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11 Reasons to Maintain Your Skin With Vivace Every Year

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THE SKIN IS AGING EVERYDAY Lack of medical-grade skin rejuvenation maintenance treatments year after year is one of the biggest pitfalls of patients who strive to prevent the aging process. All too often, we see patients who have over-estimated the effectiveness of drug-store or department store skincare products, or rely too heavily on superficial treatments like dermaplaning and facials. Underestimating the importance of aesthetic dermatology devices in one’s annual skincare plan can lead to undesirable outcomes such as negative body image, or early face-lifts accompanied by long periods of downtime and healing. Here are 11 science-based reasons to remember to re-treat your skin with Vivace every year: 1. Intrinsic aging. Our bodies are continuously undergoing intrinsic aging. Intrinsic aging is the aging caused by our internal biological clock. Age-related changes in our genetics and metabolism result in several changes in the skin, the most notable change being in the basal epidermis layer of the skin. The end result? Thin, dry skin, fine wrinkles, and gradual skin atrophy. A successful preventative aging regimen should include non-surgical rejuvenation on an annual basis to restore and maintain function of the basal epidermis. 2. Extrinsic aging. At the same time we’re undergoing intrinsic aging, our bodies also undergo extrinsic aging. In contrast with intrinsic aging which is unstoppable, extrinsic aging is caused by factors within our control such as lifestyle factors, individual behaviors, and our environment. Collectively, these factors can cause up to 80% of skin aging in the form of sagging, loss of elasticity, coarse wrinkles, and impaired blood flow. Radiofrequency therapies such as Vivace deliver heat at controlled depths to directly rebuild collagen, tighten skin, and rejuvenate blood and nutrient flow to the skin. 3. Air particulates. Soot, cooking fumes, motor vehicle traffic, and daily household chemicals cause daily chemical wear and tear on the skin that can result in skin aging, inflammation, irregular pigmentation, and inflammatory skin diseases. The Vivace technique combats these effects by using minimally invasive microneedles to achieve controlled dermal heat injury. The thermal injury results in destruction of old collagen bundles and initiates a wound healing response, essentially converting abnormal skin to normal skin. 4. UV radiation. Did you know UV light is classified as a complete carcinogen because it both mutates DNA and mutates it in a random fashion? In fact, UV light has properties of both a tumor initiator and a tumor promoter. Whether we spend a summer by the pool, or go on vacation, these UV effects can accumulate over time. This is why making non-surgical skin rejuvenation such as Vivace radiofrequency microneedling is an essential part of any annual skincare regimen. 5. Sugar intake. When we consume dessert, pastas, sweetened coffees and beverages, or pastries that result in a spike in blood sugar, glucose molecules attach themselves to collagen and elastin in the skin in a process called “glycation.” These toxic byproducts of sugar consumption cause clumping and stiffening of the skin fibers, decreased resistance to mechanical forces on the skin, impaired wound healing, and disturbances in the blood flow of the skin. Not to mention, accumulation of glycation in the body is also thought to contribute to neurodegenerative diseases, diabetes, cardiovascular disease, gut disorders, eye conditions like cataracts, and cancer. Some expert dermatologists believe that the combination of spikes in blood sugar plus sun exposure is a leading contributor to fine lines around the mouth (such as “lipstick” lines.) Since the average modern diet includes a high amount of sweetened foods and beverages, it is important to continuously combat the effects of glycation by repetitive stimulation of new collagen growth. 6. Dermal remodeling window. Dermal remodeling from any aesthetic device has a limited time window of action. Dermal remodeling slows down 6-12 months after each Vivace treatment. This means the elevated metabolic activity that generates new skin tissue only sustains for 6-12 months, depending on the individual, their lifestyle choices, and their skincare regimens. After that period, a repeat treatment must be done in order to continue the same elevated level of new skin activity. Patients often notice dulling or less radiance in their skin after about 6 months without Vivace. This is a signal that new skin production has slowed and the body has returned to it’s baseline. To keep the biological clock “turned back” and retain the same youthful skin production, the treatment can be repeated. 7. Gravity. Gravitational forces manifest themselves in the form of lowered brows, tear trough length and depth, eye bags, and nasolabial folds. It is believed that heat application from radiofrequency can target both the dermis and the deeper fibrous network below it to achieve increased collagen density, increased organization of collagen fibers, and increased elastin fibers. These results help to counter the effect of gravity with 3-dimensional  improvement in thickness, density, firmness and elasticity of the face. Microfocused ultrasound (Ultherapy) is also a powerful method of lifting against gravity. Because we use Botox primarily for its preventative abilities, the ideal patient can range in age from their 20s to 60s. By weakening muscles in the face, it is able to relax facial contractions so they cannot “bunch,” crease, or contort the skin. With continued use over time it can dramatically reduce the lines and wrinkles associated with aging. At this time in present history, there is no other substitute in the dermatology world that can prevent forehead lines, crows feet, bunny lines, or glabella lines as well as botulinum toxin. 8. Daily facial movements. Although Botox is the gold standard for relaxing facial movements that cause creasing and wrinkles over time, an anti-wrinkle regimen that is 100% dependent on Botox is usually not the most natural looking result. Vivace’s microneedle delivery mechanism inserts its pins directly into fine lines or coarse lines, where it can deposit heat that will re-align and reconstruct wrinkled or disorganized bundles of collagen. This allows patients to keep wrinkles at bay without completely removing normal facial movements. 9. “Inflamm-aging.” Inflammaging is a relatively new term coined to describe the aging

