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Aesthetics Practice Today

Platelet-Rich Plasma for Treating Hair Loss
March 5, 2014 10:26 AM by Mina Grasso

Hair loss can be devastating to both men and women. Various genetic and environmental factors can cause hair loss. Environmental factors may include chemotherapy, diet, nutrition, stress, hormonal shifts, autoimmune disorders and various illnesses due to imbalances

Treatment options for hair loss include magical topical lotions and potions, prescription medication and surgical procedures. A revolutionary procedure gaining popularity utilizes a patient’s own rejuvenating properties. It applies the patient’s own platelet-rich plasma (PRP) to the scalp after the process of microneedling. Microneedling is much less traumatic to the skin than dermal rolling or injecting the PRP directly into the scalp.

The patient’s blood is drawn directly into a special blood collection tube similar to that used for laboratory tests. The tube of blood is then placed into a centrifuge to allow separation of the red blood cells from the plasma. Multiple channels are created into the scalp during the microneedling process. Immediately after the microneedling, the patient’s plasma is applied onto the scalp. The microchannels allow absorption of the PRP into the scalp.

The plasma contains the platelets that are rich in growth factors that stimulate stem cells to promote a natural process of wound healing, resulting in repair and regeneration of cells. PRP can generate new hair growth and enhance hair transplant results for thicker, healthier hair growth. Unfortunately, for patients with absence of hair follicles, PRP will not likely stimulate new hair growth. Healthy hair follicles need to be present.

PRP to the scalp for hair loss is well-tolerated. A topical anesthetic is applied prior to the microneedling. A mild “sunburn” feel can be expected following the procedure. There may be minor pinpoint bleeding during the procedure, prior to the PRP application. Anti-inflammatories are not recommended since they may interfere with the natural healing process stimulated by the PRP. Multiple treatments may be needed before results are seen.

Combination therapies with PRP are being performed in various clinics, and we will continue to learn more about effective treatments for hair restoration.

The Power of Brows
February 25, 2014 4:17 PM by Kimberly Cray

If our eyes are the windows to our soul, then our eyebrows are most certainly the curtains. And it has been studied to be true - eyes are the first thing another person notices about our appearance. 

With all the care that goes into taking care of our eyes, I find that eyebrows are often overlooked. The shape of our brows is very specific to our face and with a little professional tweeking we can really (and easily) improve our appearances. Full brows are en vogue while thin, over plucked brows can really age us.   


Tweezing is a great way to keep up with unruly brows but I caution you to seek professional attention for dramatic shaping. I only tweeze outliers and leave the artwork to the professionals. My biggest pet peeve is young girls who over pluck their brows. What! No! Stop! Just say no to over plucking. P.S. Invest in really good tweezers and you'll never regret it. 


Waxing is the old standby for brow shaping and definitely works wonders. Pay extra attention to not using any products with retinol or retinoidic acid the week of your treatment as the skin could more easily lift (and result in burns and potentially scarring).    


Threading has been gaining popularity in eyebrow shaping - we have malls in Miami that offer threading only services. I find it more painful than waxing but it also seems to negatively affect the skin less (score!) and give a manicured arch. Careful not to overdo it with threading and have too much hair removed.  

Permanent Makeup

As we age, brow hair becomes more sparse (think of all the years of abuse adding up too) so for women who truly have no brow hair, permanent makeup could be a great option. We have a particular artist and salon that we recommend, and most importantly trust, for this unique service. I would caution anyone to go very conservative in this department or hold off all together and use brow makeup which is non-permanent. If you are trying to improve sparse brows, also consider Latisse! 


The popular product for eyelashes can be used, off label, to help hair in the brow region grow. I decided I wanted to grow my brows out to change their shape and Latisse has helped me get there much faster. This stuff works. Not to mention your fabulous brows will look even better accompanied by gorgeous lashes.   

Brow Makeup

Some of my favorites in this category include powders, pencils and gels. Going a shade lighter than your color tends to give the best results, depending on the look you are going for. I love thin brow pencils and using very small strokes to mimic the look of real hairs. Clear brow gel is an essential for me so hairs (not to mention all your hard work) stay in place. There are also colored versions that are fun if you want to mix things up or to match your brows to a new hair color. Don't have brow specific products on hand? No worries, eye shadows can also be used with an angled brush to fill in brows.   

