Entries Tagged as 'Medicine'

Perfect Pout: What type of filler is best for you lips

posted on: February 4, 2017

Minor cosmetic procedures like botox and filler have skyrocketed in the past few year. With Kylie Jenner putting lip enhancement on everyone’s radar, filling those lips has never been more popular. What you need to understand is there is no one size fits all when it comes to lip fillers. There are about 10 different fillers on the market you can use in the lips. All of the products are different. In this post we are going to break down the different types of filler so you can educate yourself and discuss with your injector which filler would be the best for you.

While there are many different fillers that can be placed in the lips, for simplicity sake let’s discuss the Juvederm family of products made by Allergan. They have a broad range of fillers we can compare. When it comes to Filler and Botox in general there can be this stigma that if you have these treatments you will look frozen, fake or over done. That may have been the case with the first generation of fillers but that is not the case these days. If you go to the right injector, fillers and botox have the ability to make you look rested and refreshed while not changing your look. The most reassuring thing about most fillers is they can be dissolved if you don’t like the results.

Lips are one area in particular where people have a fear of looking over done. Not everyone wants lips as big as Kylie, and the great thing is you don’t have to. There is a filler type out there for everyone’s needs and desires. Let’s break them down so you can figure out what filler is best for you.

Volbella XC- This is the newest filler in Allergan’s arsenal. This filler is intended for subtle results. This filler works best if:

  • You are a first time lip filler with thin lips
  • You suffer from “smokers lines”, the little fine lines that makes your lipstick bleed that you want improved but don’t necessarily want your lips bigger.
  • You are nervous about having your looks look too big
  • You simply want your lips to look hydrated vs much larger.

Volbella currently comes in a 0.55cc syringe which is smaller compared to other fillers. Keep this in mind when making your decision.

Juvederm Ultra XC- A great in-between filler. Juvederm Ultra comes in a 1.0cc syringe giving us more filler to work with. This filler would be great for you if:

  • It is your first time getting lip filler, but fear looking too big.
  • You have thin/medium lips.
  • You want your lips to look enhanced, but want a very soft feeling lip.
  • You have “smokers lines” plus you want to enhance your lips too.

Juvederm Ultra Plus XC– A more robust filler in the Juvederm family. This filler also comes in a 1.0cc syringe. This filler would be great for you if:

  • Your end lip goals are a very full look. (this may require more than one syringe)
  • You’ve had filler done before and liked the results, but wouldn’t mind more fullness.
  • You desire to spread the filler around and use in multiple areas (i.e. nasolabila folds or marionette lines).
  • You have fuller lips to start with.
  • You have deeper “smokers lines” and have lost a lot of volume in the lips.

The thickest filler in the Juvederm family is Voluma, while injectors will put Voluma in the lips, I do not recommend this as the results risk the area becoming hard and bumpy. There are other great Juverderm products available for lips and as Voluma is more expensive and more risky, I do not recommend it.

Fillers in the lips can last anywhere from 3-12 months. After your treatments wears off you can discuss with your injector your experience and determine if another type of filler would be better for your next treatment. This is intended to be educational, however you should take the time to discuss your enhancement goals with your provider and together determine which type of filler is best for you.

Chronically Chapped Lips: Is there really a solution?

posted on: February 2, 2017


Chapped lips are an issue I see very often in my practice. For many people, liberal use of a lubricant will help ease the discomfort. But there are people who have tried every chapstick and lip scrub out there with no relief. Some people are prone to just having dry lips, but there is another condition you should consider.

Allergic Contact Dermatitis

This condition occurs when an allergen causes a reaction and irritation to the skin. The lips are a very common area to see this type of reaction as the skin on the lip is thin and it reacts easily to allergens. Scaly skin or itchiness can occur directly on the lips or around the lip area. Figuring out what is causing this reaction is easier said than done. This rash could be caused by an allergy to one of the countless products, ingredients and chemicals we are exposed to every day. From shampoos, make-up and perfumes to metals such as nickel, gold and cobalt, allergic contact dermatitis will continue until the allergen is no longer coming in contact with the skin. Fortunately, there are things you can do to get to the bottom of this annoying condition.

Be You Own Detective

Your lips come in contact with hundreds of ingredients per day. Take the time to be aware of what you are using directly on your lips and what is in your environment. Make a journal of things you came in contact with on the days your lips are worse. Think beyond what you are putting directly on your lips. Remember that indirect application can occur from an allergen transmitted via the hands.

