Author Archives: The Woodruff Institute

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Microneedling: an older treatment with a renovation in the COLLAGEN P.I.N.

Microneedling is the process of creating tiny micro-injuries to the skin in order to improve the appearance of scars and wrinkles. It is s a minimally invasive skin-rejuvenation procedure that involves a device that contains fine needles. This sounds scary but patients tolerate this very well and a topical anesthetic cream is applied prior to the treatment. The controlled injury stimulates the growth of collagen and improves the scaffolding under the skin. The process works well for patients with acne scars or fine lines and wrinkles looking to improve the texture of their skin. It is also used to reduce the appearance of traumatic scars, pore size, irregular pigmentation and stretch marks.

Generally, 4 to 6 treatment sessions are recommended that can be performed at 4 week intervals. The whole procedure takes about 30-90 minutes depending on the areas treated. Typically, the treated area will look pink and puffy for 1-5 days depending on the level of treatment with most patients looking near normal at 2-3 days. Microneedling can be performed anywhere on the body with the most common areas being the face, neck, chest, hands and abdomen.

Collagen P.I.N. (Percutaneous Induction Needling) differs from older generation microneedling devices as it is motorized and has an adjustable gauge to precisely control needle depth. This can be adjusted throughout the treatment depending on the skin thickness and problem being addressed. Depth and delivery are very important for better results and a shorter recovery. More importantly, the Collagen P.I.N. utilizes special sterile surgical grade disposable needle tips to ensure the highest level of safety.

Microneedling is different than our resurfacing lasers because it is safe for patients of all skin colors, including those with a tan and anyone looking for a shorter recuperation period. That being said, many patients combine lasering and microneedling for optimal results and studies show that they can often work better together. We are seeing great results with the Collagen P.I.N. on fine lines and wrinkles around the eyes and mouth. These can be combined with our more traditional neurotoxin treatments (i.e. Botox, Dysport, Xeomin) and may help them last longer! With a new treatment device available, we are excitied to offer and tailor the best treatment regimen to fit your skin type and lifestyle.

Written by: Kathryn J. Russell, M.D.

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Microneedling with Collagen P.I.N.

We are excited to announce our NEW Collagen P.I.N. This microneedling system activates cellular regeneration to help tighten and lift skin, while minimizing common skin problems such as acne scars, fine lines, photo-aging, dull skin, poor texture, stretch marks and body scars. Now available in our Naples & Bonita Springs / Estero offices. Call TODAY to schedule your consultation with one of our licensed medical aestheticians.

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End of Summer Cosmetic Event

You don’t want to miss our End of Summer Cosmetic Event at our Bonita Springs office on Thursday, July 30th at 5:30pm. Discounts on ‪Dysport‬, ‪Restylane‬, ‪Perlane‬, and our favorite summer skin care products from ‪Skinceuticals, EltaMD‬, and ‪SkinAuthority‬. Dr. Kathryn Russell and our Physician Assistant, Debbie Wallace, will be on hand to answer all your cosmetic questions. There will be demonstrations, raffle items and plenty of food & drink! RSVP today to reserve your seat!

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Juvashape

Non-invasive body sculpting devices have been increasing in popularity over the years. Frequently I would ask my dermatology and plastic surgery colleagues about their devices and I was never that impressed with their answers. At the Woodruff Institute we take pride in only offering services that we know will work. We refuse to follow the latest fad. Our patients rely on us to do the research and wait until the technology is perfected. Well, that time has come with body sculpting devices. When I learned about JuvaShape, a radiofrequency body sculpting device, I knew we were right to wait.

Radiofrequency devices for skin tightening have been around for more than a decade, but the technology needed to mature in order to have a device that was safe and delivered results. JuvaShape is the solution to all the problems with early body sculpting devices. I have heard from friends and patients who have tried these other devices that they can be painful, don’t give results, or leave you feeling like you have a brick your belly. JuvaShape is not painful. In fact, it feels like a hot stone massage. When I tried it, the only painful part was having my before photos taken! JuvaShape requires multiple treatments, but it does deliver results. And because JuvaShape uses heat and constant motion to melt your fat and tighten your skin, your skin feels normal and natural after the procedure. JuvaShape is also superior to some of the other devices out there because it not only dissolves the fat, but it also tightens the skin. In fact, many of our patients are quite thin and use it just for the skin tightening effect.

Whenever we have a new treatment, to make sure it is safe and effective, we try it on our staff or willing volunteers before we start treating patients. Always trying to do my part, I volunteered to have the JuvaShape. First I signed up for my belly. The next day I signed up for my arms. And a week later I started treating my flanks, my thighs and my derriere. It was all for the patients, really. It takes six to 8 treatments to get the desired results, but after two treatments on my arms, my gym buddy leaned over when we were on the elliptical machines and said, “You’re doing that fat zapping thing on your arms, aren’t you?”

