This past week I turned thirty! It was a great week. To celebrate my aging, maturity and life I read a self help book on how to be awesome. If you want the deats on the book follow this link www.jensincero.com .One of my favorite ideas in the book was that as children we are not embarrassed, ashamed or nervous to learn new things. Somewhere along the way we learn behaviors of shame when we don’t know something. When you learn to ride a bike as a child it is so joyful and exciting but then as an adult some  people may be embarrassed that they don’t know how to ride a bike and that feeling keeps them from ever learning even if they really want to ride a bike. The idea was to never lose the joy of learning something new. Be an expert. Practice and practice your passion to be awesome but never stop having fun doing it. It made me start thinking about learning dermatology. I will never stop learning and I love that but my patients expect me to be the know all. I totally get it because that’s what I expect from my providers. When patients come to me, they expect me to have the answers from the skin gods and the magic wand to fix them. I want to have the answers so it stinks when you can’t give them to patients. I feel like Johnson Dermatology has the skin experts of the River Valley but we all just recently  learned about a new drug called Mirvaso. There are things experts don’t know until they learn those things. Medicine is a constantly growing realm of knowledge. So how then do you, the patient, pick which expert to trust with your skin? What if you pick an expert and they haven’t yet learned about something that would cure your ailment? What if you pick one that has lost their joy in learning? What tools do you use to pick the best? Because we all deserve the best healthcare, right? I have worked in a hospital or clinic in the healthcare field for 14 years and I feel like I have learned the difference between a good healthcare provider and the best healthcare provider. So here are my tips to assist you in deciding who takes care of you and your family.

1. Word of mouth-This is the top of my list. When you pick who is going to perform your knee surgery ask other people who have had knee surgery how theirs went and who performed it. When you pick who does your Juvederm or Radiesse injections, it is okay to ask for pictures or to see other people whom the provider has injected. Don’t just go by the picture on the products website. Always take recommendations with a grain of salt though, please.
2. Specialty Experts-See the right expert in a specific specialty. I learned how to manage cholesterol when I was in school and according to my degree, I could see a patient and tell him or her how to manage cholesterol but over the years, I have not used that knowledge and as you know, if you don’t use it, you lose it. Please don’t ask me to manage your cholesterol. Even though legally speaking I could do it, heck if it was a basic problem I might even be capable of doing it but it’s not my area of expertise.  It’s totally legit to ask your provider if the procedure they are doing is what they excel at doing. For example: In our office Dr. Brad is the surgery expert and Dr. Sandy is the laser expert. You won’t catch Dr. Brad with laser patients on his schedule and you won’t catch Dr. Sandy with surgeries on her schedule. Even though they are both capable, they have different areas of expertise in the specialty of dermatology. FYI-It doesn’t offend us when you ask. Just like we want to brag on what we are experts at, we also like to tell you when we don’t feel comfortable doing something you are asking us to do.
3. Education- Your healthcare provider should have some credentials. Choose board certified folks. That shows that they care about their credentials, education and professional development. Continuing education is important too. I go to dermatology conferences and extra training often and I even do a monthly book review club with my peers. If you call for an appointment with your health care provider but she is out of town for a conference and you can’t get in that week, it’s a good thing. Ask for an appointment the following week. Chances are you found a good one.
4. Happiness- Does your healthcare provider enjoy his/her job? When you go to the dentist, does he/she complain about what a day it’s been or get excited talking the whole visit about a new tooth implant that is awesome? If it’s the latter, that’s what you’re looking for. You may not really care about the latest and greatest in fake teeth but you should be glad that your dentist is excited about his/her profession. Sometimes I get giddy at work. I grin and giggle a little bit over getting to witness weird once in a life time rashes or surgical repairs that are complex or injecting a woman who cries because she is so happy with her results. I literally have to jump up and down sometimes at work. Find someone that loves to take care of you.
5. You need the “click”- You have your friends because you like them. You should like your healthcare provider as well. Pick someone whom you like to be around, whom you trust, whom you feel comfortable asking why your feet stink. Also make sure you “click” with the office staff. Often times your communication is through the nurse or the front office staff or the insurance gal. You will likely, at some point, have to deal with all different areas of the practice so pay attention to the vibe in the office. Pick a place that is on the same frequency as you. Be able to say “these are my kind of people”.
6. Pick the “can’t do it all” person- Sometimes you want your healthcare provider to say “I don’t know”. It shows that they know their limitations and won’t just “give it a whirl” on you. And if they are at the end of a rope and have already had you see multiple specialist, then maybe they will try something off the books and it will work but at least you will know they are exhausting all their resources just to help you.
7. Intuition-Don’t go by my rules. Don’t go with your rules. Just use your gut. I call it my spidey-sense. Your inner self knows who will take care of you and who won’t care one way or the other about you so follow your heart, as they say.