Avoid certain products

Stop wearing jewelry that contains nickel as this is a common allergen. Remove your nail polish/gel polish. Even if you’ve been doing your nails for years, nail polish is a very common allergen. Stop all lipsticks, lip gloss, sunscreen or metal-containing products, such as a dental tools that have direct contact to the lips. Indirect application can occur from an allergen transmitted via the hands

Beef up your treatment

At this point chapstick or vaseline may not be cutting it. Pick up some 1% hydrocortisone ointment at the drug store and apply 2-3 times a day for more relief. Feel free to use vaseline or aquaphor in-between the application of hydrocortisone as needed.

If all else fails, see a Dermatologist. We have the ability to preform an examination of your lips, prescribe prescription medications or preform allergy tests to try to determine the cause of your chapped lips.

Boo Boo Basics (plus giveaway!)

posted on: October 27, 2016

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We’ve all been there- you trip on a crack in the sidewalk or over a toy, or maybe you’re simply clumsy then BAM! Next thing you know you’re on your hands and knees fully loaded with new scrapes, bumps and bruises. What’s your next plan of attack? Hydrogen peroxide, antibiotic ointment or water? Do you cover the scrape or let it dry out? Will you need stitches? In this post I’m going to give you the boo-boo basics and have you fixed up in no time.

Wounds generally fall into two basic categories:

  1. Seek medical attention
  2. Take care of it yourself at home

When to head to the ER

Yikes, You’ve got a cut and it looks pretty nasty. How do you know if you can just put a bandaid on it or if you need to head to the ER for stitches? Here are some basics to follow:

Might be time for a trip to the ER:

  • If you have anything stuck in the wound you can’t remove
  • If you can’t stop the bleeding
  • If you have a puncture wound- i.e. stepped on a nail
  • If you were bit by an animal or a human
  • if the cut is greater than 1/4″. If  you can see fatty tissue or bone you definitely need to go to the ER.
  • If the wound is wide enough for you to push together to close to cover underlying tissue.

At home boo-boo basics

So your wound doesn’t meet any of the criteria above? Good! A simple scrape or minor cut (like a paper cut) are wounds that only affect the 2 most superficial layers of skin- the epidermis and the dermis. While these have a very low risk of becoming infected, it is still important that you practice proper wound care to ensure things heal properly. Typically simple antibacterial soap and water is sufficient to clean the area. After you have cleaned the area, apply a thin layer of  anti-bacterial ointment, like vaseline or Aquaphor to the area. The skin will heal better if you keep the area lubricated and covered. It may seem like it takes longer for the scrape or cut to heal, but the ultimate scar will look better if you don’t allow a thick scab to form. On the flip side don’t keep the area too gooey. Make sure you are changing any bandages that have become wet and you only need a very thin layer of the ointment. Most basic wounds heal within 1-2 weeks. If your wound is taking longer to heal or becomes more painful you should seek medical attention for an evaluation.

If you’re treating a kiddo, you know how scary getting a boo-boo can be for them. Having 3 kids of my own and seeing pediatric patients who require painful procedures I am not above a little bribery to make them feel better during their time of discomfort. Stickers and ice packs go a long way. I love these kits from Me4kidz. My mother-in-law picked up the big doctor Medibag  for my kids last year. While my kids love playing doctor with the bag it’s also a fully first aid kit with every boo-boo dressing you could need including the ever important stickers. In addition to the big kit Me4kidz makes these little medibuddies that are perfect to throw in your diaper bag or purse.

I’m hosting a giveaway for all the goodies seen in the picture below. You can enter the giveaway in one of two simple ways.

  1. Comment on this post saying what goodie you’d be most excited to receive
  2. Tag a friend on my instagram @thewhitecoattreatment who would love some me4kidz goodies too.

I’ll announce the winner on Oct 31st! Good luck!

unspecifiedGiveaway winner wins everything above. Medibag first aid kit, medipro first aid kit pod, medibuddy first aid kit and two cool it buddy ice packs.

Boo Boo Basics White CoatTravel kit perfect for your car, purse or diaper bag. 
unspecified-2Fun stickers for your brave little patient!



More Than Just a Zit! The Ultimate Guide to Dr. Pimple Popper

posted on: July 14, 2015

Thanks to the coverage of Dr. Pimple Popper by way of Buzzfeed, UK Mirror, and more, we have now reached 205k followers on Instagram! Who would’ve thought that there were so many popaholics in the world? The idea for the Dr. Pimple Popper instagram was brainstormed when Dr. Sandra Lee and I were talking about how her most popular posts were on cysts and extractions. An instagram fully dedicated to these procedures seemed like the most logical step, hence Dr. Pimple Popper was born. There is more to this instagram account then just “popping pimples”. I thought it was time for a comprehensive guide to everything we’re “popping”. After reading this article you can consider yourself an Dr. Pimple Popper expert!

