BRA Day USA

October 17, 2012 marks the first ever Breast Reconstruction Awareness (BRA) Day in the USA. BRA Day was started in order to bring to light a part of Breast Cancer Awareness that can tend to be overlooked. This day seeks to promote education, awareness and access regarding post-mastectomy breast reconstruction. BRA Day was started in Canada in 2011 and now will occur annually on the 3rd Wednesday of every October.

The spokeswoman for the BRA Day campaign is singer/songwriter Jewel. Her charitable song
 "Flower" was written to benefit breast reconstruction patients. Below is a video of her Public Service Announce regarding Breast Reconstruction and BRA Day

It is important that we spread the word about Breast Reconstruction as 7 out of 10 women eligible for breast reconstruction following mastectomy or partial mastectomy are not being fully informed or informed at all about their options for reconstruction. All women have the right to know what the different breast reconstruction options are and which specific options they would be eligible for.

To find out more information about BRA Day USA or Breast Reconstruction visit BRADayUSA or Breast Reconstruction Options.

We need your help to spread the word about Breast Reconstruction! Help us close the loop on breast cancer!

The Trifecta of Skin Care: The 3 Ingredients you need to fight photo damaged skin!

One of the most common questions we get in the office is what kind of skin care regimen the patient should be on. Patients are always asking about the specific brands of skin care they use, if we have heard of it, if it is good, or if they should be using something else. They want to know if there really is a difference between the products you find in a drugstore vs. a department store vs. a doctors office. They are curious about the specific ingredients found in skin care and if there is one particular “magic cure all” ingredient out there. 

The brand of skin care that you use is important. Skin care lines that you will find in a drugstore will have lesser quality ingredient than you will find in products in a department store. Which makes sense seeing as the products in a drugstore are much cheaper than the products in a department store. The more important difference though is between the products you find in a doctors office, or specifically a plastic surgeon or dermatologist’s office vs. pretty much everything else. Product lines sold to or created by doctors will have ingredients in them that actually work to change the cellular structure of your skin in order to enhance the overall tone and texture of it. These ingredients unfortunately cannot be found in products sold at drugstores or department places simply because they hold the potential to cause a reaction that lets face it, the CVS or Nordstrom clerk wouldn’t know how to deal with, but, a doctor would.

So, what exactly are these ingredients and are they magical cure alls? Of course they are not magic and of course there is not just one single ingredient that will give your skin everything that it needs. However, there are basically 3 main ingredients that are the most important to look for in your skin care products if you are looking to improve sun damaged skin and help the overall tone and texture of your skin.

1. Some form of Retinol or Retinoid. Retinols and Retinoids are Vitamin A derivatives that work to increase the number of Fibroblasts in your skin. Fibroblasts are cells found in the skin that make collagen and elastin. It is obvious how this would be appealing as collagen and elastin are what helps to make the skin plump and resilient. As we get older we lose some collagen and elastin which leads to wrinkly, loose skin. Retinoids and Retinols also help increase cell turnover. When we are younger our cells in our skin turn over very fast which is why if you get a cut when you are younger you heal quite a bit faster than when you are older. As we get older the amount of time it takes for our skin cells to turn over double and even triples! Retinols and Retinoids help to make this number closer to what it was when we were younger. This helps to exfoliate the skin getting rid of that dull look and creating a fresher more glowing appearance to our skin! Retinol is the non-prescription strength of retinoid and can be found in many over the counter products as well as in product lines in doctor’s offices. It is a good place to start when you first begin using this type of product, as it is less irritating. For example we sell in our product line Retinol 50 and Retinol 100. We will very commonly start a patient on one of these strengths initially before bumping them up to the prescription strength retinoid.  It is only necessary to use a retinoid every other day, or for example Monday, Wednesday and Friday as the product actually stays in your skin for 48 hours. Only about a pea-sized amount is needed to cover the entire face and it should always be applied at night after cleansing as the sun deactivates it.

