Thursday, December 18, 2014

High Altitude and your Skin

This is my husband!  in the Dolomites in Italy.  He is a mountaineering guide based in Utah, as well as a physician and web developer.

He is pretty good at reapplying sunblock which is crucial when he is on the job.  Most sunblocks last only a couple hours and need reapplication.  He also tries to where a brim on his hat or helmet to protect his eyes and skin.  I check his face, neck and ears monthly for any odd skin lesions just in case.  His climbing buddies tend to get problems with pre-cancers on their neck and ears.

Tuesday, December 16, 2014

My Take on Bio-Oil

Many of my patients ask me about Bio-Oil.  It is a skin product that has been very effectively marketed to the point where some people describe it as practically magic.  It is even sold at Costco.

I would like to look together at the ingredients and tell you my thoughts.  You can see that there are multiple fragrances, many of which are known contact dermatitis allergens, which I would recommend avoiding if you have sensitive, eczema-prone, or allergic skin problems.  So, I would not recommend Bio-Oil for my patients with sensitive skin problems.  The botanical oils are calming, anti-inflammatory so for other people they not only moisturize but can be soothing to the skin.  Other than these calming and moisturizing oils which are found in many good skin products, the Bio-Oil product is not that unique or special in my opinion.  If I bought Bio-Oil I would use it for dry skin or dry hair, and avoid acne-prone areas.

In addition, the claims that are made about Bio-Oil being helpful for scars, stretch marks are unsubstantiated by controlled scientific studies.  However, botanical oils and other moisturizers will temporarily diminish the appearance of skin texture irregularities including scars and stretch marks. In addition, studies have shown that massaging scars and striae with an emollient can result in modest improvement, though it is unclear if it is the product alone or the massage/rubbing that is most effective or both.

Here are the published ingredients which I found on the company's website:


Calendula Officinalis Flower Extract (Calendula Oil)
Lavandula Angustifolia Oil (Lavender Oil)
Rosmarinus Officinalis Leaf Oil (Rosemary Oil)
Anthemis Nobilis Flower Oil (Chamomile Oil)


Retinyl Palmitate (Vitamin A)
Tocopheryl Acetate (Vitamin E)

Oil base

Mineral Oil (Paraffinum Liquidum)
Cetearyl Ethylhexanoate
Isopropyl Myristate
Glycine Soja Oil
Helianthus Annuus Seed Oil

Fragrance (Rose)

Alpha-Isomethyl Ionone
Amyl Cinnamal
Benzyl Salicylate
Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde

Color (Orange)

D&C Red No.17 (CI26100)

Friday, December 5, 2014

Vanquish vs. CoolSculpting

I have been asked now and then which is better.  I offer both treatments in my office and can say first-hand that they are both effective for small pinchable (squeezable) pockets of fat.  If you have more than a few inches to pinch and really want drama faster, then I prefer tumescent liposuction.  As far as how to choose between the two (Vanquish and CoolSculpting), we price them similar and will use a few criteria to distinguish which patient would do best with which.

If you have excess fat on the abdomen, waist and back that continues pretty circumferentially, then I prefer the Vanquish.

If it is difficult for you to come once a week for four weeks in a row for an 45 minute long treatment with Vanquish, then you may prefer the CoolSculpting which can be done in one to two treatment sessions.

If you have lots of skin laxity in the abdomen or thighs, I may prefer Vanquish because there is more data to support collagen stimulation from heat than cold.

Both CoolSculpting and Vanquish can be done on the thighs.  CoolSculpting can be done off-label on the arms and chest (man-boobs).  Vanquish can wrap around almost 2/3 of the thigh circumference per treatment where as the CoolSculpting applicators are much smaller.  So if your thighs are large, Vanquish may be better.

Thursday, November 20, 2014

Article from Racked on tallow in skin creams

Click on the link (or copy the link and paste in your browser) below to see my take on tallow-based skin creams.

Monday, November 17, 2014

Aesthetic Blueprint with Kent Remington, M.D.

My partners and I just returned from the Aesthetic Blueprint Conference with Dr. Kent Remington in Dana Point, California.
I am now armed with my aesthetic calipers so I can measure everyone's intercanthal distances and verify that they have properly place brow peaks and cheek apices.

Wednesday, November 12, 2014

Tightening Saggy Skin

For years we have not had good treatment options for improving lax, saggy skin from the neck down other than surgical excision.  Many people will develop saggy skin after weight loss, hormone changes, pregnancy in women, sun damage and simply aging.  Non-ablative lasers, ultrasound and radiofrequency devices are capable of some modest skin tightening and stretch mark improvement but only after multiple treatments - three to ten depending on the device.  In addition, ultrasound (Ultherapy) is infamous for being very painful, yet no more effective than some of the radiofrequency devices.  Recently, subcutaneous radiofrequency treatment has been introduced as a more effective skin tightening option.

