For those of you that know me at all you know I can get pretty excited about some things. I’m a high energy person and that energy explodes before vacations, when my family is having fun and with anything dermatology. The past 5 days I have been at my favorite educational conference of all time, Maui-Derm. It is a conference for NP’s and PA’s in dermatology. A LOT of the big names in dermatology are there to speak and it is so much fun learning about new advances in dermatology and networking with peers. I was honored to listen to Dr. Zirwas, the world’s leading expert on hot tub allergy, Dr. Zone who has published over 100 original articles and over 40 book chapters related to immune disorders in the skin, Dr. Rosen who has a resume I can’t even fit in this blog post, Dr. Rich who is a founding member of the Council of Nail Disorders, Dr. Marghoob, the world’s leading authority on dermoscopy, and so on and so on and so on. Who I came in contact with this past week made me feel what I would imagine is the equivelent feeling a 13 year old girl feels when she meets Justin Beiber. So this week I would like to share with you some of the exciting news in dermatology and “pearls” that I heard about this past week.

1. New Drugs- You have all seen the commercials for Enbrel and the other injectable medications we use for psoriasis. Well there are a lot more in the pipeline. Medications for people with chronic urticaria (hives that won’t go away), topical prescription products for brittle nails, Dalvance, an antibiotic like Vancomycin but less toxic. I mean we are really getting some cool drugs in the derm world which is exciting for people that haven’t had any luck with what has been available.

2. Arkansas made a top 10 list- Okay so during the venereal disease talk they put up a list of the top 10 states with the most syphillis and Arkansas was on that list. Sigh

3. Coconut Oil- With the world becoming a greener place people often ask me about natural products. We reviewed a research article that tested coconut oil against mineral oil for dry skin relief. It found that coconut oil showed 68% improvement versus Mineral oil’s 38% improvement. I wish they would have tested it against my favorite, petroleum jelly, but they didn’t so moral of the story is, go ahead, use coconut oil for a moisturizer. Seems to work well.

4. Hidradenitis advances- Hidranenitis simplified is a chronic problem where you get “boils” commonly in the groin and armpits. It can be scarring, painful and REALLY difficult  to treat. Some people have surgery to get rid of a large portion of skin and it still comes back. We reviewed studies about new treatments including new antibiotic combinations, metformin, (a medication for diabetes) and biologics (medications for psoriasis, bowel diseases and bone diseases). Hopefully we are getting better answers for people that suffer from this horrible disease.

5. Women use 12 skin products with 168 ingredients per day. Enough said. Please let Johnson Dermatology trim down your products. Help us help you save your skin and pocket book.

6. Gonorrhea- There is a new gonorrhea that recently made it to America that is drug resistant. That means we don’t have a good treatment to rid it like we do with the traditional Gonorrhea. Oh, and it is believed to be passed by oral sex. Not cool.

7. Nail Melanoma fact- 25% of nail melanomas are amelonotic. That means they don’t have that black, brown color in them. Frightening! Please keep your skin cancer checks at least yearly so a dermatologist (the skin experts) can help catch skin cancers early.

8. Scary Treatments- The main cause of death from the autoimmune blistering disorders is side effects of oral steroids. One in 300 people who have a sentinel lymph node biopsy will have a stroke related to the procedure. Although oral steroids (example-prednisone) and procedures can be very helpful in mutliple diseases these things have side effects and all clinicians should be reminded of that often, to do no harm.

9. Patients don’t fill prescriptions- Historically speaking people have said studies show that 50% of people fill the prescrition they were given from their doctor. Hmmmm, I know ALL my lovely patients fill their prescriptions. My patient’s are perfect!

10. Melanomas are changing- Most people know the ABCDE of melanoma and how it helps to spot melanomas. But now, some of the top expert dermatologist are using a different acronym called “looking for the ugly DUC”. The D stands for different then all the other moles, U is for uneven. Uneven in any of the Asymmetry, Border or Color of the traditional ABCDE. Lastly the C stands for Change. Any mole that is changing warrants a biopsy. Just another reason you need a skin expert in your life.

That wasn’t even 1% of the exciting things I did this past week. So come see me at Johnson Dermatology and I can give you an ear full of the other 99%! You will see me get excited if nothing else!

