Summertime Skin Care with Rebecca Rose, PA-C

The end of summer is fast approaching, and many of us are likely buying back-to-school supplies. However, summer will continue for a few more weeks into September, which means your skin, the largest and fastest growing organ of our body, will continue to be exposed to problems posed by warmer weather. Our dermatology specialist, Rebecca Rose, PA-C, has some skin care tips for preventing sun damage.

Sun Exposure

Sunburn, skin cancer and the fine wrinkles of premature aging are major problems due to over exposure to the sun. Although some dermatology information guides recommend wearing sunscreen with a sun protection factor (SPF) of 15, Rebecca recommends “wearing an SPF 30 sunscreen to protect against general sun exposure, and an SPF 50 sunscreen for the major sun exposure - the type faced by beachgoers and outdoor workers.” Apply the sunscreen to all exposed areas of skin, including toes and ears. If possible, try to stay inside between the hours of 10:00 am and 2:00 pm. This is the time when the sun is highest in the sky and when people are at the greatest risk for overexposure.

Eyes are at risk for sun damage such as pinguecula and pterygium (also known as “surfer’s eye or farmer’s eye”). According to the American Academy of Opthamology, these are growths on the cornea or the conjunctiva. They are non-cancerous, but may need to be removed surgically. Avoid these conditions by wearing sunglasses.

Other Skin Care Tips for Fun in the Sun

Here are several other tips for preparing to be outdoors in the sun:

• See your physician or dermatologist for annual skin checks.
• Lips are at risk as well for sun burn. The best preventive measure is to apply an SPF 15 or 30 lip balm.
• Remember to re-apply sunscreen after swimming and exercise, both of which wear away sunscreen. Wait a few minutes for the sunscreen to dry before returning to swim or exercise.
• People with thinning hair should wear a hat to protect the scalp.
• Stay hydrated! Drink water or drink a sports beverage with electrolytes in order to maintain your skin’s moisture.
• If you do become sunburned, apply aloe vera, which can be found in any pharmacy.

Skin Rejuvenation from Regeneris Medical

It is important to maintain the health of your skin. However, if you do have long-term sun damage, know that Regeneris Medical offers non-surgical, skin rejuvenation treatments than can beautify your skin by reversing wrinkles and sun damage; toning and tightening the skin and possibly reducing scarring! Some of these treatments are the Regeneris Facial, the Obagi Blue Chemical Peel and Mesotherapy, among others. You can learn more about them on our Skin Rejuvenation page, or call to schedule a consultation today at 1-855-734-3678.

In future blogs we will continue the conversation by discussing the importance of skin care, more on our Clinical Research Team and other staff, and cellular therapies for orthopedic, cosmetic/aesthetic, hair loss and other purposes and therapies.

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The Regeneris Medical Blog is a resource containing general information about potential uses of stem cell therapies for hair loss, orthopedic injuries, and autoimmune disorders, as well as updates on other popular health topics. The information contained within is not medical advice, and should not replace advice from a medical doctor. If you have questions about your health, consult a physician first.

Chemical Peels - by Dr. Tomassello

Exfoliation removes dead skin cells thereby allowing lighter, brighter and more vibrant skin to grow. I am a big fan of exfoliation. Chemical peels do a fabulous job of exfoliation … and so much more. Remember, exfoliation can be physical; using a product with beads, microbeads or powder to clear away dead skin cells (commonly with the aid of a rotating pad), or chemical, where the chemical itself does the work.

Chemical peels are divided into three broad categories; Superficial (light), Medium and Deep. In addition to beautiful exfoliation, deeper peels are able to clear unwanted pigment, improve acne (and acne scarring) and remove fine lines and wrinkles.

Through penetration into the skin; through the epidermis (top layer) to the dermis (layer beneath epidermis) and beyond, deeper chemical peels can stimulate fibroblasts which improve the structure (collagen) and elasticity of the skin.

Have a realistic goal in mind

A chemical peel can bring many benefits to your skin, however will not reduce the appearance of blood vessels and typically is not going to give you immediate results. Peels have to be tailored to the individual and his/her skin type and medical history. The results come as your skin rejuvenates and heals. Though you will get results, many times repeated peels are needed. Also, deeper, more aggressive peels come with a much longer downtime.

The factors that determine the type and strength of the chemical peel depend on: 1.The chemical used 2.The percentage (strength) of the chemical 3.How long it is applied 4.The PH level attained (how acidic the peel is) A lower PH means a deeper chemical peel. If the PH is less than 2.5, it should be done by a doctor, nurse or aesthetician. Peels with a higher PH can be done in day spas, beauty salons or at home. Remember, a reduction of PH from 2 to 1 means the peel is 10 times more powerful.