Subcutaneous radiofrequency skin tightening is known by the brand name ThermiTight or ThermiRF. It can be done for saggy skin of the jowls, lower face, neck, arms, abdomen, back, neck, and legs (buttock, thighs).  The procedure is done one time, outpatient, with local anesthesia and light or no sedation.  It takes one hour to a few hours depending on the size or treatment area.  Results after just one treatment are exciting and equivalent or much better to multiple treatments with the laser and device treatments I described earlier.

Results after any procedure designed to stimulate new collagen and elastin via heat ( as in laser, ultrasound, and radiofrequency) may take 3-6 months to see the full improvement.

Tuesday, October 28, 2014

Trick or Treat: Sodas, sugar, aging and acne

It's the sugar in sodas that a recent study found causes faster aging via shortening DNA telomeres.  There are other studies that show how sugar binds to collagen in the skin via glycation, stiffening the collagen so it cannot function properly and accounting for some wrinkles and saggy skin.  In addition, a high sugar (high glycemic) diet has been linked (in multiple dermatologic studies) to acne.

Hmmm....bad news for Halloween weekend.

Friday, October 24, 2014

CoolSculpting my office staff

We just CoolSculpted on of my medical assistants last week.  CoolSculpting is cryolipolysis, where fat is frozen underneath the skin.  She is a beautiful girl and she is getting married next summer, so really wanted to look her best.  She is only 24, and has stubborn pockets of fat that we treated below her belly button, and on her hips.  She did fine this week, and just had a little sensitivity in her waist.  One or two days she had some nerve pain beginning on day 4 after the procedure but that has since subsided by day 7.  She took a medication called Gabapentin which helped with that.  We were told this side effect is transient and rare, <10% of people who CoolSculpt.  Her new hourglass figure should be visible at the earliest 30 days and latest three months.  Sometimes a second treatment is needed for larger fat pockets.  Today we are treating a man for "man boobs."  I will try to post pictures in another month of my assistant.

Thursday, October 9, 2014

CoolSculpting - to loose stubborn pockets of fat

As with other bodysculpting methods (Vanquish, Liposonix, Lipodissolve, see Page on Bodysculpting) CoolSculpting is meant to remove a stubborn pocket of fat that is resistant to change with diet and exercise.  CoolSculpting from the Zeltiq company is cryolipolysis for body fat removal. Basically, pockets of fat gradually dissolve (over 2-4 weeks) after freezing treatment that lasts an hour.  CoolSculpting has become wildly popular in the past few years across the U.S. mainly due to excellent marketing from the manufacturer.  I am happy to report that I offer this procedure and can vouch for the good results we are seeing with this.

CoolSculpting may be our most rapid and powerful non-surgical fat slimming treatment other than Vanquish, which have never been compared head to head.  I also carry Vanquish which is radiofrequency heating to remove stubborn fat pockets.  I prefer the Vanquish for people with mild to moderate fat and saggy skin.  The CoolSculpting I like for people with moderate or worse fat with or without saggy skin.  CoolSculpting has not been formally studied for skin tightening whereas the radiofrequency technology in Vanquish has been.  That being said, many people report skin tightening with both devices.  Recovery from CoolSculpting involves swelling, soreness, bruising, for a week or two.  Results are usually seen in four weeks.

Sunday, October 5, 2014

Skin lifts and tightening without surgical cutting


A non-surgical neck and lower face lift  !

Thermi-RF has been available in the United States for over two years now, but too many people are not aware of this incredible option.  It is deemed by the top cosmetic physicians to be the closest thing to a surgical neck and lower face lift, but done with local anesthesia, and without surgical cutting.  Results are more dramatic than Ulthera and other non-invasive skin tightening treatments which are done on the outside of the skin.  We are seeing more effective new collagen and elastin formation with skin tightening done under the skin rather than from the outside.

What is Thermi-RF ? 

Thermi-RF is controlled radiofrequency heating of skin to stimulate new collagen and elastin formation, to remove wrinkles and skin laxity resulting in rejuvenated skin.  Anyone with saggy skin may benefit.  Even if your skin laxity is most severe and you thought surgery was the only answer, improvement will still be seen.  It can also be used to tighten skin with stretch marks or after weight loss. During the treatment, the patient is relaxed with valium, and local tumescent anesthesia (Lidocaine or Marcaine) is given to the treatment area.  A heat-sensitive camera is used to visualize the skin during treatment.  A radiofrequency probe is introduced through a very small puncture in the skin.  Multiple radial movements of the RF heat probe under the skin are performed to evenly heat the dermis to the precise temperature to achieve safe and effective new collagen and elastin formation.  The treatment takes less than an hour for neck and lower face.  It can also be done for lax skin on arms, legs and abdomen and more.  Following treatment, the patient must wear a compression garment to the area for 4 days or until swelling is mild.  After treatment, patients should expect swelling for a week or less, mild bruising, and tenderness for a few days to a week.  By contrast, with surgical skin tightening, involving incisions and cutting, recovery is many weeks to months.  The cost of Thermi-RF is based on size of the treatment area.  The average neck treatment is $3500.