2. The second ingredient to look for is Vitamin C. Vitamin C works synergistically with retinoids and can be used at night on the days that you do not use your retinoid, so, for example, Tuesday, Thursday, Saturday. Vitamin C is a nutrient needed by Fibroblasts in order for them to work properly, so you see how this helps retinoids as they increase the number of Fibroblasts in the skin. Vitamin C is also a powerful antioxidant that can help to protect skin cells from UV-related damage, reduce inflammation and improve the appearance of sun-damaged skin. Some patients will ask us if taking a multivitamin or Vitamin C supplements will help their skin. Multivitamins are an excellent idea for your overall health and can help you get the nutrients you need if you are not finding them in your diet, but it is unlikely that the vitamin C you consume in a pill or a food will ever reach your skin. If you are looking for the benefits of vitamin C to be seen on your face, you must use it topically. The form of vitamin C is also important to consider. Most product labels do not say vitamin C on them but instead various long scientific names that most people would not realize is vitamin C.  These names represent different forms of vitamin C. The most stable and effective forms of vitamin C that you should look for in the ingredient list are: ascorbic acid, retinyl ascorbate, L-ascorbic acid, ascorbyl palmitate, tetrahexyldecyl ascorbate and sodium ascorbyl phosphate.

3. The last ingredient to complete the “trifecta” is some form of alpha hydroxy acid (AHAs). The most common forms of AHAs are glycolic acid, lactic acid, citric acid and mandelic acid. Glycolic acid has the smallest molecular size and therefore is able to penetrate the outer layer of skin the easiest so that it can reach the layer of skin where living cells reside. This is why it is the most commonly known AHA and it is the one you will likely find in most products. That being said, products with other forms of AHAs are still beneficial and it is not necessary to only buy products containing glycolic acid. AHAs work to improve the appearance and texture of photo damaged skin by increasing collagen in the skin as well as by increasing the thickness of skin without causing inflammation. They also help with general exfoliation of the skin. These products are best used in cleansers and can be used every day. They can be somewhat irritating in high concentrations especially if you are just beginning a retinoid regimen.

So, there you have it, the 3 most important ingredients to help with photo damage! Of course, everyone’s skin is different and therefore it is wise to meet with a skin care expert to get the best advice on exactly what regimen you should be on! At Spa on the Green, located above Dr. Brooks’ practice, we offer Skin Care Consultations with either of our fabulous aestheticians, Jennifer or Heather! Call the spa if you are interested in learning more about what you should be doing for your skin or to learn more about Dr. Brooks’ personal skin care line, Brookskin MD!

LED YOURSELF

What is an LED and why should you care?

LED stands for Light Emitting Diode. An LED is basically a semiconductor light source. LEDs come in many different colors as depicted in the above photo. The first practical visible-spectrum LED was red and  was developed in 1962 by Nick Holonyak Jr., while working at General Electric Company. LEDs are currently used for televisions, radios, watches, telephones, calculators, traffic lights, large display screens as well as for skin care treatments!

LED skin care treatments or LED facials have been available in medical spas for a long time. They include treatment with either a red LED or a blue LED. Red LEDs are used to treat photo-aging while blue LEDs are used to treat acne. Having these treatments in a medical spa usually involves sitting in front of a bank of these light emitting diodes that are either blue or red. These lights are targeted toward whatever area of the body the patient is looking to treat. Most commonly this is the face, but the back or chest can also be treated, specifically for teens with acne. 

LED treatments are completely safe for either facial rejuvenation or acne reduction. It is not painful and does not require any downtime. LED light is not the same thing as a laser and therefore does not carry the same risk as lasers. It is not necessary to wear protective glasses while being treated with LED light and the light may be used on the skin surrounding the eyes.

The latest breakthrough in LED treatments has come with the creation of an at home treatment device! Now these medical treatments are available to be used in the comfort of your own home, making them much more convenient. While it is still beneficial to come in to a medical spa to get large areas such as your back or your chest treated for acne (we do still offer this at Spa on the Green), it is so much easier to treat your own face and neck at home and not have to worry about finding the time to come into the office/spa for a treatment!