Hey, did you know Johnson Dermatology is having a hashtag contest this summer? Use #Johnsondermatology this summer in any skin related post and you could win a prize. I’ll be watching on social media so be sure to follow us on facebook or my personal twitter @skinnyonskingal

Dance the week away (in sunprotective clothes),

Nina

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This week Honey (the best Physician’s Assistant ever) became my neighbor. For those of you that haven’t met Honey, she has been a PA at Johnson Dermatology for about 3 years and truely is a gem! She is my work sister. For most of her time at the clinic she has commuted from Tulsa, OK. I’m not sure if she moved here because she was tired of the drive, loves the Fort Smith community, got sick of people asking why she commuted or just really wanted to be my neighbor. I am sure of one thing though and that is that Honey and I would both move mountains to be able to work at Johnson Dermatology forever. Some people never find a job they are happy going to every day. Your work life really does affect your overall happiness. When I sit back and reflect about why I love my job so much the obvious things come to mind first. I love my patients, I love what I do, I love my coworkers, I love my hours, I love the location and I have great bosses. There are some things about being happy at work that are just up to the person though and so this week you may not learn a skin trick but you will learn something about Johnson Dermatology and why we love our jobs. Here are some of the Johnson Dermatology Midlevel tricks to a happy job inspired by my new neighbor Honey Hill.

1. We try to be healthy– Don’t get me wrong, we currently have a large bag of chocolate in our office. But generally speaking we both stay on each other about sticking to healthy food. We recently did a juice cleanse together. We ban ourselves from Starbucks sometimes when it gets to be too frequent a habit. I go to barre regularly and Honey runs with her fiance. The point is, our bodies feel good and are feuled to feel good at work. If you feel good and look good, you’re setting yourself up for a better work jive.

2. We find a reason to dance, every morning– Have you ever seen kid president? If not, go to you tube and watch all his videos. In every single one he dances at some point or recommends it in making the world a better place. Every morning Honey and I play music to dance to while we get ready for our first patient. We may only get 20 seconds of a song, we may get 2-3 songs in, but we don’t skip dance party time. If my baby woke up 50 times last night or Honey is sick of driving (not anymore) it clears that bad mambajamba and brings happiness and joy to start the day with a good attitude. I am usually the only one dancing in my chair and I nominated myself DJ but Honey does a lot of the lip syncing. Most of the time we don’t need a reason to dance but some days we choose something great about work and dedicate our dance party to that. So instead of thinking about how tired we are, we think about the patient we saved from Melanoma. Try it! I don’t have the science behind it but it works everytime, I mean 100% of the time… Dance people!

3. We don’t make excuses– Excuses are great, aren’t they? I mean they totally take a little of the blame off of you. Whether you’re placing the blame on circumstances or someone else, with an excuse problems are less your fault. Get rid of excuses. Honey and I were covering a duty while one of our co-workers was out. Honey had Wednesday and Friday to finish this task and I had Monday, Tuesday and Thursday. Well, when we got to work Wednesday morning we realized that the person who sets everything up for Honey to do this task wasn’t told about the change of plans, so it wasn’t ready to go. The easy thing to do would be to say that because it wasn’t set up and ready to go, Honey could just do the task later. But being that it was not set up and ready to go would just be an excuse, because really, that would just be a bump in the road that slows you down but you can still get it done. So Honey and I set it up together, helped each other finish the task, got it done twice as efficiently and boom, it was done. When someone asks you to do something at work, do you say “I won’t have time” or “I don’t know how”? Those are excuses. Make time and learn how. I think you will be proud of yourself, feel like a harder worker and therefore be happier in your job.

4. We admit we have weaknesses and make mistakes– Honey told me last week that she was sorry for biting my head off. I apologize daily for being inpatient. My blunt, straight forward attitude is my best friend and worst enemy. I apologize for it often. We know we aren’t the best to share an office with or to work for. We aren’t perfect employees. But we want to be the best we can be. We try to recognize our faults and improve on them. It’s like a step program. The first step is always admitting you have a problem. I got 99 problems but finding ‘em ain’t one.

5. We put others before ourselves– All day, every day. We try to never tell our bosses no, as a general rule. We try to keep our nurses happy. We try to do things the way the lab staff asks us to do them. Above all else we put our patients first. They are always right, their needs come first. If a patient is waiting to be seen and I need to potty, patient first, everytime. If I’m hungry but my first patient after lunch got here 30 minutes early, patient first, then lunch. Kid president says you should treat everyone like it’s their birthday. That is especially true with your co-workers and in our case our patients. If everyone around you is happy that vibe surrounds you and you’re happier by association.