Dr. Karen Stolman performs Thermi-RF Skin Tightening regularly and will do free initial consults for interested patients.  To schedule a consult, call Dr. Stolman's office in Salt Lake City at 801-595-1600

Thursday, September 25, 2014

No more turkey neck ! Thermi RF, the non-surgical neck lift

My office tested Ulthera and Thermage and compared it to Yag laser neck tightening and found the Yag laser to be more effective, and much faster and less painful.  Until now, I would not recommend anything other than the Yag laser for non-surgical saggy skin tightening.  The Thermi-RF is a newer device which employs radiofrequency heating with a subcutaneous probe.  It achieves neck tightening and can be used to tighten saggy body skin anywhere - abdomen, arms, legs, sides, breasts.  The treatment is done with local tumescent anesthesia.

Thermi is the next best thing after the surgical neck lift!

Thursday, September 18, 2014

A non-surgical brow lift with filler

As we age, our brow will tend to sink downward and the tails of our eyebrows will trend downward as well, that is if we still have adequate hair (see eyebrow hair transplant for more info,).  In a woman, if the brow is sunken, it will tend to masculinize as well as age the face.  In a man, it will age and make for a meaner or more angry expression.

A subtle natural brow lift, as can be achieved with hyaluronic acid filler, will serve to feminize and rejuvenate a woman giving her a more alert and healthier look.  For a man the lift will rejuvenate, and also give a more approachable, happier, healthier look.

Brow lifts with hyaluronic acid (HA) filler can last a year, and each time stimulates new collagen and elastin for more permanence.  It can be modified or adjusted easily with the enzyme that dissolves HA filler which is more forgiving than a permanent correction with surgery.

The filler can also be placed in the brow, to improve symmetry.  Asymmetry can be unattractive and distracting.  Many people will develop worse brow droop on their left side due to many years of excess UV radiation through the car window and worse skin laxity on that left side.  Filler is helpful to correct this problem.

With filler treatment, expect slight tenderness within 24 hours after, and possible bruising and swelling for a few days to weeks.  Most physicians will suggest a follow up visit where additional filler or adjustments may be needed.

Tuesday, September 16, 2014

PicoSure Laser for Tattoos

We got it !

I now have the PicoSure Laser available for tattoo removal treatment.  It is supposed to clear the dark tattoos faster than the usual 1064 Q-switched Yag laser but more data on is needed.  As soon as I get some feedback about that from my patients, I will let you know.  This laser is not as safe on darker skin types or tanned skin, which should instead be treated with a 1064.  Fortunately, we will have a 1064 picosecond laser soon, but itis currently not available yet.

P.S. I will remove a radiation marker tattoo in a former cancer patient NO CHARGE!  Please check with your oncologist prior to booking your removal appointments.

Friday, September 12, 2014

Sorting out what cream is best for your aging face

It can be overwhelming, the many choices of rejuvenating facial skin creams.  I frequently get asked about which is the best cream or cream(s).  While I do not believe there is one best cream for everyone, I do believe there is a best combination of creams for any given person.  The latest philosophy on daily home skin care rejuvenating regimens is to include the following:  Growth Factors, Retinoids, Antioxidants, Sunblocks and Specialty Products (like skin lighteners).  The SkinMedica line coined the term "GRASS" to help us remember these five components of a good anti-aging daily skin care regimen.  Most women and men will benefit from a GRASS regimen if their goal is to fight aging changes in their skin.

To find products that contain these ingredients, please see my skin cream ingredient database,

Thursday, September 4, 2014


For Anti-aging...

The main components of a rejuvenating home topical skin care regimen should include the following:
1.  Sunblock
2.  Antioxidants
3.  Growth Factors
4.  Retinoids
5.  The as needed Extras:  skin lighteners, anti-redness, DNA repair, exfoliating, acne-fighting.
It is best if you see a dermatologist to have your regimen personalized and designed based on your skin type and any other special needs.

For Acne-prone skin...

1. Exfoliating cleanser or gentle cleanser (if sensitive skin)
2. Retinoids
3. Anti-inflammatory
4. Anti-bacterial
5. Sunblock

For Rosacea-prone skin...

1. Gentle non-medicated cleanser
2. Sunblock
3. Anti-redness, calming, vasoconstricting
4. Anti-inflammatory

Thursday, June 19, 2014

Making the nose look smaller with filler

                Before                         After
If your nose has a scooped out bridge or concavity on the dorsum, adding a little hyaluronic acid filler may give the appearance of a smaller nose.

