Category Archives: Cosmetics

By Dr. Papantoniou

We all know how popular eyelash extensions are today, this trend has been building in popularity over the past 1-2 years. With more salons and spas offering the laborious beauty treatment, false lashes are glued to individual hairs and can take upwards of an hour to do and can cost over $150 to do. The end result is luxuriously rich, full and “natural” looking lashes.  Who needs mascara when you can have lash extensions?  As enticing as this all may seem there are 3 things you should know about lash extensions before you get pulled into this expensive routine.

1. There is potential for you to actively thin out your own natural lashes after long term use of lash extensions. Just as eyebrows can become permanently sparse from repetitive plucking, so can the use of adhesive lashes. The lashes can get weighted down by the glue and pull on the growing hair follicle, this can overtime lead to thinning and loss of hairs on the eyelids. Having eyelash extensions periodically for special occasions should be safe, however keeping this up as a routine maintenance for the long-term may lead to trouble for some people.

2. This happens to many women because when you are getting adhesive extensions there may be some loss of your own eyelashes in addition to when the false lashes come off. This can force you into a pattern of actually needing to have lashes applied again and again to compensate for the thinned lashes, and this can occur so gradually as so that you yourself do not even realize what has happened.

3. I have seen a handful of patients that had developed allergic sensitivity to the adhesive for the lashes. This was difficult for the patients to accept because they had become so accustomed and dependent on their lash extensions they could not be convinced to stop having them applied so the skin condition could resolve. If you develop upper eyelid dermatitis it could very well be from the lash extensions.

So, I have been not very supportive of lash extensions, and you may be wondering why I am being such a party pooper. Well, don’t get all upset just yet, there are plenty of natural and prescriptive alternatives that end up being much cheaper and can actually help your lashes to grow, promoting longer and fuller lashes. Latisse has been around for a long time and safely does just that, and is less expensive than having eyelashes artificially applied. For a natural alternative there are those who swear by pure castor oil, it has been shown to help promote hair growth. Another natural source for hair growth is Rosemary oil, which has been shown to work as effectively as minoxidil in some scientific research.

You can still pursue the full and beautiful eyelashes of your dreams. But consider the 3 points I have made about the long term use of false lash extensions. If you develop any skin concerns I suggest consulting a Dermatologist for expert evaluation and treatment.

Dr. Kally Papantoniou is a Board Certified Dermatologist, sought after for her expertise in Cosmetic Dermatology. She is highly regarded as a clinical source for many media outlets. Dr. Papantoniou specializes in a layering approach to rejuvenation to deliver the most natural results. Dr. P works in Queens and Long Island with Advanced Dermatology, PC, she also teaches at the Mount Sinai Hospital. To connect with and follow Dr. Papantoniou:  www.DrPapantoniou.com  @DrPapantoniou

Silhouette Instalift

By Dr. Kally Papapntoniou

Ever pull back on your cheeks while looking in the mirror and wished that your skin could stay like this? Just hoping that this does not mean you actually need a facelift…with so many advances in non-invasive cosmetic procedures, who want to have surgery these days? With the help of injectable dermal fillers and tightening energy devices such as the Ulthera and ThermiTight we have been able to make a big impact on reversing the aging process and rejuvenating skin appearance and facial contours. But, as with anything non-invasive we sometimes reach a point where a few injections and tightening procedures are not going to give us the dramatic lift we are looking for. A new emerging technique only mastered by select Dermatologists and Plastic Surgeons, which first was developed in the European Cosmetic Market and now has become available to patients in the United States, Instalift, may be the game changer we have been looking for.

Instalift is exactly as the name entails, it is a device used in a minimally invasive technique that consists of a patented suture or thread that when placed under the skin helps sculpt and lift facial contours – finally providing a non-surgical facelift that is delivering results that patients are raving about. The way it works is really simple…through several anesthetized insertion points, the suture is delivered into the skin and then adjusted to help lift cheeks, jowls, necks and even brow lines.  The suture material is a combination of Polyglycolide/L-lactide which has been used for years in surgery and is completely broken down and metabolized by the body.