SkinPen Precision Gains FDA Approval for Neck Microneedling

 I am thrilled to announce that our own SkinPen Precision device was approved by the FDA to treat neck wrinkles a few weeks ago on April 12, 2021. WHAT DOES THIS MEAN? CONFIDENCE IN YOUR INVESTMENT Although microneedling has been performed on the neck for years, this means there is more clinical data than ever proving its results. This FDA approval signifies the culmination of years of research and thousands of patients who have received microneedling. Ultimately this means the consumer can rest easy knowing that their investment in neck microneedling using the SkinPen Precision is worth it. WHAT DID THE FDA APPROVE? SAFE FOR DEEP DEPTHS OF SKIN. The SkinPen Precision microneedling technology is safe for use with a depth of up to 2.5mm on the neck. This is the deepest setting of the SkinPen Precision which allows licensed clinicians to access the living layer of the skin. WHAT DO THE STUDIES SHOW? MOISTURIZE SKIN. WITHOUT MOISTURIZER. 94% of patients noticed an improvement in how their neck wrinkles looked 1 month post-procedure. This treatment can successfully be used to reduce neck crepiness and “tech neck” lines. Decreased epidermal water loss to the air. Skin was more hydrated and plump. Essentially, skin was more moisturized without using moisturizer.  Facial dermal density increased 101.86% Facial epidermal density increased 19.28% Facial elasticity increased 28.2% after 3 months. Collagen type III and elastin gene expression was higher 3 months after a series of 4 treatments. Blood flow decreased 25.8% in the face and 42.3% in the neck. This demonstrates increased oxygen levels in the tissue.  Total elastin remained unchanged, thus elastin-booting treatments like Neocutis Bio Serum Firm and Vivace are still needed to enhance elastin. (Subjects were 44-65 years old. Treatments were conducted 1 month apart. Biopsies were done before the first treatment, before the 4th treatment, and 3 months after the 4th treatment.) WHY IS MICRONEEDLING BETTER? PRESERVING THE EPIDERMIS IS KEY. Ablative techniques like laser and dermabrasions run a high risk of discoloration because they cause lots of damage to the epidermal layer of skin where the melanin-producing cells reside. Stripping the epidermis = high risk of scarring and irregular pigmentation. Microneedling is a minimally invasive alternative that triggers new skin formation while preserving the valuable epidermis.  LESS DOWNTIME, REDUCED SIDE EFFECTS Removing the epidermis also leads to prolonged healing, downtime, and increased risk of infection.  While ablative techniques have been used over the past 30 years, we now have a better solution with microneedling. SAFER FOR SUMMER MONTHS Skincare lovers know sun and dermatology treatments often don’t mix well. However, since microneedling preserves most of the epidermis, patients can still receive microneedling treatments safely during the hot, sunny summer months because of the mild side effect profile. Of course, SPF and hats will still be required for 30 days after the procedure while outdoors. WHAT SHOULD PATIENTS EXPECT? HIGH PATIENT SATISFACTION Over 90% of patients noticed an improvement in how their neck appearance 1 month post-procedure QUICK RESULTS 88% of patients were pleased with ther treatment 1 month post-procedure.  FAST RECOVERY Ability to recover quickly, even during the summer months. Epidermis is left intact, Pro tip: Add-on Vivace sheet masks, Biopelle Tensage ampoules, and PRP to accelerate recovery further. TAP HERE TO RECEIVE A SPECIAL DISCOUNT ON MICRONEEDLING AT SLK TODAY.