I know you all join me in welcoming Honey to the River Valley as her new home. I am originally from Fayetteville but Fort Smith has been my home since 2007 and I wouldn’t leave it for the world. I have lived in San Francisco, CA, Orlando, FL and many places in between but this little community is special and one that Johnson Dermatology is honored to serve.

Hope to see you all at the clinic this week with any skin needs you may have!

Peace, Love and Skin care, Nina

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Happy Father’s Day to all you Dads out there. Fathers are so hard to buy gifts for, men in general really. After the basic cologne, polo shirt and sports equipment you start to run out of ideas. Lets face it, those basics only get you through Valentines Day and an Anniversary then you still have to figure something out for Birthday, Fathers Day and Christmas. Men, as the saying goes, can’t live with ’em, can’t live without ’em. So in honor of Fathers Day here are some men skin gift ideas.

1. Laser hair removal- Does your man have weird hair patches on his back? Or just hate shaving? Buy him a laser hair removal package. Price is dependent on the size of the area being done and he will likely need 3-5 monthly treatments. Now this is a little painful and we all know God didn’t make man able to carry a child for a reason but our laser technician Tasha is an expert and she gets most men through it without a problem.

2. Laser tattoo removal- Did your Dad get a naked lady tattooed on his arm years ago? Does your husband have an ex’s name inked permanently onto his skin? This is the gift that keeps on giving…… to everyone! Get him an ATV laser package to have a tat removed. The ATV laser we use at Johnson Dermatology is new to our laser family and we are seeing amazing results.

3. Bro-tox- Think your man is too manly for Botox? Consider this. We women started the tight jean look and now men are wearing the straight-leg tighter fit. Pink is a stereo-typically girl color, we have worn it since the day we were born. Now it is totally in style, men rock pink all over the runway. It’s just a matter of time before it is socially accepted for men to use Botox too. Tell him he isn’t necessarily metrosexual. Tell him it’s to help him stay competitive in the workplace with all those young new college grads. Tell him he has to keep up with you. Tell him whatever you want, after his first injection he will be hooked.

4. Aftershave balm- Not that fru-fru smells like you just walked in Abercrombie and Fitch stuff. The kind that is good for your skin. I like the Avene After-shave balm because it has purifying ingredients made to prevent bacterial infections, is alcohol free and a rich moisturizer. It will calm razorburn and is good for sensitive skin.

5. A Buff- Okay, seriously I am officially not as cool as I once was, or just don’t watch enough Survivor. A buff is a seamless tube of fabric that you can wear a million ways. It comes in all kinds of decorated fabrics. This weekend alone I have worn mine as a headband, neck gaitor and face mask to protect me from the sun. A wide brim hat can sometimes be difficult for a man to wear, especially during sports events. Your Father can use a buff as a hat liner to protect his ears from the sun and still be stylish in his ball cap. I’m pretty much in love with it and mad that no one told me about it sooner. Go to www.buffusa.com and get one, you’re welcome.

Hope all the Dads out there had an awesome Fathers Day. Next time you have to buy a dude a gift consider a treat for his skin. It is the largest organ in his body, it’s worth taking care of!

Stay skintastic this week and always!

Hope to see you all at the clinic, Nina

P.S. Check out my Buff as a facemask!

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So incase you haven’t heard there is a new organic juice place in Fort Smith called Carrot Dirt. I love juicing but it can be a lot of work and since I have had my child my juicer has been collecting dust. The convenience of being able to buy a bottle of juice that is as good as the juice I made in my own kitchen is ahhhhhmazing. So one might say I’ve been a little obsessed. This week I did a 3 day cleanse and had nothing but juice. I talked it up enough that I was able to get Dr. Sandy and Honey to join in on the cleanse with me and it was actually really fun! We weren’t hungry, tired, cranky or anything really unpleasant. Actually, we felt great! We didn’t even drink all the juices we were allowed in one day because we were so full. Don’t ask me how much weight I lost because that wasn’t my goal. As a matter of fact I didn’t even weigh myself before or after. When I don’t have a lot of sugar and carbs and all the evils of food I just feel better. I can’t put my finger on what it is exactly but I think what it boils down to is food is simply fuel for the body. Just like your luxury Lexus, you can put premium gas in your car and run smoothly or you can use regular unleaded. The car still goes but your Lexus engine probably skips a few beats without the good stuff. There are lots of reasons to eat healthy but is good skin one of them? I get this question a lot. The simple answer is yes, there are conditions of the skin associated with food but if you are just looking for overall skin health there are other things I think you should put at the top of your “steps to healthy skin” list. For example, in my opinion sun smart behaviors are more important for your skin health than eating blueberries everyday (these berries make magaizine “good food for the skin” lists all the time). Here are a few food tips I do recommend for the skin.

