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Living in rainy Pacific Northwest deprives the body of the essential Vitamin D. Besides bone health Vitamin D also plays a major role in skin health as it contributes to cell metabolism and growth and lessens itching and flaky skin. While creams and supplements can fight Vitamin D shortages, they can also cause toxicity if the dosages are not monitored carefully while they can be ineffective if taken in moderate dosages. Since Vitamin D is best produced in the skin by exposure to the sun, many of us Seattleites try to compensate for the lack of sun exposure by going to tanning beds with UVA and UVB rays. We all know that excessive tanning can lead to skin damage or even skin cancer. How do we then, make up for the lack of Vitamin D that is essential to keeping our skin looking healthy without risking aging it? That is quite a quandary.

The outer most layer of the skin is called the epidermis. Vitamin D3 is produced in the deeper layers of the skin as a result of the pre-vitamin D3 ‘s exposure to the sun’s UVB rays. UVB rays do not penetrate the skin past the epidermis layer but UVA rays do. Since most sunscreens on the market protect only against UVB rays, it is essential to find ones that protect from UVA like sun blocks with zinc oxide. So if you expose yourself to the sun or in the case of us, Seattle folks, to the tanning beds WITH MODESTY while using the right sun block, then you should be able to compensate for the lack of Vitamin D without damaging your skin with wrinkles and spots. Again I emphasize “WITH MODESTY”.

Katy Issa

Obesity in both men and women can cause multiple illnesses including heart disease and cancer. Few people, however, think of skin problems when it comes to obesity. Obesity results in extra folds of skin that may be difficult to disinfect and keep clean. That in turn can make the skin an ideal host for bacteria and fungi. Resistances to insulin as well as vein problems are two other issues that result from obesity which can affect the skin negatively.

Obese people tend to develop a skin condition called Acanthosis Nigricans, a skin disorder that results in brown and black spots. This is mainly due to the increased insulin levels. The discoloration normally appears under the arms, on the neck and sometimes in the groin area.

Another skin condition related to obesity is folliculitis. It is normally due to small whiteheads around one or more of the hair follicles on the skin. Obese people are at risk for folliculitis because the extra weight puts added pressure on the hair follicles, which can damage them and allow infection to occur.

Skin tags are yet another skin problem resulting from obesity. Skin can grow and stick out and may be connected with a narrow stock. Skin tags are benign and usually do not cause any pain. They are, however, more common in overweight people because the extra weight causes friction between the affected areas of skin.

One obvious and major issue of the skin related to being overweight is cellulite. Cellulitis is not only a cosmetic issue that causes undesirable stretch marks. It also causes infection of the skin that is caused by bacteria. Cellulitis can cause chronic pain and tenderness in the affected area, as well as excessive sweating and muscle aches.

Few people know that Obesity can be the cause of enlarged varicose veins. These veins will be raised above the skin’s surface. They are more common on the inside of the legs and backs of the calves. If the valves of a vein are weak due to obesity, blood leaks back into the vein and collects in a pool. The pooling of blood in the vein causes the vein to become enlarged. Not only varicose veins are aesthetically undesirable, they can also cause other vascular health problems.

In summary, if you are suffering from weight problems, you most likely have skin problems as well. While major health concerns such as cardio and heart problems should top your agenda, it is highly recommended that you also seek help from your local dermatologist or skin clinic to address any skin issues. A healthy lifestyle comprised of a balanced diet and exercise should lead to weight loss and in turn reverse some of the skin problems.

Katy Issa

1) Don’t over moisturize but increase your exfoliation.

Due to the dry heat inside your house and the cold air outside, your skin will be depleted of its natural moisture, leaving it feeling tight and dry. One huge mistake people make is to load on the extra moisturizer to compensate for the dryness. Putting on extra cream to re-hydrate dead, dry skin cells doesn’t make much sense. Try increasing your exfoliation with a gentle facial scrub to remove the dry skin cells so that when your cream goes on, it hydrates the new cells rather than the dry cells.

2) Stay away from greasy hand creams if your skin is prone to breakouts.

Many people suffer from a condition called ‘hand cream acne’. This can be caused by keeping the hands on the face while sleeping at night. They use hand cream during the dry winter months to alleviate the dryness. Most often, this cream is applied right before bedtime. If you sleep on your side with your hands on your face, the cream may be getting into the skin and clogging the pores. To prevent this from happening change the hand lotion you are using or wear some cotton gloves when you go to bed.

3) Alter your routine.

