Hands, hands, hands

Many different hands

Our hands wear many hats.  Patients always ask, How can I make my hands look younger? There isn’t really anything on the market yet, right?

Wrong.

There are 3 important steps for maintaining youthful hands.  Before we go there, a brief overview of why hands age.

Overview: Our hands may appear to age before the rest of us due to sun exposure, chemical exposure, wear and tear, and volume loss.  Hands bear the burden of constant heavy sun exposure throughout our lives, all year round.  Even in the winter, when most of us don’t wear sunscreen, your hands are getting sun while you carry groceries, push the stroller, or go for your run! Over the years, hands are also subjected to the thousands of chemicals that creep into our every day household and beauty products.  Whatever you’re applying to your body, no matter the area, your hands are sure to get exposed.  Finally, for purely anatomical reasons, hands age because there is little fat and subcutaneous tissue reserve.  Any volume loss in the hands, either of fat or muscle, exposes veins and tendons, which make hands appear old!

The 3 important steps for maintaining youthful hands are:

1) Strict sun protection. The more vigilant you are about keeping your hands out of the sun and wearing sunscreen, the better. Sunscreens containing zinc oxide or titanium dioxide, also known as physical blockers, are the best.  They don’t cause allergic reactions and they block all types of light, not just UVA and UVB.

2) Topical cosmeceuticals.  Start with vitamin C and vitamin A-derivatives, because they have great evidence behind them.  Vitamin C is an essential ingredient in collagen formation and also reduces hyperpigmentation or brown spots.  Vitamin A is an essential exfoliant with special sun protective benefits as well.  Finally, heparan sulfate is a building block for skin.  Look for these multi-taskers in your beauty products.  Some of our favorites include Skinceuticals Phloretin-CF, tretinoin 0.05% cream such as Refissa, and Sente’s Dermal Repair Cream containing heparan sulfate. For those of you who easily bruise on the hands, a great over-the-counter cream by Dermend contains retinol, vitamins K and B3, arnica and ceramides.  Dermend is more than just a bruising formula, it is great for prevention of bruising and keeping the thin skin around the hands and forearms protected!

3) Office-based treatments.  Fraxel laser, YAG laser, and IPL treatments are very effective at treating the brown spots that often develop on mature hands.  The recover for Fraxel and YAG are 5-7 days on average, and IPL has virtually no downtime.  In terms of camouflaging unwanted veins and tendons, Radiesse is an FDA-approved filler for the hands.  Results are instant and the recovery consists of 1-2 weeks of mild swelling. Patients return to work the very next day!

What you don’t already know about miraDry

miraDry is one of the few permanent solutions for underarm sweating, also known as Primary Axillary Hyperhidrosis.  Unlike medications (which have side effects) or Botox injections (which wear off), miraDry leads to permanent reduction in sweat.

miraDry is FDA approved and takes approximately 90 minutes in the office.  At our office, the entire procedure from start-to-finish is performed by the doctor.  During the consultation the doctor will inquire about your medical history and perform a special test called the Starch Iodine Test, to see where you are actually sweating.  Next, the underarm skin is numbed with local anesthesia; this is actually the most important step in the entire treatment since your comfort is our #1 priority.  Finally, you are ready to start the treatment.  Each armpit requires approximately 20-30 minutes treatment time, and you are able to lie on your back throughout.

Starch iodine test (purple=sweat)

Starch iodine test (purple=sweat)

Downtime varies but the average patient reports 3-5 days of mild soreness and swelling.  These are normal and temporary side effects, and are relieved with over-the-counter pain medication and frequent icing of the area.  Results are noticeable within 24-48 hours.  There are no hard restrictions after the treatment however we recommend that you rest for 12-24 hours.  It may be difficult to do upper body exercise for the week after the treatment, so if you’re an avid tennis player, for example, just make sure to schedule your treatment appropriately.

miraDry procedure uses a light handheld device that is placed directly on the skin and moved across the entire area, one pulse at a time

miraDry procedure uses a light handheld device that is placed directly on the skin and moved across the entire area, one pulse at a time

Hyperhidrosis is a diagnosable medical condition, and getting relief is possible with miraDry.  In our experience, both men and women respond well; men in particular are excited about the “cosmetic” aspect of doing something that feels good for themselves, yet still treating a medical condition.  By treating hyperhidrosis and all the stress, anxiety and embarassment that it can cause, miraDry addresses both medical and cosmetic concerns at once.