Superficial/Light Chemical Peels

Don’t be fooled into thinking that if you are receiving a superficial peel, that it need not be taken as seriously. With any chemical peel you are putting acid on the skin which, as we will discuss, carries potential for side effects and can not be used everyone. Superficial peels remove the top layer (epidermis) and it is here where your dead skin cells reside.

Commonly used ingredients: Alpha-Hydroxy-Acids (AHAs) like glycolic, lactic or citric acid and Beta-Hydroxy-Acids like salicylic acid.

Fruit enzymes from papaya, pineapple, pumpkin and cranberry can be used for light chemical peels as well. Tartaric (from grapes) and Malic (from apples and pears) are milder than glycolic. They remove dead cells, increase cell renewal while clearing oil (sebum).

Advantages: 1.Minimal down time, other than skin redness (erythema) which typically only lasts a few days. 2.Relatively non-painful – other than some mild tingling and burning. 3.Safest – Problems such as scarring, infection or pigment changes are quite uncommon.

Disadvantage: Multiple treatments are typically needed (6-10) to achieve desired results.

Results: reduces fine lines, wrinkles, mild hyperpigmentation, and improvement of acne scarring.

Medium Depth Chemical Peels

Medium depth peels penetrate further, removing the epidermis as well as some of the dermis. These peels are more painful and have a much longer down time. The skin may remain red for several weeks or longer until the skin is fully healed.

In many cases a light peel will be used before a medium depth peel to help the medium peel better absorb deeper into the dermis.

Commonly Used Ingredients: Trichloroacetic Acid (TCA), Jessners Peel (combination of resorcinol, salicylic acid and glycolic acid) or higher concentrations of glycolic acid (50%).

Advantages: More dramatic results in fewer treatments.

Disadvantages: More burning and stinging, face may remain swollen, pink, itchy with more ‘peeling’ of skin for weeks or longer. As the pigment is cleared you may get brown patches on your skin.

Results: Helpful for clearing melasma or other unwanted pigment. Works well to reduce fine lines and wrinkles. Jessners peel does exceptionally well to help treat both acne and acne scarring.

Deep Chemical Peels

Deep peels do just that, they go deep; through the epidermis and dermis down to the subcutaneous (deepest) skin layer.

Ingredients in Deep peels; Phenol (carbolic acid), or high concentrations of Trichoroacetic Acid (TCA) to penetrate deep into the dermis

Advantages: excellent clearing of sun damage, scarring, fine lines and deep wrinkles with the fewest needed treatments.

Disadvantages; Painful, may take a month or longer for full recovery. Excessive redness, swelling, scabbing, itching and peeling are commonly present. Has the highest incidence of post-procedure pigment issues (dark or light) and scarring.

Results: Deep peels improve fine lines as well as deep wrinkles, scars, sun damage and pre-cancerous growths.

Relative strengths:

It is important to understand that the peel strength does not equate to how deep it will penetrate. For instance, 30% Glycolic is a light peel whereas 30% Trichloroacetic acid (TCA) is a deep peel.

A TCA of 10% and Glycolic of 30% are light peels

A TCA of 20% and Glycolic of 50% are medium peels

A TCA of 30% and Glycolic of 70% are deep peels

A Jessner Peel is typically a medium strength peel.

A word on skin types and safety:

Skin types are defined by what is well known in dermatology circles as the Fitzpatrick Scale •Type I – Never tans, always burns (extremely fair skin) •Type II -Occasionally tans, usually burns (fair skin) •Type III – Tans on average, sometimes burns (medium skin) •Type IV – Usually tans, rarely burns (olive skin) •Type V – Mostly tans, almost never burns (dark brown skin) •Type VI – Never burns (black skin)

The best candidates for chemical peels are the light skin types 1, 2, and 3, which have less chance for such complications as hyper (dark spots) and hypo (light spots) pigmentation and scarring. Although skin types 5 and 6 are not ideal for chemical peels, they can be peeled using such superficial agents as salicylic acid or a low percentage glycolic acid such as 30%.

People with history of scarring (keloids), recent facial surgery, prior sensitivities to peels, auto-immune disorders, aspirin allergy, herpes, or are pregnant or nursing should not have chemical peels. A good doctor, nurse or aesthetician should do a thorough medical history before giving you a chemical peel of ANY strength.

