Monthly Archives: May 2019

But I Still Get Burned!

I cannot tell you how many times I have been told “I always wear sunscreen but I still get a sun burn” or “what is a good sunscreen because I always burn even when I use mine” or something similar. So why do so many people still get a sunburn when they apply sunscreen? Here is your answer.

1. We trust sunscreen too much! There is no sunscreen in the universe that protects as effectively as sun protective clothing. In my opinion it’s much easier and that’s why. Throwing on a long sleeve swim shirt is simple. Wearing sunscreen is complicated. With sunscreen you need the right amount applied, the right frequency of applications, the right sunscreen out of millions to pick from. So get your swimshirts, pants, hats, and sunglasses ready this Summer! And don’t worry, you won’t be too hot. As a matter of fact, you will be cooler because the sun won’t be hitting your skin. It’s like a perma-shade you wear.
2. We didn’t re-apply properly. When outdoors we need to re-apply at least every 2 hours. When participating in water activities we need to apply more frequently according to directions on your sunscreen bottle, usually every 60-80 minutes.
3. We just didn’t use enough sunscreen. Most adults need a full shot glass of sunscreen to cover the body adequately. Think about how long you would have to spray a can of sunscreen to fill a shot glass. Are you using enough?
4. We used expired sunscreen. Did you know sunscreen expires? How many times have you reached in the boat cabinet or poolhouse cabinet and grabbed sunscreen from last year because you hadn’t really thought about buying more yet? Guilty? Better check your expiration dates.
5. We used a sub-par sunscreen. The American Academy of Dermatology recommends at least a 30 SPF, broad spectrum(UVA/UVB), water resistant and physical blocker (zinc oxide or titanium dioxide). I also recommend one that protects against infrared and blue light for your face like the colorscience face shield.
6. We didn’t give the sunscreen time. It takes at least 15 minutes after application of sunscreen before it’s absorbed and protecting you. You need to apply indoors or in the shade and wait that 15 minutes before sun exposure because I’m telling you, in the course of a day those 15 minutes add up.

May is skin cancer awareness month and we are celebrating at Johnson Dermatology. If you haven’t had a full body skin exam to screen for skin cancers in the past year you should schedule an appointment. Just e-mail If you would like a good sunscreen for this Summer you can e-mail for a free consult. If there is anything else we can do for you just let us know. As Dr. Sandy always says “an ounce of prevention is worth a pound of cure” so in this case make sure you get that one ounce of sunscreen for your body during all your outdoor activities this Summer!

Stay Skintastic, Nina


You want to be an injector?

The aesthetics industry is booming. It’s a great time to be an injector! We have so many products to choose from and much better techniques we have learned over the years. I LOVE my job and it’s hard for me to comprehend why anyone wouldn’t want to do it every day! That’s probably why I see so many people from so many pathways interested in becoming an injector. At least once a week someone asks me directly or indirectly for advice on how to become an injector. There are multiple disciplines wanting a piece of the pie. At a recent meeting I was amongst oculoplastic surgeons, plastic surgeons, dermatologist, dentist, family practice doctors, RN injectors and I’m sure more occupations were represented that I didn’t meet! So how do you pick which path to take? Here is my advice and a few tips on how to become an aesthetic injector.