Sugarbear Hair: Fact Or Fiction?

If every influencer on Instagram is a spokesperson for SugarBear Hair vitamins, they must truly work, right? Well, the truth about the vitamin and supplement industry is that they don’t require FDA approval for any of their products. This allows companies like SugarBearHair to take quite a bit of liberty in marketing their health claims. At SLK, we don’t take any skin or hair advice unless it’s backed by science, so let’s do a scientific breakdown of the ingredient list: VITAMIN B6 – FICTION Vitamin B6 is known to improve hair growth when it is injected, but unfortunately there is no scientific evidence demonstrating any effect with oral administration. VITAMIN B12 – FICTION Deficiency of B12 can result in hair loss but this type of hair loss only occurs in vegetarian populations, those with gastrointestinal conditions, or malnourished populations. If you have a B12 deficiency, you should take a true b12 supplement and SugarBear hair supplements should not serve as a substitute. VITAMIN A – FICTION This ingredient is a real headscratcher for us. Not only is Vitamin A deficiency not an established cause of hair loss, but excess intake of Vitamin A is actually known to cause hair loss (and dry skin too). Additionally, beta-carotene (the food form of vitamin A – your body converts this precursor into Vitamin A in the digestive tract) supplementation may increase mortality from cardiovascular disease and may increase the risk of lung cancer in some people. Anyone living in an industrialized country like the US receives plenty of Vitamin A just by eating a couple meals a day, so we are really not sure why anyone would find the need to supplement this. If a nutraceutical company must use Vitamin A as an ingredient, no more than 2500 international units of Vitamin A is recommended. We will give SugarBear credit for staying within these guidelines – a single serving of bears only contains 2100 IU. So although it is not beneficial, this dose is not harmful either. FOLIC ACID – FICTION Again, we are not sure why this is included as an ingredient. There is already a considerable amount of folic acid in the diet as it is found in leafy greens and fortified grains. If you are eating a normal diet, extra folic acid will not change anything about your hair. VITAMIN C – FICTION There is some promising data showing Vitamin C promotes hair growth, but only when it is applied topically. There is no evidence showing it has any effect in any oral or gummy bear form. We also noticed a strange claim on SugarBear’s website that “a study found in the Journal of Clinical and Aesthetic Dermatology references the use of Vitamin C to improve hair growth.” Well, that study happens to belong to their competitor, Viviscal®, which is a supplement that consists of shark and mollusk powder, silica, and vitamin C. Viviscal’s study actually shows some nice data demonstrating improved hair growth. So all we can conclude here is that maybe we should just buy Viviscal so we can reap the added benefits of shark and mollusk powder. VITAMIN B5 – FICTION Vitamin B5 deficiency is exceptionally rare, only seen in starvation. Again, if you are eating a normal diet, supplemental Vitamin B5 will not change anything about your hair. VITAMIN E – FACT Data is scarce, but oral supplementation with Vitamin E has been shown to increase hair growth upwards of 50%. It is thought that Vitamin E’s potent antioxidant properties reduce oxidative stress in the scalp which is a known cause of hair loss. There are 8 compounds in the Vitamin E family and SugarBear chooses to use “dI-alpha tocopheryl acetate.” however we would prefer to see “tocotrienol” used as an ingredient. It is considered to be more efficacious than tocopheryl acetate because its structure allows for better distribution in the fatty layers of the cell membrane. BIOTIN – FICTION This is one of the most common ingredients in many hair, nail, and skin supplements. But the truth is, we already receive all the biotin our body needs (35–70 MG/day) naturally in our diets by consuming foods like spinach, tomatoes, eggs, dairy, and more. Plus your intestinal bacteria produce biotin for you too. Thus, biotin only needs to be supplemented when someone has a clinical (read: you had your blood tested and your levels are low) biotin deficiency, which only exists under conditions of extreme poverty and malnutrition, or in people with serious illnesses affecting the gut such as alcoholism or inflammatory bowel disease. Symptoms of biotin deficiency besides hair loss include numbness and tingling in the extremities, hallucinations, and red rashes around the eyes, nose, and mouth. So unless you have a recent history of digestive illness or malnutrition, plus some of these other symptoms, you probably have plenty of biotin. There is good evidence, however, that even if you do not have a biotin deficiency, biotin supplements can improve brittle fingernails if this is an issue for you. SO IN SUMMARY, DO SUGARBEAR HAIR REALLY GUMMIES WORK? Yes, it’s possible these gummies are effective due to the presence of Vitamin E, the only ingredient with any “Fact” behind it. However we conclude there is no scientific basis for any of the other ingredients. Is it worth the price-tag though? You be the judge!

