Emsella Pelvic Floor Strengthening

The EMSELLA is a new treatment that uses magnetic energy to strengthen the pelvic floor muscles, all while you’re fully clothed.  This energy, commonly referred to as HIFEM (High Intensity Focused Electromagnetic), stimulates contractions of the muscles around the pelvic floor; like doing Kegels without any effort.  One 28 minute session will cause 11,200 contractions, the equivalent of performing 11,200 Kegel exercises.  HIFEM has been around for a few decades and has also been used to cause muscle contractions in other body areas. Read more

Welcoming the Spring

Even though Spring is here, temperatures are still fluctuating and it’s cold outside. Check out this article about weather changes. Since you will be spending more time outdoors, just a friendly reminder to use sun protection.

All Natural Hair Loss Treatment

We are pleased to offer PRP Injections for Hair Loss.  PRP is a perfect, all natural procedure for anyone looking for thicker, healthier hair.


PRP stands for platelet-rich plasma.  Platelets are the cells that help you stop bleeding when you scrape or cut yourself, but they are also rich in many growth factors, including: platelet-derived growth factor, transforming growth factor, and vascular endothelial growth factor.

Since platelets release many important factors, they have been used to treat joint problems, and now hair loss as well.  PRP has been shown to benefit patients with a variety of hair loss sub-types, including androgenic alopecia (also known as “male” or “female” pattern hair loss).

The best part about PRP is that it is all-natural, as it comes from your own blood.

PRP promotes hair growth via 2 pathways:

  1. encouraging new blood vessels (angiogenesis)
  2. encouraging hair follicles to enter and extend the duration of the anagen phase (the growth phase)


Studies show that PRP injections may even be as effective, if not more effective, than Rogaine (minoxidil 5%) at stimulating hair regrowth, in certain types of hair loss (El Taieb et al, 2016).

After we draw blood into a tube, it is spun in a centrifuge machine, and the platelets can be removed.

after drawing your blood, the sample is spun in a centrifuge machine, causing the platelets to collect at the top (yellow) and rest of blood to sink to the bottom (red)

after drawing your blood, the sample if spun in a centrifuge machine, causing the platelets to collect at the top (yellow) and rest of blood to sink to the bottom (red)

In our office we follow a protocol that consists of 4 monthly visits, and then maintenance.

Because it is all natural, there are no concerns about side effects with PRP.  Just make sure to stop any vitamins, fish oil, or pain relievers 1 week before, as they can cause bruising.

To schedule your PRP treatment, call (212) 249-8118.

Skin Cancer Take A Hike!

Patagonia here I come

Patagonia here I come

You may have heard that one in five Americans will develop skin cancer. But did you know that when caught early, skin cancer has a 98% cure rate! That’s why raising awareness about skin cancer prevention and detection is so important to the American Academy of Dermatology (AAD) and its members. It’s also why I’m participating in the SKIN CANCER TAKE A HIKE event.

Please support my efforts: http://events.aad.org/goto/diane

Your donation to my hike will help the AAD:

  • provide free skin cancer screenings for more people across the country,
  • offer free resources to help teach kids and others how to protect their skin,
  • build permanent shade for outdoor community and play areas, and more.

Your donation will help save lives! Our goal is a world without skin cancer…and we need your help to get there.




Good luck to all the NYC marathoners… 3 tips for you!


Good luck to all of our patients and friends who are running in the TCS NYC Marathon on November 6th.  We are rooting for you!

An estimated 20% of people will develop skin cancer at some point in their lives.  Studies show that marathoners have a higher exposure levels to ultraviolet radiation and pollution, all of which contribute to skin aging, brown spots, and skin cancer.  Protect yourself!  Here are some steps that you can take to protect yourself on the big day:

1) Look for a sunscreen that has SPF 30 or higher, is water resistant, and offers broad-spectrum (UVA/UVB) protection.  Both UVA and UVB are implicated in skin cancer.  Dr. Madfes and Dr. Williams both highly recommend the ELTA brand because their line of sunscreens are often also very moisturizing.  Dr. Williams recommends that patients layer a lotion first, and then use a spray for touch ups every 2 hours. Coppertone Sport spray and Coppertone Sport face stick are 2 other favorites.

2) For your face, try a brush on powder sunscreen for a second layer of protection and to set the sunscreen. We like this product from BrushOnBlock and this one from Colorscience.

3) Never underestimate the power of physical blocks via clothing, shades, and garments.

We hope you find these tops helpful.  Check out 26 more awesomely helpful tips brought to you by Runner’s World.


Dr. Williams lectures at HAPPI Anti-Aging Conference

Dr. Williams lectures at the HAPPI Anti-Aging Conference; from L-R: Navin Geria (course director), Dr. Robb Akridge (founder and CEO Clarisonic), and Ms. Raqiyya Pippins

On September 20th, Dr. Williams spoke at the HAPPI Anti-Aging Conference in New Brunswick about the molecular mechanisms of skin aging.   Some of the highlights from her talk include:

1) Skin aging reflects global aging, and skin aging the same way other organs do.  Because skin is so visible these aging changes are readily apparent, sometimes to our chagrin.

The many faces of skin aging

The many faces of skin aging

2) Skin aging may be broken down into 2 categories: intrinsic aging and extrinsic aging.  Intrinsic aging is a function of the passage of time; also known as chronological aging.  Extrinsic aging is the result of environment and lifestyle, and includes sun exposure, smoking, pollution, etc.  Dr. Williams emphasized that the sun is a major carcinogen and “age accelerator.”

3) Skin aging is more than just wrinkles.  As we age, skin starts to thin, sag, and can hyperpigment. There is loss of subcutaneous fat, and therefore skin can bruise more easily.  Skin gets dehydrated, and therefore prone to eczema (dryness, cracking). Eczematous skin is prone to infection and does not heal well after any trauma, etc.

4) On a molecular level there are several theories of aging that all work in tandem:

genetic mutations

telomere shortening

mitochondrial DNA mutations

free radicals


5) All of the above lead to Cellular Senescence.  Senescent cells are cells that are no longer replicating.  When skin cells become senescent they stop replicating, hence skin ages.  A common misconception is that senescent cells are resting, and not active.  To the contrary, Dr. Williams talked about the “Senescence Associated Secretory Phenotype” which is a mixture of pro-inflammatory molecules that these “resting” cells are very busy making.  All these cytokines lead to chronic inflammation, which has harmful effects.

6) Diabetics have accelerated skin aging.  Under the microscope their collagen bundles are all disorganized!

Normal collagen bundles (left) versus diabetic collagen bundles which are disorganized and nicked (right)

Normal collagen bundles (left) versus diabetic collagen bundles which are disorganized and nicked (right)

This may be due to the high amount of Advanced Glycation End Products.  AGEs are the result of glucose bonding to other molecules such as proteins.  AGEs are destructive to cells.  They can cause mutations, block normal functions, and lead to wrinkling and hyperpigmentation.  Maintaining normal blood sugar levels, and avoiding diabetes, is a major anti-aging action!

7) Lastly, Dr. Williams turned the audience’s attention to the importance of FAT in looking youthful.  The face is fat pads that form an important cushion for the soft tissue envelope.  As we age we lose facial fat.  This causes hollowing and shadows.  In addition, patients with low BMIs who are malnourished lose a lot of fat in their faces.  This causes an aged look.

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?


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!