Moral of the story - don't forget those beautiful brows! Everyone is looking at your eyes, whether you like it or not. Keep your look fresh, rejuvenated and the Wow Factor going with proper care of your brows.   

Melasma – A Chronic Condition
February 19, 2014 5:10 PM by Mina Grasso
One of the biggest skin challenges we encounter on a daily basis is melasma. Melasma appears to be most prevalent with darker skinned women, primarily Asians and Hispanics. 

I have seen a few Fitzpatrick II-III patients that present with it as well. Melasma usually presents somewhat in a symmetrical pattern involving one or a few areas such as the forehead, cheeks, jawline, upper lip and chin.

The pigment can involve the epidermis, dermis or a combination. Most women report a seasonal pattern with complaints of pigment worsening at the end of the summer.

We have learned to keep our patients' expectations low as far as treatment results and counsel them that maintenance treatment may be required. We recommend sun protection on a daily basis, even on a rainy, cloudy day. Prescription and nonprescription topical creams may include one or more of the following:

  • Hydroquinone
  • Kojic Acid
  • Retinoids
  • Lactic Acid
  • Azelaic Acid
  • Various Botanical Ingredients

Various modalities can be used to treat the symptoms. In our clinic, we use a combination of laser or light type devices, such as IPL and laser toning, microdermabrasion and chemical peels. Micro-needling and conservative fractional CO2 laser resurfacing alone, or enhanced with Platelet Rich Plasma (PRP), also known as the "Vampire Facelift", aid in treatment. 

PRP utilizes the patient's own repair-response to be activated. Their plasma, rich in growth factors, is applied after micro-channels are created in the skin to stimulate the stem cells to repair. Great caution is taken with these patients, because melanocytes can be over-stimulated. When too much inflammation is created, symptoms can worsen. 

Fraxel was one of the first laser type technologies that had FDA approval to treat Melasma. Unfortunately some patients developed more hyperpigmentation post procedure.

I like explaining to patients that the development of melasma is not fully understood. Genetic factors can play a role in the formation of melasma and can be affected by hormone fluctuations and imbalances.  

Estrogen receptors on melanocytes have been found to stimulate the production of more melanin in some studies. I think we will learn more about the hormonal activity in the very near future.

In summary, I set their expectations low, recommend a variety of modalities, and emphasize the importance of home care regimen, sun protection and possible need for maintenance treatment. 

I tell patients that we can't "cure" this condition because it is chronic, but we can help them control the symptoms and get them to the point where it may appear completely resolved. However, even one hour without sun protection can bring all the symptoms back.

Product Spotlight: SkinMedica’s TNS Essential Serum
January 28, 2014 3:37 PM by Kimberly Cray

It's a rare occasion that a product gets me so excited that I would literally jump up and down in excitement talking about it. SkinMedica's TNS Essential Serum is one such product. 

My personal addiction to this product aside, TNS Essential Serum opened my eyes years ago to the world of growth factors and antioxidants. If you are not using growth factors, you should be. Growth factors, such as TNS (or Tissue Nutrient Solution), rejuvenate the skin by stimulating collagen and improving the appearance of fine lines, skin tone, texture and resiliency of the skin. TNS Essential Serum in particular combines growth factors, antioxidants, soluble collagen, cytokines and matrix proteins. Simply put, growth factors are game changers in skin care. 

This growth factor in particular consists of two chambers separating the two components which cannot be mixed until you put them on the skin. The two components of this product are TNS Recovery Complex and APS Corrective Complex. Think of this as recovery and regeneration of your skin.  

TNS Recovery Complex is formulated from naturally occurring growth factors, antioxidants, soluble collagen, cytokines and matrix proteins. TNS Recovery Complex has been clinically proven to reduce the appearance of fine lines and age spots, and improve skin texture, tone and elasticity.  

APS Corrective Complex is a potent mixture of antioxidants, peptides and other innovative anti-aging ingredients which promote the skin's natural regenerative process. This works to strengthen the skin's natural ability to regenerate itself, fights against environmental damage as well as smooths and tightens skin. Together the products truly work synergistically to rejuvenate the skin. 