Fall’s Must Have Skin Treatment: Revepeel Enlighten Mask

WHAT IS THE BEST TREATMENT FOR YOUR SKIN IN THE FALL? One of the top skincare concerns we try to address immediately following the end of summer is the brown pigment that accumulates during the sunny months. Deposited in the form of freckles, sun spots and darkening of melasma, these stubborn brown stains will take years to fade on their own without proper treatment. The production of melanin (brown pigment) is easily stimulated by sunlight, thus as soon as the cooler months arrive and patients are spending more time indoors and wearing longer clothing, this gives us an opportune window of time to begin reviving your skin’s natural even skin tone. THE BEST TREATMENT FOR DARK SPOTS ON THE FACE Unlike lasers or photofacials that remove pigment from the skin’s surface but do not address melanin production at its root cause, at SLK we use the revolutionary Revepeel Enlighten Mask to deeply penetrate the skin with skin-brightening ingredients which paralyze the production of melanin for a long period of time. The Enlighten Mask formula contains 6 bioactive skin-lightening ingredients including hydroquinone, retinol, kojic acid, arbutin, niacinamide and an oil-based form of Vitamin C that penetrates much deeper than your typical Vitamin C serum. Normally a patient would have to buy 4 or 5 different skincare products to obtain all of these ingredients but Revepeel Enlighten Mask allows us to deliver clinically-effective doses of all these ingredients in just a 30 minute appointment. ANTI-AGING BENEFITS Not only does the Enlighten Mask address pigmentation concerns, but because it also contains peeling ingredients, patients also receive the benefits of your typical peel such as soothing acne blemishes, shrinking pores, and smoothing fine lines and wrinkles. Collagen production will be elevated over the next 3 months. HOW DOES THE REVEPEEL ENLIGHTEN MASK WORK? Since the Enlighten Mask contains prescription-strength concentrations of active ingredients, the Mask can only be obtained at a nurse practitioner or doctor’s office. The nurse applies a thick putty-like substance to the skin and spreads it over the face similar to a mask. The patient then wears the mask for several hours then rinses it off at home. The peeling process occurs for 3-4 days. It is not a sheet peel, but more of a light shedding. This mask-peel has absolutely zero pain. Dramatically noticeable results will be seen in 1 week and full results in 1 month.  BEST TIME TO SCHEDULE THE REVEPEEL ENLIGHTEN MASK Anytime preceding time out of the sun for 1 month is a great time to receive the Enlighten mask. Click here to meet with our staff to determine if you are a good candidate for Enlighten Mask!

What Is The Best Device For Laser Hair Removal?

