Monthly Archives: September 2017

Botox isn’t Botox

When I found out I was pregnant I had no idea who to choose for a pediatrician. I called other mothers to find out who took good care of their children. I asked other doctors I knew who took the best care of babies. I called to see who had nurse practitioners or who sent acute illnesses to the ER. I did NOT however call to see which pediatrician was cheapest. On the other hand, when I found the hair dryer I just had to have all I cared about was the cost. I checked every on-line site I could find to get the cheapest price of the same hair dryer. Because no matter which online site I bought the hair dryer from it would come to my door step exactly the same. Now that hair dryer in my hands never could fix my hair exactly like my hair dresser (Caroline Mackey at Roots) could fix my hair. Who knows the feeling? Your hair looks so good when your hair dresser does it so you buy the same curling iron, shampoo, conditioner and hair spray but then when you use all the same tools your hair looks completely different! Never as good.

Botox is a tool. Just like that Hair dryer. If you take every single injector in the United States and take their Botox vials and set them on a counter they all come from Allergan (the company that makes Botox cosmetic)exactly the same. However, in whose hands that vial is placed makes all the difference. The injector may mix it any concentration he/she chooses, place it to lift the brows or drop the brows, make a smile symmetrical or make it crooked, shelf the cheeks around the eyes or open the eyes up youthfully and naturally. Good and bad results can come from a vial that once looked the same sitting on a counter. Just like that hair dryer that I searched all over the Internet for the best deal. Once it was in my hands I got okay hair-do results but once placed in my hair dresser, Caroline’s hands, I had the best hair I could possibly have. If it was placed in the wrong hands I could have my hair singed off.
That’s why Botox isn’t Botox. That’s why when you shop around for Botox you should be shopping for an injector, not a price. Shop for Botox like I shopped for my pediatrician, not my hair dryer. Ask a friend who you think looks great where she is injected. Call the clinic and ask what type of experience the injector has, did the injector train at an 8 hour course on a free weekend or was he/she trained by dermatologists or plastic surgeons? Ask how much they inject, 10 people a month or 100? Ask what awards they have won. Ask the person you’re talking to on the phone if they have had it done and why they trusted their injector. Johnson Dermatology offers Botox at $9-$12/unit depending on what program you’re in with our clinic. So I hope you know I don’t make these suggestions because we are expensive(we are competitively priced with other expert injectors) and I want to validate that. I make these suggestions because Botox may come in a bottle the same but I promise it goes out of the needle differently. I often joke that our clinic could run an episode of “Botched” from all the corrections Dr. Sandy and I perform. It’s not a funny joke. It’s scary and sad and I would love to prevent it from happening, even if it means the patient spends a few extra dollars. Thank you for trusting Dr. Sandy and I as your injectors. If you would like to come interview us in person because you’re interested in injections, then come this Friday, September, 29th and watch us inject live. We are going to have a lunch and learn at noon that day. Please RSVP to or if you plan to join the fun!
Have a Skintastic week , Nina


Derm Conference Fun Facts

I’m at a conference the rest of the week learning ways to improve the care I give to my patients. I feel so blessed to have patients that trust me with their skin. I take that honor seriously and enjoy learning and improving all the time. Thank you to Dr. Brad and Dr. Sandy for opening a dermatology practice in Fort Smith that continues to “deliver efficient, quality, compassionate, comprehensive, patient-centered skin care” (JD mission statement) and for allowing me to be a part of the team. With that being said, I am fairly certain the pearls I pick up at conferences are more exciting to me than most but here are a few from today I thought my readers would enjoy!

  1. One study showed that adding one tablespoon of peppermint oil to your Vaseline decreased “itch” 50% more than plain Vaseline.
  2. Lexus windows do the best filtering UV rays. (Currently considering a clear UV tint for my windshield found at California Customs in Fort Smith)
  3. Patients prefer white coats over suits and scrubs. How do you guys feel about patterns, leopard as a neutral and chokers? Asking for a friend.
  4. Chlorine Dioxide wash is highly effective for the hard to treat condition Keratosis Pilaris (red sand paper like bumps often found on upper arms). Fine it at for about $20.
  5. A good alternative to my eczema patients who dislike the bleach baths idea is a tablespoon of apple cider vinegar added to moisturizer. Y’all know I love a good organic option!
  6. Rogain helped NAILS grow 0.5 mm more than placebo. Why didn’t I think of that?
  7. Low risk products for sensitive skin according to Dr. Zirwas the contact dermatitis expert: Cerave cream, Certain Dry antiperspirant, cleure toothpaste and Wella Koleston innosence hair dye. Has anyone heard of those last two? Anyone?
  8. New topical out for excessive arm pit sweat coming this year!
  9. New topical for removing Seborrheic Keratosis(brown crusty age spots) coming in December!
  10. It’s only 10 AM who wants another post this week?!?!?!