I'm a big believer in great products with scientific backing that yield amazing results. There are also several other growth factor products that also work very well. If you aren't already on board with growth factors, I encourage you to get your feet wet and see what great things they can do for your patients' skin. 

Voluma: The New Tissue Filler for 2014
January 22, 2014 9:45 AM by Mina Grasso

Juvederm Voluma with Lidocaine is the hot new filler for 2014. With the natural aging process we lose facial volume. Voluma was developed to provide more volume and lift in areas such as the cheeks,  cheekbones and chin which are areas of larger-scale volume loss.

Voluma is hyaluronic acid that is smoother than other hyaluronic acids which makes it easier to inject during the treatment and results look and feel smooth and natural. Voluma is developed using Vycross technology, which is responsible for these results. It has been proven to last up to 18 months. 

A youthful face has round contours, high cheekbones and definition of lower face, chin and jawline. With Voluma injections, cheeks can appear higher and firmer. It can also support the chin, replacing some structural integrity due to volume loss partially due to bone loss. Patients can regain the youthful curve and angles that they once had in their youth.

Because Voluma is made with Lidocaine, patients tolerate the procedure well. A topical anesthetic can be used to minimize discomfort from the needle puncture. Although Voluma is considered to provide more lift and seems “thicker”, it passes smoothly though a small guage (27gauage) needle. I feel it is easier to inject than Juvederm Ultra.

Caution must be taken with injections because less pressure is needed to inject this product. Routine aspiration prior to each injection is critical to avoid intravascular injections when using standard needles. 

Optimum results in some areas require injecting just above the periosteum, and patients should be prepared for tenderness post-procedure when the anesthetic wears off. Due to the depth of injection in most sites, patients seem to experience less swelling post-procedure. 

For years patients have been asking for something to provide more volume and last longer. With the safety profile of hyaluronic acid and Voluma’s volumizing and lifting properties, patients will have a higher satisfaction with their liquid facelift results.

Successful Weight Loss
January 8, 2014 10:23 AM by Mina Grasso
Over half of the US population is overweight. Most of us are considering again our old resolution for the New Year - losing weight. Fad diets that require severe calorie restriction have historically failed us long-term. Many of us lose weight with these diets temporarily, but then the weight comes on again, and is usually much more difficult to take off. The body goes into survival mode with severe calorie and fat restriction. When this happens, the body holds onto fat and burns muscle tissue, reducing the body's ability to burn fuel in the future.

The vicious cycle of calorie restriction has allowed many to give up. Patients need more structured guidance on what types of food to consume, how much to eat for their size and how often. We need to think of food as medicine or poison to our system. What we put in our mouths triggers certain responses.

The most successful programs recommend the following:
  1. Small, frequent meals (typically five throughout the day)
  2. Adding healthy fats such as nuts and avocados
  3. Complex carbohydrates
  4. Unlimited leafy greens
  5. Avoiding simple carbohydrates - sugars and high glycemic foods
  6. Moderate amount of protein and fat
  7. Engage in moderate exercise that is enjoyable

Addressing hormone imbalances in conjunction to diet and exercise is critical to improving the body's metabolism. Hormones that play a role in weight control include:

  1. Thyroid
  2. Insulin
  3. Adrenaline
  4. Cortisol

As a healthcare provider you may not have time to address this in detail with your patients but you can have resources available. You can still play a part in the success for a healthier year.

All Natural Tattoo Removal
December 27, 2013 11:11 AM by Mina Grasso
The art of tattooing has been performed since ancient times and will continue to be performed for years to come all over the world. People get tattoos for a variety of reasons. Tattoos may be a loved-one's name, identify an individual belonging to a group, a symbol of a significant event in someone's life or something that seemed like a good idea during a rebellious time in someone's life. 

Laser technology for tattoo removal has advanced over the last decade, however many of the latest lasers continue to have a challenge with removing certain colors like aqua green or blue. Some tattoos can be significantly reduced in one to three treatments. However, multiple treatments are usually required.

Toxic acids have been used as an alternative to lasers for removing tattoos, and unfortunately tattoos had been replaced with scars. Some permanent makeup artists have been successful with removal of unwanted cosmetic tattooing with some acid solutions without scarring, however this is dangerous practice. Fortunately, the face is very vascular and allows for faster healing. When toxic acids are used for tattoo removal from the neck down, the risk of scarring increases.