There are many laser hair removal devices on the market. With so many options, how do you find the right laser removal device for you? Below is an in depth discussion of the five most common types of hair removal systems: Ruby, IPL, Alexandrite, Diode, and Nd: YAG. 1. Ruby (694 nm) The Ruby laser is the first laser hair removal system brought to market. Due to the age of the Ruby laser, there is significant research available to support its efficacy. However, many providers consider the Ruby laser outdated, (it was developed in 1960), and opt for more current laser systems because the laser has not been significantly updated since the initial release. The Ruby laser emits a red-colored beam and produces a shorter wavelength of 694 nm that targets melanin (brown pigment) found in hair follicle. The Ruby works best on pale skin and dark hair. This laser is not effective on lighter hair (blonde, red or grey). Due to high melanin (skin pigment) laser absorption rate, Ruby is not safe to use on darker skin types because it can cause dyspigmentation. The ruby also has a slow repetition meaning laser treatments require significantly longer treatment times than other hair removal systems. As a result the Ruby laser is suited for small areas of skin only.  Pros: Many decades of safety data. Cons: Can only be used on pale skin. Treatment time is very long so can only treat tiny areas. Inexpensive because device is older. Common Ruby Devices: EpiPulse Ruby, Palomar, RubyStar 2. IPL IPL stands for “intense pulsed light”. Although IPL is not technically a laser, it is frequently used in aesthetics to remove unwanted hair. This device uses an intense, visible, broad-spectrum pulse or flash of light. IPL, like a laser, targets melanin in the hair to cause destruction to the follicle. IPL shares some similarities with laser treatments in that they both use light to heat to damage their targets. Good candidates for IPL hair removal have pale skin and dark hair. IPL is not safe on tan skin because it uses broad spectrum light which targets all types of structures in the skin, unlike laser which is ultra-focused on concentrating heat in the follicles. IPL also has a slow coverage rate and a bulky handpiece, so it is rarely used for hair removal. However, it remains a popular and effective device for removal of brown spots and facial redness. Pros: Very common device found in almost every dermatology office. Removes freckles and brown spots. Inexpensive. Cons: Does not use a laser beam and heat can damage other structures in the skin besides the hair follicle. Cannot be used on anyone tan or darker. Bulky handpiece with patchy results. Common IPL Devices: Aculight, Epilight, PhotoDerm, Quantum, Vasculight, Alma 3. Alexandrite (755 nm) The Alexandrite laser hair removal system is the most frequently used laser on the market because it is so quick and extremely effective. Alexandrite (“Alex” for short) can provide quick treatments on large body surface areas due to fast laser pulse repetition rates and larger treatment spot sizes. The Alex is most effective and safest on patients with light to olive-colored skin because of how well the laser targets brown pigment. The pulses of the laser are rapid, which may create slightly more discomfort for the patient but it is still very popular because treatment times are much quicker. Newer Alexandrite devices have built in cooling systems to reduce discomfort and improve the patient experience. Unfortunately, due to the strength of the laser against brown colors, the Alexandrite laser cannot be used on dark skin tones because it will cause burns, dyspigmentation, and scarring.  Pros: Ultra-efficient at removing hair. Rapid repitition rate with quick treatment times. Painless. Cons: Latest technology means more expensive. Common Alexandrite Devices: Candela GentleLase, EpiTouch Plus, Cynosure Apogee, Deka Motus Ax 4. Diode (810 nm) The FDA (Food and Drug Administration) has approved two wavelengths that may be used for laser hair reduction on darker skin tones including the diode (810 nm) and Nd: YAG (1064 nm) laser systems. The Diode laser is a newer laser hair removal system meaning there is less research available to show long-term safety and effectiveness. The Diode produces wavelengths that penetrate deep into the hair follicle. Deep laser penetration is safer on darker skin types because the energy produced by the laser is not able to concentrate where pigment resides in the skin.  Common Diode Devices: Apex, Epistar, F1 Diode, LaserLite, LightSheer, MeDioStar, SLP, SopranoXL 5. Nd: YAG Laser (1064 nm) The longer wavelength Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) laser is the newest form of laser hair removal and is considered ideal gold standard for treating patients with darker skin, due to reduced scatter and deeper penetration of the laser light. Nd: Yag lasers produce wavelengths that penetrate deep into the hair follicle. YAG laser penetration is safer on darker skin types because the energy produced by the laser is not able to concentrate where pigment resides in the skin. Also, shorter pulse durations can be used more safely with Nd: YAG laser than with the diode. This is an additional advantage when dealing with hair that is more fine. Shorter pulse durations allow for quick treatments on large areas of the body.  Pros: The safest laser for hair removal, ever. Rapid repitition rate with quick treatment times. The dermatology community agrees this is the best, safest laser for all patients with tan or darker skin. Cons: Latest technology means more expensive. Popular Nd: YAG Devices: Cynosure Elite, Candela, Cutera Excel, GentleYAG, Lyra, Medlite IV, Sciton  Laser Hair Removal At SLK Clinic At SLK Clinic we have hand selected the Candela Gentlemax Pro laser system for our laser hair removal treatments. This unique laser system contains two separate laser devices considered the gold standard for treating both light and dark skin tones, the Alexandrite (755 nm) and Nd: YAG (1064 nm). The Candela Gentlemax Pro treats all skin types quickly, comfortably and effectively. The laser system also utilizes a dynamic

