Category Archives: Uncategorized

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

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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

Dr. Sandy Patient Helping Patients

I really enjoy traveling. I also really enjoy using the toiletries at the various hotels. I asked Nina if I could write this blog while I am traveling and after sampling various lotions and responding to work emails. Unfortunately, not everyone can enjoy using the various toiletries and sampling various lotions and potions. I do however consider part of my job to test products.
One of my favorite patients is one of those unfortunate people who cannot try various toiletries or lotions. She suffered with various rashes and ailments for years before she presented to our clinic. She would often “break out in a rash” while traveling or visiting a friend. We decided she should be patch tested and learned that she was/is sensitive to some chemicals and ingredients. She learned how to avoid those ingredients and became loyal to “free and clear” products. She was doing fine for a few years but then returned to the clinic with a new rash around her eyes and neck. She was perplexed because she did not change anything. She has not tried anything new. She didn’t even travel somewhere and try their soaps and lotions. So we decided to patch test again. Lo and behold she now is allergic to Cocamidopropyl betaine. This is not something I could easily pronounce but do know that it was the allergen of the year in 2004. I also know that it is related to coconut oil. The surge in popularity of coconut oil may be related to the surge of people allergic to Cocamidopropyl betaine.

One of the reasons that she is one of my favorite people is that she is a great researcher and sleuth. She learned that there are many alternative names for this ingredient and that it also cross reacts with other ingredients. She also learned that it is in some products even if it is not listed on the label. For example, it is found in many mascaras…even the “organic” or “natural” ones.

According to livestrong.com (I like the way they worded this) “Cocamidopropyl betaine is a chemical found in many personal care products, including shampoo, toothpaste and body wash. The chemical is derived from coconuts and is used to make products produce more foam. Because cocamidopropyl betaine originates from coconut oil, even some personal care products labeled as natural still contain it. Although the government regards the ingredient as safe, some people do have negative reactions after exposure to it.” Many of us like Cocamidopropyl betaine because it is a “natural” surfactant that makes products sudsy. After all, we all like “natural” products, right? After all, coconut oil is natural. Poison ivy is natural. True mascara is made of bat guano which is also natural.

She was generous enough to share with all of us some ingredients that she can use even though she is allergic to Cocamidopropyl betaine. She shared this list with us.

1)Laundry detergent-the only SKU from 7th Generation

2) soap/shampoo bar from amazon-all 3 of us love this. It has no chemicals so after 3-4 washes, your hair is much softer. It takes a few times to detox the hair.

3)lotion-this is WalMart’s version of Aveeno. We use both.

4)I’m making my own makeup remover with equal parts Witch Hazel (Walmart) and Grapeseed oil (Old fashioned Foods) plus 4 drops lavender oil. You have to wipe it off with dry cloth but it works.

Like many people who suffer with contact dermatitis, she has learned to be creative. We would be honored if you suffer with contact dermatitis or other skin ailments and would like to share some of your creative solutions with us. Please do so by emailing our skin care product specialist Brooke at brooke@johnsondermatology.com or posting on Instagram or Facebook and tagging us at location Johnson Dermatology or with #realJDpatient Until next time, stay skintastic and know that our team at Johnson Dermatology is here to serve you and your skin care needs and wants. S

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Go Back!