1. Ask yourself why you want to become an injector. Make more money? Because you don’t like your current job? Because you love beauty? I personally wanted to be a plastic surgeon since I was very small. I gained a mentor in high school and she was very influential in me choosing nursing as my profession instead. Later in my nursing career I met Dr. Sandy who lit my fire for cosmetics again and became my mentor. I’ve always loved beauty and taking care of people and doing both everyday is a dream come true. I didn’t hate being an ICU nurse nor an ER NP. Can you imagine if you were about to have open heart surgery and asked your surgeon why he became a cardiothoracic and he responded “because I wanted to make money” or “because I didn’t like being a neurosurgeon”? NO, you would be terrified for your surgery. On the other hand if he said “I love the anatomy of the heart and being able to refresh your life, this is such an exciting surgery and I can’t wait to be in the OR with you today!” The point is to be good at something like this you have to have a fire in you. A love for some part of job. Whether it’s a love for caring for people or a passion for beauty you better be on fire for it because if you aren’t you and your patients aren’t going to excel.
2. Seek out a mentor. The core specialties that are most respected in the cosmetic industry (in my opinion as of 4/21/18 @16:37)are Dermatology and Plastic Surgery. I would start there. These are the people that are paving the way. The ones doing clinical trials on new products and going to advanced trainings(usually as the teacher) and working together for all the advances that help us all be better injectors. They also are more likely to be the only specialties that have injection training during their residencies/fellowship. My advice would be to find a mentor while you are in school that is interested in hiring. Do some of your training during your school rotations and get to know each other. I spent my Dermatology rotation in NP school with Dr. Sandy. It’s like dating. If you don’t click move on. A mentor ship is beneficial to you but also to your mentor if you become an injector that helps build their practice. Send out e-mails and resumes and don’t give up.
3. There is no such thing as a botox certification. I would like to put that sentence in bold lettering everywhere. I see people all the time asking where they can get botox certified or advertising they are botox certified or they are offering a “botox certification” course. I have heard of people paying $5,000 to $10,000 to go to a class for a week and then they think they have some pass or legal right to inject. I spent 6 months injecting with Dr. Sandy before I ever injected my own patient. I practiced on staff and family for months before I started injecting patients. I can not imagine being ready to inject after a one week class. Don’t let these classes trick you. There are good classes out there but they are trainings not for a certification and there is a difference. Be smart.
3. Know your state laws. Injecting botox and fillers and kybella and biostimulators are medical procedures. The laws vary by state but you need to know them. Texas has had some arrests in the news lately you may have seen of spa owners that were actually injecting illegally. You can read about Arkansas state law in Dr. Sandy’s post from last week. As a general rule, if your medical director isn’t an injector and doesn’t know how to guide you then you are going to wind up in trouble one way or another.
4. Know your anatomy. Study where vessels are, where muscles are, what depths you should be at, what are no fly zones, know it like the back of your hand. Our first job is to do no harm. Did you know you could cause someone blindness with filler? Or skin necrosis that causes a forever scar?
5. Be prepared for complications. No one wants them. Everyone will eventually get one if you inject enough. Have a plan. Have hyalenex or vitrase on hand just in case. Have a relationship with an ophthalmologist that will inject it into the eyeball if needed. Have a relationship with a wound care doctor in case you ever had skin necrosis you wanted in the hyperbaric chamber. Bottom line, have a plan. If you never need the plan great!
6. You have a passion, you have a mentor,you have the knowledge, you are ready to inject. Congrats! Now what? Always bring your patients back in two weeks. To make sure they are satisfied but also to learn from them. I study my patients before and after photos to help me know what techniques worked and what didn’t. What I would do again and what I wouldn’t. How one patients anatomy is a little different from the next. Keep educating yourself every chance you get. This is a good time to dive into those trainings I was talking about previously.
7. Enjoy. It’s the best job ever. Don’t worry about other injectors because there are enough fish in the sea for everyone. We should want everyone to be an awesome injector because that reflects on aesthetics positively and all of our patients can worry less about being botched. As Dawin sang, they can imitate you but they can’t duplicate you! We are each different injectors serving a specific population.

I hope this is helpful. Follow your dreams. Follow your heart. Then work hard, really hard. If you have any questions you can e-mail me otherwise good luck!


Skin Cancer Awareness Month

Do you use protection?

May is Melanoma Awareness Month. Being part of a Dermatology clinic team with a motto of “specializing in skin cancer while providing comprehensive skin care”, I asked Nina if I could write a blog about sun protection. This will not be as cool as some of Nina’s sun smart blogs where she shows pictures of herself in her bikinis and entertains all of us but I will try my best to educate you.