During the winter season, the skin produces less oil, so for many people, oil must be added back into the skin to maintain its balance. Moisturizers containing Safflower Oil, Avocado Oil and Shea Butter can help dry skin. Also cream-based cleanser and eye creams are a must in the winter. ‘

4) Your neck matters.

The friction caused from turtle necks and wool fibers can rub on the neck causing it to be dry and irritated. Use a hydrating cream mask on your neck once a week to replenish essential moisture. Make sure to exfoliate in upward motions with a mild facial scrub.

5) Cleanse your skin at the gym.
Always wash your face and use an alcohol-free toner and a nourishing moisturizer after a workout. At the end of the work out, the salts created from perspiration can have a drying effect on the skin, combined with the cold, dry air outside and the heat in your car. So removing the salts and locking moisture back in the skin will greatly reduce dry skin.

Katy Issa
Clinic Manager

Tightening loose, lax, or saggy skin can be done nowadays without the need for any surgical procedure but rather with the use of lasers. The procedure is called laser skin tightening. The technology was changed in the early 1990s from the ablative to the non-ablative technology. This is turn made for no recovery or down time for such procedure. Laser skin tightening technology has advanced with the change from the use of radiofrequency to the infrared frequency. This allowed for an increase in the penetration depth, allowing a greater degree of skin tightening.

The laser skin tightening procedure is quite short and the length of time it takes depends on the treated area. The laser is applied over the skin that is to be treated. It penetrates through the middle layer of the skin, known as the dermis, heating the collagen and the elastin fibers of the skin. This results in a contraction of the aged collagen fibers while also re-growing new collagen. The process is called collagen remodeling and results in much tighter and younger skin. Due to the progressive nature of the treatment, multiple sessions are needed to achieve the desired outcome.

Laser skin tightening treatment is quite simple with some preparation to be taken. Firstly, the patient is to avoid direct exposure to the sun for about 5 to 7 days. If exposure to sunlight is necessary then SPF35 or higher must be applied to the skin. The number 35 in SPF35 means that the sunscreen lotion is to be applied every 35 minutes on average while the skin is being exposed. The patient should also refrain from using any tanning beds a week before and after treatment and during treatments. Any patient who is pregnant or who has oral herpes cannot get the treatment.

Laser skin tightening technology is very common in the Seattle area and is extremely comfortable. Unlike many other aesthetic skin treatments, laser skin tightening does not require any anesthesia. This means that patients can get back to their daily routine right after the treatment. There are many laser skin tightening technologies out there like the Affirm by Cynosure, Refirme by Syneron, and Titan by Cutera. While all 3 of them have the same goal which is getting rid of mild and fine wrinkles and skin laxity, the Refirme technology, in our experience, is the one that does it best through the use of the ELOS technology. ELOS stands for electro-optical-synergy which is the process of combining bi-polar radio frequency with laser energy to increase the treatment’s safety and efficacy.

Katy Issa
Clinic Manager

People living in the Pacific Northwest tend to forget that the summer sun can still have a damaging effect on the skin especially when during the rest of the year we live in an overcast rainy weather that causes our skin to be more photosensitive. The summer of 2009 we had here in Seattle was a prime example of an unforgiving hot summer. The face is a very important part of our everyday appearance and is the most exposed, so it is very important to keep it looking young and healthy. If we forget to wear adequate sun protection we will most likely end up with sun spots, wrinkles and lines or red complexion which will make the faces look older.

A new and effective skin treatment technique called IPL FotoFacial combines intense pulsed light (IPL) with bi-polar radio frequency to provide non-ablative treatment for any of the mentioned skin conditions above. Using IPL FotoFacial does not damage the surface of the skin, and uses high intensity pulses of broadband light different from the narrow band light of lasers. IPL FotoFacial does not damage the surface of the skin as it works on the deeper dermal layer. This means that there is no recovery time after undergoing this treatment that takes between 30-45 minutes on average. IPL FotoFacial treatments are progressive in nature and hence multiple sessions spread 3 to 4 weeks apart are recommended. The end result is radiant skin improved with tone and texture.

A common misconception about IPL FotoFacial treatments is the assumption that they fix scarring. For acne scarring and other deeper wrinkles lasers such as Erbium Yag and Diode can be used for skin resurfacing as well as skin tightening. The one thing to remember with IPL FotoFacial is that it is safest and works best with skin types 1 through 4. So IPL FotoFacial produces great results for Caucasian, Middle Eastern Olive, and Asian Skin. It is however inadvisable to use IPL FotoFacial on darker East Indian or African American skin due to the pigment in the skin and the risk of burning and scarring.