Vinegar- This is one we use in dermatology for a variety of things. One of the most common is mixed toe webb infection. It’s that athlete’s foot like rash between your toes. I usually recommend a 1:4 vinegar to water ratio to soak your feet in.

Red Dyes- These are a no-no for people with perioral dermatitis (an acne-like rash around the mouth and chin). Try to avoid things like cinammon gum, fruit punch and diet Dr. Pepper these red dye enriched foods have been known to trigger perioral dermatitis.

Yogurt- Ladies you know when your doc puts you on antibiotics and tells you to eat yogurt to ward off yeast infection? Well yeast can cause problems on the skin like the infamous “heat rash”. Get the good yogurt with cultures for the most benefit.

Potato Chips, Pizza and Ice Cream- Somehow these foods got a bad rep for causing acne. Although I think these foods should be limited in your diet for overall health the research hasn’t found them to have an effect on your acne. So while they increase your dress size they will not be increasing your pimple size.

Colloidal Silver- People have claimed silver supplements can help rosacea, psoriasis, viruses (warts, fever blisters) and bacterial infections. I don’t recommend this. As a matter of fact, if you aren’t careful you can actually turn your skin a blue hue with too much silver, a condition called Argyria. I’m sure there are easier ways to become part of the blue man group.

Caffeine and Alcohol- These are known triggers of flushing. Those of you prone to redness and flushing, you should avoid these as part of your treatment plan. An ounce of prevention is worth a pound of cure.

I wish the best of health to all of my followers. Check out Carrot Dirt if you are in the Fort Smith area, you won’t be dissapointed!

Hope to see you at the clinic this week and maybe we can chat about this ever so popular topic more.

Until next time, stay healthy, stay happy and ALWAYS stay skintastic, Nina

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By far the most frequently made comment from someone who is about to be injected with fillers or Botox is “I don’t want to look done”. Everyone wants to look natural. No one wants to be that person that everyone whispers about as they walk by “psst, look at Elsa, now that’s Frozen”. I agree! I certainly do not want any of my sweet, beautiful patients to look like they have been treated. But there is a lot more to the “natural look” than just botox and filler injections. The other things you do to beautify affect your entire look. So, this week I want to encourage you to embrace your natural beauty. Here are some tips to enhance you and not change you, keep you just like you are!

1. Pick an above average injector-Who you choose to inject your botox and fillers should not be whoever is having a sale. Your injector matters. Pick one who has a natural looking staff because likely she/he has injected them. If the person coming at you with a needle has lips that look unnatural and ducky then you can bet that’s what she is going for on you too, so take note.

2. Keep your eyebrows natural- If you were born with thick dark eyebrows don’t go to thin lines. If you were born with thin, hardly there eyebrows don’t go to thick tattooed permanent eyebrows. Tattooed eyebrows may be a look you are going for and if so rock it girl, I know some people that look great with permanent make-up! But sometimes I look at tattoed eyebrows and think “she has tattooed eyebrows”, it’s not a “not done” look, it is something people are likely going to be able to tell you have had done. Be careful how much you pluck and shape, try to enhance your natural shape not change the shape of your brows.

3. Careful with fake eyelashes- Now these have become ever so popular over the past few years and sometimes they look full and beautiful but I must say sometimes they will make you get the “done” look. If they are peeling away from where they were stuck, you’re “done”. If they are freakishly long, you’re “done”. If your eyelashes are so long that you can give butterfly kisses with a 2 foot standing distance from the other person, it’s unnatural. An alternative is Latisse. Latisse is a topical prescription that will give you those longer, fuller lashes you’re looking for in a natural occuring type of way.

