participating in surveys and referring friends.  The Aspire program points last longer than Brilliant Distinctions® points,  although they do eventually expire.

Both programs have smart phone apps that make it that much easier to access and utilize.

If you are a fan of medical aesthetic treatments check these out.  It can only save you money!