Sunday, June 15, 2014

Gentle Laser vaginal tightening for help with urinary incontinence and/or sexual pleasure

Have you ever leaked in your pants after jumping up and down in a dance class or while jogging?  Would you like to improve your sexual pleasure for both you and your partner?

The gynecology literature states that trauma from pregnancy and aging changes both contribute to urinary incontinence and vaginal tissue laxity in many women.

Treatment of vaginal aging and pregnancy changes does not have to involve surgery.  I am excited that we now have the laser technology to safely and gently but effectively treat vaginal tissue and skin laxity and urinary incontinence with laser.

In my office in Utah, as laser skin and tissue treatment experts we offer treatment for vaginal tissue/skin laxity and urinary incontinence with our Fotona brand Erbium:Yag laser.  Treatments take just a half hour to 45 minutes, are usually pain-free, and need to be done 1-2 times for improvement and sometimes eradication of symptoms. Even with a history of bladder prolapse this treatment is helpful.  In fact, it is often because of tissue laxity that prolapse occurs, and tissue laxity is the target of this treatment.

The Fotona Erbium:Yag laser has a variety of settings so it can be used for a variety of medical or cosmetic treatments.   For vaginal tightening we are relying on lower energy and longer pulse durations of the laser, which translates to thermal heating of the tissue dermis in order to stimulate new collagen formation.  So it is essentially controlled heating at precisely the right depth to result in tissue rejuvenation.

This treatment has already swept Europe where there are long wait times to get in, but american gynecologists are thrilled with the technological advance and have been referring their patients for this exciting treatment.

Wednesday, June 4, 2014

Scar Treatments

Scar treatments keep advancing and improving.   The best treatment for your scar depends on whether the scar is thickened (hypertrophic) or thinned (atrophic) and/or discolored (pink or brown or full of blood vessels.) 

What is a keloid scar?  The term "keloid" seems to be one of the most misused words in dermatology.  A true keloid is a tumor-like growth of scar tissue that goes significantly beyond the original borders of the scar both in height and width.  True keloids are more common in darker skin types.  If a scar is just thickened but still roughly within the confines of the original wound or scar, then dermatologists prefer to call it a hypertrophic scar.

Hypertrophic scars and keloids are often treated with a steroid injection, or liquid nitrogen followed by a steroid injection.  There are some unusual, off-label (not FDA-approved) treatments for scars and keloids like 5-fluorouracil, bleomycin and interferon injections that are still considered safe by most dermatologists, especially because of the small quantities that are use for treatment.  In addition, fractionated lasers are often very helpful for both hypertrophic and atrophic scars.  All these treatments, including laser, need to be repeated multiple times for full benefit.  The number of treatments varies depending on the severity of the scar and the power of the laser.

Discolored scars can be improved with laser treatment.  For example, if the scar has redness or prominent vessels, an IPL device or pulsed-dye laser can help.  In addition, if the scar is brown, the IPL device, QS-alexandrite or fractionated 1927 nm lasers may help.

Friday, May 23, 2014

Spinning Brushes to Clean Your Face, a review of these home devices

Home microdermabrasion, spinning brushes (Clarisonic, etc.) are very popular right now.  Even the ProActiv info-mertial acne treatment system, added a spinning brush to their line.  So what is the deal with these brushes? Do they work?  There are a handful of mostly biased studies on home microdermabrasion devices, published by the manufacturers of these devices that show exfoliation and mild improvement in texture and tone of the skin, but not the more significant improvement seen by stronger in-office procedures like Clear and Brilliant, Chemical peels, Fraxel Restore.  Gentle exfoliation is helpful to improve acne, melasma, brown spots, and even fine lines/wrinkles.

Some patients of mine have reported that their acne or skin got worse after using the brush.  A possible reason for this, is that they are supposed to exfoliate and are often paired with exfoliating cleansers, so it is possible that acne that was deeper down in the dermis may begin to surface in the first few weeks of treatment.  I would recommend not judging the brush until you have done a trial of it for at least six weeks.   In addition, I have heard concerns from other dermatologists that the brush is grinding dirt and bacteria deeper into the skin and this may trigger more inflammation and acne.  There is just not enough data to support or dispel that notion.  So, until there is, I suggest pre-cleansing prior to using your brush with an exfoliator.  For example, washing with a gentle liquid cleanser like Cetaphil or CeraVe before starting the microdermabrasion routine.

Friday, May 9, 2014

Lip Augmentation

As we age our lips will thin and the distance from the underside of our nose tip to our upper vermilion (red portion) lip, also called philtrum, lengthens.  In women, all of this tends to age and even masculinize our face. 

The philtrum can be shortened and the lip plumped slightly to rejuvenate and feminize and even give more sensuality to the lip.