4.Hair style affects the overall look- What is Dolly Parton known for? Her music sure, and maybe a couple other things, BUT that hair! I don’t know what the saying is about teasing it closer to heaven but bleached blonde hair that is that tall is not natural. It may be considered beautiful, but not natural.

5. Make-up matters- Do you guys remember Mimi off of the Drew Carey show? She had electric green and blue eyeshadows and hot pink lipstick. She was not going for the natural look. Now she wore it well but I am going to go ahead and say I feel comfortable recommending against that look if you want to become a more naturally beautiful you. Don’t cake on make-up. Get a skincare regimen that works so that you don’t need it. You CAN get there. You could be using a make-up that is actually irritating your skin and making your skin problem worse. I use Colorescience powder and also recommend Jane Iredale.

6. Be secure- This is key to keeping the natural you beautiful. Insecurities can lead us to change what is already beautiful. Sure, we can get botox injections, filler, color our hair, get a nose job, get fake lashes, tattoo on the brows we want, wear make-up so thick we are unrecognizable after a shower but all that together, it’s just not us anymore. We should enhance what we have to feel good without changing what we look like. That takes embracing our imperfections sometimes. The perfect example is filler and botox goals. Your goal should be ten years younger, not thirty. A 60-year old with skin that is as tight and wrinkle free as a 20 year old is unnatural. You don’t want to rid every single line because at 60 a few lines show maturity. Look natural, you’ve earned those lines and you’re still beautiful. If a 60 year old wants enough filler and botox to rid every line and get the tightness of a 20 year old, it can be done but it’s not natural, it’s just done. But a 60 year old that looks like a 50 year old naturally occurs all the time so we can do that and look very natural.

I hope you all feel beautiful when you come to see me and even more beautiful when you leave me! There are a lot of opinions in this world and these are just mine so I really appreciate all of you that follow, trust and listen to my blog. Above all else, beauty is in the eye of the beholder so when you look in the mirror remember that, be nice to yourself. Hope you have a great week!

Stay totally skintastic, Nina

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So I obviously had a great holiday weekend as I am just realizing this is Monday and I didn’t post Sunday, time flies when you’re having fun. Happy Memorial Day. Thank you to all the service men and women. Freedom isn’t free. So very thankful for our troops; past, present and future. I am sure some, if not all of you enjoyed the holiday with some sun, whether it was like me at a waterpark and zoo or at the lake or just outside grillin, it is the unofficial start of Summer. As I scroll through my social media newfeeds they are overloaded with sunburn pictures. I mean I expect to see tanners out in public. I almost walked up to a lady at the waterpark to tell her she looked like she rolled in doritos and that is a bad example to her children but my husband wouldn’t let me. I figure premature aging is enough punishment for her anyways, those leathery wrinkles, bless her heart. But MY friends, on MY socialmedia feeds, SUNBURNED!!! Oh I just can’t have it, just won’t allow it! The thing is most of you tried. Most of the pictures were failed sun protection attempts. It’s amusing that it is so hard to use sunscreen which is why most of the pictures made it to social media anyways. I like the tips the American Academy of Dermatology gives on sunscreen (www.aad.org) and I will include some of that info in this post.

Drumroll please………Here are the top five sunscreen mistakes of Memorial Day 2014.

1. Thinking sunscreen is enough-MISTAKE! One made by the best of ‘em too. I saw one of my most favorite people posting a pic of her using her sunscreen, in a bikini, not under any shade, c’mon! You gotta seek shade, avoid the hottest hours of the day and wear sun protective clothing, sunglasses and hats. There is a reason the FDA made them quit putting the word sunblock on the bottle-its more like a screen door then a metal door-some stuff still gets through.

2. The mistake of thinking it is waterPROOF sunscreen when it is acutally waterRESISTANT. There is no such thing as waterproof sunscreen so you have to be extra careful when in the pool, lake, etc. The bottle should say 40 or 80 minute after the word waterresistant and that is how often you should be re-applying if in water. BUT you need to at least reapply everytime you get out of the water or after a good sweat. Just to be safe I advise a swim shirt, especially on your littles who have more sensitive skin. Use water resistant all the time.

