Skin Perfections Med Spa

Onycomycosis is common in the adult population. It becomes more common as we age.  

The nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. There is usually no pain or other bodily symptoms, unless the disease is severe.

Treatment usually offered for most forms of onychomycosis is similar. Traditional topical therapies are generally ineffective for clearing the primary infection and even oral therapy is associated with a high rate of treatment failure and recurrence. Nevertheless, treatment is often indicated in documented cases because of the morbidity associated with the infection associated with ingrown nails and when there are specific comorbidities such as diabetes. Surgical treatment is often used in severe cases. 

A new treatment option has now become available. It was observed that nail bed treatment by pulsed laser light could effectively diminish the fungal infection and improve the nail bed appearance. Several studies have found benefit when the treatment involved using the laser on the nail directly. The effectiveness appears promising. 

The Patholase laser company is currently marketing their Nd:YAG laser as the treatment of choice. They asked for FDA approval and it was given this year after it proved effective in the treatment of onycomycosis. According to the patholase site, they had improvement percentages as high as 80%. The FDA approval has caused an eruption from other companies to market their lasers, already approved for hair removal, to treat the nails as well. One must wonder if the benefit was first noted by laser technicians treating toe hairs and maybe wandering a bit further down with the laser.

The most interesting and humorous part of this is that the actual study presented to the FDA has not been published. Why? Most likely because Patholase doesn't want the settings it used in the research to easily become an industry standard for all the larger laser companies. However, I suspect that all of them knew the settings before the study was even presented to the FDA.  Today, Sciton, Cutera, Syneron, and Palomar are all marketing, or in the process of marketing their lasers for nail treatments. Patholase has not invented a new laser to combat an age old problem. They only tried an old one in a new manner. Great for the world hopefully, but hardly worth the expense of having another 1064nm laser to purchase just for their name associated with the study. Sciton, which I own, has named their new treatment Clear Toe (original huh?). We will be offering treatments in the near future. It is always exciting to have a new treatment modality for a disease that has been especially bothersome and difficult to treat. Albeit, not cancer, there are many awaiting a cure. Those with comorbidities such as Diabetes and immunocompromised individuals with whom infections are a problem will certainly benefit.

There are some wanting to take a wait and see attitude. They are advising not to try it until there are more clinical trials and not spend the money for treatment. Well, the laser treatment is usually only one or two treatments at around $400. Surgical removal of the nail is much more expensive and certainly with more risk of complications. There is a 60%-80% success after one treatment so does it make sense to wait?

So what about the patients not improved by the laser?

Well there are lots of phase II and III trials going on with new nail permeability drugs that may make topical treatments finally effective, but that is years away, and the new drugs are sure to be expensive.

I recently searched online just two words, botox ripoffs. What I found truly amazed me. The search was inundated with accusations of doctors offices giving poor botox treatments, diluted botox, unwarranted botox alternatives and worse. Physicians all take a hippocratic oath that among other things makes undermining our patients trust a complete breach of that oath.
 As a businessman, I know how hard it can be to make ends meet. Overhead costs and cash flow issues are a burden never taught in medical school. But standards must be kept, for the sake of all physicians who enjoy the variety and satisfaction that aesthetic medicine brings to their practices.
On several websites for physicians there are advertisements for botox at nearly half the price I pay for mine. While we order ours from allergan in the US (the only authorized Botox cosmetic provider), they purchase from overseas distrubutors purporting that it is real botox and comes from the same place as the botox distributed in the USA. This is patently false. Botox is produced in the US and not only in Ireland as purported in the ads.  Also, when Allergan ships us our botox, we get it packed in dry ice straight from the factory insuring its potency.
How can botox from overseas through a secondary distributor give that sort of guarantee. Ok, so how can one tell?  Ask to see the bottle and insure that there is an NDC # on it. Holograms schmolograms don't count. Also, be very wary of botox that is too cheap. If you are paying $7 or less per unit for botox it better be from your best friend, because he is giving it away. Check out to see how big a client of allergan the physician is by asking about their membership status. A gold or better means they order alot of botox from allergan and are much less likely to be also ordering counterfeit botox.
I hope this is helpful.

Aesthetic skin care has greatly improved over the past 10 years. Each year we attend the Aesthetic Show in Las Vegas and review the newest machines from the manufacturers. While some of these are true advances in cosmetic medicine, most miss the mark. It seems that the FDA will approve anything as long as it isn't harmful and has a study with a modicum of improvement. Some procedures and machines get FDA approval for one thing, but is marketed for another. For example, one machine touted for skin tightening was FDA approved for only heating the skin. No studies were put forth to say it would tighten skin, and only a supposition that the heating would lead to collagen and elastin production. But did it heat it enough? Why no studies first before hawking such a device. Because the competition is fierce. Every major company wants to have the latest and greatest.
But really, are any of them greater? Well yes and no.