Having even a mild peel will make your skin much more prone to burn, so please be sure to apply your SPF of 50 vs UVA and UVB in the days and weeks following your peel. Regardless of the goal you wished to achieve with your skin peel, leaving your skin unprotected after a peel will not only make your skin burn more easily, it will provide the perfect skin environment for development of sun spots.

Be well,

Dean M. Tomasello, MD

Derma Roller and Microneedling - by Dr. Tomasello

  Microneedling is a procedure gaining incredible momentum in the medical aesthetic world. Environ™, led by plastic surgeon Des Fernandez, MD, introduced a microneedling roller as far back as 1996 for treatment of fine lines around the mouth. I have used an Environ™ derma roller for many years. There are new dermal rollers entering the market every year. Most have a needle range of 0.25 – 2.50 mm. Many and find it to be a cost effective anti-aging option.

How Derma Roller Microneedling Works

Microneedling is a procedure whereby thousands of tiny holes are punctured in the skin. It is ‘controlled skin injury.’ These holes or ‘micro-wounds’ trigger the body to fill in these holes by producing new collagen and elastin in the dermis along with new capillaries. The new blood flow and collagen production results in improvement of scars and rejuvenation of the skin. The texture, firmness and hydration of the skin are also improved. The depth of the needle penetration dictates the level of injury to the skin and the potential results to be achieved. So why is microneedling increasing in popularity? I see six main reasons.

Reasons to Choose Microneedling with a Derma Roller

1. It is an effective means to treat a wide variety of common skin concerns.
2. It is less expensive than laser skin resurfacing. We all know laser treatments are expensive; because lasers are very expensive. The cost for buying or leasing a laser will rival most home mortgages. Don’t get me wrong, I am a fan of cosmetic laser treatments but I am also a realist. Most people will choose to get tangible results for less money when possible.
3. There is far less downtime with microneedling vs. laser skin resurfacing.
4. Unlike chemical peels, microneedling can be used on any skin type.
5. Studies have shown that microneedling with a derma roller is a simple, inexpensive method for treatment of facial scars.
6. Microneedling creates hundreds of micro-channels allowing for enhanced penetration of skin care products deep into the dermis.

            “Microneedling Helps the Skin Help Itself”

We have seen this before

In medical aesthetics we have seen other types of skin damage result in improved skin appearance. Chemical peels, for instance, penetrate through skin layers in an attempt to clear dead cells and stimulate new skin cell and collagen growth. New cells make the skin more vibrant while new collagen (and elastin) makes the skin more smooth and firm.

The Derma Roller Verdict

Microneedling has clearly come of age. It is less expensive, comes with less down time and is less damaging to the skin than laser resurfacing. Microneedling with the use of a dermal roller brings a long list of benefits to your skin. Unlike chemical peels, it can be performed on all skin types. Derma roller devices (i.e. Skin Spin) offer people a very cost effective at-home way to treat a wide range of skin concerns including:

• Fine lines and Wrinkles
• Mild to moderate acne scarring, or other scars
• Loose skin (the face, neck, décolleté area)
• Uneven skin texture or large pore size
• Stretch marks
• Melasma / hyperpigmentation

A few cautions with the Derma Roller:

1. While your skin is healing, sun exposure should be limited for at least 2 weeks (or use SPF 50).
2. Avoid use of Aspirin or NSAIDS (Advil/Aleve) for 3 days prior to 2 weeks after procedure.
3. Avoid use of Retinoid (Vitamin A) creams or serums for 1 week.
4. Skin infections should be fully resolved for 1 week prior to treatment.
5. Micro needling should not be done until 3-4 weeks after Botox, Dysport or dermal filler treatments.
6. Not all needles are the same, and the treatment can be technique dependent. For example, overly aggressive needling may cause scarring and potential hyperpigmentation in certain skin types.

Anti-Aging skin care, to a large degree, involves making improvements to the surface (epidermis) while improving the collagen and elastin (architecture) of the dermis. Microneedling is one procedure that provides and effective means of making noticeable results in both the epidermis and dermis of your skin, leading to a fresh, vibrant and youthful result.

Be Well,

Dean M. Tomasello, MD

Pinning the Skin and Anti-Aging - by Dr. Tomasello

You have very thin skin. No, that is not an insult, it’s a fact.