Being sunSMART means so much more than choosing a sunblock. It includes avoiding the peak hours between 10 AM and 4 PM, seeking shade, and wearing sun protective clothing including a sun hat and sunglasses. Most people however are understandably confused about choosing which sunblock to use. The simple answer is that the best sun block is the one that you use daily and will reapply every 2 hours. I have 3 favorite sunblocks. I use TD&R daily because it protects against UVA, UVB and infrared while repairing my skin. I frequently reapply either BOB or Colorscience brush because they are mineral based and easy to apply without getting my hands dirty—this is my favorite before I go outside to watch the kids play sports or before I work or run outside. My third is a sunblock spray that I use on exposed skin while I will be outside.

Now the longer answer—Sunscreens are considered over the counter products and are regulated by the FDA. The FDA last updated their position on sunscreens in 2014 with the Sunscreen Innovation Act. In February 2019, The FDA proposed new regulations for OTC sunscreens in the US. They are addressing vehicles of sunscreens including wipes, towelettes, shampoos, etc. They are improving transparency in labelling also. The active ingredients will need to be listed on the front of the package. The maximum allowable SPF will be increased from 50+ to 60+. A skin cancer/skin aging alert for sunscreens that have not been shown to help prevent skin cancer will have an alert on the front of the package. It should be clearer to see the SPF, broad spectrum and water-resitant claims. They are encouraging all sunblocks to be broad spectrum—blocking at least both UVA and UVB.

One of the aspects that I am happy about is that the FDA is really looking at ingredients. The FDA considers ingredients GRASE if they have been studied and are considered “generally recognized as safe or effective”. The FDA ruled that zinc oxide and titanium dioxide are safe and effective (something we have been preaching for years because these ingredients are physical not chemical sunblocks). They stated that PABA (P-aminobenzoic acid) and trolamine salicylate are not GRASE or safe. They have requested additional testing for many chemical blockers including avobenzone, cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octrocrylene, octinoxate, octisalate, oxybenzone, padimate O, and sulisobenzone.

Researchers are spending more time and energy addressing infrared light, visible light and blue light (the visible light that is emitted from computers and devices such as cell phones). For more information, you may go to the AAD website that reviews the ABCs of sunscreens:

Early Diagnosis/surveillance:
The AAD also advises every person with skin to have a full body skin examination by a dermatologist every year as well as every person do a self-exam every month to notice any new or changing spots—stop the spot early. This regular surveillance will help detect any potential skin cancers early. Here are some PSAs from the AAD to educate about skin cancer. Every May since we opened, we offer at least one free skin cancer screening at the Reynolds Cancer Support House. For more information, you may visit their website (although it has not been updated for this year’s screening which is Monday May 20.

Drs Brad Johnson and Dr Nelson are two skintastic skin surgeons (in my opinion). They both offer Mohs micrographic surgery as well as other treatments for skin cancer. If you do have a skin cancer, it is important to have it treated appropriately. They have treated more than 20,000 patients last year with skin cancer. They work with a great team of surgical techs and histotechs to make sure to get the entire cancer and the best cosmetic outcome. You may peruse our website to learn more information.

May Melanoma Awareness Challenge:
During the month of May—Melanoma Awareness Month, the JD team challenges you to help us raise awareness of melanoma and being sun SMART. We will be giving random prizes to people who help spread the message. We encourage you to use the hashtags #melanoma #realJDpatient #sunSMART to help us promote your post and possibly send you a prize. Some ideas include

1. Post a picture or video of you or others being sunSMART
2. Post a video of you applying the recommended amount of a shot glass of sunblock as fast as show it does not take long to apply sun protection
3. Share your skin cancer experience
4. Share your favorite sunSMART products
5. Share our sunSMART posts
6. Be creative—remember to tag us with #melanoma #realJDpatient or #sunSMART

Let us all have fun together while empowering each other to be sunSMART. After all, friends don’t let friends tan

As appreciation for being able to write this blog, here is a picture of our family from a few summers ago in our swim clothes.