Runners and other athletes who feel that underarm sweating is a problem are also great candidates.  Dr. Williams, creator of The Runner Lift, has found that runners have distinct dermatologic needs, from medical to cosmetic.  Runners with hyperhidrosis do very well with miraDry and self-report significant improvements in their training and performance.

Finally, long-term data on miraDry shows that it also mildly reduces underarm hair.  Women with blonde or very light brown hairs who previously failed laser hair removal or who want to reduce underarm sweat are particularly great candidates, and the treatment can be tailored for them.

For more information, or to read actual patient reviews and testimonials about miraDry, check out the miraDry page on RealSelf.

Stop Sweating, part II

In my previous entry, we talked about the condition Primary Focal Hyperhidrosis, or basically, excessive sweating.  The 2 major misconceptions about this condition is that, first, it isn’t a real medical problem (fact: even insurance companies recognize this as a real disease), and, second, most people don’t realize just how many great treatments exist.  Here I discuss the major treatments for Primary Axillary Hyperhidrosis, or excessive underarm sweating:

1) Anti-perspirants: with an active ingredient of aluminum salt, these topical deodorants are considered “first line” up front therapy, meaning you should try them first; there are both over-the-counter and also prescription deodorants and both are affordable

How deodorant works

How deodorant works

2) Oral medication: the main class of medication for treating hyperhidrosis are the “anti-cholinergics” and include glycopyrrolate, oxybutynin, and others.  These drugs block acetylcholine from reaching receptors on the sweat glands, which normally directs the glands to sweat.  Because acetylcholine receptors are located in other areas on the body, there can be a range of side effects.  Therefore, these drugs are generally reserved for young, healthy patients with either generalized sweating in many areas of the body, or patients who already tried other therapies and failed.

Several new topical anti-cholinergics are in development, and thus far show great promise.  Notable among them is DRM04 (Dermira, Inc., Menlo Park, Calif.).

3) Botox: injections into the armpit or hands is performed every 3-6 months, depending on the patient and very well tolerated.  Downside is that the injections may be a bit painful, however this is really very temporary, and the results, while great, eventually wear off.  Prior to injections, we do a Starch Iodine Test, which tells us where the sweating is!

Starch iodine test (purple=sweat)

Starch iodine test (purple=sweat)

4) miraDry: a 90 minute office procedure that uses microwave energy to permanently shut down the sweat glands.  Overall one can expect 65-80% reduction in sweat, and approximately 20% reduction in odor (from experience).  Results are obvious after even 1 single session.  The device is FDA approved in adults age 18 and up, however there is good precedent for treating certain teenagers “off label” in my opinion.  More about miraDry in my next post!

****Other cool stuff: for more information on specialty garments, bedding, and even shoes for people who sweat a lot, see the Fan Faves section on the International Hyperhidrosis Society website

“Stop Wearing Black”

The new “Stop Wearing Black” campaign by the International Hyperhidrosis Society is really catchy and so very true.  How do we enable patients embarassed by excessive sweating to continue to live life as normal, when they are constantly physically reminded of their condition, especially during the summer?  The first step towards in treating any problem is know, first, that there are really effective treatment options.  Many people, doctors included, lack awareness that hyperhidrosis is a distinct medical condition, fortunately with many great treatments to boot.

Having trouble staying dry?

Having trouble staying dry?