Check out Dr. Lee’s full videos on YouTube.

The Dr. Pimple Popper Instagram shows many different types of extractions using different tools and an array of “pimples”-all of which have specific terms. Below are definitions of the different terms of what we remove or “pop”.

 

Comedone: Open Comedone are also known as “Blackheads” (comedo is singular). Comedones are formed when cells lining the sebaceous duct build up and there is increased sebum production. In simplest terms it is a plug in your pore; made up of dead skin cells, oil, and bacteria.

Blackhead/Comedone Extraction

Dilated Pore of Winer:  Named after the Doctor who first desribed it, a dilated pore of Winer is a hair structure anomaly that appears as an enlarged solitary comedo. In layman’s terms-a big and usually old blackhead that hardened, one that has been building for years! Sometimes a stitch or 2 is required because the gaping pore needs help closing.

Dilated Pore of Winer

Lipoma: Lipomas are the most common soft-tissue tumor. These slow-growing, benign (harmless) fatty tumors form soft, lobulated masses enclosed by a thin, fibrous capsule. In non-med terms, Lipomas are typically a soft and rubbery glob of fat that does not cause pain. They usually remain the same size over time.Surgically Extracting Bumps on the Arms, Called Multiple Lipomatosis

Epidermoid Cyst: Epidermoid cysts are the most commonly found cysts and they contain a soft “cheesy” material made of keratin, a protein component of skin, hair, and nails. The surface of your skin (epidermis) is made up of a thin, protective layer of cells that your body continuously sheds. Most epidermoid cysts form when these cells move deeper into your skin and multiply rather than slough off. Think of it like a “snowball effect” of collecting more and more dead skin along the way.  A cyst appears as a domed-shaped, skin-colored growth that usually moves when touched and pressed upon. It may have a small opening in the center called a punctate.

Removal of a large epidermoid cyst, upper back

Pilar Cyst (Cyst on Head): Pretty common fluid filled growth that forms in hair follicles, most often found on the scalp. They are smooth and filled with keratin (that soft “cheesy” material I referred to in the Epidermoid cyst). In the animation below, the cyst is removed while the keratin stays intact in the sac, popping out like a garbanzo bean. Excellent removal!

Pilar Cyst Removal

Milia: Milia are very common, benign, keratin-filled cysts. Milia occur when dead skin becomes trapped in small pockets at the surface of the skin, forming a tiny little cyst.  An individual milium (the singular of milia) is formed at the base of a hair follicle or sweat gland. Milia appear as 1–2 mm white-to-yellow, dome-shaped bumps that are not painful or itchy. Many patients try to remove these themselves, thinking they are whiteheads, but they are difficult to remove without the help of a trained professional.

Milia Removal

TOOLS OF THE TRADE & PROCEDURES

“Punch” aka Biopsy Punch: This disposable biopsy instrument handles like a pen, with a grip at the top that allows you to twist, apply pressure, and drive the stainless steel blade into the skin with ease. It creates a very clean, perfectly round incision which leaves minimal scaring. This is best practice when excising a small cyst.

Punch biopsy on neck cyst

Comedone Extractor: The wire loop of this tool when pressed on the skin, creates a pressure which forces the blackhead (trapped sebum) up to the surface which then can be easily removed. Official Dr. Pimple Popper comedone extractors are coming soon!

Solar Comedones Extracted, aka Favre Racouchot

Forceps: Small forceps, which look like tweezers, are used to grasp fine objects. In the animation below, forceps are used to pull out the growth.

A Dilated Pore of Winer. For medical education- NSFE.

Excision: Simply put, to remove completely.  In the animation below, a pilomatricoma (benign tumor) is removed from behind the knee with dissecting scissors and a tug!.

Excision of a pilomatricoma behind the knee

I&D (Incision & Drainage): Slice and squeeze! Below is an animation of a cyst I drained

Incision & Drainage of cyst

Thank you for following! If any of our posts help answer your questions or demystify dermatology, then I am a happy Physician Assistant.

Why Powdered Sunscreen is the Shiznet

posted on: May 19, 2015

Approx 5,328 times a day I educate patients on sun protection. This includes everyone from patients on sun sensitive acne medications to those concerned with brown spots and wrinkles. When I tell my patients that the most important aspects on using sunscreen is reapplication every few hours I commonly get the side-eye mixed with “haha you’re crazy if you think I’m reapplying this thick white crap over my make-up” look.