I’ve been injecting for about 7 years. When I first started injecting I had very few side effects or undesirable outcomes. I’ve had more this past year than any year before. Sounds backwards, right? I should be a more experienced injector now. Well, I am. I also inject over 100% more patients than I did 7 years ago. The more patients you inject the more likely one of them will have a side effect. That’s because any injector that injects long enough will eventually have a complication. It’s not a matter of if an injector will have a patient with a complication, it’s a matter of when. Now don’t get me wrong, a good injector that knows the anatomy of the face and puts safety first is less likely to cause a complication. However, an injection is never 100% safe with zero possibility of undesirable outcomes. I’ve had patients who have had complications. I also have prepared for how to treat those complications. Through continuing education and consulting with colleagues and choosing to practice in a Dermatology clinic that values patient safety I feel prepared for complications. At JD we keep hyaluronidase on hand at all times to be able to immediately dissolve hyaluronic acid fillers. We take MANY precautions to prevent complications like infection and vascular occlusion and bruising and swelling and more. Some complications happen immediately but many develop over a period of time. This is why it is very important to have a good relationship with your injector. At JD we have an after hours phone number that I encourage my cosmetic patients to call if they are having any symptoms that were not expected with their treatment. It is always important to contact your injector and follow up with them if you have any undesirable outcomes or fear you are having a complication. Often times patients come to me from another injector after being “botched”. The very first question I ask them is “did you go back to discuss with your injector?”. If they have and still don’t have desired results then I proceed but often times they come to me immediately and I recommend they allow their injector to “fix” the problem first. Because that’s usually how the patient has the best results. Botox and fillers can be forgiving. I have all my first timer patients come back and see me in two weeks for this exact reason. We want to make sure it’s perfect and usually if there is any small tweaking we would like to do we can achieve it at that visit. It’s easier for me to tweak my own injections because I know exactly what I injected and where I injected it. When someone comes from somewhere else, especially if it wasn’t a medical facility, it can be difficult to track down what was injected and where. I’ve had times when I didn’t know if the patient had silicone or HA filler or something else. This makes it difficult to know the best way to fix the problem. It’s also important to keep the same injector because we get to know the little things you like and don’t like. No one has the exact same anatomy. Yes we all have a nose but none of our noses look EXACTLY the same. We all have the same muscles in the face but they don’t move and look EXACTLY the same. So there is a science to injecting and an art to injecting. The more times you are treated by the same injector the better the art of injecting becomes for you specifically and results tend to get better and better over the years. Which is how we age backwards naturally at JD. If you’re still hanging on at this point, thanks for reading. The moral of the story is there is value in trusting your injector and building a long lasting relationship with them through good communication. I hope all my patients know I sincerely care about their results and their safety. I hope they all trust me to do the right thing to enhance their beauty and know that my heart hurts with every complication but that I promise to do everything possible to make it right. I hope that everyone that is injected understands the risk of cosmetic injections and the importance of an expert injector. The core specialties are Plastic Surgery and Dermatology and I recommend starting there for your search for the right injector for you and not on social media. Photos can be a trap. Lighting and angles and more really affect before and after photos and they can be deceiving on social media. Interview your injector during a consultation before you pull the trigger. Make sure they (and their staff)look natural and in line with your goals. Make sure they know how to treat complications. Do your research and then feel the vibe. There are some patients who don’t vibe with me and we agree together to not form a long lasting relationship. There are other good injectors out there. More often than not, we do vibe and we stay together for a long, long time. And that my friends is my favorite part of being in aesthetic Dermatology. The relationships with all my clients that will last a lifetime, of 29. Vibing at 29 years old forever. That’s the goal.

Stay Skintastic, stay vibing and stay 29 with me forever, Nina

Almost Spring Break!

It’s almost spring break. Who is excited? I am! It’s my first time to celebrate spring break in 8 years. I was in that chapter of life between graduating from grad school and having children in school. My oldest daughter started kindergarten this year and that means spring break is back baby! We are heading to the beach so I immediately started my wardrobe search. I’m so excited about some of my finds I just knew I had to share them with you! I added in a few of my tried and true beach must haves to the list.