A safe all-natural non-acid saline solution can now be used as an alternative to laser tattoo removal. After a specific technique is used, using a tattoo machine with a specific needle configuration, the solution is applied directly over the area. Over time a scab forms. 

Patients have to take extreme care during the healing process. The longer the scab stays on, the better the results. Once the scab falls off the process is interrupted.  The scab must be kept dry. Patients experience more pain at the site of tattoo removal after 4-5 days. An average of 3-5 treatments are required, spaced 6-8 weeks apart. The biggest advantage to this procedure is that all tattoo colors can be removed.

Non-laser, all natural solution tattoo removal has risks just like laser tattoo removal.  Pain, swelling, infection, scarring and skin discoloration can occur. There is a higher risk of hypo and hyperpigmentation with darker skin types. 

A technician performing non-laser, all natural solution tattoo removal must not only be trained in proper techniques of performing the procedure, but must know how to minimize risk of complications as well as know how to treat complications from the procedure.

“Bleaching” an Outdated Term
December 17, 2013 10:04 AM by Kimberly Cray
A common concern among patients is treating and improving skin tone and brown spots on the skin, particularly the face. These changes can often be reflections of long term sun exposure or hormonal changes. We have many options for treating such conditions; however, our go-to treatment remains topical creams because of their effectiveness, low cost and low risk nature.

I often wonder how many times a patient has gone to a dermatology office and been offered a "bleaching" cream. I am guilty of using the word frequently myself. We have been using the term for years. More recently, though, I am trying to avoid the term. My reasoning? When people hear the term bleach thoughts of Clorox come to mind. We are not treating skin like a soiled garment of clothing. I believe we must be more creative with our terminology.

It is almost 2014, people. Let's move beyond the term bleaching and use words such as "brighten" or "lighten" or "remove excess pigment." Just as we don't use straight bleach in laundry as much these days, we don't need patients envisioning themselves leaving white spots on the skin. I can't tell you how many patients have been given an unknown "bleaching" cream in which they did not know the ingredients or what mechanisms were at play to help their condition.

By simply educating and being careful with our use of the word bleaching, we can remove a lot of the misconception that can go along with the age old term. I do not feel that the word is the most appropriate term in treatment of hyperpigmented skin conditions. Use it how you wish, but I urge you to be creative and detailed in your discussion with patients for their skin care treatment. And remember, with all the great treatments out there please don't just throw another "bleaching" cream at them!

Liquid Facelifts
December 10, 2013 9:23 AM by Mina Grasso

Liquid facelifts using products like Restylane, Perlane, Juvederm and Radiesse as well Sculptra have become extremely popular during the last few years. Using a blunt cannula has increased the safety of these injections tremendously. Blunt cannulas minimize the risk of intravascular injections.

The use of blunt cannulas various widely from practitioner to practitioner even in the same office. The gauge range I have used is as fine as a 30 gauge to 22 gauge. The length I now prefer is one inch, however, for several months I preferred 2 inches.

I still find myself having a new favorite as I try various sizes. I feel I have more control with the more rigid the cannula is, so I know exactly where I am. I do not use a blunt cannula for Sculptra, because I had issues with the cannula getting clogged. 

The safety of using cannulas has given me more confidence of injecting various areas of the face; however, it is not without challenges or complications. The following are a few challenges: 

1.     More time is generally required when using the cannula

2.     Some areas of the face, especially lateral to the mid pupillary line, are more painful when using cannulas

3.     Extra care needs to be taken to maintain sterility of the needle if you set the needle and syringe down on your tray

4.     Patients experience more swelling after injections under the eyes

5.     I use more product when using the cannula

6.     Bruising can still occur, so patients should be aware that the cannula does not guarantee that they will not bruise

7.     In areas like the marionette lines, I almost always now use the needle to do fine tuning

I find myself varying my technique depending on the patient's condition, their expectations, the area I am treating, the amount I have to use and social downtime factors.  