3.Mistakenly not using broadspectrum sunscreen-Always use broadspectrum sunscreen. This means it gets the UVA and UVB types of harmful UV rays. UVA and UVB are basically just different wavelengths but they can both cause skin cancer so you want a broadspectrum to protect you. If you really want to get fancy use physical blockers like the ingredient zinc oxide-you can still see it after application but for kids you can do fun colors they like anyways.

4.The ever popular mistake of not using enough sunscreen-Apply liberally. This is one of those “the more the better” kinda gigs. AAD recommends a 30 SPF or higher and to use at least 1 ounce. One ounce is two tablespoons or a full shot glass. So don’t be stingy, lather up!

5. And my least favorite is the mistake of not applying frequently enough- If you put your sunscreen on at 7AM and then never reapplied, that’s a problem. You should reapply every two hours. If in water then everytime you get out of the water and every 40-80 minutes (check the bottle). If you get super sweaty then you should reapply like you’re in a pool. The more (often) the merrier but make sure you didn’t get a sunscreen/insect repellant combo because insect repellent should be put on less often and in a lesser amount.

Hope you all enjoyed the holiday weekend! If your sunburn made facebook then I expect to see you this week at the clinic to help you with that. I won’t even scold you, it’s hard to be sunsmart. That’s partly why 1 in 5 Americans will have skin cancer in their lifetime. Hope you all have an amazing week, stay skintastic.

Sending skin love your way, Nina

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I had the honor of spending the weekend in California at the Skinmedica Physicians Summit. As most of you know Skinmedica is my favorite skin care line. It is one of the only nonprescription skin care lines that has real science to back it up, I mean research and all people. It was so much fun connecting with dermatologists, plastic surgeons and other healthcare providers from around the US and Canada. It was even more fun learning more about all the Skinmedica products and how other experts are incorporating them into their patients’ skin health care plan. I could write this post about the stability of growth factors or melanin transfer to keratinocytes or even keratinocyte migration to stratum corneum but you will just have to make an appointment for that. This blog is way too fun for that chat. So here are the fun “take homes” I brought back from the Skinmedica Summit in California to Arkansas.

1.“Tugly”- This is a combination of tight and ugly. This happens when someone comes and gets their Botox and Voluma but then they don’t take care of their skin. Although they may be tight, ridding lines and sagging with neurotoxin and filler due to neglect of skincare, they still have dark spots or dilated pores or acne. The “take home” message is skin care is important too people. FYI: none of my patients are tugly.

2. The average woman has 183 products in her bathroom. COME ON! For real? How? Apparently we have foot creams, elbow creams, neck creams, tanning lotions, wrinkle creams, soaks, masks, tightners, brighteners, etc, etc, etc…….. The message is cut back to stuff that actually works and rid the junk.

3. “80% of skin care clients who leave a facility without buying a product for home use will purchase at least 1 skin care product in a drug store or department store within 24 hours” (MedEsthetics, October 2012) So basically, after you come see me and I tell you what will work for your skin you go buy a piece of junk instead(yes, “slap in yo face” is what I felt upon hearing this). Why? Probably because I’m not a good saleswoman, I’m a nurse practitioner. On the other hand, the girl behind the make-up counter is a great saleswoman. She draws you in and convinces you to buy her non-research, no scientifically proved benefit, smell good, feel good potion because she works off commission and she needs the money to buy her dress for junior prom this May.

4.  I’ve been given a gift, the eyes for cosmetic procedures- sounds weird that I learned that at a skinmedica conference, huh? When I arrived they gave us a book with pictures and bio’s of all the physicians. I obviously flipped through pics first, judging them all, seeing who had bad filler jobs, whose Botox was looking a little Spock like, who just needed to stop, who looked amazing, who I would let inject me, who had beautiful skin and so on and so on. Terrible, I know.  Well by the time I got to the back of the book I realized Dr. Sandy’s picture was on my top five list. She looks great and it is by no means because of me. She takes awesome care of her skin, she works out, eats rights, stays spiritually healthy and so on. But no one would look at her and say she looks done. She looks natural and that makes me proud because I’m the one who injects her.

5. You need more than a personal trainer. Say you go see a personal trainer 3 times a week. You aren’t going to get in shape with just that, you have to go home, eat right and exercise on your own other days of the week to stay in shape. Your personal trainer is for that extra boost. It’s the same concept with skin care. I am your skin care trainer. You come in and I give you a Vitalize peel, Botox, Voluma, whatever you choose but then you have to go home and use your retinol and sunscreen everyday, maybe even your TNS essential serum or Lytera to keep your skin in shape. It’s good, better or best. Don’t you want to be the best? I want you to be the best!

