The Person behind the Provider

Dear Friends, Family, and Patients, What humbles me the most in my practice is, hearing my patients’ personal stories and journeys that has led them to be in the seat across from me in my office. So, I thought, why not share mine? If my patients can be at their most vulnerable in front of me, then maybe I can too. To be fair, my story isn’t quite unique. There are lots of women out there going through similar versions of what I have experienced. But that just means, that my story is RELATABLE. Relatable to people struggling out there in this world defined by the words – fast, instant gratification, comparison driven, ___ (insert what you experience). During medical school and residency, I was binge eating to deal with stress. Also, my routines…wait, what routines? There was no room for a “routine” in residency. Which meant eat when you can, how much you can, what you can. Then immediately after, was my first pregnancy (YAY!). My breastfeeding journey was wonderful, but with one humungous side effect of wanting to EAT insatiably. And this was even worse after my second son. I would definitely eat wayyy over my caloric needs and didn’t know how to stop. Raising a toddler and a newborn, working full time, and starting a new business was not easy. I was done nursing my second child, but the hunger cues never went away. I was at my heaviest and felt the worst. I did not like looking at myself in the mirror or in any of my clothes. I was, simply put, – UNhealthy. I mean… my cholesterol was high for the first time ever and so was my A1c! Working out felt futile. GLP1s were taking the world by a storm at that time, so I decided to try it after consulting with my PCP. The changes I felt were remarkable. I started not having the same cravings. I felt satisfied with food faster. My portions were much smaller. I did not feel like I had to eat every time I was stressed. And overall, I lost weight. I fit into my clothes better. The person I was seeing in the mirror felt somewhat familiar again. One of the comments I received from someone was… “taking this medication for weight loss is like cheating to get skinny.” To that, my gentle response was, “I’m not trying to compete with anyone…I’m simply trying to feel better about myself.” I was happy with what I saw and felt, but knew that I was not done. As I knew – taking this medication was only 30% of the treatment. Once the “training wheels” came off, I still needed to practice mindful eating and not let my cravings get the best of me. Also, where was my muscle? If you are my patient, you know that when you are on a GLP1 medication, you not only lose fat, but also your muscle bulk. We NEED to increase protein in our diet AND focus on resistance training to build muscle. Working out was not optional anymore – it became non-negotiable. For that, I joined a gym. Yes, a gym. If you know me personally, your jaw would have dropped hearing this. I felt motivated to work out and to see the muscle-mass percentage move in the right direction. I workout so that I can be healthier. I workout so I can support my joints and bones as I get older. I workout so I can be off any meds. I work out so I can feel happier mentally. I workout so I can get some “me time”. I workout so I can tell that little “can’t” voice in my head that it can take a back seat. I workout so that my kids can see their mom get stronger. Thank you for coming along in this journey with me.
PRP/PRF Treatments for Under-eye dark circles, bags, and puffiness.

Under eye dark circles and bags have plagued people for a long time. Dark circles and bags can not only make you look tired, but can also age you. The appearance of these tend to have a pretty strong genetic predisposition; and also influenced by other factors such as smoking, diet, sleep habits etc. But those later ones are modifiable. Genetics – not so much. So, although you may be inclined to just “learn to love” them, there are a few options out there to help lessen the appearance of under eye dark circles and bags. Do your under-eye dark circles bother you? Are you ready for a PRP consult?
Jowl got you down?

What are Jowls? They are the drooping lower cheeks and skin over your jawline that can form as we age. So- you have jowls that you don’t quite like, and you want to pull them up? Well, if you want the real deal – that’s a FACE LIFT. Invasive plastic surgery. Many people definitely do not want to go that route for many reasons. So what are the next best treatments? Fillers and Tox! PDO threads can be used as well. It is a good idea to have a realistic goal in mind as these treatments will give you a natural and a subtle lift. First, let’s figure out why we get jowls. Over time, many factors contribute to the formation of jowls, such as: gravity, skin laxity due to loss of collagen, ligament laxity, bone loss, and overall facial volume loss. So what can we do about it? We can use tox help relax the platysma (the superficial neck muscle) to stop it from pulling the jowls down. It has a pretty name too- a Nefertiti Lift! But we should also really address the underlying structures and support them – and this is when HA fillers come in. Supporting the MIDFACE – yes, supporting the DEEP TISSUES in UPPER CHEEKS can provide the lift to elevate the jowl and bring focus up. Furthermore, also adding filler to smooth out the concavities on your CHIN/JAWLINE can help with the appearance of the jowls as well – ultimately giving you a refreshed look! Everyone needs different amounts based on the anatomy and severity of jowls. That’s why consults and frequent re-assessments are key! PDO threads can be used as well, but there is evidence that they can cause scar tissue to develop in the underlying tissues, making it relatively challenging if you ever want to consider a facelift in the future. So, waiting on more long term studies on that for now.
Sculptra: Collagen Re-Builder