Katy Issa
Clinic Manager

I deal with a lot of acne patients especially younger teenaged ones. I recently remember a young 16 year old gal whose mother brought in for assessment and acne consultation. The first step to any skin regimen and need is the medical history for us to be able to assess any medications and or allergies the patient may have. Knowing the health history also enables us to give the best advice and be informed about all the possible reasons for the acne flare-ups. After the initial consult with this young girl I did not see that she had any medication or allergies listed on the medical history form. I specifically asked her as I do many patients whether or not she uses marijuana? Her answer was “no”. A study of patients stated that women more than men were affected by acne while smoking marijuana in and around the mouth. One of the possible reasons is the effect of marijuana on increasing the testosterone levels. After examining her acne I was almost positive that she is using marijuana. I informed her that if she was and we were to start treatments the acne can actually worsen! The young patient reassured me she doesn’t use any drugs whatsoever so we started treatments with acne laser, microdermabrasion plus chemical peels and topical medications. Her skin became radiant and acne free within 2 months and she continued to show great results in her follow up appointments. She was happy, I was happy and Mom was particularly happy for the return on her investment…But wait!!! The plot thickens. As the patient went on what we refer to as “Maintenance Treatments” which happen around once every four to six months, she came back at her maintenance after 4 months and low and behold: A face full of acne????? Mom is now furious!! I, on the other hand, am baffled. As to how this kid could do this to herself again!!?? I asked to have Mom in the room at the follow up consult to discuss what happened. At first the kid opposed, but being 16, she didn’t really have any say!! I started to ask the same questions: Any new meds, any new skin products, and finally I asked sweet 16 to leave the room and point blank told Mommy Dearest that she needs to do drug testing on her daughter to make sure nothing is in her system. Of course Mom was not happy but by now, and after seeing her daughter’s acne subsiding the past few months, she had enough trust in my opinion to realize that I am not just being judgmental towards her one and only apple of her eye!! ( understandable). The following Monday sweet sixteen was marched into family. Dr. and tested for multiple drugs in system….Guess What?? Sweet sixteen was smoking and taking other colorful drugs!!! Mom called to thank me and informed me that the daughter went into counseling. A couple of months later Mom and daughter came back to see me for a follow-up along with a nice thank you card!!! Her skin is like Gerogia Peach again!!! Boy I really love my job.

Katy Issa
Senior Medical Aesthetician

Dysport is the new injectable treatment for frown lines and wrinkles. Although it is made from the same neurotoxin (botulinum toxin type A) as Botox, there are some subtle differences between the two. Dysport is only new in the US as it has been used to smooth wrinkles in Europe for several years. It was originally developed in the 1990s to treat neuromuscular disorders. Just very recently, Dysport had the approval of the Food and Drug Administration (FDA) for use in the United States.

Botox is currently the most popular cosmetic procedure in the US and Dysport is poised to compete head to head with this market leader. The differences between Botox and Dysport are fairly small. Both drugs contain the same main ingredient: the botulism toxin. Like Botox, Dysport temporarily freezes the muscles that cause facial wrinkles. One of the main differences with Dysport is that its effect starts faster than Botox. Rather than waiting for a week to see results with Botox, Dysport begins to work in just a day or so. A second difference is that Dysport diffuses to a larger area when injected making it easier to treat such areas as the forehead and glabella.

One of the common misconceptions about Dysport is that it is 1/3 the strength of Botox. Untrue. Dysport comes in a 300-unit vial while Botox comes in 100 units. However, a one-to-one comparison between the two is like comparing apples to oranges due to the different dilution. Bottom line is as a patient, just because you need more units of Dysport than Botox does not mean that Dysport is an inferior product at all.

It is not quite clear yet as to whether Dysport will become as popular as Botox. If widespread clinical practice does show that Dysport is as good as Botox or better, it is unlikely than a lower price for Dysport will persist for long.

Katy Issa
Senior Aesthetician - Aura Laser Skin Care

As obesity is reaching an epidemic in the US, more people are becoming obsessed with thinness. With dieting and exercising being the slow path to weight loss and healthy looks, liposuction is the popular get-thin fast way for many and has become the most popular elective surgical procedure to date.

In the past couple of years a new laser assisted lipo procedure for fat removal has come to light. One such procedure is the Smartlipo™ by Cynosure. The procedure involves inserting a very small cannula, or tube, approximately 1.0 mm to 2.0 mm in diameter containing a laser into the skin. The cannula is moved back and forth delivering the laser’s energy to the fat cells, causing them to rupture and easily drain away. Due to the cannula’s small size, Smartlipo™ is a minimally invasive procedure and can be performed under local anesthesia.