6. You spend lots of money on skin care products that don’t work. The Skinmedica Retinol 0.5 that I use every night is $82.31 with tax and last me 3-4 months. They showed us a product called la prairie platinum rare cellular cream that cost $1080.00 before tax!!!!!!!!!!! I choked on my ice and had to spit up some water. Skinmedica skin care products are cost effective!

Okay I will stop at 6 because that was a long post and because I am jet lagged and need to go to bed. Dr. Sandy and I went all the way to California to make sure we are bringing the best to the South, to Fort Smith. We care about this community and its skin! Come see us this week and let us share some SkinMedica secrets with you! Until then, please stay skintastic!

Love yourself, you’re awesome, Nina

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Mothers are all we really have when we are born. We rely on them for all our basic needs; food, shelter, bathing and protection. As newborns we can’t even go to sleep without them, scratch that, as newborns we can’t hardly sleep period. As we grow up we rely on them for much more complicated needs. In elementary school they help teach us how to read, in junior high they teach us how to get a date to our first school dance, in high school they are a shoulder to lean on during our first break up and our personal assistant to get into colleges and apply for scholarships. When we get married our Mothers are wedding planners and then we have children and they are our babysitters and life coaches. The job just gets more and more difficult for Moms but they just seem to get better and better at it. Then, at some point in our lives we look in the mirror and say “Wow, I’ve turned into my Mom”. It’s a proud moment and simultaneously a little gut wrenching. I mean we don’t usually decide to be just like our moms in our teenage years. Most of us aren’t really sure how it happened. Some people probably wish it hadn’t happened. However it comes to be, it most definetely happens. At some point in your life you will do something that is your Mom. So this post goes out to all the Moms out there. Make the realization that your kiddos are taking a piece of you with them forever. Let it be the good part, let it be something they are happy they got from you. Without further delay here are my Top 5 “Mom Skin Habits” you should pass on to the kiddos.

1. Don’t get in the tanning bed- Preach to them that the tanning bed increases their risk for melanoma and they may or may not listen but if you get in a tanning bed what’s the point. Don’t get in the tanning bed and use the excuse “because I’m the Mom”, lame! Teach them that not getting in that tanning bed is keeping the beautiful skin God gave them. Teach them to keep healthy skin habits through example!
2. Wash your face every night- Mom, I know you worked all day then chauffered to soccer and dance, then cooked dinner, then put the kids to sleep, then did laundry and now you are about to fall asleep on the couch and stumble into the bedroom but STOP and take the time to create a habit of skin care. If you wash your face before bed (and hopefully apply retinol) every night they will see that and it might just be a habit they can’t go without in adulthood. I see your daughter now telling her new husband “Oh I can’t go to bed without washing my face, it’s just not right”, she will tell him she doesn’t know why she can’t but we will all know its because she got it from her mama.
3. Wear sun protective clothing- If you only think you look good in an itsy bitsy teeny weeny yellow polka dot bikini that perception will be cast on your child. On the other hand if you can rock out a swim shirt and a big floppy hat and make it look good your daughter will probably think she can make it look even better. Won’t you be proud to see her strutting her stuff around the pool all covered up while all the other girls have to wear a bikini to feel like they look good. Different is so empowering!
4. Be proud of your cosmetic procedures- Why do Moms feel the need to hide the fact that we have Botox and fillers from our kids, like we are doing something wrong? We are taking care of ourselves, making ourselves feel good and beautiful. Don’t be ashamed of your actions. Rock out your Botox and teach your daughters that it is something women do to feel good and look good, just like we dye our hair and put on make-up. Change the negative connotations around it now so that our children’s generation doesn’t have to feel any embarrassment about their Botox injections.
5. Be comfortable in your own skin- Love yourself. Love your skin. Don’t be so hard on yourself. Don’t say you “hate” anything about your skin to your sweet kids. Teach them to be themselves and love living in the skin they were given. You are awesome! Own it and one day when you see that confidence in your child you will be proud you instilled it into their brains.