If you have seen my information reel about Sculptra, you know the gist of this blog. What is Sculptra? Sculpture is poly -L-lactic acid. This is a synthetic compound, which, when injected in the right plane of your tissues, helps stimulate fibroblasts-which are cells that build and lay down the collagen under your skin. Why Sculptra? As we age, we lose our natural collagen over time. This causes skin laxity and decline in overall integrity. Different factors affect how fast and how much collagen you lose overtime. Such as sun exposure, smoking, dehydration, pollution exposure, product usage, chronic illnesses, and other daily habits as well. Regardless, in order to tell your body to build more collagen, we need to tell the collagen building cells – fibroblasts to produce more collagen. This is where Sculptra comes in. Incremental increase in collagen provides natural volume and structural integrity to your skin. This helps reduce the appearance of wrinkles, fine lines, and folds. It provides amazing support and hydration, as well as structure to the skin; especially when added to hyaluronic acid fillers, which could be used as target treatments. How to treat with Sculptra? Sculptra is injected on face and even neck. In the neck, it can help with crepey skin. It can be injected with either needle or cannula after mild superficial numbing. The swelling is minor post treatment. Because we need to wait for the cells to actually start producing collagen, the results are not immediate. The results take 4 weeks to appear. But they last for two years. That’s why it is important to start treatments a couple o f months prior to any particular occasion. People typically require anywhere from 2 to 4 sessions on average. It is said that you need one treatment of Sculptra for decade of your life after 30. How long does it last and is there any maintenance? Sculptra can take 2 to 4 sessions on average to get the desired results and can last up to two years. Maintenance treatments can be done every six months for upkeep as needed. Are you ready for Sculptra?
Little lips?

In the journey towards facial balancing, we HAVE to address the lips! And NO! I am not talking about duck clips, big lips, wide lips, flat lips. I’m talking about enhancing YOUR natural lip shape that you have in order to fit the overall aesthetic of your face in a very NATURAL way. In younger patients who don’t have significant volume loss or upper lip droop, a little lip plump with very lightweight filler does the trick effectively. 0.5 cc to 1 cc can make a big difference. You can achieve such natural looking results without looking overdone. It is key in the overall facial balancing process. As we get older, the area above our top lip loses laxity and can make our top lip droop, making it look thinner and smaller. We also lose volume, which can exacerbate this. Lip filler can help restore shape and volume. Also, supporting the philtrum columns (the two vertical lines between your nose and your top lip) can help pull the lip up for support and add volume without actually adding more filler in the lip. Effectively making you look… Younger. It is a fairly quick procedure, giving you the biggest bang for your buck in terms of your investment in your facial aesthetics. Most fillers last 9 to 12 months, if not more. If you have a high pain tolerance, topical numbing cream can help take the edge off. But if you are quite sensitive to pain, we can do a nerve block as well. Downtime is minimal. So what are you waiting for?
Managing Complications

One of the most common concerns of an aesthetic patient is: what happens if I get a complication? I believe every single patient should be extensively educated on the potential complications of any aesthetic treatment prior to proceeding with a treatment. The good part is – these are rare with a mindful and experienced injector. Let’s TOX about it: neuromodulators such as Botox, Disport, Jeuveau etc are relatively safe in the dosages we use. There tend not to be any irreversible complications per se. Rather, potential is for some unintended temporary effects. Such as: eyelid droop during forehead botox, difficulty using a straw or smoking after upper lip botox (which some people actually desire), changes in smile pattern, smile/eyebrow asymmetry, minor lumps/bumps for a day or so after treatment, and minimal bruising. Fortunately, all these effects are relatively mild and go away in days to weeks. Of note, there is no particular reversals as of yet for tox treatments. How about Hyaluronic Acid (HA) Fillers? Lumps/bumps can be felt at times after treatment but smooth out over a span of days to weeks. Bruising can be common, which can last up to a week. Fillers can migrate overtime, but can be mitigated by the type of filler used. Overuse of filler in a space can also cause migration, but this can be spot dissolved with hyaluronidase. In my acute care setting as a hospitalist, I have also seen a couple of cases presenting with an autoimmune reaction and granuloma formation in the injected area which can be helped by dissolving the filler, and systemic steroids. Infections can occur, but are very rare if proper aseptic techniques are employed. Main concern with fillers is a Vascular Occlusion (VO). This is when an injected filler goes into blood vessel and can cause a blockage of blood flow to that area, leading to tissue necrosis. That is why, a good injector is always on the lookout for any blanching of skin after injections, and will always follow up with you regarding how your treatment is settling in. You should never hesitate to reach out to your provider after a treatment if you have any questions of concerns. If a VO occurs, hyaluronidase can be injected to dissolve the filler and restore blood flow in that area. This also is useful to correct any undesired aesthetic results for a quick fix. What if I don’t like my filler results? – hopefully in a mindful experienced injector, this will be rare – but can happen. We can use hyaluronidase to dissolve it and restore the tissues. There are other types of fillers as well which do not have a reversal/dissolving agent, but if used cannula technique, the risk of VO is quite low. So overall – low risk, high reward? I like it! And the fact that all of this is temporary, is quite reassuring. Did this information help your concerns?
Is it your first time too?

