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Botox Special

Disclaimer: the purpose of this blog is to provide information for patients, friends and  anyone else who happens upon the site. It is not my intention to solicit or promote my practice. However, a patient requested that I post on my blog about Botox and other cosmetic specials.

Valentines Botox special: $12/unit (regularly $15/unit). Minimum 16 units

Thursday February 12 & Friday February 13 2016

The Polyclinic Madison Center 904 7th Ave Seattle 98104

Call 206-860-4605 for information or appointments

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To Clarisonic or not?

Four years ago I bought my first Clarisonic at a conference. After enjoying the facial the reps gave me in the middle of the expo I drank the koolaid and bought one. That trusty device lasted three and a half years! This summer it finally gave up, and I didn’t replace it. I didn’t replace it because I wasn’t sure it was doing anything. At that same conference four years ago I also bought into the “cosmeceutical” world and started using retinols, hyaluronic acid, vitamin c and vitamin E. My skin did look better, but I wasn’t sure what was really making a difference. So I decided to ditch the Clarisonic and save two minutes in my nightly routine.

Fast forward to this January, I had noticed over the past month that my skin had been looking more dull.  I had not changed anything else in my routine, still using the same products and trying to squeeze a peel in every few months. I decided it was time time to try the Clarisonic again. Instead of the “Pro” that I got last time I picked up a Mia 2 (meaning two speeds) in last seasons color at Nordstrom Rack. It cost $99 for the device, one deep pore brush head (for my husband), a deep pore mask and cleanser (both given to my husband). I picked up a “radiance” brush at sephora for myself for $22. I usually use the acne or sensitive brush, but decided to give the “radiance” brush a try because my skin was feeling dull (again drinking the koolaid). Overall a pretty good deal.

After one week of use I can say that my skin feels smoother and looks brighter. I am hopeful things continue to improve.  I think the Clarisonic may provide some benefit, it certainly wasn’t the January weather in Seattle that made my skin brighter.

If you decide to buy the Clarisonic here are a few tips:

  1. Buy from an authorized dealer. While I love Amazon, they are not authorized to sell Clarisonic and the reviews suggest that many that are sold on Amazon are duds. If you want a good deal try Nordstrom Rack- they usually have the same model in older colors for $50-100 less.
  2. Use the brush that is right for your skin. If you have acne or rosacea use the acne or sensitive skin brush.
  3. Replace your brush ever three months minimum. The brushes can grow lots of bad stuff so keep them clean and replace them often.

This post was not sponsored by Clarisonic. I paid retail price for all products discussed in this post.

Clarisonic Mia 2

 

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Eye Candy

Eyelashes are all the rage these days. There are salons dedicated to giving us long, full and dark lashes that rival Kim Kardashian.  There is a prescription medication, Latisse, that also makes lashes darker, longer and more full- though not as quickly or to the dramatic degree as extensions.

Similar to many of my posts, this post was inspired by personal experience. As a long term (though I admit intermittent) user of Latisse I decided to try extensions over the holidays. Like most people, I don’t always use my products as directed and the Latisse only works when you use it. So I decided to see what the extension rage is all about.

After a month I would say that eyelash extensions belong in the same category as hair extensions and shellac nails. They provide a look that is unattainable through nature, but they damage your real lashes/hair/nails.

Here is my rundown on the pros and cons of both Latisse and extensions

Extensions

Pros: Big lashes immediately, skipping makeup entirely

Cons:  Expensive (at least $100-200) damaging to your lashes, allergies and irritation to the glue, painful amd irritating when they get wet, very high maintenance ( fills needed ever 2-4 weeks)

Latisse

Pros: Home application, simple and quick, doesn’t damage your lashes

Cons: Expensive ($120-200 for a 3-4 month supply), prescription only, irritation or allergy (less common than with extensions), works slowly, pigmentation of the lash lone or eye (this is rare)

Bottom line: Latisse hands down. I am back on Latisse and recommend this for eyelash plumping, or a tube of Maybelline.

 

 

 

 

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Out Damn Spot!

It is officially fall. Gone are the long days of sun and the summer glow is starting to fade (I never had one of course). As the tan fades, those pesky brown spots become annoyingly obvious.  I probably have at least five people ask about getting rid of brown spots every day. Unfortunately I can never devote the time needed to the topic because insurance companies (who are always watching and auditing) don’t want me to discuss cosmetic issues if they are paying the bill. Now brown spots should be evaluated to ensure they are not cancerous (so making an appointment for brown spot evaluation is ok with most insurance companies), just last week one of those brown spots turned out to be a melanoma. Fortunatley, the majority are not melanoma and represent either solar lentigos (age spots), seborrheic keratoses (another type of age spot) or melasma. All three of these conditions are somewhat cosmetic in nature (if you are looking to remove them).

Solar lentigos (which look like brown spots) and melasma (often looks more like brown blotchy skin) are caused by the sun. They are very sun sensitive and are not prevented 100 % by sunscreen. So before treating, you have to be committed to protecting your skin from the sun with heavy sunscreen and hats.