The TANDA luxe is an at home hand held device that uses red LEDs to help fight the signs of aging. This red light is coupled with sonic vibration and gentle warming in a unique massaging treatment head to deliver a professional photo-facial experience at home in order to obtain luxurious, soft, smooth, glowing skin. Red light penetrates into the skin to boost cellular energy increasing the production of collagen and elastin in the skin as well as increasing micro-circulation in the treated area. This helps to reduce the appearance of fine lines and wrinkles and make skin look younger, firmer, plumper with a overall enhancement in tone and texture. 

The TANDA clear+ uses the exact same technology as the TANDA luxe except for the fact that instead of using red light, it uses blue light. Blue LED light has been clinically proven to kill acne-causing P. acnes bacteria, clearing existing blemishes and preventing future outbreaks. The clear+ also uses sonic vibration and gentle warming to increase the efficacy of the treatment. Blue light works by producing oxygen singlets which attach to the P.acnes bacteria. These singlets have a photo-toxic effect on key porphorins, causing the P.acnes bacteria to self-destruct. The vibration increases micro-circulation in treated areas, which helps to reduce swelling and inflammation in the skin. The gentle warming opens pores allowing more light to reach the bacteria. 

TANDA luxe and TANDA clear+ should be used as part of your at home skin care routine. To get the most out of either of these treatment systems, they should be used 3 times per week over the entire face and neck. The TANDA luxe may also be used on the hands to treat the signs of aging. 

The head of the TANDA must make full contact with the skin in order to turn on. When it turns on it will emit the light and you will feel a slight vibration. Each area should be treated for 30 seconds. When 30 seconds has completed the device will beep. The triangle shape of the head makes it easy to maneuver the device over your entire face. We find it easiest to use this device with a facial serum to help it glide easily across your skin. We recommend our BrookskinMD C-serum. The vibration of the device will help to push the product into the skin. The Vitamin C in the C-Serum works as a nutrient for the Fibroblasts in our skin which make collagen and elastin, enhancing the overall treatment!

If you would like to learn more about LED treatments or the TANDA products please leave a comment or visit us at the office or the spa! TANDA luxe, TANDA clear+ and TANDA zap are all sold at our office and at our spa!

ALL WRINKLES ARE NOT CREATED EQUAL!

Botox...lasers...fillers...OH MY!

Do you want to get rid of your wrinkles, but aren't sure what the best treatment is for you? Are you feeling overwhelmed by the multitude of facial rejuvenation treatments out there? Let us break it down for you!

It starts by determining what type of wrinkle you would like to rid your face of! There are actually FOUR different kinds of wrinkles that can be found on the face! The next step is to determine which treatments will work for the specific wrinkle you want to kiss goodbye!

Wrinkles

1. Atrophic Wrinkles
These wrinkles are fine lines occurring on the face that appear to be almost parallel to each other. When you stretch the skin surrounding these wrinkles they tend to disappear. These wrinkles are caused by the loss of collagen in your skin which can be due to sun exposure as well as the normal aging process.

2. Permanent Elastic Wrinkles
Crease lines that may start out as Atrophic Wrinkles, but become permanent over time. They occur on the cheeks and upper lip most frequently. These wrinkles are also caused by sun exposure as well as by smoking.

3. Dynamic Wrinkles
Wrinkles caused by movement of facial muscles. These wrinkles are commonly referred to as frown lines, smile lines, crows feet or "11's" (the lines in-between your eyebrows). They are not caused by sun or smoking (however ALL wrinkles are exacerbated by both of these things), but rather from the repetitive movement of skin as your muscles of your face move in expression.

4. Gravitational Wrinkles
These lines are caused by the effect of gravity as we age. They are also due to the redistribution of fat as we age. These include things like nasolabial folds (the lines framing your mouth) and jowls.

Treatments



1. Botox & Dysport
Botox (onobotulinumtoxinA) and Dysport (abobotulinumtoxinA), are both neurotoxins that treat Dynamic Wrinkles. Botox and Dysport work by stopping the nerve from firing, which stops your muscle from contracting, which stops your skin from moving! Once your skin is not constantly moving all day it allows the skin to smooth out and viola, NO wrinkles! Botox and Dysport are temporary treatments and need to be done every 3-4mo. If your wrinkles are deep and do not go away when you are not moving your muscles it make take more than one treatment of Botox or Dysport to completely correct these wrinkles. Some wrinkles may be too deep to ever achieve 100% correction, but can be softened by multiple treatments.