As I previously stated skin care has improved. Knowledge of the stimulus for collagen production, safer technology, and more options have been created.  But it must be remembered thogh that one machine may be touted as a better option for a skin ailment, it may not be. Only based on your individual situation can the right treatment be chosen. So a machine that experts say is the best, may not be in all scenarios.

But there are still some some dogs out there. Many Medspas have equipment that they wish they didn't own anymore. Like a little art statue, it sits in their offices gathering dust. It seemed like the latest and greatest until they used it, and got dissatisfied patients.

I like many physicians got interested in adding aesthetics to my practice and looked for a company that could help  take the guess work out of equipping our business properly. I purchased a laser and an Intense pulsed light machine for doing photofacials.  Both can do what they are touted to do, but the IPL machine was requiring 3 times the amount of procedure time over newer machines, and frankly was a little more scary to use.

Had I to do it over again, I would have left that IPL off my purchase list. However, my next two IPL machines were clear winners. Why? Because experience had taught me to never buy anything without a good long testing period to assess the effectiveness of the equipment.

I have turned deaf to the sales pitch, no matter how smooth. I get very cautious when someone tells me how much money I will make with a new procedure. That is usually a definite warning sign.

I would rather know that patients will be satisfied and that results are very effective. Unfortunately, that is not always the case if you try to have the machine with the latest buzz. As previously mentioned, these manufacturers are putting out new equipment that may or may not work, or at the very best only work negligibly better than what is already available. The latter results in an expense that really isn't worth it for the practice.

Our equipment is modern and approved by the FDA for the purpose with which we use it. Experience and the desire for effective treatments that could be performed safely have been the driving forces behind the growth of our Med Spa. We now have more options for treatments than any other Aesthetic Skin Center in the area. With 4 separate laser systems and over 25 treatment options among them we are able to treat conditions safely after taking into consideration a patient's medical history and circumstances. With dark skin or light skin, recent sun exposure, or other skin conditions demand that a medical spa have options and not be just one trick pony.

So be wary of the new technology unless there is true unbiased evidence of benefit. An experienced practice is aware of the nuances in equipment, and is a safe choice to go to for treatment options.

We've just published a new edition of our newsletter! You can check it out on our website and get the latest information from Skin Perfections Med Spa. Let us know what you think!

Read It Now Here

Trying to fix all skin ailments amenable to treatment with just one machine would be the dream of every physician who has entered the practice of cosmetic skin care. This rapidly changing field can be very challenging even to the most astute physicians who everyday try to keep abreast of the information available. That being said. We are very excited about the new technology added to our practice. Sciton's Profractional Laser is a truly fractional laser thats results are the best in class with regards to reduction in wrinkles, brown spots, acne scar reduction and more. It provides our Med Spa the tools needed to help those with hard to treat issues, that perhaps have been resistant to the nonablative therapies such as IPL or FRAXEL. Information on the Profractional is available at www.sciton.com. Call for a free consultation now. 281-812-7232.

"Out, out damn spot! Lord Starr doth this way come!" I am often reminded of this line from Shakespeare when dealing with one of those pesky age spots, sun damaged areas on the cheeks, or unwanted freckles. The patient will ask what is the best way to treat this? I think to myself, "don't go out in the sun". But of course we live in Houston, and it is 70 degrees in January, so outdoor activity is hard to avoid. I do of course recommend sunscreen, and other cosmeceuticals that may help especially retinol, and hydroquinone (which blocks the melanocytes from making melanin). But that only helps prevent or inhibit further darkening for the most part. The options of actually getting rid of the spots are broad. Go to a med spa and ask, and you will get widely varying opinions. Answers will vary from chemical peels and microdermabrasion to pulsed dye lasers and Co2 resurfacing. The latter being the hard core doctors who don't care how long the patient will be out of service. The general consensus among physicians now is that Qswitch lasers and Erbium lasers do a great job on brown spots. Q swtch technology works by causing a photoacoustic "blasting" of the melanocytes at a certain depth. While erbium technology ablates the skin to a certain preset depth. So why is IPL so often used? Because most Med Spas don't have an erbium laser or a q switch laser, and IPL is the clinics best choice. Also, to be fair, the erbium and q switch technology have advanced greatly in the past few years. The result of which has been safer and more predictable outcomes. Both can be done with even less pain than IPL. So while IPL can do the job, for fewer trips to the clinic, and more permanent results, those erbium and q switch technologies have the advantage. Remember, lesions that are multiple shades, changing in size, bleeding or crusting, or anything else of a suspicious nature should be evaluated by a physician before treatment. A physician owned and operated med spa is your best choice. Miles Mahan MD

So you have noticed that your skin seems dryer and duller, and you wonder what to do about it. You probably went to the store and saw all the skin care products describing ingredients touting new breakthroughs with names you have never even heard of. Then you heard about all the treatments such as IPL and Fraxel, and laser rejuvenation. Chemical peels and microdermabrasion also probably came upon the radar. Lets explore what exactly is going on with the skin and then get back to the treatments.