Now how do you get rid of the spots?

Liquid nitrogen.      This treatment works very well if you have just a few solar lentigos or seborrheic keratoses. It does not work for melasma. The advantages of this treatment are speed and low cost. The disadvatages are possible lasting redness, post-inflammatory hyperpigmentation (a medical word for a brown spot) or even a scar.

Creams.      Creams don’t tend to work well for large solar lentigos, but are first line for mottled brown pigment and melasma. The most effecitive creams are a combination of prescription strength hydroquinone and Retin A. At my office we sell a 4 percent hydroquinone and .1 percent Retin A for $68 each, which is a pretty good deal. There are several commercial prescriptions available from the pharmacy as well. There is a commercial cream (Tri Luma) that adds a hydrocortisone which can help if you have irritation from Retin A tyoe creams. Hydroquinone creams must be used for limited time periods (8 weeks) before taking a break- or they can cause worsening of pigment. Retin A can be used continually but will cause increased sensitivity to the sun. If you prefer to avoid hydroquinone or you are breastfeeding, there are creams that can help lighten skin- though they are not as effective in most cases. Look for products with kojic acid, arbutin, licorice, azelaic acid, soy and vitamin C. We have one called Perle by Neocutis, but there are other brands available.

Peels.  Peels can be effective for brown spots as they contain the same ingredients as the creams above. A benefit is they can work faster than creams.

Laser and light treatments.  IPL (Intense Pulsed Light), is commonly the first light treatment used for dark spots. It has to be used cautiously on melasma (it can make this worse) but works very well on non-melasma brown spots. It can be safely used on the neck, chest and arms. It has low downtime and is pretty affordable ($300-400 for full face treatment). You may need more than one treatment (depending on the level of sun damage) but many have good results in one treatment. Other lasers used for brown spots include non-ablative resurfacing lasers such as Resurfx and Fraxel. CO2 laser is very intense, but does provide treatment for brown spots.

So how long do these treatments last? The great news is that they are long lasting- if you protect your investment. None of these treatments will prevent brown spots if you are out in the sun. In fact, they may make you at risk for more brown spots due to increased sun sensitivity. So if you decide to get rid of your spots, invest in a few good hats and good sunscreen!

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Take care of your feet, you will thank yourself later

I am back. Summer was  very busy, we had a full three months of nice weather in Seattle (which is unusual) so there were less rainy afternoons to spend blogging. I promise I wore my hat and sunscreen.

I was so flattered and happy today to meet a new patient who read my blog! You inspired me to get back on here. I have so many ideas for blog posts and it took just a little nudge to start writing.

So why I am talking about feet?

Feet are so important and you take them for granted until something goes wrong. There are so many skin conditions that affect the feet- and many of them are preventable. Below I discuss some common conditions and how to treat and prevent them.

Athletes Foot

The medical term is tinea pedis – and every will get this at some point in their life. A mild case often starts with little cuts or cracks between your toes. This can spread to involve peeling and redness on the entire foot (or both feet). It can even spread up your legs. If you notice cracks between your toes or itchy flaky skin on the feet, go to the drug store and get 1% lamisil cream. Don’t get lotrimin- it doesn’t work as well. Apply this to your feet and between the toes twice a day for a month. Get the spray and spray your athletic shoes and consider getting rid of shoes that are really smelly. The reason why you need to treat athletes foot:

  1. It can get into your toenails- and this is REALLY hard to treat.
  2. It can be a risk for other infections – especially if you have diabetes or a condition that affects your immune system.
  3. It makes your feet and shoes smell bad.

It is hard to prevent this condition 100 percent, but keeping your feet covered when you are at the gym or at yoga, at the pool or in the locker room. If you forget your shower shoes at the gym- wear socks! Avoid walking on any floors that are not your own with bare feet. If you find yourself getting athletes foot frequently use lamisil cream weekly as prevention.

Dry & cracking skin (especially heels)

Unfortunately as we age our skin gets more dry, especially the legs and feet. The “dust” you see when you pull off your socks- that is dry skin.  Summer is terrible for your feet with lots of swimming, sweaty socks and flip flops. Keeping your skin soft will help prevent the thick skin and cracks. If your feet are in pretty good shape, get a heavy cream or vaseline and apply it nightly, lotion will not do the job. If you have thick skin or cracks try using a cream with lactic acid or urea (available at the drugstore- common brands Carmol and Amlactin). If this doesn’t work you might need a prescrption or compounded cream (there is a wonderful cream called Whitfield’s ointment that works miracles).

Warts.

The dreaded warts. I tell my husband if he doesn’t enforce the “water shoes at the pool” rule at all times- then he has to take the kids for wart treatment- and this is not fun. If you think you have a wart on your foot start treatment immediatly. Plantar warts will sometimes go away, but more often they get bigger and deeper. The longer you leave a wart the harder it is to treat.