Photo Courtesy of Silhouette Instalift

The results are phenomenal and speak for themselves, lasting for an average of 1.5 years.  The recovery period is very short, usually patients can even go back to work the next day. For those who are easy bruisers pretreating with arnica and bromelin can help reduce this. The only post procedure instructions are for one week after the procedure patients must limit certain activities such as heavy exercise, chewing gum, and should stick to a soft diet.

So how does this change what we are already doing for non-invasive tightening? Well, when we think of rejuvenating as a layering process it makes more sense. We want to volumize to compensate for fat loss and bone changes which occur with aging, all of which you still can do even before or after the Instalift. We still want to resurface, reverse signs of aging with lasers and chemical peels to target discoloration, age spots etc.

We already treat fine lines and wrinkles that happen with strong facial expression with Botox. When we want to tighten the skin, we can still do this with Ulthera or Thermismooth, but now the Instalift provides us instant dramatic improvement that is not achievable with energy devices alone. Energy devices will still have a strong role in tightening skin around eyes, and the submental area for areas that are not able to be treated with the Instalift, and will work well together when combined.

I predict the Instalift will become a quick favorite for patients looking to improve themselves without surgery, because of how simple a procedure it is and how great the results really are. We already are seeing many patients inquiring about the Instalift treatment for midface and jowl tightening.

Dr. P shows how ears can show our age.

How to do microneedling at home, & which derma roller to get?

Wearing sun protective driving gloves and or sunscreen daily can prevent your hands from aging prematurely, and will reduce risks of skin cancers in these areas.

                                                                                         Fraxel 2 Sessions

Every day I treat people for acne and acne scarring.  Luckily there very effective treatment options available to improve the appearanceof acne scars. There are also some treatment myths that need to be cleared up.

1. The first thing I always address with my patients is whether they are still breaking out, if you are still getting acne lesions, you first need to get control of the acne. Otherwise, new scars will be developing, and money and effort will be wasted to treat scars without doing anything to prevent new scars. I make a point to make this clear to my patients, because I believe it is important in order for the outcome to be the best possible.

2. The top 3 treatments I believe work the best for acne scarring are the Fraxel (a fractionated resurfacing laser), the pixel (which is a CO2 laser), and microneedling. The Fraxel will take 3-5 treatments, but has a relatively quick recovery, it creates “micro” perforations in the skin with spared healthy skin in between these areas, so the skin heals quickly. Patients will have redness after a treatment, similar to a sunburn, but this resolves usually over 3-7 days, and makeup may be worn. The CO2 laser which is often used together with an Erbium Yag laser, is similar to the Fraxel but is slightly more invasive, with most patients only needing 1-2 treatments. This laser treatment does require a recovery period of 7-10 days, with frequent application of ointments to the face until completely healed. Microneedling pens are gaining popularity for acne scarring. They are mechanized tool with fine needles which are used over the areas of scarring, creating perforations mechanically. The outcome is very similar to results seen with fractional lasers, with less redness and shorter “down time”, this may be a better option for darker skin types than a laser – offers a reduced risk of post treatment hyperpigmentation.

3. A lot of people ask me what kind of creams should they purchase. The ingredient that is most helpful in the treatment of scarring is retinoic acid or retinol. Retinoic acid comes in many different formulations from the generic tretinoin, to well-known brands such as Retin A, Renova, Tazorac or Atralin. Retinoic acid/Retinol containing creams can help stimulate new collagen production. Used in a pea size amount in the evening, these creams are usually very tolerable. It is a useful medication to treat the acne and acne scarring together.

4. Get a dermroller. If you haven’t heard of a dermroller, imagine a roller with numerous fine needles, this is used to roll over the surface of scars to create small perforations similar to the lasers. These small injuries to the skin heal with new collagen in the areas treated. Out of curiosity, I myself purchased a dermroller, and I cringed in anticipation of pain prior to using it on my cheek…I was surprised that it actually tickled/felt like mild scratching. The needles come in different lengths, I would recommend starting out with a shorter needle, the 1mm, and working up to a longer one. Topical numbing creams are usedfor the longer needle rollers, and the depth of treatment is controlled by the amount of pressure being used when you press down on the rollers. If the roller is used 1-2 times per week, over the course of several months the texture of the skin and scarring can be greatly improved.