I hope these tips help you with your search for someone to care for your health. These tips are all just my opinion and I appreciate you all following my blog and listening to my opinions, it’s an honor. Stay skintastic! See you in cyber world next week. Until then, follow me on twitter @skinnyonskingal for quick, fun skin tweets.

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Happy Easter to all! Whether you celebrate the holiday or not you all know the age old tradition of the Easter Egg Hunt. How fun it is to watch all the children get excited about the Easter bunny coming and then finding all the hidden eggs. It’s quite the process; dying eggs, hiding eggs, preparing baskets, getting Easter dresses and teaching the reason for the season. Well, there is a hunt we do in dermatology that is actually a lot less exhausting. The hunt for skin cancers. The three skin cancers we mainly deal with are basal cell skin cancer, squamous cell skin cancer and melanoma. Melanoma is the bad guy that can move into your body and kill you. They are all bad guys but he is like the serial killer that needs to be locked up forever and the others are more like drunk drivers that deserve at least a night in the drunk tank maybe even an extended stay at the local jail. You should all come in and let a dermatologist hunt your skin for skin cancers at least once a year, maybe more often if you are high risk.  If it’s your birthday month then make that the month you always come for your skin cancer check, it’s easy to remember that way. I usually recommend taking pictures of your spots/lesions/moles and retaking the pictures in 3 months for comparison. Anything changing or growing needs a look sooner than later by a pro-fesh-on-al. Here are some red flags that should bring you to your derm sooner than later.

1. Spots that bleed and don’t seem to heal reasonably.

2. Asymmetry – That basically means a funky shape. If you draw a line through your mole and one side doesn’t match the other that needs further investigation.

3. Borders – Are the borders ill-defined or smudgy looking? Not good, please let me check that mole for you!

4. Color – In most instances of life variety is a good thing. Not when it comes to your moles. Different colors in one mole can be a characteristic of melanoma. Is a mole darker than the others and just really stands out? Go get that mole checked!

5. Diameter – Big moles need to be looked at by a dermatologist. Big is generally defined as bigger than a pencil eraser.

6. Evolving – We rely heavily on this. Anything that is new, changing or growing we want to see.

Are you worried about a spot and want it checked? It’s usually a pretty easy process so don’t fret! I had one removed a few weeks ago and then worked all day and forgot I even had it done(oh and I’m a baby that hates needles in me). In my opinion, you should make sure whoever removes your mole sends it to a dermatopathologist. That’s a pathologist that is expert at looking at diseases of the skin under the microscope. Did you know Johnson Dermatology has a lab with a dermatopathologist, Dr. Amy Hudson? We do and we are pretty proud of her! Yes that is my horn you hear-TOOT TOOT! Don’t just hunt eggs this Easter, get in on the skin hunt for cancers and come let us look you over at Johnson Dermatology. We promise to be gentle and take good care of you!

Stay happy, stay beautiful and as always stay skintastic! Thanks for following! Just opened a twitter account at the request of some very hip co-workers. You can get to know me better there as soon as I find the twitter manual on how to start tweeting. Yes, I am that old. Follow me there @skinnyonskingal

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Sorry but the only vampire I get excited about is Edward Cullen. The vampire facelift is all the buzz since Kim Kardashian had a vampire facial on national television. A dermaroller with microneedles made tiny little holes in her skin and then her own blood was placed in those holes. Her skin is beautiful but I’m not optimistic that’s solely because of her vampire facial. Who knows, maybe it is. The vampire facelift claims to be a combination of steps to make your skin rejuvenated. The first step is drawing your blood and putting it into a centrifuge to separate the parts of your blood. While that process plays out, you will be having hyaluronic acid injected into you-that’s juvederm or restylane. After your volume loss has been corrected with the filler of choice then they take the plasma part of your blood and inject it into your skin. On www.vampirefacelift.com they call this third step “injecting the magic into your face”. That just sounds awesome. No seriously, I would expect to have Harry Potter powers after that. I believe in magic. It’s called platelet-rich plasma rejuvenation. Theoretically this part of your blood is high in growth factor which then produces collagen resulting in a more youthful appearance. So what’s wrong with that, right? According to an article in medscape http://www.medscape.com/viewarticle/759592 “the efficacy and safety of PRP for cosmetic treatment have not been studied in controlled clinical trials.” Well all the FDA approved fillers that I inject have been studied in controlled clinical trials and are proven to show effects. Since they use one of these fillers in the vampire facelift, I’m sure people see some results in volume loss. What I don’t know with complete certainty is whether or not having the PRP part of the procedure is making any difference? So why go through the process and pay for that extra procedure called PRP on top of filler? In hopes that it works I guess. In hopes that it’s a procedure that will turn out to be awesome and it’s not just a gimick. In hopes that the results are worth the money. I rely on science, research and evidence and I can’t spend my tax return nor my savings on a hope. If I rolled like Kim K and Kanye then I might be able to give it a try. Maybe one day with more research and experience I will be using the vampire facelift on patients. Until that time comes, if you’re like me, you’re wondering “what is the newest advance in technology that’s cutting edge AND evidence based?” In my opinion it’s Voluma. Voluma is the most recent FDA approved hyalurinic acid filler. I’ve been injecting it since it hit the US in November and the results are pretty ahhhmazing! What’s the best part about Voluma? I can’t decide.Maybe that it’s so smooth or that it’s easy to inject. Oh, and did I mention it lasts up to two years?!?!?! I don’t know where this quote is from but I love it and it sums up how I feel about the vampire facelift.

