All posts by Nina Copeland

Lighten Up with Dr. Sandy

It is the most wonderful time of the year.   I am so giddy with joy and excitement and gratitude.  We celebrate national gratitude month every November at Johnson Dermatology.  December is full of joy with the anticipation of Christmas and the new year—or in this case a new decade.  This is the best time of year to lighten up.  I am referring to 3 ways of lightening up—emotional baggage, excess weight and hair and dark spots.  The first is difficult for me but I try every year to let go of people, situations, and things that weigh me down as well as to fill up with people, situations and things that bring me joy and lift me up.  The serenity prayer and Pink’s new song Courage are helping me currently to lighten up in this regard.

 

The second is also difficult this time of year and that deals with excess weight and excess hair.  We should all be trying to continue our good habits of exercise and healthy eating even during this time of celebration and gratitude.  Now is the time to consider ultrashape power.  Three years ago, I tested this painless, permanent fat reduction machine for Johnson Dermatology.  I went down a full pant size and have not gone back up in the pant size.

 

The first treatment I had performed on myself in dermatology residency was laser hair reduction.  Being Italian, I am hairy —or should I say I was hairy.  We have the best laser hair reduction devices on the market at Johnson Dermatology.  The hair grows in cycles and not all hairs are in the same cycle—that is why humans typically do not shed.  Because of these phases of hair not being in sync, it takes at least 5 laser hair reduction treatments spaced at least monthly for laser hair reduction to be most successful.  I advise starting now to be smooth and ready for summer.

 

The third way to lighten up this time of year is in regards to dark spots on your skin.  We say to try to prevent worsening of you brown spots, melasma, lentigos, freckles, ephelids, and other hyperpigmentation from March to October.  From November to March, we advise to get aggressive and get improvement.  The past few years have brought much better products and treatments to treat discoloration.   Our picosure laser continues to impress and amaze me at lightening dyschromias/brown spots.  Another luxurious treatment we now offer to lighten up is the dermal infusion for hyperpigmentation…it really makes the skin glow.  To learn more about either of these treatments you should email liz@johnsondermatology.com.   As far as what to do at home to help excess pigment, we have created a basic skin care regimen to help.  Part of the program involves a prescription product called hydroquinone.  It is recommended to only use hydroquinone for up to 12 weeks at a time.  This is because long term hydroquinone use can actually do the reverse and darken skin instead of lighten it.  We have partnered with MediSav on Rogers Avenue to be able to offer hydroquinone in a combination for better results.  Since hydroquinone only works on one step of the pigment making process, it should always be combined with Lytera 2.0 to block more of the pigment producing pathway and to maintain the results every day.  Lytera can be used lifelong– not just for up to 12 weeks.  We also all know that an ounce of prevention is worth a pound of cure.  It is important to prevent pigment alterations with environmental protection. EVERY DAY, ALL DAY we should all use a broad spectrum sun screen that is at least SPF 30, protects against environmental pollutants, protects against the blue light of computer screens/ devices/ iPads/iPhones and contains antioxidants.  In addition to prevention during the day with sun protection we should all reverse the damage nightly with retinol that will passively exfoliate the damaged skin and improve cell turnover.

 

We would like to be your partner to help you get and stay skintastic. If there is anything we can do to help you lighten up or be more skintastic, please feel free to email liz@johnsondermatology.com.  Hope you enjoy this season and are filled with joy, excitement and gratitude.    Dr. Sandy

Dr. Sandy’s basic skin lightening regimen

*AM

Step 1- AHA/BHA cleanser or Aveeno cleanser

Step 2- Lytera 2.0

Step 3- Lumivive AM

Step 4- Faceshield, Even up, or TD&R

 

*throughout the day use sunSMART behaviors

 