I have now completed all my treatments and I must say I am impressed.

I am still not a runway model, but my clothes fit me better, I will wear a bathing suit without a cover up (wearing sunscreen, of course), and overall feel more confident. We all know it is hard growing older and seeing our bodies change. And just at a time when I was accepting that my middle aged body was never going to look like my younger body again, JuvaShape came along and gave me a little boost.

What’s the biggest problem with JuvaShape? It is addicting. When you start seeing results you just want more, more, more. Next, I want to do my neck and jowels.

If you would like to learn more about JuvaShape, call our office at 239-596-9337.

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Here’s What You Need to Know About Injectable Fillers

Unlike topical lotions and creams, fillers can target the signs of aging deep beneath your skin. They can also help replace the youthful fullness that’s slipped away due to age-related fat loss in your face, which can leave you with a sunken look. Concerned about unnatural results? The goal isn’t to get rid of every crease or wrinkle on the face, so don’t overdo it.

With a couple dozen FDA-approved fillers in available, picking the right one that can handle your specific aging concerns is intimidating. Here’s the low-down on everything related to fillers—including which best suits your aging issue.

What’s in these fillers?

Fillers come in 6 different formulations: collagen, fat, hyaluronic acid (HA), hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate (PMMA):

  1. Collagen This protein plays a key role in supporting your skin’s structure. Though collagen fillers were the first type of fillers available they are seldom used to day as their effects fade fastest—results last just three to four months.
  2. Fat A potentially permanent option, fat injections are the most invasive of all fillers. A liposuction procedure is performed to remove fat from another part of your body such as the abdomen or hips. Results are immediate but downtime is significant due to swelling and bruising. Another downside is a lack of reliability, in that fat is not permanent in every patient.
  3. Hyaluronic acid Hyaluronic acid (HA) naturally occurs in the body, plumping the skin when it binds with water. HA fillers are reversible: If you’re unhappy with results, the filler is easily dissolve by injecting an enzyme called hyaluronidase.
  4. Hydroxylapatite Designed for moderate-to-severe wrinkles (like smile lines), hydroxylapatite is a mineral-like substance that naturally occurs in human bones and is suspended in a gel-like solution to create one specific filler: Radiesse. FDA-approved in 2006, Radiesse fills in wrinkles and stimulates the production of collagen in the body. Its effects last 12 to 18 months.
  5. Poly-L-lactic acid This man-made material is what’s in the filler Sculptra, which was approved by the FDA in 2009. It’s intended to add lost volume back to the face, and it stimulates collagen production. You’ll need three injections over a period of six months and you won’t see results immediately as it takes a number of months to see the benefits for Sculptra. That said, results can last for a couple of years.
  6. Polymethylmethacrylate (PMMA) Another permanent and man-made, PMMA beads are tiny bits of shatter-resistant plastic, which, when used in filler-form, are suspended in a gel-like formula that also contains collagen. These fillers are permanent and offer gradual but lasting results.
What are the risks?

Most filler treatments are quick, lasting between 15 to 30 minutes. And though there’s usually no downtime (applying makeup and doing your normal activities afterward is fine), you may experience some redness, bruising, swelling, and itching. There’s a small risk that a filler will cause skin discoloration and may possibly form tiny bumps under the skin Also, know that there’s a slight risk for infection. Bruising is common with fillers and is more common in areas with thin skin such as the tear troughs. Applying ice for an hour or two after treatment decreases the risk of bruising.

While the pain related to fillers can range depending on the area being treated (lips are the most sensitive). Topical numbing medicine applied prior to treatment is helpful in keeping discomfort down. Most fillers are formulated with an anesthetic to minimize pain and those that aren’t can have numbing medicine added to their syringes. As for results, though you’ll see them immediately (excluding Sculptra), they’ll look even better once the filler has “settled” into place—typically one to two weeks after the treatment.

What does “off label” mean?

When a filler—or any drug for that matter—is approved by the FDA, it has to go through a lengthy process to show that it’s safe and it does what it says it will. This costly and slow-moving process gives the official go-ahead for the filler to be used for a specific purpose (like filling in wrinkles) in a specific area of your face (like around your mouth). So when an FDA-approved filler is used in an area not approved by the FDA, it’s considered an “off-label use”.

Which fillers work best for what?