“I’m not interested in competing with anyone… I hope we all make it”.

I don’t think the vampire facelift can compete with the fillers because part of the vampire facelift is filler. I don’t know if the PRP part makes your results better. In fact, I don’t think anyone knows on a level with which I’m satisfied. But, for the sake of all our youthfulness, I hope it does turn out to make the cosmetic world a better place! Until then, I’m gonna stay on the brink of research and on the look out for products proven to keep all our skin young and beautiful! Here are some before and after pics of a lady I injected with Voluma whose inner beauty is just as rad as her outer beauty.

Voluma may or may not be the choice for you. Come in for a cosmetic consult and let’s chat about it! I hope you have all noticed the follow button I added and put it to use. Thanks for following my blog! xoxo

Hope to see you all at the clinic this week. Remember you’re gorgeous so let it shine out through your skin this week!

Joy to all, Nina

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I hear it almost everyday, “I don’t want my face to be frozen” or “I don’t want to do anything that drastic”. I’m not sure where all these negative connotations against Botox started. I don’t think Botox is for everyone but I am here to tell you there is no moisturizer or prescription cream you can put on that does what Botox does for lines or wrinkles you don’t like. Although there is a topical botulinum toxin type A in the works who knows when or if it will ever hit the market. So this week I hope to bust the myths of Botox, Xeomin and Dysport. Plus, to prove it looks natural I have some before and after pics, yay!

1. MYTH-You will lose expression in your face. The botulinum toxins will relax the muscle. We inject it into the muscle and it blocks the nerves from sending messages to the muscle to move. I can still squint in bright lights, raise my eyebrows, smile, laugh and scold my daughter after injections.
2. MYTH-Your injecting a toxic chemical into your body. Botulinum toxin is a natural occurring protein. I guess this myth depends on your definition of toxic. Tylenol works by blocking an enzyme called cyclooxygenase. Botox works by blocking release of a neurotransmitter called acetylcholine. They both cause “harm” to a process in your body which then results in a desired effect.
3. MYTH-Xeomin and Dysport are “offbrands”. There are three FDA approved botulinum toxin type A which are offered in the US. None of them are considered “generic”. I describe them as Coke is to Pepsi. Some people like coke, some people like pepsi. Botox has been around the longest and is the most predictable because of that fact. Xeomin has less inactive proteins then Botox making it a purer product, which is theoretically a good thing. Research shows they are generally equal BUT do you consider coke and pepsi equal? No you probably like one better than the other. In my experience Dysport spreads a little more which can be good or bad depending on what your goals are. I offer all three products and I’m available anytime you want to chat more about their differences.
4. MYTH-Botox will make my lips bigger. There is a very big difference in botox and fillers. Botox relaxes the muscle so you can’t make lines in motion on your skin. Fillers replace volume loss and fill in lines at rest in your skin. Often time both of them together can be the best result!
5. MYTH-I only need Botox again when its completely worn off. Botox lasts up to 4 months. Some women tell me it lasted 3 months and some say 6 months, there is some variation person to person. You should make your appointments every three months just like you schedule hair appointments. You don’t let the color on your hair grow completely out, you color when you start seeing roots. Be diligent with your Botox don’t let the muscle get completely back to motion so you aren’t starting from square one. Over time that muscle will atrophy (become weaker) and you get even better, longer lasting results.

Next weekend is the big cosmetic event at Johnson Dermatology. April 12th from 10AM-noon. We will have special prices on all injections! Botox, Dysport, Xeomin, Voluma, Juvederm Ultra Plus, Radiesse, Belotero and Sculptra all discounted, can’t beat that! We will also be revealing a new service at Johnson Dermatology that I am giddy about, so be the first to know! You need an appointment so hurry and make one, it’s gonna be too good to miss. GIVEAWAY: If you share this blog post and comment shared below you will be entered to win an ELTA MD gift package. Elta MD carries my favorite moisturizer and spray sunscreen, this is an awesome prize. We will announce the winner on Saturday so get to sharing!

Here are some before and after pics for your enjoyment!

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