  1. Blue Stone Sun Shields. This is my favorite new find this year. These are basically a visor that has a shield that you can pull down to protect your entire face from the sun. They come in the best colors. I’m not going to lie, I also love that people can’t see my face. I feel so incognito like I’m someone important hiding from the paparazzi when I wear it out. Go check ‘em out! https://www.bluestonesunshields.com/
  2. Beachriot. My new favorite swim pants. Rashguards and swim shirts are fairly easy to find. Swim leggings are harder. Finding anything but black is even harder. Then I found beachriot who has the cutest swim pants ever. They run small so I would size up when you order. I got the leopard but plan to get more because I love the waistline. It sits in the perfect spot for slimming and it’s wide so it doesn’t roll down with activity. Promise you will still be fashionable with these on poolside. https://beachriot.com/collections/leggings
  3. My kids favorite sunscreen. Sea Star Sparkle Sunscreen. It is SPF 50, water resistant, physical blocker with zinc oxide and broad spectrum so it meets all my requirements. It smells like cake and is FULL of rainbow glitter so my kids love it! They have other fragrances/colors but I’ve stuck with the rainbow. Might not be best for sensitive skin children due to the fragrance and all the glitter however, my kids never complain about how it feels on the skin. Find it here https://sunshineglitter.com/product/seastar-sparkle-spf50-4oz-party-cake-with-rainbow-glitter/
  4. My favorite rashguards. The Seea is by far my favorite swim top. They have the cutest designs and it’s fashion first when you are dressed like a ninja on the beach. It’s what I’m wearing almost anytime you have seen me out. They are on the luxury side price wise but they always have sales and that’s when I stock up. Here is the link to one of my favorite designs that is currently on sale! https://www.theseea.com/collections/rashguards/products/doheny-rashguard-marguerite
  5. Tinted Lip balm with sunscreen by Coola. This is one I haven’t worn all day. Just got it though and love one application. It comes in multiple colors so everyone can find a tint they like. It’s one of the only lipbalms I have been able to find that has a physical blocker. It has zinc oxide and titanium dioxide. I plan to pat a little on my cheeks while I am at the beach for a little blush look too.
Leggings:beach riot. Rashguard: The Seea Visor: Blue Stone Sun Shields
Leggings:beach riot. Rashguard: The Seea
Visor: Blue Stone Sun Shields

I hope you all have a Skintastic spring break! Let me know if you enjoy any of my favorite Skintastic finds by tagging @johnsondermatology

Nina

Botox isn’t for Freezing

When patients call and schedule an appointment with me for Botox, they often times don’t get Botox. Why? Because what they were really making an appointment for was an unwanted appearance of something but they weren’t sure what procedure would remedy the problem so they assumed it might be the ever so popular Botox cosmetic. Maybe a line or wrinkle they didn’t like, maybe sagging skin or maybe they feel they look angry or tired when they don’t actually feel that way. I always address the issues and where we want to enhance beauty and then I recommend filler, botox, devices, lasers, topicals, surgical consults or all or none of the above. People don’t ever initially come in for Botox and say their complaint is that their face moves. Most people like their face to move naturally. If you have met me you know I like to make facial expressions, I don’t want my face to not move. However, I don’t like the lines that some of my facial muscle movements make in my skin. This is why I love Botox and I think it is so fun to inject. When I inject Botox I’m not just thinking about how to make the line go away but I’m also taking into consideration how that relaxation of the muscle can change the shape of the eye or the length of the forehead or the placement of the eyebrows or the shape of your smile. For example, if someone does not like a line directly above the tip of their eyebrow I usually do not use Botox. Botox in this area can drop the eyebrow and flatten it or even cause eyelid ptosis (dropping of the upper eyelid). I tell clients to keep the line or use topicals, laser or filler to enhance the beauty in that area while getting rid of the unwanted wrinkle. What’s interesting is my longtime patients will sometimes say “freeze me” I don’t want any movement at all. That is because they have become addicted to the smoothness of the skin that Botox gives when they are moving less. They get the impression that less movement will mean less wrinkles. That might be true but it also may mean less beautiful results. The real reason we all get Botox is to enhance our beauty. So this is my PSA. That person you know who took injectables too far and looks fake, (they aren’t my patient) they became obsessed with chasing the line and “freezing” the face. Don’t do that. Get yourself an injector who is an expert at beauty, not a line chaser. If you go in and ask for Botox and they didn’t recommend anything else for your skin then eventually you will look Botoxed. Your forehead will be 29 and your lower face might be 49 and that looks Botoxed every time. Don’t become obsessed with that one little line. Remember the reason you started getting Botox. To enhance your beauty. Not to be frozen or filled up. These are the keys to looking naturally injected. Small tweakments over the years. What is so ironic about this post is when I am due for Botox I often tell Dr. Sandy to freeze my whole face and raise my brows to the Gods. I’m grateful she knows what I ACTUALLY want and injects me to perfection. Just one more reason to find an expert injector. An expert injector enhances your beauty and knows what will look good even when it’s not what you asked to achieve.