Some physicians say that Smartlipo™ is no better than the tried-and-true surgical liposuction techniques and that it is little more than a marketing ploy. There is no pain free quick fix for obesity and Liposuction is no such fix. In general, people who eat and exercise well after the procedure are the ones most likely to benefit the most from it. Smartlipo™ is not an un-risky procedure as 20 out of 100,000 people who undergo it die from blood clots or infections. This is a higher risk than dying from a car accident or due to smoking.

The bottom line is: If you are to have such surgical procedure make sure you do it in conjunction with healthy eating and exercising. Also you should fully discuss the procedure with your family physician.

Katy Issa
Senior Aesthetician - Aura Laser Skin Care

The Anatomy and Growth Cycles of Hair and Laser Hair Removal.

For a better understanding of how laser hair removal works, we must gain an insight into hair anatomy, physiology, and growth cycles.

The human body surface is almost covered with hair follicles, except for the palms of the hands and soles of the feet. Each person has approximately 5 million individual hair follicles. Hair follicles may be straight, wavy, helical, or spiral. Caucasian people typically have thinner hair shafts than persons of Asian or African American heritage. The hair density can also vary in a given skin surface. All of these factors along with the skin type (ethnicity) play a role in determining the right laser and settings to be used when performing laser hair removal.

There are primarily 2 types of hairs on adult bodies. Vellus hair can be found over the entire body and appears as soft, fine, short hairs that are nonpigmented or very lightly pigmented and are almost invisible. Terminal hair is the longer, coarser, and more darkly pigmented hair found on the scalp, underarm area, and groin. Vellus hairs outnumber terminal hairs greatly; however, terminal hairs are more important, as they are responsible for the appearance of hair on the body since they can be a source of embarrassement.

Hair on the body has 3 distinct development cycles: anagen, catagen, and telogen. As hairs progress through these cycles,they are affected differently by treatment with laser hair removal. Anagen is the cycle in which active hair growth occurs. Follicular matrix cells are actively producing cells that will make up the growing hair. During the catagen (the dormant phase), matrix cells degenerate and the bulb begins to die, causing the hair follicle to shrink. Telogen is the final resting phase of the hair follicle. Growth of the hair has stopped, and the follicle becomes inactive. During telogen, the hair is released from its attachment to the skin and sheds.

The process begins again in anagen to form a new hair. The length of time spent in each phase depends upon the location of the hair. On the scalp, hair follicles spend up to 10 years in anagen, but on the trunk, brow, and limbs, anagen lasts no longer than 6 months. Catagen lasts only 2-3 weeks, and telogen lasts from 3-4 months.

Up to 90% of hairs in a given body location can be in the anagen phase at a given time. This is a very important fact in the laser hair removal process since hairs in the anagen phase of development are very responsive to laser treatment. Due to this FUNDAMENTAL FACT, MULTIPLE TREATMENTS are necessary to treat all hair follicles for a given area.

Katy Issa
www.AuraLaser.com

Pre-Treatment Considerations The existence of the below conditions will prevent a patient from getting a laser hair removal treatment.

• Any hormonal, familial, drug-related, or tumor-related conditions.
• Facial herpes (a sore on the lip for example) for consideration of facial hair removal.
• Herpes of the genitalia for consideration of pubic hair removal.
• Keloids or history of scarring
• Accutane intake in the previous 6-12 months.

Pre-Procedure Care In order for a patient to be prepared for the treatment, the below instructions are to be followed/met:

• Sunscreen SPF35 or higher is recommended, and sun avoidance must be practiced if hair removal is planned in exposed sites.
• A bleaching cream such as hydroquinone may be prescribed to patients with darker skin types or a recent suntan.
• The patient should avoid plucking, waxing, or electrolysis. Research has shown greater hair loss at shaved versus epilated sites, suggesting that light absorption by the pigmented hair shaft itself plays an important role.
• Shaving is to be performed up to the day before laser treatment. The patient is instructed to shave the area to be treated; however, the area must not be irritated. If the patient is uncomfortable with the idea of shaving the area, a depilatory cream may be used instead.

Treatment Day On the day of the procedure, the following is to be done

• The area to be treated should be clean and free of makeup or powder.
• A thin layer of ultrasound gel can be applied to the treated area to lessen the level of discomfort.
• In very rare cases, a thick layer of a topical anesthetic cream can be applied under a plastic wrap for 30 minutes before the scheduled laser treatment.

Katy Issa

Senior Aesthetician - Aura Laser Skin Care