The most permanent way to achieve shortening of the philtrum and more vermilion show, is with a surgical lip lift, which is done by some cosmetic surgeons. 

A quick, natural, and shorter term way to shorten the philtrum and plump the lip would be to have a filler treatment, usually a hyaluronic acid filler or silicone.  The hyaluronic acid fillers may last 1-2 years depending on the brand, and are reversible with an enzyme called hyaluronidase.  This treatment varies in cost from $500-$1400 depending on Brand of filler, and quantity. 

Tuesday, May 6, 2014

Laser Treatment of Rhinophyma type of Rosacea

Actual Patient with progressive worsening rhinophyma, before and after a single laser treatment.
Rhinophyma is a complication of rosacea that is marked by enlargement of the nose, and change in color and texture to include redness, prominent veins, and plugged pores.  It tends to be worse in men and worsen gradually over time.  While we don't have a perfect cure for rosacea and this complication called rhinophyma, we can do alot to control it and improve it.  This treatment was done by me with the Erbium/CO2 resurfacing laser in one session, using local anesthesia.  With this treatment, there is about two weeks of healing with crusting/peeling/inflammation but one can work or do normal daily activities during this time.  Sun avoidance is crucial while healing and indefinitely thereafter b/c sun is a prime trigger of rosacea.  This is a lasting improvement;  however, not a cure for rhinophyma, and it can recur slowly if the person is genetically susceptible or fails to avoid the rosacea triggers like sun and certain foods.  For more information about rosacea triggers and prevention, I recommend going to

Monday, March 24, 2014

Under-eye bags and rolls

I treat undereye bags permanently with lower lid laser blepharoplasty, which is the ultimate solution for people who have under-eye bags where there is a fat bulge.  For those who have swelling, or edema causing their under-eye bags, there is a new product made by Living Proof, called Neotensil, which is a polymer which temporarily but quite effectively reduces the undereye puffiness.  It is like putting a hammock for your undereye bags.  Some of my co-workers tested the product and reported high satisfaction, and no complaints of any irritation or strange sensations.  It is also possible to use the product for the under-eye roll (banana or jelly roll) some people have from strong under-eye muscle contraction with expression.  I also like to treat this problem with Botox which helps relax the muscle. 

                                                            This photo is from the Living Proof Neotensil product brochure, from Obagi Medical.

Friday, March 21, 2014

Brows: To Be or Not to Be ?

   Brows are very important for maintaining a youthful, attractive look.  I see alot of female patients at my office that have thinned or almost absent eyebrows from either overplucking, thyroid problems, hormone changes, aging and genetics.  There has been an overplucking trend in recent years that likely originated from a woman's desire to enhance the lateral arch of their brows.  Thinned or barely visible eyebrows can instantly age a person, not to mention look unnatural.  When we first meet a person or begin speaking with a person (whether we know them or not) there are psychologic studies that show the first place we look is the eyes, nose and mouth soon follow.  The eyebrow accents the eye, and is very important as a beauty enhancer. 

  That doesn't mean you should immediately go and paint the eyebrows in.  I have seen brows that have been painted or tattooed-in and look equally strange as if they were absent.  If you do pencil or tattoo them in then be careful to do only as dark as the roots of your hair or the darkest shade of hair on your head, and try not to over thicken them.  In addition, if you're hair is thinned or absent I would consider hair recovery or replacement with either minoxidil or NeoGraft (see below).  Overdone, overthick or too dark eyebrows not only look unnatural but masculinize the face.  Please see my post on permanent make-up, and celebrity weekly featuring Khloe Kardashian for more tips.  If you are losing eyebrow hair for whatever reason, there are some other options that can be tried.  One:  try minoxidil (Rogaine) liquid sparingly twice a day to the face.  This is off-label, may not work, and could irritate the skin so use with caution.  Two:  try NeoGraft eyebrow hair transplant.  It's a permanent solution to the problem, requires monthly trimming (hair comes from head) and may cost $2500 or more.

Enhancing your arch is still advisable to give your eyes a more open and awake appearance, but do it gently and cautiously with limited plucking under the lateral brow where you have a natural arch.

Friday, March 14, 2014

Hair-Free at Last, thank God almighty I am hair-free at last

We have come a long way since the 60's and 70's.  Women are now "hairless from the eyebrows down," as Jonah Hill's character in the "Wolf of Wall Street" recently put it.  A current issue of Cosmopolitan proposed the theory to explain this hair-free phenomenon as due to porn stars being bush-free, and the indirect pressure women may receive from their boyfriends or spouses to emulate this look.  Some advocates will profess the beauty and cleanliness of less hair, and others will argue that it adds a strange, juvenile look.  On a positive note, it seems it may be a way for adults to look and feel younger.  While I am not necessarily advocating this look, I don't think it causes any significant health problems except maybe a little less protection from chill when it's cold out.