 Natural moisturizing factors

One of the primary elements in keeping skin healthy is making sure the structure of the epidermis (outer layer of skin) is intact. Skin cells are held together with a component known as the intercellular matrix. The intercellular matrix is the "glue" or “mortar” between skin cells that keep them together. It helps prevent individual skin cells from losing water and creates the smooth, non-flaky appearance of healthy, intact skin. The components that do this are often called natural moisturizing factors (NMFs) or ingredients that mimic the structure and function of healthy skin. While the oil and fat components of skin prevent evaporation and provide lubrication to the surface of skin, it is actually the intercellular matrix along with the skin's lipid content that gives skin a good deal of its surface texture and feel. As a person ages there is less natural moisturizing factor produced. This causes dryness, and to compound the aging problem there is less epithelial cells produced.

Sunlight Effects on the Dermis

Sunlight damages collagen fibers and causes the accumulation of abnormal elastin. When this sun-induced elastin accumulates, enzymes called metalloproteinases are produced in large quantities. Normally, metalloproteinases remodel sun-injured skin by manufacturing and reforming collagen. However, this process does not always work well and some of the metalloproteinases actually break down collagen. This results in the formation of disorganized collagen fibers known as solar scars. When the skin repeats this imperfect rebuilding process over and over wrinkles develop.

Free Radicals and Wrinkles

Free radicals are unstable oxygen molecules that have only one electron instead of two. Because electrons are found in pairs the molecule scavenges other molecules for another electron. When the second molecule looses its electron to the first molecule, it must then find another electron repeating the process. This process can damage cell function and alter genetic material. Free radical damage causes wrinkles by activating the metalloproteinases that break down collagen. There are several factors that start this cascading process including exposure to even small amounts of UV radiation in sunlight, smoking, and exposure to air pollution.

Hormone Effects and Wrinkles

It is likely that there are skin changes as a result of the hormonal effects of menopause or decreased estrogen production. However, studies in humans have not documented which skin changes are specific to decreased estrogen and which skin changes are a result of sun exposure or just normal chronological aging. In animal experiments lack of estrogen can cause a decrease in collagen levels of 2% per year and a decrease in skin thickness of 1% per year.

How to treat it?

The first step in skin care is and always will be prevention. Over the past  decade there has been a large emphasis placed on developing effective sunscreens. Remember suntan oil? Still, the desire of some is to have that tanned look. Fortunately there are much better products out there to help one have that tanned look and prevent skin damage from sun or a tanning bed. Remember, it is usually years later before the damage is apparent.  So what one does in their teens will come back to haunt them in there 30's and 40's. Put on that sunscreen, and encourage others to do so as well.

Ok, so if it's too late for that what do you do? Well fortunately there are some options out there that can be of benefit, and help slow the aging of the skin.

A good sunscreen that blocks both UVA and UVB rays with both a chemical (inside the cell) and physical block (outside the cell) is a must. One should consider a good anitoxidant cream, and a good moisturizer as well.  This will help with protection from the sun and pollutants, and with the natural effects of drying due to the loss of NMF's.  Exfoliation by microdermabrasion or chemical peel can help by allowing active cosmeceuticals to penetrate the stratum corneum.

Thirdly consider one of the treatments known to help improve the production of collagen and elastin. Putting it simply, the heating of the dermis is known to have an effect on the fibroblasts to produce collagen and elastin. Think of it as stressing a musckle to make the muscle grow. The trick is how to best heat the dermis. Many lasers and IPL's (intense puled light) have been developed, and some are better depending on circumstances such as skin tone or other skin problems. Some are more agressive, and therefore may not be for everyone. Chemical peels have also been touted with success in stimulating fibroblasts, though their exfoliative effects are probably of more importance.

From the above one can obviously see that there is no single treatment or procedure that will give the end all effect. Instead, a treatment plan needs to be developed uniquely for each person.  Then individual treatments or combination of treatments and procedures can be implemented. At Skin Perfections Med Spa we instill the priciple of not trying to treat everyone just alike, and we get more effective treatments by doing so. Education of skin care is also important, and we are always here to answer questions.

Miles Mahan MD

www.SkinPerfectionsMedSpa.com       281 812-7232