*PM

Step 1- AHA/BHA cleanser or Aveeno cleanser

Step 2- Lumivive PM

After 12 weeks Step 3 becomes Lytera 2.0 & Retinol 0.5

Step 3- JD/MediSav bleach cream x 12 weeks

Step 4- If needed dermal repair cream or other bland moisturizer

 

For even better results, consider adding one of the following treatments.  You may schedule one of all of them by emailing Dani@johnsondermatology.com

  1. in office PicoSure laser treatments
  2. in office Dermal Infusion treatments
  3. personalized JD skin care coach
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Gratitude Week

This is my favorite week of the year. At Johnson Dermatology we offer all our patients who have trusted us with their skin 20% off all cosmetic procedures and products. It is a week of giving thanks. We thank our patients, we thank each other, we think thoughts of thankfulness. This leads to appreciation and gratefulness that we may have taken advantage of in previous weeks. We feel happy and content. It is one of my most satisfying weeks of work throughout the year. Then, when the work week is over we have Thanksgiving day and it is just a perfect celebration with family. It is the calm before the storm of Christmas hustle and bustle. I just LOVE Thanksgiving and the days leading up to it. In celebration of that I wanted to tell you some of the things that I’m grateful for at JD this year.

1. I’m thankful for knowledge sharing. I’m thankful that Dr. Sandy has taught me so much about aesthetic medicine. Do you know how many people are trying to be injectors and have nothing more than a one week class? Dr. Sandy has given me 7 years of constant guidance.  I’m thankful to industry partners who offer me training from the best injectors in the world. I’m thankful for experts who share their knowledge with me through trainings like Dr. Steve Yoelin (my injector idol) and Dr. Arthur Swift and many more. I’m thankful to colleagues who share their knowledge with me like Noreen Bollinger who told me over drinks one night that she was going to force me to like cannulas and pushed me out of my comfort zone. Thank you to everyone who has shared their knowledge with me.

2. I’m thankful for good skincare. Skincare that has science behind its proven results. I now use a sunscreen that protects not only against UVA/UVB but also against blue light, infrared light and pollutants! I use retinol because it is the tried and true workhorse of any skincare regimen. I use Pepup, HA5, Lumivive, TNS recovery and Element 47 spray  and my skin thanks all of these products.

3. I’m thankful for devices. I’m thankful for the YAG laser because I no longer have to tend to my upper lip hair, my bikini line hair, my underarms, my feet nor my belly hair (I’m Maltese we grow hair everywhere). I’m thankful for UltraShape and Velashape that tightened that post baby belly bulge without any pain, numbness nor downtime. I’m thankful for PDL that treats my occasional acne prone skin problems. I’m thankful for PICO that tightened the skin on my neck.

4. I’m thankful for access to an expert injector, one of the largest laser centers in the state and a great team right here in Fort Smith. I believe in Fort Smith and I am thankful for all the great amenities that people take for granted.

5. I’m thankful for my team. I could not see the patients I see this week without Alondra, Margaret, Christine, Brooklyn and Katelin right by my side. I could not give our patients a great experience without the laser team and front/billing office team. We could not see the cosmetic volume without Honey and Dr.Nelson and Dr. Brad’s teams seeing more medical patients. It really does take teamwork to make the dream work and I’m so thankful for the entire Johnson Dermatology team.

I’m thankful for so much more but this post just cannot be that long! What are you thankful for? What are you celebrating and giving thanks to this year? Does giving thanks and feeling gratefulness make your life better like it does mine? Does it change your soul this time of year? Do you feel more clarity? I wish you all the best holiday!

Monday November 25th we will have a walk-in Botox clinic at 6 pm. We will have LOTS of vendors and snacks and you can come for free consults and purchase products at 20% off. Of course Dr. Sandy and I will be injecting Botox 20% off all night as well, no appointment necessary.  If you live in the River Valley please come by and celebrate with us!