The filler: Juvéderm Voluma XC (Voluma, for short)

Best for: Boosting cheek volume

How it works: The hyaluronic acid (HA) filler was FDA-approved to plump the cheeks in 2013 and is considered the gold standard for this area. Thicker than most fillers, Voluma, gives sturdy support to the face, and is injected deeply into the skin next to the cheekbone, which allows it to lift the tissue above it. And remember: If you’re not happy with the results, the filler can dissolve the HA filler with hyaluronidase, so you won’t be stuck with over inflated cheeks.

How long it lasts: 12 to 18 months

The fillers: Perlane, Juvéderm, Restylane, Radiesse, or fat injections

Best for: Softening nasolabial folds. Each works differently depending on how deep the lines are. For mild to moderate wrinkles thinner filler work best – Resylane, Juvéderm Ultra, Belotero. For deeper wrinkles, thicker filler are called for – Perlane, Juvéderm Ultra Plus, Radiesse, or fat injections.

How they work: The thinner fillers’ small-to-medium particle size allows them to be placed more superficially for a smoother look but they’re not built to handle deeper lines, which the thicker fillers handle best.

How long they last: Juvéderm Ultra and Ultra Plus, Belotero, Restylane, Perlane 6 to 9 months; Radiesse: 9 to 12 months; Fat Injections: Results can last 5 years or more, in some people.

The filler: Restylane Silk

Best for: Plumping lips

How it works: Another hyaluronic acid filler (paired with a super-fine needle, which minimizes bruising and swelling), Restylane Silk has only recently joined the elite FDA-approved club, in 2014. It can plump your lips and fill fine lines around the mouth. But take note: because your lips are sensitive, this one can be pretty painful. To minimize the pain, topical anesthetic cream and injections to numb your lips are recommended.

Cost: $550

How long it lasts: 6 months

The injectable: Botox, Dysport, Xeomin

Best for: Smoothing frown lines and crow’s feet

How they work: While two other injectables, Xeomin and Dysport, have less recognized names, their effects are, generally the same as those of Botox. This trio of injectables reduces the ability to frown by temporarily relaxing the muscle and also smooths wrinkles. The FDA first approved Botox it in the 1980s to treat spasms in the eyelids and misaligned eyes, but gave it the green light for use on between-the-brows wrinkles in 2002. Botox is also FDA-approved to relax the area around your eyes and smooth out the wrinkles. Apart from bruising, potential risks include a headache, and, in rare cases, eyebrow or eyelid drooping. You’ll generally see the full effect in 1 to 2 weeks. To avoid any chance of a frozen face a light hand with the amount of Botox is recommended.

Cost: $250-$500 for frown lines; $250-$350 for crow’s feet

How long they last: 3 to 4 months

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Skin Cancer Prevention by Craig J. Eichler M.D.

May is national Skin Cancer Awareness Month and for my first ever blog posting I get to write about something that I am passionate about: the prevention of skin cancer.

To appreciate the enormity of the problem with skin cancers here are a few statistics to show why dermatologists say we are facing a skin cancer epidemic.

  1. Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.
  2. Each year there are more new cases of skin cancer than the number of cancers of the breast, prostate, lung and colon combined.
  3. One in five Americans will develop skin cancer in the course of a lifetime.
  4. In the US, one person dies every hour from skin cancer.

The bad news is that skin cancer rates have been increasing over the years. The good news is that with appropriate sun protection you can greatly lessen your risk of developing skin cancer.

So, what can you do to decrease your risk of developing skin cancer? The one risk factor we can control is how we protect ourselves from the sun. The sun emits ultraviolet light, which is believed to be the single biggest trigger of skin cancer. Ultraviolet light is part of the spectrum of light our sun emits, is divided into Ultraviolet B (UVB) and ultraviolet A (UVA). UVB is associated with sunburns and UVA with tanning and aging appearance. Although UVB is more potent, both UVB and UVA exposure can increase risk of skin cancer.

Ways to decrease ultraviolet exposure include:
  1. Avoidance
  2. Clothing
  3. Sunscreens

For many, sunscreens are the mainstays for sun protection. Although sunscreens play an important role in sun protection; they have limitations. It is these limitations, which I will elaborate, that lead to the misconception that as long as you applied sunscreen you are protected. You will see that rather then being the main method of sun protection; sunscreens are best used as an adjunct or additional means of sun protection. For that reason, I put it 3rd on the list above as measures we should take to protect.

Next, lets review some important aspects of sunscreens: what they do and don’t do well.