Please make sure you guys call the clinic soon and get on our schedule September 29th for cosmetic day! Discounted Botox, skincare travel kits free, lunch and learn and live injections! Don’t miss out! See you there!

Stay amazing, happy and skintastic! Nina

P.S. The conference is at the Hilton New Orleans Riverside (amazing location) so follow our snapchat and I will try to get some local photos for ya! Jdermatology

Eczema vs Psoriasis

With Dr. Google and all the awesome free information online sometimes it’s easy to diagnose ourselves at home. Often times patients tell me what they think they have, often times I agree. Sometimes I disagree. Dr. Sandy has been gracious enough to explain the differences between eczema and psoriasis. These are two very commonly confused diagnoses among patients and sometimes even health care providers.


It’s a bird. It’s a plane. It’s superman. Sometimes that is what it feels like in clinic. It’s psoriasis. It’s eczema. It’s a rash. It’s a job for Super-dermatologist. Really though, most people don’t know or care to know the differences between eczema or psoriasis or any other rash. Most people just know they have a rash and they don’t want to have a rash. Well as dermatologists, we care about what kind of rash you have and what the best way to treat that rash is. Most people are fortunate and only develop self-limited rashes that resolve over a few days, weeks or months. Other people however develop rashes that last a long time. We call those long lasting rashes “chronic” and the two most common are eczema and psoriasis. A simple way to differentiate between the two is this chart


Eczema Psoriasis
Age when rash starts Usually first 5 years of life Usually after first 5 years
Where on body Usually  “flex” areas—bends of elbows and back of knees Usually “extensor” areas—backs of elbows and front of knees. Involves nails
Appearance Moist and eroded, “wet” Thicker skin, white scales, “dry”
Associations Asthma, allergies, itchy eyes Arthritis, obesity, metabolic syndrome




Above are 2 pictures taken from the internet to compare and contrast the 2 rashes. The top photo of psoriasis shows the well demarcated thick red silver scaled plaques on the elbow of an adult. The bottom photo of eczema shows the wet lichenified (accentuated skin lines) patches on the back of the leg of a young person.

Some of the treatments for the different rashes are the same but some are different and specific for the specific rash. I have been blessed in my careering many ways. One way is that I got to be involved with the research for the first “biologics” for psoriasis more than 20 years ago. Now, the Johnson Dermatology research team and myself, got to and continue to get to take part in the clinical trials for the first “biologic” for eczema, dupixint. We are also researching other treatments for both eczema and psoriasis. Since these treatments are not yet available to the general public to learn about them you get to (sounds better than have to) email Crystal who leads our research team at

Crystal will probably want me to also mention that we are also researching treatments for warts, acne, rosacea, and itch in addition to psoriasis and eczema. We are also researching treatments for kids who have acne, warts and psoriasis. I love clinical research which makes my inner nerd happy. I would be remiss if I didn’t also admit that I love cosmetic dermatology which makes my inner artist happy. It is truly a blessing to be able to work with an amazing group of people and be able to use both the left side (nerd) and right side (artist) parts of my brain.

Since Nina let me write a blog, I would like to take this time to brag on both Nina and Honey. The three of us have worked very closely together for more than 5 years. We practice very similarly. However, Honey is definitely more left brain. She excels in treating patients with complicated rashes. She is even recognized nationally for her approach to treating patients with psoriasis. Nina is definitely more right brain. She is so artistically gifted especially when it comes to helping people who feel “botched” (no I have not watched that show but I hear about it often) by someone who is offering a sale or does not fully love the skin as much as we love the skin. Nina appreciates symmetry, proportion and the natural look. The 3 of us make a great team. Adding in Dr Amy as our board certified dermatopathologist, my husband Dr Brad as a dermatologic surgeon, and Dr Nelson as both a dermatologist and a dermatologic surgeon—we have a complete skin care provider team. Together with the rest of the JD team—the entire team is needed–we are here to keep you skintastic.