Skin Care > Coffee
December 3, 2013 4:57 PM by Kimberly Cray
When attending a skin care seminar, learning about a company's product line and how you could potentially incorporate certain items into your practice is the intended purpose. However, one of the greatest things you can take from such an experience is far more than just information from a PowerPoint slide or an ingredients list. For me, it is the experiences discussed "between slides" from other providers and lecturers that is invaluable. Their lessons, if you will, can impact your practice in a very positive way.

I recently attended a national product seminar for a well-known cosmetics company. While at times "salesy," I left with knowledge about new products, backed by clinical data and lots of pretty before and after pictures. The lecturer also brought up a few points that had my mind thinking and wanting to share with you.   

I was taking notes on a product when someone asked about pricing. The lecturer said the price but didn't stop there. She also mentioned that many people enjoy a cup of coffee on their way to work in the morning. Now, a cup of coffee can run say $5 or so. Over the course of one month that is approximately $150. In a year, that coffee a day could total almost $2,000.  

How is this useful in clinical practice? Well, for starters it can open patients' eyes to their priorities. The price point for some physician dispensed products can be higher than OTCs, although in many cases the difference is not much. 

As a provider, think of all the money wasted on failed attempts to improve a skin condition with over-the-counter products. This skin care over coffee idea just helps to show patients that if skin care falls in the category of important to them then it is not a leap at all to purchase a high quality product. Especially patients who really want to see results and come to us for our expertise. Sometimes we need to break it down and give them that push to get them closer to better skin.    

I find this simple concept such an excellent example when it comes to patients questioning the price of products. Sometimes inexpensive OTCs are great options (see my previous post "When to Skimp, When to Splurge") but often the old saying is true: "You get what you pay for." Of course great skin care can come at a price and it must be one a patient is comfortable with.  

But when we look at the big picture, I feel this is a great way to help patients feel "ok" with making a skin care purchase outside their comfort zone when it comes to pricing. This doesn't mean pushing someone to purchase something they can't afford. This is just a means of comparison where money can go on a daily basis.    

The cost of products can certainly deter patients from purchasing them. We all want to be the provider that changes our patients' skin for the better. Having great products at our disposal that a patient can use and improve with is a must. Being able to have the patient leave with that product is essential in helping them. 

Lesson learned - sometimes a little education, story, comparison or just simply time can go a long way. In my eyes, the health of my skin is far more valuable than a Starbucks, not to mention a few less calories.

Benefits of Clarisonic Brush
November 29, 2013 11:19 AM by Mina Grasso
For many years I felt that home care cleansing brushes like the Clarisonic Brush was a gimmick and really did do much. Over time as I inquired patients about their skincare regimen, I found that a good percentage of patients used the Clarisonic Brush and were happy with their skin when they remembered to use it regularly.  It's difficult to recommend something that I did not have experience with or have not seen any clinical studies.

When Clarisonic developed the Clarisonic Pro to be available only in medical clinics, I reviewed the clinical studies that had been performed. Although the samples sizes were small, the study results that Clarisonic reported were similar to the positive feedback that I received from my patients.

The following is a list of benefits patients have reported and have been studied using the Clarisonic Brush: 

  1. Cleaner skin: Image analysis software was used to show that six times more makeup was removed using the Clarisonic brush versus washing makeup manually. 
  2. Improves absorption of skincare products: Spectrometric chemical analysis showed up to 61% greater absorption of Vitamin C after using Clarisonic sonic cleansing compared to manual cleansing.
  3. Improves photo-aging, fine lines, wrinkles and fewer dry patches
  4. Improves skin texture, tone and firmness
  5. Safe and gentle treatment even for rosacea and sensitive skin
  6. Improves skin color and brightness
  7. Men reported softer, smoother skin, less irritation and experience a closer shave

I routinely do a skin analysis imaging using the VISIA skin analysis program in our clinic. Although I have not done a formal study, I often notice that my patients who do use the Clarisonic Brush generally have better skin analysis profiles than those who don't.

Lytera Skin Brightening Complex
November 20, 2013 3:40 PM by Kimberly Cray
I recently attended a National Product Seminar hosted by SkinMedica in Miami. Did I mention I love my job? One of the products highlighted was Lytera. This product is being marketed as effective in reducing the appearance of dark spots to create a more even skin tone. Results, they say, are seen in as early as 4 weeks with continued improvement over time. 