Want to come naturally age backwards with me? E-mail Margaret@johnsondermatology.com and set up a free consult. I would love to help you meet all your skin goals. Once you get a little Ninamen C I hope you feel more beautiful, not frozen.

Stay moving, stay beautiful, stay skintastic, Nina

How many units of Botox do I need?

Every patient that sits in my chair gets a full consult. I suspect the most frequently asked question I get in regards to Botox is “How many units do I need?”. Interestingly, almost no one that has had Botox before actually knows how many units they have had in the past. My experienced, Botox savvy patients usually know but most do not recall. I find it interesting that people ask how many units they need but what they really want to know is something completely different. Like “how much will this cost?” Or “how bad are my lines?” Or “how many needle sticks do I have to have”. In our clinic we usually do not sell Botox by units. As a matter of fact we don’t really sell Botox at all. We sell beauty. We sell results. Most patients invest in packages that will make them feel their best Skintastic self. Packages include products, lasers and/or injectables that target a concern. Either way I thought I would try to explain to everyone how many units you really need.

In my opinion, how many units you get is more related to how long your Botox lasts and not necessarily what it looks like. I think that what your Botox results look like are more related to where your injector places your Botox. For example, if I get 40 units of Botox in my forehead and around my eyes it looks exactly the same as if I get 50 units in the same locations. The difference is that 40 units only lasts me about 2.5 months and 50 units lasts me about 4.5 months.

It’s also important to consider what has been studied and FDA approved. That is 20 units for the glabella(the area of the forehead between the brows that makes the “11”lines), 20 units for the frontalis(the muscle that raises the brows that causes horizontal forehead lines) and 24 units for the crows feet. Those are the dosages that have been shown to last 3-4 months. If you get less than that you can expect to either not have satisfactory relaxation or results won’t last the entire 3-4 months.\

Every person is likely to need a different amount of units. Men tend to need more than women since they tend to have bulkier muscles. Every single person is different. We all are born with a gallbladder. Some of our gallbladders come out at some point due to malfunctions and some of us keep our gallbladder our entire lives. Even though it is the same organ it is different in everyone. Same goes for our muscles. One patient may get 20 units in their crows feet and it look perfect and last 4 months and the next patient gets 28 units in the exact same location and it only last 3 months. Their orbicularis oculi muscle is the same muscle injected just different from person to person.

The moral of the story is get an injector you trust. You can’t figure out how many units you need on your own. You need to come in and let me look at your muscles. Let me assess you. Then stay with me. Let me check you in 2 weeks to make sure your botox is perfect initially. Let me make adjustments every 3 months as needed. When I know where I injected last time and can see what adjustments we make your Botox injections could quite possibly get better and better. It’s hard to know who the expert is and who you can trust. I encourage you to make an appointment with my cosmetic coordinator, Margaret by e-mailing Margaret@johnsondermatology.com and find out exactly how much you need to reach your goals and stay in your budget. You will never pay full price at Johnson Dermatology because we offer brilliant distinctions, elite program and more! We are just an e-mail away to help you reach all your skin goals. And FYI, one of my favorite patients told me this weekend that she needed to come in for her “Ninamen C” so for the record that is what I will be referring to Botox as from here on out!