How SLK Generates PRP

SLK’S PRP PURIFICATION PROCEDURE, STEP-BY-STEP There is a ton of variability in how different clinics harvest and purify their PRP. At SLK, we don’t just buy a PRP system and follow a cookie-cutter recipe, we spend a LOT of time researching and studying the best ways to purify your platelets so that they have the highest viability and efficacy. That said, we wanted to share with our patients our process for generating PRP so they can become better informed about the PRP process. At SLK we use the following method to purify our PRP because it has proven to be the best method for eliminating inflammatory red blood cells and white blood cells. Failure to eliminate red blood cells during the PRP purification process may result in inflammation, cell death, free radical formation and impaired healing. Presence of white blood cells will also lead to inflammation, free radicals, tissue damage and impaired healing. STEP 1: GEL SEPARATION A collection tube containing a physical gel separator is obtained. This is a key step in ensuring platelets rise to the top of the tube, while larger inflammatory cells like granulocytes and red blood cells are filtered to the bottom of the tube. Many clinics use PRP systems without gel separators but we find it is critical to ensuring plasma quality. STEP 2: BLOOD DRAW A SLK nurse or nurse practitioner with many years of phlebotomy experience draws the blood into the collection tube. The collection tube is pH balanced so the PRP does not produce a burning sensation when injected into the patient’s skin. STEP 3: CENTRIFUGATION The collection tube is then placed into a centrifuge where it is spun for several minutes to separate the plasma from the red blood cells.  STEP 4: SEPARATION INTO LAYERS The nurse removes the collection tube from the centrifuge. The red and white blood cells are now located below the gel separator so they cannot contaminate the upper layer of plasma. The plasma layer is now yellow or straw-colored. This matrix provides a scaffold to keep platelets in place and to support prolonged growth factor release, resulting in prolonged stem cell activation. The PRP remains liquid for approximately 10 minutes before forming the matrix. STEP 7: INJECTION The platelet-rich plasma is now ready for injection. Small needles or cannulas will be used to inject the PRP into the subdermal layer of skin where the platelets may now release significant levels of growth factors while being securely retained in the fibrin matrix.