Thankfully, Nina

 

National Botox Cosmetic Day

It’s National Botox Cosmetic Day! You didn’t know? We have been celebrating all day with LOTS of Botox injections. You might even be able to hop on the website www.botoxcosmeticday.com and purchase a $100 gift card and get $100 gift card free! Best BOGO ever! As you may or may not know there are four wrinkle reducers FDA approved in the US. Botox, Dysport, Xeomin and Jeuveau are how they are commonly known. To celebrate Botox Cosmetic Day I wanted to tell you why you might want to choose Botox!

1. It is the tried and true. It has been FDA approved the longest (almost 20 years) so it is what injectors have the most experience using. Consistent results you can trust.
2. It is the only neuromodulator that is FDA approved for horizontal forehead lines and crows feet. The injector can use the other ones off label but they haven’t been studied in that location. We can show the science behind why we use the amount of units we use and why we choose the location when it comes to Botox.
3. Brilliant Distinctions. A loyalty program that has more coupons, rebates and programs then any other neurotoxin.
4. Botox points accumulated in Brilliant Distinctions can be used on any of the Juvederm fillers, kybella and coolsculpting.
5. In my opinion Botox has the best molecule size and manufacturing process. The tiny details count when we are talking about our faces.

If you would like a free consult to see if you are a candidate for Botox please e-mail Margaret@johnsondermatology.com and come see me! I LOVE Botox!!!

Hope your National Botox Cosmetic Day was as skintastic as mine, Nina

Grateful

It’s National Gratitude month. It is my favorite month of the year. At Johnson Dermatology we all put extra attention towards having an attitude of gratitude. For example, when a patient is 30 minutes late for their appointment we don’t stress or get angry but instead we think and then say “I’m so thankful that patient chose us to care for their skin, I’m grateful for patients”. We also celebrate all month with specials for our patients who have trusted us all year long. We do lots of other things to express gratitude all month and it is really fun! I’ve been thinking about all the things in my life for which I am grateful and thought “I’m so grateful to have a great injector”. I mean right here in Fort Smith, AR I have one of the top injectors in the United States. I see patients all the time who have been botched and don’t even realize they have been botched. They sit in my chair and say they want to look natural but when I point out their upper lip towering over their lower lip and the resulting duck effect they don’t see it and want more in their lips completely ignoring the volume depletion in their mid face. Their proportions are out of whack but in the mirror they don’t see it, they don’t see the angles we see and they walk out just as botched as they were before. We don’t look at ourselves from the side, we can’t see our profile in the mirror. We don’t watch ourselves make all the expressions we make all day. That’s why we have to trust our injector. That’s why a good injector is such a blessing. So today I’m thankful for a great injector that keeps me fresh and youthful but still looking like myself. Here are 10 signs that you should be thankful for your injector too….

1. The lady at the cash register at wal-mart doesn’t ask you where you had your lips done. If strangers ask where your “work” was done then they can tell you’ve had work and that’s not a good sign. Be thankful when no one can tell.
2. Your closest friends and family DO ask you where you had your work done. When you tell Aunt Karen at Thanksgiving that you’re thankful for Botox and then she asks where you go that’s a compliment, thank your injector.
3. Your husband doesn’t say anything the day you got filler in your cheeks. Now lips are one thing but cheeks go undetected by most men even the day of injections.
4. You get your lips done and your girlfriend ask you if you got new lipstick because that color looks so good on you. She knows you look good and maybe different but can’t tell what it is, thank your injector.
5. You got all the instructions on what to do when you leave the clinic. Your injector may have told you no heavy lifting or no extreme cold or no make-up. Whatever instructions she gave you be grateful because I can’t tell you how many people come to me from other injectors and I explain aftercare to them and they say “no one ever told me that before”. Sorry for you, now you can thank your injector.
6. You walk into your appointment knowing exactly what you want and walk out with something completely different but love it. You aren’t the expert injector no matter how many beauty gurus you follow on instagram. Your face is different than those pictures, you are unique and you need an expert injector who can assess your face and know what it needs to keep you looking yourself at your best. So if you look good and aren’t real sure how or why, thank your injector.
7. You didn’t use a groupon for your injections.
8. Your injector promises the best results, not the best prices. If you have a result driven injector rather than a money maker, thank ‘em.
9. Your injector addresses your concerns and gives you a plan. No good injector thinks they can inject you one time and then you are done and 29 forever. You need an injector that has a plan for you to age backwards, a friend for life. If you have that, be grateful for your injector.
10. You have fun at your injection sessions and look forward to them. If you aren’t excited for fresh Botox, you might need a new injector. If Botox days are just as good or better than hair days and the nail salon days then thank your injector.