5. Chemical peels were historically among the first treatments available for scar treatments, but now with advances in technology I generally don’t recommend them in my practice for the treatment of scarring. The reason for this is that in order for a chemical peel to be useful in the appearance of deep acne scarring the peel has to be very strong. A strong peel, such that would be necessary for deep acne scarring should only be used in a very fair skin type, otherwise this can be very risky for skin discoloration and scarring. Because of their limitations of use for lighter skin types, it becomes prohibitive to other patients. It can take many peels in order to see results, meanwhile only several laser treatments would have been necessary to achieve better results for the same price. That being said, I do use chemical peels routinely with great results: for discoloration/hyperpigmentation and dull complexions.

6. Time! Time has a role in the treatment of scars, a new scar will often have a red appearance to it. And this can take time to improve. There is a delayed healing process that occurs after a scar treatment has been administered. It can take 3 to 6 months to see the full effect of a treatment, this is because there is a slow tissue remodeling process which occurs with new collagen and elastin being produced in the areas treated. This is why good photographs are so important! Often patients even forget how their skin looked prior to starting their treatments, and are very encouraged when they see how much they have improved.

7. Filling pitted acne scars with fillers. Injectibles, such as Restylane (a hyaluronic acid based filler) or Artefill (human collagen based semi-permanent filler) can be used to fill select pitted and boxcar acne scars. The advantage is that the results are instant, without the long wait for tissue remodeling.The drawback is that it is usually not permanent, will not address the textural component of the scarring or skin tone.

If you are interested in what would work best for your skin see your Dermatologist for the best fit for your needs. Scarring does not need to be newer in order to be amenable to treatment, the oldest of scars can still be improved!

Dr. Kally Papantoniou, MD, FAAD

Board Certified Dermatologist: Cosmetic & Medical

Advanced Dermatology Laser & Cosmetic Surgery

Mount Sinai Dermatology Clinical Instructor

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Ask these 7 questions prior to a cosmetic procedure!

Spa treatments: Dr. P’s 5 tips for what you want, and what you don’t want to go home with.

Who doesn’t want to have a relaxing and refreshing Spa visit now and again to recharge your battery and feel pampered for a moment. It is important that we do indulge in these luxurious treatments for our skin and nails, but we must proceed with caution.

I recently was in a large shopping mall, and was quickly pulled in by a kiosk worker who started to buff my 1 fingernail before I could say yes or no to his administration. After I walked away, I was preoccupied with the thought that the very same emery board had been used on countless other people, and I could potentially develop a wart on that finger now! Sometimes the more you know, the worse off you are. However, this is just an example of how you can pick up a skin virus or infection without even knowing, and it is delayed often and will not present itself for weeks oftentimes. A similar incident once occurred during a massage when the masseuse began to use a cactus bristle brush against my skin as part of her routine, and the entire time I was concerned about the reuse of the tool, and was too polite to request that she not use it.

It may seem paranoid and I may be overthinking things, but this only comes to my attention because of what I see regularly in the practice of dermatology, I have many patients that have acquired warts from nail salons, the gym, and even from facials or waxing. Poor young women who have tiny warts disseminated over the face or body, and they will commonly have a history of frequenting a spa or salons. When you are using instruments on patients and not properly sterilizing them it can lead to the transmission of diseases, though not life threatening in the cases I have presented they are none the less difficult to treat and unpleasant.
Tips.

1. Seek out a salon or spa that uses a heat autoclave to sterilize their instruments.
You can ask directly if the instruments are autoclaved and they should be able to answer this question. Establishments that use autoclaves will often have their instruments in sealed bags. Other spas or salons will use an alcohol based solution to clean their instruments, this can be helpful, but is inferior to heat autoclaving. Autoclaving entails placing instruments inside a machine which under intense pressure and high heat destroys all organisms on tools and is the gold standard for sterilizing even medical and surgical instruments.