Hyperpigmentation Part III: 3 Dermatology Procedures That Eliminate Dark Spots

Jennifer Stieber Our last post (Hyperpigmentation Part II) focused on prescription creams that reduce dark spots. Although these creams are extremely effective, they do take months to see final results. To accelerate dark spot removal, we can turn to elective in-office procedures. 1.IPL IPL stands for Intense Pulsed Light. It is often referred to as a laser, which is a misnomer, since IPL uses bright flash lamps, rather than isolated beams of laser light. IPL is very effective at removing brown spots like freckles and sun spots, however it is not safe for anyone with tan skin because the device cannot differentiate between the melanin in a dark spot and the baseline melanin that makes up someone’s skin color. Due to this limitation, many offices have shied away from using IPL in recent years, or sold off their devices. 2. PEELS: Whereas topical therapies such as retinoid creams can be very slow-acting, chemical peels rapidly lift all types of hyperpigmentation in a matter of days, including freckles, sun spots, melasma, and post-inflammatory hyperpigmentation from acne scars. Chemical peels can also be tailored to be safe on all skin colors, and they can be used all over the body- including the chest, arms, legs, and back. Unlike IPL which is better for “spot treatments” and cannot evenly treat large areas of skin, chemical peels can be spread evenly over large stretches of skin. It is important to recognize, however, that the results of peels completely depend on the frequency and quality of topical skincare (See our past posts for more on this) used before and after treatment. If your provider does not have a thorough discussion with you about pre-care and after-care, this is probably a red-flag that they do not have a deep knowledge of how the peeling process works. Peels also have the added benefit of inducing the repair mechanisms of the epidermis and dermis, resulting in brighter, thicker, more overall glowing skin. Our favorite Peel is Revepeel because it is the safest for all skin colors. ViPeel is another effective, commonly used peel. 3. MICRONEEDLING. Although chemical peels and IPL have been in use for decades, only recently has microneedling been studied as a way to remove pigmentation. About 6 clinical studies since 2011 have shown the benefits of microneedling, and that these benefits are augmented when used in conjunction with excellent pre-care and after-care, or when alternated with chemical peels. In particular, microneedling is a very safe technique for dark skin types, where risk of side effects is very high with techniques that are light or laser-based. Some of the most commonly used microneedling devices include: MDPen, Skin Stylus, and Skin Pen.

Hyperpigmentation Part I: 3 Over-The-Counter Ingredients That Are Clicinally Proven To Reduce Unwanted Dark Spots

HOW TO TREAT HYPERPIGMENTATION FROM SUN, SCARS, AND HORMONES Melanin, the brown molecule that gives skin its tan color, plays an important role in protecting our DNA from the harmful effects of UV sun radiation. However, it tends to accumulate over the summer months, often in the unwanted form of sunspots or freckles, and it can even darken pre-existing skin conditions like melasma or hyperpigmented acne scars. Without treatment, these dark spots may take months to years to resolve. Read on to learn 3 nurse-recommended over-the-counter ingredients to look for on skincare labels. A NOTE ON HYPERPIGMENTATION Before we discuss the following 3 ingredients, it is important to note that hyperpigmentation is one of the most complex and stubborn conditions to treat in aesthetic dermatology, sometimes requiring several adjustments to the treatment plan. Thus, if over-the-counter therapy doesn’t appear to be working for you (which is common), you should begin a patient-provider relationship with a licensed professional who can review your progress every 1-3 months. 1. KOJIC ACID Kojic acid is one of the most effective over-the-counter skin-brightening ingredients on the market. This molecule was first isolated in Japan from steamed fermented rice (called “Koji” in Japanese.) Clinical studies have shown that kojic acid acts by inhibiting the principal enzyme in melanin synthesis. This action is the same as that of hydroquinone, the gold standard in prescription-grade hyperpigmentation therapy (see our “Hyperpigmentation Part II” post for more thoughts on hydroquinone). While kojic acid has long been the most popular skincare ingredient in Eastern Asia for treating melasma, it has more recently gained popularity in the US for all types of pigmentary conditions. It is important to note is that kojic acid has been known to cause skin sensitivity in some individuals, and should be decreased or discontinued if redness or irritation occur. 2. NIACINAMIDE Clinical trials using 2% niacinamide have shown that it significantly reduces the total size of hyperpigmented areas and lightens baseline skin color after 4 weeks of treatment. Niacinamide’s action is to block the transfer of melanin from the base skin layer where it is synthesized by the body, to the superficial layer that gives us our skin color. Niacinamide also has anti-inflammatory properties, prevents water-loss from the skin, and is very stable in formulation, so overall it is considered very useful by skincare chemists and can be found in a wide array of cosmeceuticals. 3. LICORICE EXTRACT Licorice extracts, derived from the roots of licorice plants, are the safest over-the-counter pigment-lightening agents with the fewest side effects. The active agents in licorice extract are known as glabridin and liquiritin. Glabridin acts similarly to kojic acid, in that it inhibits the principal enzyme in melanin synthesis, and liquiritin facilitates dispersal and removal of melanin by the body. Additionally, licorice extract has anti-inflammatory properties which aid in reducing any redness or irritation. Tatcha Deep Brightening Serum containing licorice extract-$185.00 These 3 ingredients are all well-studied with superb safety profiles, hence why they are all available over-the-counter at your local sephora or department store. However, these ingredients cannot be compared to prescription grade ingredients which are by far the most clinically-effective at reducing pigmentation. See our next blog post for part 2 of 3 on hyperpigmentation: “3 of the Best Prescription-Strength Dark Spot Creams According to a Nurse”. DISCLAIMER : THIS CONTENT IS FOR INFORMATIONAL PURPOSES ONLY AND IS SOLELY THE OPINION OF JENNIFER STIEBER, NP WHICH MAY DIFFER FROM THE OPINION OF OTHER HEALTHCARE PROFESSIONALS. IT SHOULD NOT BE USED AS A SUBSTITUTE FOR PROFSSIONAL DIAGNOSIS OR TREATMENT.