2. Fillers
There are many different fillers out there on the market. The most common are Juvederm and Restylane, which are made of Hyaluronic Acid, a naturally occurring sugar molecule found in your skin. These fillers last anywhere from 6-18 months! These are best used to treat gravitational wrinkles where you have actual loss of volume. They can be used to fill the nasolabial folds & marionette lines (vertical lines going down from each corner of the mouth) as well as to plump up the upper cheek and lips!

3. Lasers Treatments
Laser resurfacing or Fractionated Laser Therapy can be used to help with the appearance of fine lines and wrinkles. Both of these treatments can help with the overall appearance of your skin including correction of tone and texture. Lines around the mouth and underneath the eyes as well as atrophic and permanent elastic Wrinkles on the cheeks benefit greatly from a Laser resurfacing treatment. These treatments do require more downtime than treatments with Fillers or Neurotoxins as the skin needs anywhere from 2-10 days to recover depending on how aggressive the treatment was.

Of course Botox, Fillers & Lasers have contraindications, risks and potential side effects associated with them just as any cosmetic procedures do. These treatments should only be performed by a trained and licensed medical professional! Make sure you do your homework and know who is treating you!

If you are interested in learning more about any of these treatments or are interested in receiving any of these treatments, please book a consultation at our office with Dr. Glen Brooks, Leah Kenney, PA-C or Julia Boucher, PA-C. Call 413-565-4400 to book now!

EYELASH LOVE

When it comes to getting the long luscious lashes that all women want, there are many different options to chose from. It can be a bit overwhelming with all of the products out there boasting guaranteed increase in length and volume of lashes. There are many over the counter products including lengthening mascaras, eyelash conditioners with lengthening, eyelash extensions & false eyelashes. Lengthening mascaras can improve the look of your lashes, but we all know there is no magic in them. Obviously, the mascara you chose does play a part in achieving that perfect lash look though. We recommend making sure you use a lash conditioner or "base" prior to putting on the black stuff. This gives yours lashes one more coat which will make them appear fuller and longer! We love Jane Iredale's PureLash Extender Conditioner. Check out this video to learn how to properly use a conditioner prior to your mascara.

As for false eyelashes and eyelash extensions, while they do create a beautiful look, they can be very expensive and a lot of work to keep up! So, even though there are many options at your local drug store and Sephora there doesn't seem to be one that has it all. This is when it's time to visit your plastic surgeon! You may have heard of a prescription medication called Latisse. Latisse (bimatoprost ophthalmic solution) 0.03% is a topical medication applied to your upper lash line daily to promote growth of lashes, including length, thickness and darkness.

Results after using Latisse for 16 weeks

The medication in Latisse was originally used intraocularly (into the eye) to treat glaucoma. It was then observed that patients who were you using this medication started growing fuller thicker lashes, so Allergan decided to formulate it into a cosmetic application to help treat hypotrichosis (inadequate or not enough eyelashes).

Like any medication, there are risks and contraindications associated with use of Latisse. Patients who have Glaucoma and are on medication to decrease intraocular pressure (IOP) should only use Latisse with close monitoring for changes in their IOP as concurrent administration of Latisse and IOP-lowering prostaglandin analogs may decrease the IOP-lowering effect.

 Latisse may cause hyperpigmentation (darkening) of the eyelid or the iris (the colored part of the eye). If hyperpigmentation of the iris occurs this is likely permanent. Eyelid hyperpigmentation usually resolves once Latisse is discontinued. This risk is something that we find patients to be particularly worried about prior to explanation. The hyperpigmentation of the eyelid is something that most women will barely notice. If  you have light skin you may notice a slight red hue to the skin just above your lashes and if you have darker skin you may notice a slight purple hue. For most women this does not turn out to be a problem as once you have your eyeliner and eyeshadow on you can no longer see this hyperpigmentation. As far as pigment in the iris, this is a very rare occurrence and has in fact only happened with the use of bismatoprost intraocularly. Patients with completely blue eyes are not at risk at all as blue eyes lack any pigment and therefore no pigment can be put down in them. Brown eyes, while at risk for more pigment to occur, would be unlikely to show any noticeable difference in pigment, as they are already dark. Patients most at risk are those with hazel eyes, green eyes, or blue eyes with flecks of gold or brown in them. Other risks include red itchy eyes, dry eyes, and swelling around the eyes.