So thank you Dr. Sandy for being such a great injector. I’m so grateful to have you as my mentor, my teacher, my boss, my friend and my great injector. What are you grateful for this year? Let me know on social media and use #gcw or #natinoalgratitudemonth or #gratitude30

Grateful for all my readers, Nina

Colorescience

I promised a post about my new make-up skincare addiction. I’m not a foundation girl. I’ve worn powder foundation from time to time due to my acne prone skin. When I’m having a flare up, I want to camouflage it, who doesn’t? As I get older I find myself wanting a little something but I work hard on my skin and don’t want the feel of foundation covering my skin all day. These products we brought on at Johnson Dermatology changed my make-up and skincare game. Here are my three favorites in detail.

1. Total Eye. Game changer. Everyone’s favorite. This is a concealer, sunscreen and antioxidants to treat under eye circles and crinkles all in one. It comes in an easy to apply metal applicator that is mess free and doesn’t have that dingy sponge that’s on some concealer applicators. The sunscreen is 100 percent physical which I love. It goes on so smooth and leaves a luminous glow under your eyes. Pro tip: spread it where you put highlighter on your cheeks for a natural pop of that cheek bone when the light hits. Also use on upper eyelids as a base to eye shadow!
2. All calm. This is for those who suffer with redness. It is a sunscreen, color corrector and treatment for redness rolled into one! It makes a perfect primer for those that want more coverage or perfect alone for those that want light coverage. It’s all I wore today and my skin still looked like MY skin but that pesky hormonal outbreak was hidden away beneath the Colorescience perfection. Pro tip: Awesome for after procedures like pulsed dye laser because it covers the redness from the treatment AND protects you from the sun which can cause problems after a laser treatment!!
3. Even Up. This product is for people with brown discoloration or “sun spots”. It is a sunscreen, color corrector and treatment for brown spots rolled into one. See the theme here? These three favs of mine are all so cost conscience because you are getting three products rolled into one! I wore this all Summer and it’s the first Summer my melasma didn’t flare since I had my 4 year old. It covers brown spots but doesn’t look cakey so there is immediate satisfaction but the more you use it over time the better your skin looks naked. This is one you have to come in and try because it is so fluffy and yummy feeling. Pro tip: use this for sunscreen poolside or at the beach for easy coverage and great protection!

If you want to come check out any of these products just e-mail Brooke@johnsondermatology.com and she can set you up with a free consult with her or Liz. Tell them I sent you from my blog and they might even have a gift for you! If you are a make-up lover and want great naked skin too then these products are for you! I can’t wait for you to try them. Have a super week and please stay Skintastic, Nina

New! New! New!

Can someone please tell me how the Summer is over? Why did I pick up my child from the last day of kindergarten and send her to the first day of first grade in the blink of an eye? Who is with me? Why are the years getting shorter? Why have I just realized how long it’s been since I’ve blogged!?!?!? So many exciting thing happening at JD but I am going to try to shove them into one post right here!