Hyperpigmentation Part II: 3 Of The Best Prescription-Strength Treatment Creams According To A Nurse

1. HYDROQUINONE Hydroquinone is the gold standard for treating hyperpigmentation in dermatology. Its effectiveness and safety is so well-documented in clinical studies that almost all dermatology providers will recommend 4% hydroquinone as a first step for anyone with significant pigment concerns. This ingredient works by interrupting the same step of melanin synthesis that kojic acid and licorice extract do (2 ingredients mentioned in our previous blog post: Hyperpigmentation Part 1) however on a much more significant, medical-grade scale. It is important that anyone using hydroquinone consult regularly with a nurse practitioner or physician, because very rare cases of overuse or misuse have resulted in unsightly side effects. Oftentimes, your nurse practitioner will schedule you for a “hydroquinone vacation” during which you take time-off from using the drug. 2. RETINOIDS Retinoids like tretinoin, tazarotene, and adapalene, are powerful synthetic versions of retinol which is a naturally-occurring vitamin that plays a role in maintaining many organs in the human body, including the skin. Numerous clinical studies have shown that when applied to the skin, retinoids are very successful at reducing freckles and sun spots. The effectiveness of retinoids results from their ability to interrupt multiple steps of melanin production. Furthermore, retinoids are an excellent choice for treating hyperpigmentation because they increase skin cell turnover and shedding, allowing for greater penetration of other active melanin-suppressing ingredients like hydroquinone. Although there are a handful of FDA-approved retinoids on the market, the most studied and well-vetted of all is tretinoin, which is why it is the prescription retinoid cream of choice for many dermatology providers. Topical over-the-counter retinol is also effective, however these formulations are not as stable and have a short shelf-life. 3. TRI-LUMA Now that we’ve discussed retinoids and hydroquinone, this brings us to another favorite tool amongst dermatology providers, Tri-Luma, a combination cream of hydroquinone, tretinoin, plus a small dose of fluocinolone which is a steroid anti-inflammatory. As we mentioned above, retinoids like tretinoin have the ability to act as a penetration-enhancer, augmenting the effectiveness of hydroquinone. Although this combo is quite powerful, both tretinoin and hydroquinone have the undesirable side effects of redness, irritation, and dryness. This is why the added anti-inflammatory is important – it counters these unwanted side effects, increasing patient comfort and convenience. Even with the use of prescription-strength creams, improvements in pigmentation can take months, and not all pigmentation will always resolve. For more rapid improvement, in-office elective dermatology procedures are a wonderful supplement to any topical therapy. In fact, when high quality topicals are used in conjunction with procedures like chemical peels or microneedling (discussed in our next blog post Hyperpigmentation Part III), dramatic improvements in pigmentation can successfully be achieved. DISCLAIMER : THIS CONTENT IS FOR INFORMATIONAL PURPOSES ONLY AND IS SOLELY THE OPINION OF JENNIFER STIEBER, NP WHICH MAY DIFFER FROM THE OPINION OF OTHER HEALTHCARE PROFESSIONALS. IT SHOULD NOT BE USED AS A SUBSTITUTE FOR PROFSSIONAL DIAGNOSIS OR TREATMENT.

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