I have only been a Mom for 14 months so I don’t really know why I think I have earned the right to give out Mom advice. Although, I have spent 30 years on this planet under the guidance of one of the best Moms you could ask for. She did all five of the things that I recommend and even though there are days I really hate to admit it, I am her. We are kinda twinsies. Hope you all had a wonderful Mother’s Day. Would love to see you at the clinic this week. If you’re a Mom, I think it’s time you come give yourself a skin treat. Let me help you with that!

XOXO, Nina

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I spent this weekend celebrating a very special bachelorette’s last fling before the ring in Sin City. My Las Vegas weekend was filled with lots of laughs (7 BFF’s ), Brittany Spears, shopping, eating and poolside fun. Yes, you heard correctly, I spent a day at the pool, I may be afraid of the sun but I don’t let it keep me from a good time! We had reserved a cabana and I planned to stay in the shade all day reading a good book, laughing with friends and obviously, sipping a lemonade with an umbrella decor. As most plans go, we had a small detour. We got to the pool and the “Cabana concierge” informed us that there had been a mistake and he gave away our cabana. There were no cabanas available. He offered us a cabana at a different resort, which appalled most of my friends. He then offered us a day bed with a credit for food and drinks. I informed him that it is Melanoma awareness month and not having a shaded area was bad for my skin health, he looked at me like I just grew a third arm, in disbelief. I’m sure he is used to people who enjoy laying in the sun and getting a tan, I mean he lives in the middle of the desert right? Well I’m not that girl, I like my skin how God made it for me. After a few tears, seven disgruntled women agreed to the daybed. Poor guy must have wished he called in to work that day. So with 8 spray on sunscreens and two powdered sunscreens in tow I realized being sun safe just got a little bit harder for the day. I asked for an umbrella immediately but apparently it was too windy. I applied sunscreen every two hours on the dot to myself and my 6 girlfriends. I set a timer on my phone and when the alarm when off my girlfriends just stood up, closed their eyes, held their arms out and started doing a little turn (which soon turned into a turning shimmy and shake) so I could spray them down with sunscreen. Just letting me have my way was much easier than any debate they may try to have with me. Plus, they all trust me with their lives so why not trust me with their skin? It actually was really fun and other people at the pool started coming over for sunscreen from us. Dancing in a mist of sunscreen every two hours livened us up and was actually a blast. I sprayed down our waitress, who then asked to be covered in sunscreen during our two hour timer check which then turned in to all the waitresses in the pool area which then turned in to the dancers which then turned into basically anyone who wanted sunscreen coming to our day bed. While at the pool we went through 11 containers of sunscreen. Now I have to admit that 7 women spraying you down with sunscreen might be what attracted the males to get sun smart that day but who cares if we saved at least one sunburn, right? The lessen learned is that tanning is a culture. At the beginning of the day Henry, the cabana concierge, thought that I was very strange for demanding shade and sunscreen but by the end of the day the pool party was where the sunscreen was, our day bed. We made staying our natural colors and not getting tan fun and that was contagious. People saw us having fun, being silly with sunscreen and that feeling is something humans are drawn to. Sometimes I get discouraged listening to young women talk about loving tanning beds and saying that tanned skin looks good but this weekend rejuvenated my goals for sun smart behaviors. People were loving it. I can’t wait until that is the culture we live in, that tanning isn’t cool nor beautiful, that staying sun smart is what all the cool kids do.  So I hope this summer you can all find a fun way to wear sun protective clothing, apply sunscreen, seek shade and avoid the hottest parts of the day. I hope you are proud of the beautiful skin you’re living in and keep its natural beauty. Let me know any fun tricks for sun safety you use with friends and family. Remember to use at least one ounce (that’s a shot glass) of 30 SPF UVA/UVB on your uncovered skin every two hours please!

Are you doing any airline traveling this summer? You MUST get a BOB! The powder sunscreen is awesome for getting through TSA because there is no liquid. YAY, one less thing to go in that tiny quart ziploc bag you are supposed to fit all your liquids into. You have to carry on sunscreen in case you get a window seat! Perfect Mothers Day Gift so come to the clinic and get one stat!

Thank you for following the blog and helping me change the culture of our youth to a place where the only way to want a tan is if it comes in a bottle. Hope you all have a blessed week! If I don’t see you all at the clinic this week then just remember, stay skintastic and love yourself. You’re all awesome!

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

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

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

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