Sunscreens contain ingredients, which either absorb or reflect ultraviolet rays. The SPF number is the most recognized feature of the sunscreens effectiveness. The SPF represents a measure of UVB protection and is based on how much longer it would take to develop sunburn. For example, applying an SPF 2 sunscreen should make it twice as long to get sunburn. You may have read else or been told that SPF higher then 15 isn’t necessary since you get very little added protection using ultra high SPF numbers. After all, an SPF15 which block about 93% of UVB and a SPF 30 about 97%. So why would dermatologists recommend SPF 30 or higher when there appears to be relatively little added protection compared to SPF 15? Here’s why:

  1. If we look at the SPF another way; instead of saying that SPF 15 blocks 93% of UVB, the SPF 15 sunscreen allows about 7% of UVB to get through. A SPF 30 lets about 3.5%; so it is still blocking twice as much as the SPF 15.
  2. Most people apply their sunscreens too sparingly; on average less then half the amount that is needed to get the SPF that is on the label. The SPF on the label is based on applying so that there is 2 mg/cm2 thickness of sunscreen product. So instead of getting an SPF 15 the average person applies an amount that gives them an SPF 8 or less. Using a high SPF sunscreen may offer you some margin for error if you under apply. So, how much does it take to get to the recommended thickness? About an ounce for the exposed body area. That is about a quarter of a 4 oz bottle. I recommend to use a teaspoon of sunscreen for the face, ears, and neck; a teaspoon for each arm, and each leg, one for the back and one for the chest and belly.
  3. Sunscreens wear off. If you are swimming or sweating, the sunscreens lose their effectiveness over time. The sunscreens labeled “water resistant” (maintains protection for 40 minutes in water) or “very water resistant” (maintains protection for 80 minutes in water). There is no true “water proof” sunscreen that doesn’t wear off. And if you don’t see “water resistance” at all then the protection after sweating or swimming may be minimal.

For each of these reasons a sunscreen with SPF 30 or higher can offer valuable more protection then lower SPF sunscreens.

As mentioned earlier the SPF is based on UVB protection. But what about UVA protection? UVA protection is also very important to avoid damage, particularly aging appearance of the skin such as wrinkles, coarseness, and brown spots. In fact it is believed that 90% of aging appearance of the skin is due to sun exposure. More recently studies also show that UVA exposure is important risk factor for developing skin cancer, particularly melanoma. Besides the sun, tanning beds emit these damaging UVA rays. So despite tanning bed industry’s claim that use of their tanning beds is safe; UVA is a proven carcinogen. Tanning bed use can be deadly.

There are several ingredients in sunscreen that offer UVA protection. You should look for a sunscreen, which contains at least one of the following UVA blockers: Zinc oxide, titanium dioxide, avobenzone, or ecamsule (Mexoryl).

When asked which is the best sunscreen, I tell patients it’s the one that you actually will use! I then remind them of these parameters: ideally one that has an SPF at least 30; strong UVA blocking ingredients, and apply generously and reapplied every 2 hours.

I want to emphasize that sunscreens are helpful but they don’t block all the UV light and therefore they are not the end all of sun protection you should use.

My next post will discuss more about importance of clothing and tips for avoidance of UV exposure.

Written by:
Craig J. Eichler, M.D.

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Are You Suffering From Tech Neck?

Put down the screen.! Your never-ending texting and Facebooking may cause you to age more quickly. Some call it ‘tech neck’; others call it ‘text neck.’ Either way, it’s a problem for the iPhone 6 generation. The skin of the neck is sensitive and thin and it’s an area uniquely at risk for fine lines and sagging. Furthermore, gravity and the constant craning over smartphones don’t help matters.

The solution—aside from directing your gaze upward every once in a while (sky! trees! other human beings!)—is to treat your neck with the same care you give your face. Apply sunscreen every morning to prevent the collagen breakdown that contributes to lines and sagging. Every night, use of an anti-aging product such as Skin Authority’s Moisturizing Lift Cream that hydrates and firms dry, depleted, and sagging skin. Retin-A, usually used to tone the skin of the face, can also be used to rejuvenate neck skin.

Be warned, the neck skin can be more sensitive than the skin on the face and some find that Retin-A needs to be diluted with moisturizer when used on the neck. Certainly, significant amounts of excess skin require surgical correction but mild to moderate Tech Neck does not require going under the knife. A variety of lasers are available to tone lax neck skin. Pixel RF uses radiofrequency energy to tighten the skin and smooth fine lines and wrinkles, reducing excess skin on selfies.

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Are You in JuVaShape?

When you need to get in ‪JuVaShape‬… call for back up!

Meet Kandice & Kerin – The Woodruff Institute’s certified JuVaShape Specialists! Beautiful, sweet-spirited, and upbeat, Kandice and Kerin welcome everyone with a smile and are happy to use their knowledge and skills to help our patients receive their desired outcome of looking their best!

Call to schedule your JuVaShape consultation at The Woodruff Institute today!