1. Colorescience gamechangers- I have to do an entire post about all our new Colorescience products next week but for today I want to tell you about All Calm. It is a three in one product that has antioxidants that treat redness, color correction and a 100% physical sunscreen. So basically it’s your make-up, skincare and sunscreen all in one easy step. My redness is usually crazy during the Summer and this year it’s been non existent because of this product.
2. Dermal Infusion. I just peed my pants a little bit with excitement! You may know about hydrafacial, a device that sucks out and cleanses the pores while infusing serums. Well dermal infusion is that PLUS a diamond tip that offers microdermabrasion during the treatment. So you get exfoliation, extraction and infusion! It feels like a cat licking you and the satisfaction of looking in that bottle at the end and seeing what came of your skin is as good as being first in line at your favorite store on Black Friday! E-mail brooklyn@johnsondermatology.com to get scheduled or set up a consult or learn more or just to say “hey girl!”.
3. New neighbors. Okay so this isn’t really something new at JD but it’s exciting for our community, especially south Fort Smith. Premier Pediatrics opened a pediatric walk-in clinic directly in front of our clinic. What a game changer for the River Valley pediatric population! It’s going to keep lots of babies from being forced to go to the ER. Plus, Dr. Wilkinson is my kids pediatrician so selfishly I’m in love with the proximity! You can contact the at 479-763-3050. Also moving in right next door is Riley Farm Dental &Braces! So basically you can come to Our parking lot and have your teenagers acne treated, braces placed and get a physical without moving parking spaces! I have an appointment with Cynthia to get my teeth cleaned there so I will share my experience with you guys soon! I already love Dr. Sparkman though and I asked a few of my dental hygienist friends about his work and they said it is the BEST! So basically nothing but excellence when you turn into Riley Park Dr.
4. New Nurse Practitioner. You didn’t hear? Scarlett Bone joined JD to be a sub-Investigator in all the clinical trials JD has to offer. What a great thing research is to our community. Clinical trials could give someone suffering a new drug that helps them more than anything we could have prescribed and at no cost to the patient. The medications and the healthcare offered during clinical trials are a great option for people who have “tried everything” or delayed their care because they didn’t have health insurance. If you are interested in a clinical trial e-mail Scarlett@johnsondermatology.com because she is currently enrolling for atopic dermatitis, alopecia areata, psoriasis and hidradenitis supportiva.
5. New and coming soon! TNS Advanced Plus! This is the breast milk of growth factors recreated! No formula is exactly like breast milk because breast milk can change to your babies needs. Well we needed TNS to smooth our skin quicker. SkinMedica listened and the new formula will show results in 4 weeks instead of having to get through two entire bottles of the stuff! I’m so excited because who wants to wait longer for results?!?!

Who wants in on all the action?!?!? E-mail brooke@johnsondermatology.com for a free skincare consult, e-mail brooklyn@johnsondermatology.com for more info on dermal infusion, e-mail scarlett@johnsondermatology.com for more information on studies and don’t e-mail me….. JK if you need anything else you can always e-mail me!!!

Hope everyone has a great rest of the week! Stay Skintastic, Nina

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 appointments@johnsondermatology.com If you would like a good sunscreen for this Summer you can e-mail Brooke@johnsondermatology.com 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 nina@johnsondermatology.com otherwise good luck!

Nina

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.

Prevention:
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: https://www.aad.org/media/stats/prevention-and-care/sunscreen-faqs

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. https://www.aad.org/media/public-service-advertisements 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. https://reynoldscancersupporthouse.org/sun-s-m-a-r-t/

Treatment:
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. https://johnsondermatology.com/mohs/

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 possible..to 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.