If you are ready to embrace this look, here is my advice regarding the options available to remove the hair.  If you are committed long-term to being hair-free, do not try shaving alone because you may struggle to keep up and suffer lots of razor bumps in the process.  Waxing may last a little longer and when done well may give fewer bumps and less irritation than shaving. 

Ideally, laser hair removal can be done for permanent "thinning."  What does "permanent thinning" mean?  Most of the hairs do go away in a dark haired person with lighter underlying skin, but there could be a few stray stubborn hairs remaining even after the suggested 6 treatments.  Some locations are more stubborn than others, or more resistant to the laser, especially areas where the hair growth cycle is slower, such as upper lip and chin.  I have treated darker skinned patients, and it is done the safest with the Yag laser (not Alexandrite).  Safe meaning the laser is able to distinguish the hair from the dark skin and not cause too much burning or irritation.  The Yag laser is more painful than Alexandrite and Diode, but it is possible to make the procedure more tolerable with use of cold gel, cold air, and/or numbing cream.  In-office prescription numbing cream (usu. 5-6% Lidocaine) tends to be much stronger than over-the-counter, and is not safe to use in large skin areas. 

Thursday, March 13, 2014

See my story on socialite and blogger Dori Cooperman's website


Dr. Karen Stolman of Gateway Aesthetic Institute and Laser Center

Dr. Karen Stolman of Gateway Aesthetic Institute and Laser Center
by Dori Cooperman March 7 2014
2014-01-24 10.12.03 2014-01-24 12.11.44 2014-01-24 12.12.37 2014-01-24 12.21.22
I was passing through Salt Lake City for the Sundance Film Festival recently and was invited to visit the Gateway Aesthetic Institute and Laser Center where celebrity Dermatologist and Blogger Dr. Karen Stolman practices in the world’s largest cosmetic devoted laser center. The office is crazy elegant and has a gallery of paintings lining the halls.
She specializes in cosmetic medical care beyond just Botox and Fillers, though I did get a Botox/Filler touch up while I was there. Her office, founded by Dermatologist, Dr. Mark Taylor has over 48 devices including one of my favorite finds, the first Cellucurve in America – weight loss bike (imported from Italy), see my pic. I know I may not be a poster-child for weight loss, but some of my friends are. It speeds your aerobic metabolism of fat as you do low impact biking, by shining warm infrared lights. Patients may test ride the bike no charge, or sign up for multiple sessions – 3-5 per week. If you want to order your own bike, at an estimated $100,000, they will arrange that too, but you may want to wait until the Italian manufacturer upgrades the bike next year to include a wrinkle treatment. They showed me all the ways in which you can fix your wrinkles, scars, brown and red spots and fat pockets.
Patients fly in from all over the world, stay at the Grand America Hotel, have their treatment which is usually priced better than in another bigger city like LA or NY. You’ll be advised to not smoke or drink, and to only watch funny movies, but not because you are in Utah, you will heal much faster post-procedure if you follow those steps and live like a Mormon for a little while.

See (site) and (blog)

Tuesday, February 25, 2014

Permanent Makeup tips

I often get asked to recommend a permanent makeup artist, and I have even recommended some of my patients consider permanent makeup.

The popular SofTap brand and method of permanent makeup tattoo is actually semi-permanent and tends to fade in 2-4 years requiring touch-up or new treatments periodically.  So the commitment is not truly permanent, which I like.  What I like about the SofTap method is it can be done with a natural feathered hair look for filling in eyebrows.

Having a tastefully done thin upper and lateral lower eyelid liner can be a time saver for a busy woman. 

As women age, our lateral brows tend to thin and some of us seem to be left with no eyebrow hair by the time were over 50.  I recommend for this either NeoGraft hair transplant to the thinned eyebrows and/or permanent makeup.  If there is very little hair, and permanent makeup is done alone, sometimes it may look less natural, than if a combination (which I prefer) of hair replacement (transplant) and permanent makeup is done.

Some of my older patients, have trouble putting on makeup themselves because of poor vision or unsteady hands, but still want to look their best.  That's when I recommend they consider permanent makeup.  In addition, regular makeup can smear and fade easily which can be frustrating, whereas permanent makeup can be relied on to always look perfect.

I caution to avoid very dark lip liner colors, which tend to look unnatural and even odd.

Is it truly permanent?
No, not exactly.  I like to call it "semi-permanent".  The darker the color you choose the longer it will last it seems, but many people need touch-ups in 2-4 years.

Can I remove the makeup?
Yes, you can remove it with laser, but it will take multiple treatment session 4-15 depending on the color.

Does it hurt?
Yes, a little, unless you have really good numbing cream on, which I recommend.  It is common to have mild swelling, redness and pain for a few days after at your treatment sites.