You can get wart treatment at the drugstore. Look for a product with a high percentage of salicylic acid (17-40 percent). Dr. Scholls and Compound W are common brands. To treat the wart: soak in water for a few minutes to soften, then apply the medication directly to the wart and cover with a bandaid. Every week file down the wart. Repeat this until it is gone, which usually takes at least 3-4 weeks.  If you don’t treat to resolution it will come back. If you aren’t getting anywhere see your doctor- don’t let warts go untreated.

Toenail Fungus.

DO NOT IGNORE THIS. Toenail fungus is incredibly difficult to treat once it gets deeply into the nail. Topical medications rarely work (about 10-15% of the time with daily application for a year)- not even ones that advertise during football games. If you treat early, topicals have a better chance of working- so see your doctor early if you suspect toenail fungus. Lasers don’t work, so don’t waste your money. If you have an advanced or even moderate infection, the only real cure is taking a pill for at least four months.

I am obsessive on preventing toenail fungus. See all the tips above- keep your feet covered in public places, treat athletes foot early AND a very important tip- if you get pedicures make sure that all the instruments are autoclaved and more importantly, files/buffers/brushes are SINGLE use. Do not let anyone reuse a nail file. If you want to be safe, bring your own pedicure tools.

Hopefully these tips will help keep your feet healthy as we wrap up the summer. I apologize if I ruined your fun running around the pool in bare feet this weekend (please don’t do that).

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Photojournal of a peel.

Ok, so I am putting myself out there with this post. I always recommend peels to patients and friends as a great way to refresh the skin for a reasonable cost. The biggest downside of a peel is that you peel. So here is what I look like Day 3 through Day 10 of a peel. I didn’t include Day 1 , 2 and 3 for two reasons: 1. You don’t look much different on Day 1 and Day 2, if anything your skin looks a little tighter and a bit bronzed. Peeling doesn’t start until late Day 3 or Day 4. 2. I didn’t think of this blog post until Day 3. My bad.

So what do I mean by Day 1, 2, 3 etc? Here is the breakdown:

Day 1: The day you apply the peel. I generally apply on Wednesday evening and leave it on all night. I use a peel that recommends leaving on for 6-8 hours, so overnight is perfect. Some peels require removal after just a few minutes. For this peel I used The Rejuvenize Peel by Skin Medica, this is currently my favorite peel

Day 2: The day after the peel is applied. Your skin might look a bit red, bronzed or “glowing.”

Day 3: Peeling usually starts late in the evening on this day- about 48 hours after putting the peel on. I try to time this so that peeling starts late Friday afternoon or evening, so as to minimize the number of patients who ask me (or just think to themselves) if I have a sunburn.

Day 4-5: heavy peeling. This is when my kids ask “did you do a peel?”

Day 6-7: light peeling. This is usually Monday and Tuesday, so I hope peeling is minimal now. Usually it works out this way.

Day 8-10: skin is a bit pink but back to normal

Here is the photo journal – all photos are without makeup. 

Day 4: Saturday. Peeling has set in for real.

Real peeling has set in. I look like a peeled tomato. My mother in law asked if I did something to my face. I am sure several people at spin class wondered if I had a communicable disease.

4 Real peeling has set in. I look like a peeled tomato. My mother in law asked if I did something to my face. I am sure several people at spin class wondered if I had a communicable disease

Day 5: Sunday. I look scary.

Happy Fathers Day. Look pretty pink and peely today. Will Dad notice?

Happy Fathers Day. Look pretty pink and peely today. Will Dad notice?

My incognito gear. So I don't scare anyone on the Bainbridge Ferry.

My incognito gear. So I don’t scare anyone on the Bainbridge Ferry.

Day 6: Monday. I have to go to work today…

Monday. Usually I don't look this red on Monday. I wear green to try and offset the red. Who am I kidding?

Monday. Usually I don’t look this red on Monday. I wear green to try and offset the red. Who am I kidding?

Day 7: Tuesday

In 24 hours my skin has made a miraculous recovery- I actually look somewhat normal, just a little pink.

In 24 hours my skin has made a miraculous recovery- I actually look somewhat normal, just a little pink.

Day 8: Wednesday- one full week after putting on the peel.

One week after I started the peel my skin is back to normal. No makeup needed for camouflage at work.

One week after I started the peel my skin is back to normal. No makeup needed for camouflage at work.

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This is why you should always wear sunscreen (even when you aren’t outside very much)

Below is a little real world experiment with one of my favorite brands of sunscreen. BlueLizard sunscreen gives great protection and the bottle turns blue when there is sufficient UV light to cause skin damage.

The first photo was taken in the car while in the garage (and the bottle is white). The second photo was taken ten minutes later after driving just a few miles in the afternoon sun (in Seattle). The bottle was never outside- the only UV light came through the drivers window. As you can see the bottle is bright blue! This means that you are getting significant UV exposure through the car window. I have done this experiment inside my home and the same thing happens. UV light passes through windows, so protect yourself and always wear your sunscreen!
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After ten minutes driving in the car

After ten minutes driving in the car

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