Lytera has been shown to be effective enough to use as a mainstay treatment for hyperpigmentation or melasma but also safe enough to use as a maintenance therapy. Lytera is non-hydroquinone based, composed of items such as licorice root extract, retinol and niacinamide, and can be used on all skin types. It is not indicated for pregnant patients as it contains a very small percentage of retinol.     

As opposed to a hydroquinone product which is going to treat existing pigment only, this product can be thought of as an inhibitor of injury to the skin. This means more preventative treatment over just treating hyperpigmentation as it comes. For those of us familiar with hydroquinone, the stuff works well (for many patients) but typically the pigmentation recurs.  

My best advice with any pigment treatment is to always combine it with a sunblock (like zinc oxide or titanium dioxide). I like the idea of Lytera (even in combination of hydroquinone products) to help combat common skin conditions involving hyperpigmentation and to possibly help prevent new skin pigmentation. 

SkinMedica put the product in my hands and here are my thoughts: Lytera has a soft, elegant feel and pleasant scent. To me this is important because patients are much more likely to use something that they will like to wear and feel on their skin. The price point is feasible at $125 for 60 ml (approximately 3 month supply, used twice daily)  The company also packages it as a four step system (with a cleanser, SPF and retinol) which retails for around $250.  

I love options for patients and I feel this product is a great option for patients who have already tried and failed many topical modalities, those who cannot use hydroquinone, or want to take care of their skin and help avoid new pigmentation. I don't believe it to be a replacement for hydroquinone. I think there are some patients who truly need hydroquinone and do remarkably well with it. I find this to be a product with much potential especially with retinol and of course sun protection.


Beauty Rx – Catch More Zzzzs!
November 13, 2013 9:32 AM by Mina Grasso
Most of us have been told that we need more sleep. "If you don't sleep, you are not going to grow," is something that many of us heard as children and have repeated to our children. We have been aware that lack of sleep is not good for our health, but may not have understood what overall negative effects it can have on us, including our skin health and beauty.

Our bodies go through a repair and rejuvenation mode when we sleep. When we are sleep-deprived, hormonal and metabolic changes are disrupted.  Chronic sleep deprivation has been linked to increased stress, oxidative stress and inflammation, which results in conditions such as obesity, diabetes, cancer and a host of conditions related to immune deficiency. 

Sleep deprivation interferes with skin cell regeneration. Skin cell regeneration usually doubles during sleep. A small study at University Hospitals Case Medical Center in Cleveland, Ohio showed that women with sleep deprivation had a disruption in skin-barrier function, greater water loss from the skin and higher levels of inflammatory chemicals in the circulation that, over time, resulted in adverse changes in the epidermal and dermal of the skin. 

The researchers found that the sleep-deprived subjects showed increased signs of skin-aging with more fine lines, uneven pigmentation and reduced elasticity while the subjects that had quality sleep recovered from environmental stressors like sunburn from UV radiation more rapidly. An additional finding showed those who slept well perceived themselves to be more attractive than the sleep-deprived subjects.

So, don't compromise your beauty and health by depriving your body of sleep. Get a good night's sleep. Give our body time to repair and rejuvenate to maintain your skin's health and beauty.  Sleep well at night, enjoy beautiful skin and feel more attractive during the day.

VIP (Very Important Peels)
November 5, 2013 4:30 PM by Kimberly Cray
Peels are a great pick me up for the skin. Think: minimal downtime. Think: glow and go. Combined with the use of great products, peels are the type of treatment that I cannot recommend enough. 

I personally love superficial peels. I've always been a fan of Glycolic acid, whether in washes, creams or peels and this peel is a staple in any derm or aesthetics office. Glycolic acid is derived from sugar cane. This is a great option before an event or for oily or acne prone skin, and great for darker skin types with conditions such as hyperpigmentation (acne marks, scars, etc.). This peel tingles and can slightly burn but is generally very well tolerated.     

Combination peels work very well and are probably the most trending peels. We offer a great peel that utilizes salicylic acid, lactic acid and glycolic acid. There are also a number of superficial peels that combine agents such as alpha hydroxyl acids, lactic, salicylic and retinoic acid. Look into SkinMedica's Vitalize Peel and Precision MD's Milk and Spot Peel. 