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Johnson Dermatology is not a Medi-Spa

Recently the political climate for nurse practitioners has been HOT! I personally know and respect two of our state representatives who voted against a bill that would allow nurse practitioners that work in a RURAL healthcare setting and have at least FIVE YEARS of experience with a collaborating physician to practice independently in the state of AR. I believed the bill would improve access of care after hearing about a nurse practitioner in AR that closed her small rural practice due to her collaborating physicians death and the inability to find a collaborating physician in her area. Over 4,500 Arkansans lost access to healthcare in their hometown. This blog isn’t the place for me to debate that bill not to mention some of the physicians that upset me during the legislative session. In summary, I don’t want to debate it. I want us all to agree on a plan that makes Arkansas healthcare the best in the USA. I want all healthcare providers to work together on this plan and not bash each other to the point of employers getting calls. What a great world it would be if it was that simple. I struggled slightly with this post Dr. Sandy wrote for me because I didn’t want to be portrayed as bashing a medi-spa. I know owners of medi-spas that I really respect. I believe medi-spas have their place and can be really good. I also have seen my patients come to me after an untrained person they thought they could trust scarred them or botched them or worse. My first responsibility as a health care provider is to do no harm. I have people reach out to me asking me to do procedures I feel are unsafe (like silicone injections). They would pay me for that procedure but I still refuse. Why? Is that good business? No, it’s good healthcare though. Unfortunately, the lines blur between business and healthcare sometimes. This blog is meant to show the black and white lines. The laws. The truth that some patients don’t know. It’s not to debate nor argue about someone’s scope of practice or skill set . It’s to educate my readers so they can choose where they are injected with knowledge and confidence. So know your stuff. Dr. Sandy wrote it more eloquently than I ever could.

Johnson Dermatology is not a medi-spa
Written by Dr Sandy AKA Sandra Marchese Johnson MD, FAAD

I love skin and am blessed to be a board certified dermatologist. I am blessed to have fallen in love with skin and the care of skin while in my second year of medical school when I met my professional mentor and friend Dr. Bob Brodell. He taught me to love the anatomy and physiology of skin. He taught me to love and respect skin in both sickness and health. He helped me to match into a 4 year dermatology residency after medical school at UAMS where I stayed on faculty for 4 years and started their cosmetic dermatology training program with another friend Dr. Suzanne Yee. After Dr. Brad’s four years of college, four years of medical school, four years of dermatology residency and 2 years of dermatology surgery fellowship we opened Johnson Dermatology in 2006 in his hometown. 12 years later, we are blessed to have such an amazing team at Johnson Dermatology who work closely together with the core values to be effective, efficient, empathic and empowering. Our mission statement written by Dr Brad and myself in 2005 is that “The Johnson Dermatology Clinic strives to deliver efficient, quality, compassionate, comprehensive, patient-centered skin care. We endeavor to provide a team oriented, productive work environment. We strive to be a responsible corporate citizen and contributing member of the community through education and service.”

Now to turn the topic to something less fun and positive. We are going to address the elephant in the room. Nina wrote an excellent blog about that elephant recently. The elephant I am referring to is that unfortunately, she and I have seen quite a few complications from patients who were treated elsewhere. It seems like we have recently seen even more of those patients. Our first comment to those patients, as she pointed out, is to go back to the person who treated you, after all, they should know what they did and want to make it better. Unfortunately, everyone has complications–yes even us. If you have a complication or less than favorable result from us, please come back to us and let us make it right—we want to make it right.

Unfortunately and surprisingly also, we are getting many phone calls from “laser techs” in the community asking us questions about how to treat patients. Our answer to them is to “ask your medical director”. Unfortunately, many of them have no idea what we are talking about–they have no idea what a medical director is. In an attempt to empower all of you and re-educate myself, I thought that I would write a blog about medispas and medical directors. I started by reviewing our state laws set by the Arkansas Medical Board. I also looked at guidelines set forth by the AAD, the ASPS, American MedSpa Assocation, etc. I want to educate and empower all of you and myself in the most positive way possible. Unfortunately, this blog may upset some people–for that I apologize in advance and offer to discuss any issues in person, on the phone or by email with you. I may not have all of the facts and would love to be educated by you if need be.