That is when I pull out my semi-secret weapon. Powdered Sunscreen. Now this is not a new technology, but I find most people are not aware it exists. I am not talking about powdered foundation make-up with and SPF in it. I am talking about straight up (typically zinc based) sunscreen powder. Simply tap, brush on and reapply. I still recommend a base of liquid sunscreen (I like ones with Zinc Oxide and Titanium Dioxide) in the morning before putting on all of your moisturizers and make-up but, reapplying with sunscreen powder doesn’t get much easier. It’s seriously the best for fussy kids (and husbands) on their faces too.

This is not just for your face, I wear this on my hands as well, especially when driving. There is only so much a Dermatology PA can do once skin has been damaged by the sun. Establish your regimen now!  Hands show the tell-tale signs of aging and most people are more concerned with the wrinkles and brown spots on their face and chest, neglecting their hands.

I am not sponsored by any of these products, I just feel a personal responsibility to spread the word about them!

Colorscience Sunforgettable– this is the one I use.

Screen Shot 2015-05-13 at 10.21.05 AM

Check out this other brand too:

Peter Thomas Roth Anti-Aging Instant Mineral SPF 45

Not a whitehead, but rather a Milia

posted on: May 15, 2015

Milia are small, pearly-white or yellowish bumps right under the skin which is actually a tiny cyst filled with a protein called Keratin. They are most commonly seen on the skin around the cheeks, nose, eyelids, forehead and chest but they can occur anywhere on the body.

Although harmless, they can be so annoying and darn near impossible for you to remove yourself. Often they will disappear on their own but that may take weeks or months to occur, and most people prefer not to walk around with this white bump on their face. While thick creams and ointments applied to the skin may cause milia, often we do not fully understand what causes them.

Screen Shot 2015-05-13 at 2.28.58 PM

How do we treat milia?

There are a few ways you can treat milia. What is not recommended is that you treat them yourself at home. If you try to squeeze or pick your milia this can lead to skin damage, scarring or infection. I will not even treat my own milia, as I find it difficult to do on myself. The problem with milia is there is no opening, like an easily extracted blackhead, so you have to create an opening to get it out. My go-to way to treat milia is by using a fine needle or light cautery to create an opening in the milia and then expressing the milia out with a comedone extractor. If milia become very widespread and persistent you can consider these options:

Chemical Peels: A light acid peel is applied to the skin for a few minutes and washed off. Over the next few days this will peel off the top layer of the skin and peel some of the milia off as well.

Microdermabrasion: This procedure utilizes the application of tiny rough grains to buff away the surface layer of skin where the milia are held.

How To Prevent Milia

If you are prone to getting milia follow these steps to prevent new ones from forming:

  • Avoid heavy cosmetics and creams- These products can block your pores causing more milia to form.
  • Apply a retinol/retinoid (rx) daily- They have exfoliating properties that turn over dead skin cells and keep your skin soft and clear.
  • Gently exfoliate your skin- My preferred method for gentle exfoliation is a Clarisonic brush. This product gently exfoliates your skin without causing further irritation.

Do you follow DrPimplePopper on instagram? You can see myself and Dr. Sandra Lee extract lots and lots of milia there!

Moley, Moley, Moley: What to consider when evaluating your moles

posted on: January 29, 2015

Moles can appear anywhere on our bodies from the bottom our feet to the top of our head and everywhere in-between. While most of them are harmless, some may be cancerous and cause harm if not treated in a timely manner.  To decide if you should seek evaluation about a particular mole that may be dangerous, follow the ABCDE rules for potential skin cancer at home.

  • A is to see if your mole has asymmetry, meaning one half is larger than the other.
  • B is to look at border irregularity. Borders with jagged edges that are uneven can be some of the first warning signs.
  • C is to look at the color, if the color changes or is a shade of black or bluish-grey you can be at risk.
  • D is to look at the diameter of the mole, if it is greater than six millimeters, about the size of an average pencil eraser then you may want to have it evaluated.
  • E is evolution. This is probably the most important factor. If your mole is evolving (aka: growing and changing) it is very important to have it examined.

Although skin cancer seems scary, most moles are benign and we are able to test it in a timely manner. Having a cancerous mole is not the only reason to have a mole removed. Many people choose to have multiple moles removed for their own convenience due to factors such as; they simply do not like it, to it being in a highly seen place such as the face. The mole removal process is quick, safe, easy, and low on the pain scale. If you are questioning a mole, or feel at all uncomfortable about one, make an appointment to see what your treatment options are.

Skin Cancer and it’s Warning Signs for Beauty Professionals

posted on: November 4, 2014

Hair Dressers Spot Skin Cancers

 

 

I cannot tell you how many times my patients have told me: “I’m here beacuse my hair dresser noticed something in my scalp”. Hair Dressers are on the front line of spotting skin cancer in one of the hardest places to monitor: The Scalp. Next Monday, November 10th at 6pm,  I will be presenting a Heads Up! lecture from The Skin Cancer Foundation. If you’re in the beauty industry and would like to learn more about how to spot skin cancers come join us! It’s FREE to attend and I will be raffling off some goodies for attendants.