These peels promote collagen production, improve pigmentation, acne and melasma. After one treatment, skin will appear healthier and more youthful. These also offer minimal downtime, with excellent results and little to no peeling. Who could refuse?

More recently, I've become a fan of Mandelic acid. Mandelic acid is derived from bitter almonds and has antibacterial and anti-aging properties. This is a great peel for acne patients, rosacea patients or patients looking for minimal downtime. 

I performed a Mandelic acid peel on my face, neck and chest and received so many compliments afterwards on my "glow." I did not peel but I certainly got a bit pink and some scaling occurred by the next week (note:  my skin is very sensitive - many patients do not experience any redness). I recommend a facial two weeks later (you could also do it prior) to really hydrate the skin and pack it with antioxidants. I love the look and feel of my skin after that combination of treatments.

Quite possibly my favorite, Malic acid, derived from apples and cherries, is full of antioxidant properties. It helps fight free radicals that contribute to skin damage and aging and increases oxygen supply to the skin. Yes, please!  As a natural humectant, Malic acid hydrates the skin without contributing to oiliness. 

Trichloroacetic acid (or TCA) peels are more aggressive and can yield very good results. However, not everyone is a candidate for this type of a peel. Depending on the strength and contact time, you will pretty much be guaranteed to peel after this treatment. Patients will likely see areas that form crusts (or superficial scabs) and whole regions of skin that slough off.

These peels also present with more discomfort, although most patients tolerate them well with a hand held fan. This peel is great for fine lines, hyperpigmentation and overall rejuvenation. Careful application in the under eye region can help with the common complaint of darkness and hollowing under eyes. I'm a big fan of this peel and still remember my first patient frosting with this technique! Time flies when you are having fun.   

Talk with your skincare professional before doing any home peels or if you are not sure what is best for you. As one of my favorite professors in grad school told us, "start low and go slow." Spot testing (particularly off the face!) is a great idea if you want to see if a higher concentration can be tolerated. If you have any doubts, be conservative. For best results, a series of peels is recommended. Skincare professionals - what are your favorite peels and combination of treatments?

Educate Patients and Recommend Products
October 29, 2013 4:13 PM by Mina Grasso
NPs and PAs often times feel awkward retailing skin care products to patients in a medical spa setting. Various factors contribute to lack of sales and patient guidance on skin care products appropriate to their skin condition. The following are just a few:
  1. Underlying feelings of violating medical ethics
  2. Lack of knowledge of skin care products
  3. Fear of coming across as "too salesy"
  4. Lack of confidence in the products sold in the clinic.
  5. Fear of the patient rejecting the product.

Surveys of patients visiting a spa or medical spa revealed 90% of patients purchased an over-the-counter skin care product when skincare products were not recommended by the clinic. Clinics who perform a range of skin rejuvenation procedures from microdermabrasion to CO2 laser resurfacing should have a plan to provide or have specific recommendations for patients to use after the procedure. 

It's not unusual for patients to report that they purchased several items over-the-counter but found them to be too irritating or were afraid to break out. In my experience, there are quite a few patients who developed allergic contact dermatitis using over-the-counter antibiotic ointments after chemical peels, permanent makeup or tattoo removal.

Patients go to professional skin care clinics to get the advice of experts. The following have been very helpful in educating our patients on skin care:

  1. Computer analysis of the patient's skin care condition: UV damage, brown spots, redness, texture, pore size and porphyrins.
  2. Educate yourself and staff on effective skin care products for the skin conditions that you see in your clinic.
  3. If you choose not to sell skin care products, have a list of your recommendations for your patients to take home including guidance on sunscreen/block for protection.
  4. Follow-up appointments after skin care products sold or recommended and make adjustments if necessary.
  5. Provide retail sales product education as well as education on techniques of retailing.
  6. Keep patients' expectations realistic. Explain that skin quality improvement with skin care is usually not visible for 2-3 months.
  7. Have confidence in your approach in "prescribing" skin care for your patients.

Patients seek your advice. Educate and recommend products appropriate for their skin type and condition, and they will respect your professionalism and guidance especially when they start to see results.



About this Blog

    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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