Sciton mJoule BBL phototherapy

So what if you're focus is on neutralizing the dreaded brown spots or freckles. Maybe you thought they were cute when you were a young hipster, but now they make you think of your Aunt Doris...what can be done? And how about pink cheeks or those pesky veins around your nose? Do we offer anything to help control those?

Well commonly I would make a recommendation for one of two or three services I offer. Unfortunately treating pigment with only topical creams or gels is tricky and lackluster. If you have a lifestyle that will allow you to be a recluse for a few days and you aren't a picker, you could consider a medical grade chemical peel In combination with kojic acid or tyrosinase Inhibitors to lighten things up . These are fairly cost effective, and can do a great job of shedding the top layers of skin revealing new baby skin that hasn't yet been assaulted by the sun. This is also a great choice if the pigment you have is related to Melasma (a specific hormonal hyperpigmentation that worsens with pregnancy or other hormone changes). Melasma can worsen with heat, making it more risky to try a laser or light based treatment for correction.

If you're a social butterfly or simply cannot work from home for a few days, you should consider a light based treatment. I have both LaseMD which is a thulium non-ablative fractional laser that does a fairly good job at encouraging fresh skin and reducing pigment. But (in my humble opinion) the better option for lighter skin tone individuals with spots is a series of Sciton mJoule Broad Band Light treatments. Let's talk about those a little more!

Sciton BBL (no, not brazilian butt lift) is very similar to IPL (intense pulsed light) however it uses dual flash lamp technology so essentially doubling the light you receive during the treatment, greatly increases the effectiveness of the treatment. And while the heat from a xenon flash could burn the skin, this device Is also equipped with a cooling function to take the heat out of the flash at the skin surface while allowing heat delivery deeper. BBL uses a sapphire technology  cooling plate offering predictable cooling that wicks heat away from the skin even when double the energy is being supplied much deeper into target tissues. This cooling is so effective BBL can be used in slightly darker skin colors-though I prefer a peel in those patients for safety reasons.

Sciton BBL offers multiple size applicators, to narrow the light to a smaller target (such as a specific vein or dark patch) so the treatment can be customized and targeted; something moset IPL devices lack. I specifically offer general treatment with a larger adaptor, then switch to a choice of smaller and smaller adaptors to target brown spots and small vessels without overheating surrounding skin. I find this to support a well tolerated, effective treatment. Who does't love customized care?!

 My favorite way to use Sciton's BBL is called "forever youn g" which involves a predetermined number of pulses in a base pass, a vascular pass and a pigmentation pass. With each pass the filters on the laser are changed in order to target different issues. When done twice a year, this trade-marked protocol of treatment has been proven through studies done at Stanford University to change the genetic expression of skin cells such that the skin cells behave like younger cells. In effect, it reverses the aging process.

Of course you want to know if it hurts--so lets call it "spicy". The heat is cumulative, and when you're done you may feel like you have a mild sunburn. Some people have a pink glow, others do not. Dark pigment almost always darkens before it flakes or fades away. And if we're also treating redness, that can tend to get a little puffy for a day or two. My recommendation is to start with a series of 3 sessions, spaced about 4 weeks apart. Maintenance should be 2-4 times a year with a single session-depending on your goals. I do not use a numbing cream prior to the session but I promise we can work together to give you a good treatment without you leaving kicking-and-screaming.

So now you know!

SofWave- skin tightening

Toy alert—get onboard for Sofwave skin tightening!

Even without promotion, I’m getting inquiries on the new technology using synchronous ultrasound technology with FDA approval for lifting. You may have heard the buzz, or maybe not. But I’m here to tell you about my treatment experience since YESTERDAY I enjoyed my personal session.