Sweating is the body’s way of adapting to an increase in temperature, thus cooling off.  We don’t know why some people have an over-active sweat system (estimated at 3% of the population), but, in a nutshell, this is one of those cases where too much of a good thing, isn’t good anymore.  In 90% of the cases, the diagnosis of Primary Focal Hyperhidrosis is made (in the remaining 10%, sweating is considered a secondary problem due to another medical condition such as thyroid disease, for example).  Primary Focal Hyperhidrosis is a real condition, not a “cosmetic” one, with its own insurance code.

The following are the diagnostic criteria for Primary Focal Hyperhidrosis.  If you meet 2 or more criteria, then you probably have Primary Focal Hyperhidrosis:

  • Sweating occurs on both sides of the body almost equally
  • Excess sweat impairs your daily life
  • You experience at least one episode of excessive sweating weekly
  • The problem started before you turned 25
  • Some of your family members suffer from excessive sweating
  • You stop sweating when you’re asleep

For more on treatments, see my next entry!

 

European sunscreen that corrects DNA damage

Eryfotona Actinica is now available in our office for existing patients

Eryfotona Actinica is now available in our office for existing patients

We’re excited to carry this new sunscreen lotion that has not only sunscreen, but also enzymes that correct the DNA damage wrought by the sun, and even vitamin E, a powerful antioxidant.

Photolyase is a naturally occurring enzyme designed to reverse the specific DNA mutations caused by UV exposure.   This enzyme is found mainly in plants and algae, and they rely on it to correct DNA damage from the sun.  Human beings do not normally have this enzyme.

What You Need to Know to Manage Rosacea

Rosacea is a chronic condition affecting approximately 16 million Americans.  It is most common in women during their 30s, 40, and 50s, however both male and female patients of all ages can be affected.  Although it is a chronic condition with no permanent cure, the truth is that there are many lifestyle modifications that can majorly help rosacea get better.  In fact, the National Rosacea Society compiled a list of important dietary and lifestyle changes which we are posting here and hope you’ll find useful.  You probably already knew that alcohol and spicy foods are culprits in some patients, but did you know that fermented foods, cheese, vanilla and chocolate are also potential culprits?  Read on…

Did you know that there are lifestyle and dietary changes that can help your rosacea?

Did you know that there are lifestyle and dietary changes that can help your rosacea?

 

 

Your Butt Is Proof That You Should Wear Sunscreen

http://nymag.com/scienceofus/2016/06/your-butt-is-proof-that-you-should-wear-sunscreen.html

SculpSure Event!

girls-women-happy-sexy-53364

Join us for a live demo about SculpSure, next Tuesday, June 21st, from 4-7PM.  By RSVP only: 212-249-8118.

SculpSure Non-Invasive Body Contouring is:

  • FDA approved
  • Highly effective treatment for eliminating unwanted fat
  • Can be used on the flanks, abdomen, and other areas with unwanted fat
  • Non-surgical and non-invasive
  • No anesthesia
  • In most cases only one treatment is required
  • Treatments take 25 minutes
  • You can return to work and exercise immediately

SculpSure

UPDATE: SculpSure is the most exciting technology in the fat-melting aesthetic arena and we have been witnessing great results thus far. To hear one beauty editor’s experience getting the treatment herself, check out Elise Minton’s article in New Beauty

What are you waiting for?

Get your beach body today!

Get your beach body today!

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Summer Bodies Begin in Spring

Summer bodies begin in Spring

Summer bodies begin in Spring

INTRODUCING THE 25 MINUTE BODY CONTOURING TREATMENT

SculpSure is a breakthrough in light-based body contouring designed to reduce stubborn fat in problem areas such as the abdomen and love handles, helping you achieve a slimmer and natural looking appearance without surgery or downtime.  The procedure is noninvasive and FDA approved.

Even with diet and exercise, most people have stubborn pockets of fat that seem impossible to lose. SculpSure’s body contouring technology is able to target and destroy these fat cells in just 25 minutes without affecting the skin’s surface.

Over time, these damaged fat cells are naturally absorbed and removed from the body, with results seen as quickly as six weeks, and optimal results typically seen at 12 weeks. There is no recovery time following treatment, so you can resume your daily activities immediately.