Latisse should not be used in women who are pregnant or breast feeding. Latisse should not be used while contacts are worn. Contacts must be removed first and the patient should wait at least 15 min after application of Latisse to reinsert contacts.

 

Now that we have gone over all of the risk and contraindictions, let's talk about how you actually use Latisse. Latisse comes as a 30 day supply with 60 applicators and an eyedropper bottle of medication. It is only nessecary to use 1 drop of latisse to treat both upper lashes. Take the top of the eyedropper bottle and flip it over and then squeeze 1 drop of the liquid into the top. You can then take the applicator and dip it into the top and then glide it across the lash line just above your upper lash. You do not need to treat your lower lash. The instructions say to use a seperate applicator for each eye, but we find that it is okay to use the same applicator for both eyes. The applicator should be thrown away after 1 use though.  Watch this video from Allergan, the creator of Latisse to see exactly how to apply the product.

You will start to notice a difference after using Latisse for about 4 weeks. As you continue to use it your lashes will continue to become longer and fuller! If you stop using Latisse your lashes will slowly return to the length and thickness they were prior. They will not become shorter or thinner than before use of Latisse. If you are interesting in getting started with Latisse please call our office to make an appointment for a consult and to get your first prescription! Please comment with any questions regarding Latisse. Thicker, fuller lashes are in your future!!

JANE IREDALE: FEELING ALIVE SPRING COLLECTION

Before: No makeup

During: Trying out the new Jane Iredale spring products!

After!

I was lucky enough to be able to try out the new hues of Jane Iredale's spring collection: "Feeling Alive" first hand with the help of our lovely aesthetician, Lynne. My before picture shows how dull and drab my skin has been looking as we come to the end of the cold/dry weather of a New England winter. It's tempting to go out and sit under the harmful rays of the sun to get that perfect sun kissed look. I'm here to tell you there is another way! All you need is a little Jane Quad Bronzer and you can achieve this look without worrying about the added wrinkles and risk of skin cancer that go along with sun worshiping.

Lynne started my makeup application by color matching for foundation. This can be the most difficult part of a makeup application. It is important to first determine whether your complexion is cool or warm. Folks with cool complexions have blue undertones in their skin, while warm complexions are usually more yellow. Now, you are probably thinking, my skin doesn't look blue or yellow! You can tell which you are by looking at the veins on the inside of your forearm. These veins will either look blue or green. If they are blue you have a cool complexion and if they are green you have a warm complexion. If you still have trouble, think about what color jewelry you usually look best in. People with cool complexions tend to look best in silver jewelry while warm complexions are complimented by gold jewelry. Determining if you are cool or warm will help with color matching your foundation as well as determining your overall makeup theme. You may love the look of orange and corals but if you have cool skin chances are it won't look as good on you as your friend who has a warm complexion!

After Lynne found the perfect shade of Purepressed Mineral Foundation (which by the way has SPF 20 in it!), we moved on to bronzer. If you are pale like me, bronzer is a must, and Jane has one of the best around! Jane's Quad Bronzer comes in 3 shades, the newest shade, Rose Dawn is what Lynne used on me and is a beautiful array of pinky bronzers! Perfect for my cool skin!

Moving on to the eyes. I am in love Jane's Eye Gloss. It is soft and silky and doesn't cause any smudging or creasing! It also lasts all day long, which is absolutely necessary for the long summer days! Lynne used the new shade, Pink Silk on me for a natural ethereal day look. She used Basic Black Eye Pencil to line my lids and Purelash Extender and Conditioner for my lashes followed by Black Onyx Mascara. While we are on the subject of lashes, a quick shout out to Latisse, the medication responsible for my long and thick lashes! We will have another post specifically on this, but I would be remiss not to mention it when talking of lashes.