If you are looking for a great permanent makeup artist, ask your local cosmetic dermatologist for a referral.


Sunday, February 9, 2014

Pumas, Cougars, Jaguars, Manthers, and how looking younger can be a double-edged sword

When an older man is seen dating or marrying a much younger woman...some derogatory literary phrases come to some minds like trophy wife, gold digger, bald digger, sugar daddy, manther etc.

When an older woman is seen flirting, dating, or marrying a much younger guy...puma, cougar, jaguar, even gerbil (heard on SNL).

While I like to think these animals are attractive and even sexy, they are also aggressive predators.  Bottom line they're all pretty negative references.

I propose that at least the newer fashion of older women linking to much younger guys may have something to do with our progressing cosmetic technology where we are now capable of looking younger and more healthier than in the past.  There are biologic studies to explain that men have an instinctual attraction to a healthy, fertile women.  Looking younger may translate to healthier and more fertile to the eye.

While looking younger and more healthier can be fun in the dating world, it can have mixed outcomes in the workplace.  It is commonly known that looking younger and healthier will help one get hired and keep many jobs; however, I would suggest that in the white collar professional world it may interfere with one's ability to be taken seriously.  If you have no wrinkles or gray hair to show your maturity, will you be trusted to perform your work with the experience of a senior employee?  On the other hand, if you look older, you may give the impression of being tired, drained or even outdated.

I suggest that you look younger, healthier but show your knowledge and experience with hard work, charisma, and professionalism.

Wednesday, February 5, 2014

Why Tumescent microcannula Liposuction ?

I often get asked why do tumescent microcannula liposuction and how is it different than other liposuction surgery?

Tumescent liposuction is when liposuction is done with smaller suction cannulas under local anesthesia with a dilute Lidocaine:epinephrine mix that allows for slight inflation or tumescing of the treatment area as well as excellent bleeding/bruising control.  The inflation or tumescing is helpful in aiding safe removal of fat and avoidance of surrounding structures.  Dermatologists perfected the tumescent liposuction technique over the past couple decades and have demonstrated that it is consistently safer with a much lower risk of complications compared to liposuction done with general anesthesia.  In addition, years of successful tumescent liposuction have exposed the comparative dangers of liposuction done with general anesthesia. Such dangers include infection, respiratory depression, hemorrhage, DVT/pulmonary emboli and more which are rarely seen with the tumescent technique but a significant risk with general anesthesia technique.

To improve efficiency of fat removal and skin tightening, many dermatologists will use lasers during the liposuction procedure.  I like the SmartLipo and VaserLipo devices for these purposes.  They have allowed us to do hi-definition liposuction such as recreating the six-pack in a man's abdomen, as well as tighten loose skin after fat removal.

Neck wrinkles

Sometimes we focus too much on fixing our face and forget the neck which has suffered almost as much sun damage and aging changes.

What can be done to rejuvenate the neck?

A new cream from Revision Skincare called Nectifirm is promising for home use - see pic below.  It contains a unique natural wrinkle-fighter ingredient from "wax myrtle shrub" plant called dihydromyricetin as well as other know wrinkle-fighters called oligopeptides.  I like this product as a compliment to our in-office neck wrinkle and neck tightening treatments.

In the office, the radiofrequency, ultrasound devices and lasers can be used to improve wrinkles and sagging.  I find the laser tightening with our Fotona NdYag requires fewer treatments than radiofrequency or ultrasound.  The Yag laser will remove hair too, so not appropriate for men who want to keep their beards. In addition, for people who have pockets of fat under the chin.  I may consider Lipodissolve injection or tumescent liposuction.

When you have neck wrinkles and freckles, the Fraxel Restore Dual or Repair are helpful too.


Tuesday, February 4, 2014

Vaginal Rejuvenation

Why vaginal rejuvenation?

It is for various purposes including:  cosmetic improvement of saggy or wrinkly labia skin, for tightening of vaginal canal to improve stress incontinence or sexual function improvement. 

Many women start to experience these changes after pregnancy or with age.

Yes, one option is to have surgical correction, but why do surgery if there is a treatment method that may produce similar results with lower risk, lower downtime, and less expense?
Laser vaginal rejuvenation and treatment of stress incontinence is a cutting edge treatment that has already taken on in Europe and Asia. 

We are currently conducting a study at Gateway Aesthetic Institute (in Utah) and recruiting women who have either stress incontinence or desire to cosmetically improve their vagina as described above, where we will do a brief 20 minute or gentle Yag (1064nm) laser treatment intravaginally and/or externally to the vaginal labia.  We have been told by the laser manufacturer (Fotona Yag) that we are the only physicians in the western U.S. with training and equipment for this procedure.  The treatment will feel warm but not painful, and in fact does not require anesthesia whatsoever.  It may need to be repeated for total of 2-3 treatment sessions a month apart.