I’ve been in medicine for over a quarter of a century, and have devoted my attention to the medical spa arena for the last 8 years.  I attend several conferences each year, and hold court for a few product representatives from time to time in an effort to learn what’s hot, what’s new and then delve into my own research before buying-in on the hype.  I’ve also got a pretty good finger on the pulse of my patient population.  When I hear a request for tackling laxity, redness, sun spots or the like, I look to see what’s in my arsenal, and where I’m missing the mark.  Nothing enters my space without solid data, and a filling a need for my peeps.

So, when this platform came a calling, I was truly excited!  Why?  Well it’s FDA approved for lifting the eyebrow, the gobble under your chin, even the neck!  It’s appropriate for all skin colors.  It can be done even in the summertime.  And it’s touted to only take one treatment to see change (with recommendation for annual upkeep, cause we ALL keep on aging!). I will be able to give you my own opinion/testimony in a few short months.

Skin around the eye an even the neck is quite thin.  We have some tools available, but admittedly very few.  And most have down time, which none of us prefer.  This device does not pierce the skin, doesn’t harm the epidermis.  It uses ultrasound to heat exactly the dermis 1.5 mm down where the collagen fibrils need to be maintained to keep us taut.  It doesn’t go deeper so there’s no impairment to fat or muscles.  Just the dermis.  Just where we want it.

I suppose you can compare it to treatments like ultherapy if you’d like to, but with less operator variability. 

What does it feel like?  Spicy, but not ghost-pepper!  I numbed beforehand and still on certain areas there was a second (literally) with each excitement phase (not kidding, that’s what they call it) where I thought “holy cow!” but as long as I counted the pulse backward, I was able to get through it without an issue.  I was a little pink after, but nothing beyond that.  No swelling, no burning, nothing.  So, tick-tock watching the clock!  I will patiently wait to see what comes of it! 

My focal areas are my jowls, and my eyelids (my left upper eyelid has more hooding than my right—it isn’t horrible, but I’ve definitely appreciated descent as I’ve aged.  And of course, the beginnings of turkey gobble are headed my way, so I threw that in for good effect! Like everything, there are “on-label” areas and areas that it would seem reasonable to treat but weren’t studied (technically known as “off-label”, but industry standard).  If it’s drapey or crapey, seems like it’s a possibility to treat—we should talk.  I’m super excited to have something to offer, even in the summer! 

Treatment is available in the Bainbridge island clinic, takes about an hour or so after numbing.  No downtime. No skin tone considerations

Hormone optimization using Bioidentical Pellets!

New Service Alert!  We now offer hormone replacement therapy to optimize your wellness as we age using Biote Hormone Pellet therapy! 

What is BHRT (Bioidentical Hormone Replacement Therapy)

Unless you are living under a rock, I suspect you have heard of “bioidentical” hormones—particularly if you are in the peri-or post-menopausal decades (believe it or not, that can start in your 40’s, and continue through your 7th decade!) But just what is the difference between traditional prescribed, FDA approved hormone replacement therapies and “bioidentical” and why might it matter?

What Exactly is a Bioidentical Hormone?

The term “bioidentical” means that a substance is chemically and structurally identical to the material the body naturally produces. Bioidentical hormone therapy used to treat female menopausal symptoms typically contains estradiol but can also include testosterone (yes, it’s well documented that your ovaries make far more testosterone than estrogen!).  Unfortunately, despite this scientific awareness there are no FDA products available for female testosterone replacement in women.

Some prescribed FDA approved estrogen conjugates include estradiol and some utilize other variations of that base product (where they come from is a whole other lecture)!

Now don’t get me wrong.  I do understand why we have an FDA approval process here in the US.  It was originally designed to provide safety and efficacy of new products, and to provide purity guidance in manufacturing. BUT: The pharmaceutical industry cannot patent a structurally identical structure without adding something to it so almost all have some other binder. A single strain bioidentical product has no dollar value to them, and as thus, is neither studied or offered in its simplicity on the mass market.  In addition, there can be up to a 30 margin of error in potency of any prescribed medication from batch to batch that is deemed “acceptable” by FDA standards?  Seems like a fairly significant variance between recipes don’t you think? 