Skin covering your body has many variations of thickness. The upper layer of skin is the epidermis, whose depth on the face (and the rest of the body) is fairly uniform. The differences in skin thickness have much more to do with the depth of the underlying dermis. The thinnest skin on your body is behind your ears and on your eyelids. These areas have an average thickness of 500 microns (or 0.5 mm). The skin on the face is about the thickness of a dime (1.3 mm). Take a dime out of your pocket or purse and take a look at it. All of the products, procedures and treatments you see advertised are aimed at making your dime-thickness skin more beautiful, youthful, clear and vibrant. That’s what it is all about. One thin dime.

Without the paper-thin upper layer of the epidermis known as the stratum corneum, we would be toast.  We would be dehydrated and succumb to a myriad of bacteria and viruses.  So the skin is pretty awesome indeed. You may think that attaining youthful and beautiful skin is a very complicated endeavor requiring expensive creams and serums and procedures costing an arm and a leg.

Guess what? It’s not that complicated at all.

Before publishing my book I spoke to hundreds of people with a strong desire to have a more youthful and beautiful appearance.  Two common themes resonated.  “It is too complicated” and “I have no idea where to start.” Many just throw their hands up in disgust and head to the dermatologist or medical spa and say “fix me.”  These specialists can surely help you. The fact is that you have WAY more power in becoming beautiful than you realize. I am certain of this.

Pinning the Skin

In my recent interview with skin care expert Lillian Martini, I discussed a concept which needs elaboration. What ‘Pinning the Skin’ means is treating the skin from the outside-in and the inside-out.  It means literally ‘squeezing’ the skin between powerful anti-aging factors and treatments. Blood flow only comes to ONE layer of the skin; the dermis. That means that the epidermis, that layer of skin you see when you look anywhere on your body has NO DIRECT BLOOD FLOW. What does this mean in terms of anti-aging? For one thing, it means your epidermis needs a lot of help, from you…and blood flow from the dermis.

Hit the Outside

Skin Ingredients:  Making your skin look younger and beautiful begins with hydration and SPF protection. After this, it is about the right ingredients to clear away unwanted pigment, reduce redness (including acne and rosacea) and improve collagen and elastin to remove fine lines and wrinkles. Using the RIGHT ingredients is FAR more important than using A LOT of ingredients. Face it, if you had fewer red or brown discolorations and a disappearance of fine lines and wrinkles … you would certainly be smiling, would you not?

Treatments and Procedures: Botox, dermal fillers, cosmetic laser treatments, microneedling, microdermabrasion, chemical peels and many others help improve the appearance of your skin. These are all hitting your skin from the outside-in as well. I talk about these all in detail in my book and website in regard to what each exactly each does to help your skin appear more supple, young, clear and vibrant.  They all work very well indeed and can help to treat a myriad of skin conditions and aging concerns.

Now Hit the Inside

Powerhouse anti-oxidants and nutrients: When you eat some really high power anti-oxidant like spinach or kale, those nutrients and antioxidants are absorbed through the intestinal tract, enter the blood stream and end up in the capillaries of the DERMIS.  Now you have antioxidants in the dermis and these dermal capillaries also supply the epidermis. If you are using an antioxidant Vitamin A serum and eating powerhouse antioxidants, you have literally pinned the skin between two powerful antioxidant sources: external and internal. How is it possible for the skin NOT to improve when you are attacking it like this? From an anatomical and physiologic standpoint, the skin has literally no option but to improve.

Now let’s take a scenario where we could hurt the skin from the outside and inside. No SPF protection. Here come free radicals from UVA rays which increase collagenase; an enzyme which literally destroys collagen. Combine this with some fried food in your diet.  Plant oils oxidize in the high temperatures used in frying which causes increased free radicals. In the scenario above we ‘pinned the skin’ with antioxidants. In this example we are ‘pinning the skin’ with free radicals.

In Summary:

SPF, one cream and one dietary change gives guaranteed anti-aging results.

No SPF and fried food pinned our skin with free radicals which assured our skin would age more quickly.

Helping your skin look more youthful and beautiful is possible for anyone provided there are simple, consistent measures taken. I am not saying that eating spinach and using vitamin A is going to improve your skin overnight. However, if done consistently, it HAS to bring anti-aging results.

This is a dime-thickness skin layer. Not rocket-science. You can do it. For decades my goal has remained to try to break anti-aging, skin care and medical aesthetics down into terms that are understandable to all with an approach that is not scary or daunting. Knowledge will always be powerful.

Be well and be good to your skin

Dean M. Tomasello, MD

Keeping Anti-Aging Simple- by Dr. Tomasello

When it comes to anti-aging, it is best to think of the skin simply and layer by layer. Most every skin care, anti-aging or aesthetic procedure is aimed at helping one or more specific skin factors. I put these into three basic categories. The first step in anti-aging is to understand what each layer is composed of and what we need to do to help that area ‘act’ younger.