2. Don’t soak your feet in the foot bath in the nail salon.

Unless a disposable liner is being used for each customer, I cannot think of a dirtier place to soak your feet, as appealing as a nice warm soak might sound…I have seen some terrible infections that were picked up at nail salons. One such customer had suffered an amputation of one of her toes due to a salon acquired infection. The issue is that you never know who is going to pick up an infection. The vast majority of people who have these services have no such serious complication, but very commonly will develop a wart or athletes foot.

3. Bring your own nail filers/emery boards, and/or other nail tools if you desire.
When in doubt, you cannot go wrong by being prepared and bringing in your own supplies. You may get a few looks by other customers, and cause the employees to talk a little, but is it worth it to have fewer worries about your health, absolutely! It is not uncommon for many salon goers these days to come prepared with their own trusted equipment.

4. Do not permit the use of any reusable instruments that are not sterilized.
For example: getting a massage and being scrubbed with a brush that is used on other customers. Do not be shy, and don’t let anyone use something that has not been properly sterilized. A nice way of avoiding this awkward moment is to actually be up front and direct with your question before having a service.

5. If you do pick up what appears to be a wart, nail fungus, or another skin infection, do not delay seeking dermatological care, the earlier you start treating the easier it is to fully resolve.

There are so many great treatments to treat warts, and skin or nail fungus, that it makes no sense to waste time before getting treated. In additions, holding off treatment can result in the development of more warts and spreading warts or fungus to your loved ones at home.

Are you using the right anti-aging products?

There are so many options available when it comes to anti-aging creams, lotions, serums and cleansers. I am asked on a daily basis by my patients what really works and what do I recommend. As a Dermatologist I have found through my experience and extensive research that you should be looking for several key basic elements and ingredients when selecting a product to help reverse and prevent the signs of aging. Ask yourself if your regimen and creams provide:

1.  Broad Spectrum SPF 30 – 50 daily moisturizer.

This will help prevent sun spots, discoloration, melasma, fine lines and wrinkles from collagen and elastin break down, and prevent DNA damage and risk for skin cancers.

2.  Retinol or Retinoic Acid 2-3 times per week, or nightly as tolerated.

This will promote your skin cells to produce more collagen, even out skin tone, and is clinically proven to improve fine lines and wrinkles. This is the gold standard in skin care for rejuvenation and prevention.

3. Vitamin C: can be used in the morning or evening.

A strong antioxidant, and skin brightener, this can help reverse daily damage from free readicals and even out skin tone. May also help with the appearance of fine lines and wrinkles.

4. Hyaluronic acid serums or creams.

This may be used alone or in combination with the other recommended ingredients listed to super hydrate your skin cells, and instantly improve the appearance of fine lines and wrinkles. Some studies have also linked Hyaluronic acids with skin regeneration and increased collagen production.

5. Green Tea Polyphenols, Resveratrol, Edelweiss

These are powerful antioxidants and free radical scavengers that are anti-inflammatory, and help to promote cellular health. They have the potential to increase your skins ability to heal and repair from photo-damage as well.

If your regimen does not include the top 2 important elements: sunscreen and retinol/retinoic acid you may want to consider adding these. I will mention that there are some people, especially those who are rosacea prone or have eczema, that may have flare ups of their conditions with a retinol/retinoic acid cream and so should omit this from their regimen if they note worsening. 

What about growth factors?

Well, there is a new wave of cosmetics for anti-aging purposes that contain growth factors, some of which are plant derived, and some derived from living cells. These growth factor aim at specifically stimulating cell growth and production of collagen. I won’t get into the controversy over the use and origin of these growth factor containing ingredients, but I will mention my hesitation with recommending these products. In order for an ingredient to have an effect on the cells in your skin, it must first be able to cross your skin barrier and be able to migrate across cellular membranes, I am not sure that all these growth factor creams/serums are truly able to accomplish this and are truly effective. And as a precaution if you have a history of skin cancer or are at a high risk for skin cancer I would reconsider using these products on your skin, a growth factor has the potential to increase the growth and turn-over of many cell types and may pose a theoretical risk. On the other hand, the use of topical Retinol/Retinoic acid is beneficial for reducing the risk of developing certain types of skin cancers.