Saturday, February 1, 2014

Old Hands and how to rejuvenate them

So you're face and neck look good, but you forgot the hands.

Here are my suggestions, starting with at home treatments.  Try a retinol cream every night and/or a brown spot lightening cream such as Lytera, Ellure or Melanolyte.

At the office, I suggest treatment of the brown spots with either IPL or laser depending on your skin type.  A few treatment sessions may be necessary.  Another newer option is the Fraxel Restore Dual laser which removes both brown spots and fine wrinkles in one session.  For more severe wrinkles or thinned skin with prominent veins, filler treatment with Radiesse or a hyaluronic acid works great too.

Friday, January 31, 2014

Fat Transfer vs. Fillers to the Face for rejuvenating

This is an ongoing debate among plastic surgeons and dermatologists who perform these procedures.  We offer both of these in our office, but in recent years favor hyaluronic acid fillers for facial rejuvenation over fat transfer.  Fat transfer is more surgically invasive with a higher risk of complications including infection and scarring.  In the past with only collagen fillers available fat transfer to the face may have been superior and longer lasting, but now we have HA fillers like Voluma that last 2 years and stimulate new long-lasting collagen.  That being said, sometimes the decision should involve weighing the skill of the physician.  Some physicians are more skilled at fat transfer vs. fillers, so despite the lower long term risks of fillers they may get better results with what they are most skilled at.

Saturday, January 18, 2014

Under eye dark circles and veins

I get asked a lot by my patients how to improve their under eye circles and veins.

Some of us have dark under our eyes all our lives for hereditary reasons.  I have even seen some teenagers with hereditary prominent and unsightly under eye veins.  Sometimes it can be acquired or exacerbated by allergies, sinus congestion and lack of sleep.  In addition, with age and sun we can get thinning and wrinkling of the skin along with spider veins under the eye.

We used to not have a good, safe treatment for this problem, other than make up concealers and creams that contain vitamin K which never seemed to work very well, except maybe a new one called Teamine cream (Revision SkinCare) - see pic below.  My associate at Gateway Aesthetic Institute in Utah, Dr. Mark Taylor, recently published (now a year ago) one of the first reports of successful treatment of unsightly under eye and around the eye (periorbital) spider veins with the NdYag 1064nm  laser.  I have since been successfully treating this in people of all ages and skin types, but with caution and very good eye protection.  I must emphasize that Dr. Taylor and I are board-certified dermatologists and laser treatment experts and can do this treatment safely.  The NdYag laser can be a tricky laser to use well and safely.

In addition to treatment of the spider veins around the eyes, we also will treat the darkness and/or redness of this under eye area with careful use of our IPL(Intensed Pulsed Light) device.

Both treatments may need to be repeated 2-3 and there can be temporary swelling, redness or bruising.
It is not usually painful because we use numbing cream and ice pops.


Saturday, January 11, 2014

Safety of UV-light cured nail polishes (gel, shellac)

There was a study recently published by dermatologists at the University of Utah, which measures nail lamp UVA exposure amounts over a year and the significance.  Other than this study, there has been only one other regarding UVA nail lamp exposure, which did not provide the same helpful information.

In this new study, the doctors estimated the amount of time of UV exposure based on the average time needed under the lamp per full set of nails.  They assumed the nail client has their nails done every three weeks for a year.

International experts recommend limiting your UVA exposure to no more than 30Joules/m2 for 8 hours to avoid significant cellular DNA damage.  They calculated that the total cumulative dose of UVA exposure per year in the average gel/shellac nail polish client was 285-386 Joules/m2 which is about ten times the max. limit for 8 hours.

To translate this to a year of gel /shellac UVA-cured polish, one could say each manicure involves four minutes of UVA, and if done every 3 wks, tranlates to 17 nail treatments.    17 treatments at four minutes duration each of UVA, is about 68 minutes or just over an hour of UVA per year.  Phew, I hope that wasn't too confusing.  So what does over an hour of UVA mean as far as hazards?  Well...during that one hour the total dose is 285-386 Joules, but we all know that the one hour of exposure is divided into 17 plus treatments, so it's not one straight hour of exposure.

Bottom line is this study implies that the UVA exposure from a nail lamp COULD BE hazardous over time but it seems we need more studies to clarify if the cumulative dose over a year at 285-386 Joules is really significant when the exposure is in 4-5 minute increments.

The authors of the study I am referring to do advise that if you use a UVA nail lamp, that you put on sunblock a half hour before your treatment.  I would agree that until further study, that is probably a good idea.  Those gloves that have the fingers cutout are pretty good but they don't protect the skin around the nails, so are inadequate.  Try the gloves and then applying sunblock on the remaining exposed skin.