Stay skintastic, Nina

Illuminate the New year with Lumivive

One of the reasons Johnson Dermatology is unlike any other dermatology clinic is our team. There are many reasons, in my opinion, we give some of the best skincare regimen advice around. Our skincare products are scientifically researched and proven to produce change in the skin, we have tested them all out personally before offering them to patients and we aren’t in a pyramid scheme nor commission situation where we get personal financial gains from you buying our products. Brooke is the star that runs the skincare product show. She has had multiple advanced level training courses and spent months learning about skincare from Dr. Sandy, Honey and myself. If you haven’t met Brooke yet I highly recommend you e-mail her at Brooke@johnsondermatology.com for a free consult. My favorite new product at JD right now is Lumivive. It has made all my glow dreams come true. I have had so many compliments on my skin since I started this system. I asked Brooke to write a blog about Lumivive to help convince everyone they will love this product as much as I do!!!

From Brooke, our skincare concierge extraordinaire:

Let’s take a minute and answer the following questions:

  1. Do you have a smart phone?
  2. Does your skin look tired or stressed?
  3. Are you lacking the glow in your skin?

If you answered YES to all three of these questions, you NEED Lumivive in your life.

So, what is Lumivive?

Recharges – Amplifies – Defends

Lumivive is the booster and game changer in your skin care regimen. It has 27 daytime anti-oxidants and 32 nighttime anti-oxidants that complement the products you are already using containing anti-oxidants. It does not replace any Skin Medica product. Lumivive is a dermal bio-barrier multitasking skin care that doesn’t wash off, wear off, or needs reapplication. When used daily, your skin will have a longer lasting barrier against blue light, LED light, and pollution. Lumivive stays on for 12 hours a day at a minimum. It’s a simple morning and night single step routine that will give you the glowing radiant skin results everyone wants as early as fourteen days – that’s 14 days! Lumivive defends during the day and detoxifies (repairs) and recharges at night.

The Lumivive AM is going to defend during the day against blue light and pollution. Working in a dermatology clinic, we know that tanning bed are two words we never say. Did you know that we all carry a tanning bed in our purse or pocket? Yes, that new tanning bed is called a smart phone! Did you know on average a person is exposed to blue light for about 10 hours per day. YIKES! This isn’t just our phone, it’s a bundle of tablets, computers, tv screens, LED and fluorescent lights. Blue light accelerates the aging and damaging of our skin and can also cause dark spots, wrinkles, saggy or loose skin. Not only on a daily basis are we exposed to blue light, but we are also exposed to pollution. The Lumivive AM will defend against pollution during the day. Pollution has the tendency to make our skin look tired and stressed. These are two types of modern-day threats that are hurting our skin during the day.

The Lumivive PM is going to be recharging your skin overnight. We recharge our bodies by sleeping, but how do we recharge our skin from the damage that has occurred that day? Lumivive PM! While your body recharges at night with sleep, Lumivive PM will repair and recover your skin. Lumvivie PM will give your skin the power it needs to resist the damage that we can encounter during the day. As we age it becomes more difficult for our skin to recover from any damage.

Lumivive will help your skin be radiant and glowing. These products are bundled together and easy to use. If you’re wondering if it’s for all skin types, you’re in luck! It’s perfect for all skin types including sensitive skin. If your skin cannot tolerate a retinol, most people can use a retinol while using Lumivive. We all know everyone should be on a retinol! Overall Lumivive helps with what we are exposed to in today’s world. This is a must for anyone whether you already have a skin care regimen or if you wanted to try a regimen for the first time.  Lumivive will be what your skin thrives on to defend, protect, and give you that natural glow. Take on the challenge and try the Lumivive. Take a picture before you start then two weeks later. New year, new you!

Brooke is going to be offering bounce back coupons and free gift with purchase with Lumivive in January while supplies last. So don’t delay! E-mail Brooke@johnsondermatology.com and set up your free consult. I promise you will love Brooke and Lumivive as much as I do!

Have a HAPPY NEW YEAR! Nina