“Everyone’s doing it, but I’m nervous.” “I don’t want to look fake.” “I don’t like needles.” …And so many more concerns I hear almost on a daily basis from patients who have never had any aesthetic treatment, but have been thinking of starting. I get it! It can be nerve-racking and overwhelming, especially when you don’t know what to expect. I am so grateful that so many of my patients have trusted me to be the kickstarter of their aesthetic journey. In this blog, I want to address a few of the first time concerns. Just like I do during my consultation appointments. So let’s address the top few: “I don’t know where to start” ~ That’s A-OK! that’s why your injector is a specialist in recommending different treatment approaches based on your aesthetic concern as well as your budget. They can determine the time it will take to achieve your aesthetic goals, as well as the upkeep needed to sustain your desired results. And keep in mind- it’s okay to ask for a consultation appointment without any commitments. And if you are still unsure, get a second opinion! “I am afraid of needles” ~ you’re not alone! Nobody really “enjoys” being poked by needles. If you’ve ever gotten blood work done or have taken your blood sugar levels, these injections can be similar or even less intimidating. We do multiple distraction techniques to get you through the appointment. We also have topical numbing creams that we can use. Rarely we need to do a nerve block. Most people do just fine. The needles are very fine; plus the treatments are fairly quick. “I don’t want to look like I got work done” Or “I don’t want to look weird” “It’s expensive “ ~ yes it can be. But the longer you wait, the more expensive it will be because you may need more treatments or higher dosages. Once you’re at a steady state, maintenance treatments are much more cheaper. You can take advantage of Allē or Galderma and other rewards programs, and always keep a lookout for seasonal specials. At the end, the more information I am able to give you, the more at ease you are about your journey. And remember: good Botox looks like you don’t need Botox.
Preventative Botox

Preventative aesthetic treatments, especially neurotoxins (such as Botox, Jeuveau, Dysport and others) are a bit of a hot topic. So here’s a little bit of a background in order to understand why “preventative” treatments are recommended by some injectors. When we are young, we don’t have wrinkles or skin folds as we have not had years of use or wear and tear of our skin, muscles, and facial fat pads. We have that young & plump looking skin. But overtime, with persistent use of our facial muscles and other age related factors, we develop skin folds and wrinkles. Genetics also has a big part in this. Some wrinkles can be dynamic – meaning that we only see them when we make certain facial expressions. Some wrinkles and folds can be quite static – meaning that we see them even at our resting no-expression face. Of course, the presence of these fine lines and wrinkles allude to the aging process. So, people have been trending towards injecting Botox earlier in life so that they use a particular muscle lesser so than usual. This lack of use can help prevent the formation of dynamic & static wrinkles, fine lines, and folds; ultimately slowing the appearance of normal aging. In theory, it sounds great. And I do think there is some merit to it. But all of this does not come without concerns. One of the biggest concerns is developing antibodies/resistance to these toxins. A lot of younger patients tend to use lower doses of Botox or other neurotoxins to achieve their desired results. But if started early, there is a possibility of developing antibodies. Luckily, we have other neurotoxins that can take place if you do develop antibodies to a particular brand. And so far all of them are pretty efficacious regardless. Ultimately it just depends on your personal preference. Until there are major studies out there, recommending one way or the other, I think preventative “lower dose” Botox can be used to avoid from having to use higher doses of Botox or even fillers down the road and preserving a younger facial aesthetic.
Want a radiant age-defying glow to your skin?

There is a whole field dedicated to the science of aging. Briefly, as we age, we tend to slowly lose the structural integrity of skin leading to decrease is healthy fat pads, thinning of blood vessels, decline in collagen, overall hydration status and much more. These processes directly result in the outward appearance of aging. But, can we support the appearance of aging with external treatments? Absolutely! Here comes Skinvive by Allergan Aesthetics. Skinvive is a hyaluronic acid (which naturally occurs in your body), in microdroplet form. This is injected in the dermal layer of the skin – specifically the cheek and periauricular area where hydration loss can have the greatest effect. This attracts your body’s natural moisture which results in a vibrant, radiant age-defying skin. Also, those pesky fine lines and even the nasolabial folds? Skinvive can reduce the appearance of these as well. On top of it all, it lasts up to 6 months! Skinvive can be a great treatment by itself, or be combined with neurotoxin and traditional HA fillers for an overall full facial rejuvenation. Aging…or should I say anti-aging keeps
BROtox

“That stuff is for women,” I overhead a couple of men say while talking amongst each other at a coffee shop while I happened to be working on my aesthetics business plan. I used to hear that a lot. I still do. BUT – women aren’t the only ones getting Botox. Times are changing, oh yes! Men are increasingly adding cosmetic procedures to their aesthetic routine. Botox being a common one. Men are getting more in-tuned to their appearances, especially in terms of aging. As the wrinkles slowly set in- to where they appear on the face even without making an expression- is a pretty common sign when I see men starting to take the next steps. Many times, it is pointed out to them by their own significant others. Other treatments for men also include neurotoxin for hyperhidrosis and headaches. A lot of men’s concern is the “overdone look” of medical aesthetics. This is surely valid. But in my practice: well-done Botox looks like you don’t need Botox! Once they are reassured of this, they feel much more at ease regarding the treatment. Other than that, we just let the results speak for themselves