But let’s be fair:  the counter argument is that compounded drugs (such as bioidenticals) can also have a margin of error.  Originally independent compounding pharmacies did not all monitor for variance—but the process is much more defined and reputable compounders are monitoring, testing, and more aware of variance now.  While we discuss the bioidentical hormone arena it’s a good place to tell you that one reason I elected to partner with Biote as my source is that each batch (lot number) of pellets is piston pressed and tested for potency.  The deviation standard is 3-10%--which is quite impressive, and nearly guarantees you’re getting an equal dose with EVERY VISIT!

I think it’s also important to keep in mind that compounding pharmacies are expected to comply with USP Standards for the preparation of these hormone therapies.  Biote independently tests each lot of products for strength variability.  And while compounded pharmacies may not be required to collect information on adverse events, Biote does gather information and has a robust community page in which certified practitioners can collaborate with one another on specific situations for best patient outcomes.  

Compounded bioidentical hormone therapies are prepared by a compounding pharmacy according to a provider’s specifications with each person’s combination being unique to them. Using Biote pellets I’ll have the ability to do that as well.  Your customized dose would be just what you need of each individual hormone (Estradiol and testosterone specifically).  And since lot variance is so much lower, we should get much greater consistency. To date, there have been no well known randomized, controlled trials comparing compounded bioidentical hormone therapy with placebo or FDA-approved hormone therapies for menopausal symptoms. But we are gathering data every year and the future, your future, should be hopeful!

Is Bioidentical Hormone Therapy Safer or More Effective?

While some take home a message that bioidentical hormones are safer and more effective than synthetic hormones, we just don’t know.  Why?  Well, no pharmaceutical company is going to spend millions of dollars in a head-to-head trial for many reasons.  But there is certainly data to support why it may be a good idea to optimize your levels for the very best life.

There is a tendency to think of bioidentical hormones as “all-natural”, they, like the hormones used in traditional hormone therapies, are manufactured in the laboratory (though they come from sweet potatoes and yams). Bioidentical hormone therapy may carry the same risks as traditional replacement therapy however when you go through the data, it certainly appears the benefit exceeds the challenges.  The large studies that we have in the US which identified potential increased risk of blood clots, stroke, endometrial cancer and breast cancer (such as the Women’s Health Initiative and the Million Women Study) were in studies stopped early, with conclusive data that was poorly extrapolated, and later recanted. Those studies were also recanted (by one of the lead investigators no less!) as being so flawed in their design that conclusions should not be drawn from the original data.  So where does that leave us? Well, it leaves us with medical providers who may or may not consider short term replacement therapy for their patients, but few who understand the long-term positive benefits found in many published studies (protective in heart disease, diabetes, Alzheimer’s disease, breast cancer and osteoporosis, just to name a few).

How are they delivered?

The method I will implore includes delivery of either estradiol and or testosterone via pellet (a small incision is placed in your precious derriere where it is slowly absorbed over time and re”filled” in 3-6 months (roughly a 15 minute procedure with lab results done about once a year once we have you dialed in). That means you don’t have to worry about daily pills, creams or shots, or application of patches.  It eliminates the highs and lows of product delivery to your blood stream, and your body gets a more “normal” delivery of the good stuff.  It does require time outside of the bath/hot tub/sauna/soaking or buttock exercise for a few days (3 days women/ 7 days men)—but you can get pelleted and go right back to work. No real down time.  

If you know me, you know I’m conservative in my practice—but my goal is to optimize your hormones, including thyroid, if need be, as well as impart a healthy dose of education on how you can help yourself with only the most appropriate supplements as well as lifestyle changes to maximize the pleasure you have in day-to-day living for as many days as we have left.  

Stay tuned to learn more about why you might consider BHRT for yourself and your partner, or why you may not be a candidate.