My first comment is that I am NOT a medical director. I am one of 3 board certified dermatologists who practice at Johnson Dermatology with 1 board certified dermatopathologist, 2 certified nurse practioners/ licensed advanced practice registered nurses, and 1 certified diplomate of the Society of Dermatology physician assistants. We work closely under the same roof with a team of good people who we have trained, work closely alongside with and to whom we have delegated procedures according to the Arkansas State Medical Board Practices Act and Regulations. You should know that in the state of Arkansas, all medical practices must be owned by a medical doctor according to Regulation 4-29-305. For example, I need and have 2 medical licenses for the state of Arkansas. One is for me personally to practice medicine and one is for Johnson Dermatology for the practice of medicine to occur here. This means that a nurse or an esthetician cannot own a medical practice in the state of Arkansas since they cannot apply for the practice of medicine at their location. Regulation number 22 outlines the rules for the practice of laser medicine. I would encourage you to read the regulation before going to a laser center or medispa under or not under the same roof as a physician.

The American Med Spa organization also has clear guidelines about the practice of medicine with in a medical spa. There is a link to an article from their website. The American Academy of Dermatology has a position statement about medispas that ” Medical spas are facilities that offer a range of services, including medical and surgical procedures, for the purpose of improving an individual’s well-being and/or appearance. The distinguishing feature of medical spas is that medicine and surgery are practiced in a nontraditional setting. Procedures by any means, methods, devices, or instruments that can alter or cause biologic change or damage the skin and subcutaneous tissue constitute the practice of medicine and surgery. These include but are not limited to the use of: scalpels; all lasers and light sources, microwave energy, electrical impulses, and all other energy emitting devices; thermal destruction; chemical application; particle sanding; and other foreign or natural substances by injection or insertion. Any procedure that constitutes the practice of medicine, including but not limited to any procedure using a Food and Drug Administration (FDA)-cleared or regulated device that can alter or cause biologic change or damage, should be performed only by an appropriately-trained physician or appropriately-trained non-physician personnel under the direct, on-site supervision of an appropriately-trained physician in accordance with applicable local, state, or federal laws and regulations.”

I could write ad nauseam about this topic. Instead, I will state that the injection of a substance (botox, juvederm, etc), laser, or any manipulation of your skin or body with the above definition is considered medical care. Medical care is regulated by laws for a reason. If you are a consumer of medical care, I will state “buyer beware”. If you are a licensed medical provider or working with a licensed medical provider, I would encourage you to know your state laws. If you are someone who is thinking about providing medical care including injections or lasers, I would also encourage you to know your state laws.

The team of Johnson Dermatology strives to provide the most effective, efficient, empathic and empowering care all under one roof at 5921 Riley Park Drive in Fort Smith Arkansas. We strive to know and follow the state and federal rules. We strive to follow the Hippocratic oath “first do no harm”. We want to be your partner in all of your skin care needs, wants, desires, dreams, etc. If I or anyone at Johnson Dermatology has not treated you with the most effective, efficient, empathic or empowering care then I would like to know. We want to treat you with the highest level of care possible. If we did not then we need to learn from you so that we can make our good better and our better best. Below are some websites from which I gathered some information for this post and thought you might be interested in reading if you wanted to learn more.

https://www.aad.org/Forms/Policies/Uploads/PS/PS-Medical%20Spa%20Standards%20of%20Practice.pdf

https://www.surgery.org/consumers/consumer-resources/consumer-tips/patient-safety-advisory-on-medi-spas

https://www.naplesnews.com/in-depth/news/special-reports/2019/01/30/miami-doctors-plastic-surgery-empire-becomes-floridas-deadliest-clinics/2462068002/

https://www.americanmedspa.org/news/169407/Want-to-be-a-Medical-Director-at-a-Medical-Spa-Beware.htm

You Want A Doctor To Perform Cosmetic Procedures

https://www.hairfacts.com/wp-content/uploads/sites/5/2010/04/aada-state-regulation-of-medical-spa-facilities-toolkit.pdf