Anti-Aging Skin Category 1– The Epidermis

The epidermis is the outermost skin layer composed of five distinct areas. New cells come from the bottom (stratum basale) and move upward until they reach the top (stratum corneum) layer. This top layer is composed of dead cells that serve many protective and moisture-retaining functions.  In regard to the epidermis, anti-aging products and treatments should:

1. Clear excess dead skin cells from the skin surface (stratum corneum).
2. Stimulate new cell growth from the stratum basale.
3. Neutralize free radicals.

Anti-Agin Skin Category 2 – The Dermis

The dermis is below the epidermis. Here collagen and elastin are of utmost importance. In this layer, cells calledfibroblasts make collagen and elastin. 70% of the dermis is made up of collagen. Think of collagen and elastin as ‘architecture’ supporting the epidermis. In order to have beautiful and youthful skin you need a soft and smooth epidermis supported well by a healthy dermis. Collagen and elastin in the dermis keep the skin tight, elastic and firm. Effective products and treatments that help the dermis will:

1. Stimulate fibroblasts to make more collagen and elastin.
2. Clear free radicals that can break down collagen and elastin.
3. Improve the function or prevent breakdown of collagen and elastin through the use of neurotoxins and dermal fillers. More collagen and elastin equates to tighter and firmer skin.
4. Improve blood flow to the dermis. The blood flow in the dermis supplies oxygen and nutrients to both the dermis and epidermis. A diet filled with powerhouse anti-oxidants means these crucial anti-aging dietary factors are hitting these skin layers from the inside-out.

Anti-Aging Skin Category 3 – Moisture and UV Protection

This is an important maintenance category. The skin needs to be nurtured and protected. Hydrated skin is youthful and happy skin. Avoid stripping protective oils and keep the skin well hydrated. Block UV rays from your skin as much as possible. These rays cause the formation of hefty amounts free radicals in both the epidermis and dermis resulting in premature skin aging.

How Neurotoxins (like Botox) and Dermal Fillers Fit into Category 2

Neurotoxins (i.e. Botox, Dysport and Xeomin) inhibit facial muscle movement. Every time you yawn, smile, laugh, squint or frown, the small muscles around the eyes, brow and forehead repeatedly contract and squeeze the skin (and collagen) between them. With continued movement, fine lines and wrinkles form and deepen.  This is most noticeable around the eyes (crow’s feet), brow (between the eyebrows) and the forehead. The anti-aging effects of neurotoxins occur due to a temporary block of these facial muscles.

Botox does more than just stop muscle movement though; it goes a step further. A study in the JAMA Facial Plastic Surgery (May 2015) showed that Botox increased the stretch and elastic recoil in the skin of women studied.  This mimicked younger skin. Therefore, by relaxing the muscles, you now literally have less wear and tear on the collagen and elastin. Yes, Botox relaxes facial muscles, however it also gives collagen and elastin a chance to stretch out and strengthen. Through this, we are improving the strength and elasticity of the dermis. Our supporting architecture is improved. Therefore, Botox (and other neurotoxins) brings powerful anti-aging power beyond what was originally thought.

Dermal Fillers (i.e. Restylane, Juvederm, and Radiesse) do more than just ‘fill in’ wrinkles. If the injector is skilled, the dermal filler will both fill in the area of deficit as well as stimulate the growth of collagen and elastin. A large ‘bolus’ injection of a filler into a wrinkle is not optimal. Spreading the filler out during the injection (commonly referred to as ‘fanning’) is best.

1. Spreading the filler out presents the dermis with a larger product ‘surface area.’ For hyaluronic acid fillers like Restylane, this means a greater moisture-retaining potential. For a product like Radiesse, it means a larger collagen stimulating area.
2. The process of spreading the filler out also serves to cause a greater stimulation of collagen-producing fibroblasts in the dermis. It is true that the injection itself can elicit anti-aging effects.

There are countless products and treatments which can help your skin look younger. It is important to remember to keep it simple. With each product used or procedure performed, be aware of which category is going to benefit most. Having this awareness will be of great benefit to you in accomplishing your anti-aging goals

In “Winning Skin” I discuss how each skin care ingredient, aesthetic treatment, cosmetic procedure and dietary factor helps one or more of these important three categories.

Be good to yourself and your skin!

Dean M. Tomasello, MD