Last, but not least, lips! Lynne used In the Pink PureGloss to give my lips a hydrated feel and glossy look. She also put just a small amount of the Pink Silk in the middle of my bottom lip to create some dimension in color. If you want a little more than just a gloss Jane also has lipsticks and plumpers available. Jane's Just Kissed Lip Plumper make lips fuller and more kissable while giving them the moisture and color you crave!

My overall look is a perfect collection of pink that would work well on any summer day. It is soft and light and does not look too made up. Perfect for a picnic or barbecue. If you are interested in learning more about Jane Iredale makeup check out their website www.janeiredale.com or come in to our spa for your very own makeup application or makeup tutorial!

~Julia Boucher PA-C

TO PEEL OR NOT TO PEEL

It's pretty hard to live in our world these days and not know what a chemical peel is. Most people have either had one in the past or at least have known someone who has had one. What can be more difficult to determine is whether you are the right candidate for a peel, what type of peel you should get and what the result will be. This post will hopefully answer some of these questions!

Let's start with, are you the right candidate? The answer to this question for the majority of people is YES! There are very few contraindications for having a chemical peel. The most common contraindications include sunburned skin, open wounds, medications that cause sensitivity such as Vitamin A derivatives (Retin-A, Retinol, Adapalene, Accutane), cystic acne, heightened allergies and skin infections. Patient who are on topical keratolytics such as Retin-A will be asked to discontinue them for a period of time prior to the peel.

Another big question that must be answered in deciding if a chemical peel is right for you, is what are your expectations? If you are someone who is looking to correct deep wrinkling in between the eyes, around the eyes or in the forehead, deepened nasolabial folds (smile lines) or jowls, a peel will not be enough for you. You could still benefit from a peel but you may be more pleased with something a bit more invasive such as Botox or Dysport, fillers such as Juvederm, or even facial cosmetic surgery (don't worry there will be posts about all of these in the future!). However, if you are looking to smooth out fine lines and wrinkles, create an even skin texture and tone, brighten and refresh skin, or help lighten pigmentation then congratulations, you are the perfect candidate for a peel!

Now that we have determined a peel is right for you, the next question is what type of peel should you get? There are many many different peels out there that vary in intensity and purpose. There are very strong peels that must be performed by a medical professional such as an MD or PA and require a large amount of downtime. These peels result in a burned-skin look, think Samantha from Sex and the City after her chemical peel. There are also peels that require next to no downtime and are performed by aestheticians.

At our Spa we offer peels that require little downtime (no burned-skin look), but actually achieve excellent results. Our least invasive peel is our  BrookskinMD RosaLuxe Sensitive Skin Peel. This peel is for redness-prone and sensitive skin. It may safely be used in patients with Rosacea. Most patients experience approximately 3-4 days of peeling with this peel. It contains Salicylic acid, Mandelic acid and Azelaic acid. Our most popular peel is our BrookskinMD Glow Retexturing Peel. This peel helps to smooth fine lines and wrinkles, makes the skin look more radiant and helps even tone. The Glow peel is formulated with TCA, Salicylic acid and Azelaic acid. It is a perfect peel to do in preparation for summer to peel off the dry harsh winter! Most patients peel for about 5-7 days after this peel. If you are looking for help with pigmentation, our BrookskinMD Corrective Pigment Peel will be perfect for you. This peels helps lighten pigmentation, rejuvenate the skin from sun damage, help with fine lines and wrinkles and even skin texture. This peel is formulated with Lactic acid, Azelaic acid and Rhytic acid. This peel has the most downtime and patients can expect to have some peeling for 7-10 days. For those patients who don't want any downtime we have our BrookskinMD Quick Peel. This peel can actually be performed on the day of your big event! All of our peels come with after-care instructions and products to use for the next few weeks while your skin is healing!



This is a patient of ours five days after having our BrookskinMD Corrective Pigment Peel. This type of light peeling is what you can expect with any of our peels.





If you are still wondering if a peel is right for you or have more questions, the best thing you can do is come in for a consultation with one of our aestheticians. They will be able to tell you exactly what benefits you will get from a peel and what peel will be right for you! Happy peeling!!!