Details and How to Register: HERE

 

 

Now Offering: Pre-PA School Consulting

posted on: October 30, 2014

I started this blog and Instagram a year ago with the mission of sharing skin care tips and information on various dermatology conditions. What I did not expect is how many Pre-PA students I’ve “met” the past year via this blog and Instagram. There are many steps that one must complete prior to being accepted to a PA program. Everything from choosing which PA program is right for you , ensuring you’ve completed all necessary pre-reqs for that specific program, obtaining an average of at least 1000 hours of paid hand-on medical experience, finding PAs to shadow, taking the GRE or MCAT, accruing medical volunteer hours, and that’s just the basics. Once you’ve checked all the those off the list you need to ask yourself, “what is going to make me the most competitive applicant?” All of this can be quite a daunting task.

For years I’ve mentored and guided numerous Pre-PA applicants on their journey to PA school. This is something I am very passionate about. I absolutely love my job and couldn’t imagine doing anything else. Watching the journey of those from working on their undergraduate degree to getting through PA school and finally landing their dream job is such a rewarding experience. My goal is to help as many people as I can complete their PA journey. It seems like a natural progression to now offer structured Pre-PA School Consulting. I have joined C&C Independent College Consulting to offer comprehensive consulting for Pre-PA students at any place of their journey to becoming a certified Physician Assistant. Learn more about services offered HERE.

How I became a Dermatology Physician Assistant

posted on: October 3, 2014

Dermatolgoy Books

While in PA school you go through what seems like endless modules of every system in the body. You start to get a taste of what specialities you like (or even faster, those you don’t like) but it’s not until you start your rotations do you really learn what each speciality is all about. While in PA school you will do on average 7-10 rotations in various specialities: family medicine, obstetrics, orthopedics, pediatrics, surgery, ER, internal medicine, etc… At the end of your PA program you will be primary care trained and can start working without additional training. However, you are able to work in a speciality as a PA with additional training. You can either find a residency/fellowship program for PAs in the desired speciality or you would need to find a physician who is willing to train you. Both of those options can be difficult to find as a new graduate but it is possible.

While in my 3rd year of PA school I had narrowed down what specialties I wanted to pursue. I really enjoyed aesthetics and thought I would pursue plastic surgery. At my program our last rotation involved 2 days in the clinic in the speciality of your choice and the rest of the time was spent on campus working on our thesis. I had my advanced plastic surgery rotation all set up when I was chatting with my mom and she mentioned that she had an appointment that week with her dermatologist, Dr. Sandra Lee. I told her I was going to tag along with her to the appointment to try to get my foot in the door and do some networking. I introduced myself to Dr. Lee and told her I was in PA school and interested in Dermatology. She kindly educated me about the procedure she was preforming on my mom like I was already a student under her wing. A week later I received a call from Dr. Lee inquiring if I was really interested in Dermatology. I told her I was very interested in aesthetics and did not know if I wanted to pursue plastics or dermatology. She offered me to do my advanced rotation at her office to see what I thought about both medical and cosmetic dermatology. I was able to move my advanced rotation from plastics to dermatology and spend 4 months at her and her husband’s office. While there I rotated with one other student from a program in New York. I must have done something right because Dr. Lee and Dr. Rebish offered me a job when we met up for dinner when were all in San Francisco attending a Dermatology conference.  I will never forget calling my husband while in a bathroom stall whispering, “They offered me a job!” After graduation both Dr. Lee and Dr. Rebish took on the task of providing me advanced training in dermatology. They are a great team where Dr. Rebish focused my training in medical dermatology; Dr. Lee was my go to gal for surgical and cosmetic dermatology. I joined the Society of Dermatology Physician Assistants (SDPA) which has great resources for new graduates as well as PA students. I highly recommend joining a PA society in your chosen speciality (I’ll give you some of those resources in an upcoming post).  I attended Dermatology conferences including those put on by the SDPA and Maui Derm. I also did advanced training courses in various lasers treatments, dermal fillers and neurotoxins. I am so thankful for Dr. Lee and Dr. Rebish hiring me as a new graduate and now 5 years later I couldn’t be happier. I think the take home message here is that this job opportunity was not posted on monster or craigslist, It all started with me crashing my mom’s doctor’s appointment and that’s what opened this opportunity. If you want to get into certain specialities as a PA you really have to create those opportunities.