Microneedling......an alternative to laser resurfacing

There is an abundance of evidence that shows inducing channels of dermal injury by laser or microneedling stimulates collagen production. Microneedling has seen a huge surge in popularity. That is most likely because the results are remarkable without as much downtime, at a fraction of the cost of laser. Don't get me wrong, laser is very effective for collagen stimulation, but for the reasons mentioned above, many are opting for microneedling. Additionally, microneedling is great for all Fitzpatrick skin types, whereas laser is not safe for dark skinned individuals.

Do not confuse medical microneedling with the commercially sold, roller-type devices available from multiple skin care companies. Medical microneedling doesn't use a roller. It features a motor that very rapidly stamps multiple small needles into the dermis of the skin and goes deeper than can be achieved with a roller. Not to worry, we do numb you with a topical numbing cream prior to the procedure, and we can vary the speed of the motor and depths of the channels. Medical microneedling penetrates deeper than the roller. It penetrates down to the dermis where you make collagen.

Microneedling is considered safer than many other aesthetic procedures because there is less risk of prolonged redness, dermatitis and infection. There are however, a few contraindications to microneedling....active skin infections, open wounds, and severe collagen disorders. I personally will not do microneedling on sunburned skin, a planned prolonged exposure to the sun, nor if you have had recent extensive skin resurfacing procedures. 

With our Rejuvapen microneedler we have seen very impressive improvements in scars and discoloration. It is pretty effective for skin tightening and makes the skin look brighter overall as well. It will also help with pore size reduction and diminish the appearance of wrinkles. Recovery time is very quick. I know when I have microneedling done, I can cover almost all of the redness with make up the next day. To make the treatment even more effective we apply peptides and growth factors to the skin as we do the treatment to stimulate even more collagen growth and increase the luminosity of the skin. I personally do microneedling as a maintenance treatment two to three times a year. For those who have problem areas like acne scarring, I'll probably recommend a short series of treatments 6-8 weeks apart, as collagen continues to grow for 6 weeks.

Treatments $350 each. Discounts when purchasing more than one treatment at a time. Give us a call! We're ready to take care of all of your skin care needs!

Who Needs IPL (Intense Pulsed Light)?

A recent article in Med Esthetics talks about the benefits of IPL (intense pulsed light). According to Dr. Michael Gold of the Gold Skin Care Center in Nashville, IPL is still the #1 treatment for skin rejuvenation and photodamage in fair skin because it covers vascular concerns, pigmentation problems and stimulates collagen production. So if you have photodamaged skin  with some wrinkling, some red spots and some brown spots, there is no other device that will treat all those concerns simultaneously. With lasers, all these would have to be treated separately. IPL can not be done on dark skin like African Americans as it can cause permanent hypopigmentation.

Benefits of IPL have been published extensively, including in 2012 by Stanford University in Journal Of Investigative Dermatology and in 2016 in the Journal of Cosmetic and Laser Therapy. Due to the heat that is generated, IPL offers some collagen stimulation, temporary pore size reduction, some overall skin plumping and a reduction in fine lines. However, skin sagging and deep lines need to be treated with something like Ultherapy and fillers.

Thanks to its ability to target redness, IPL is widely used to treat the diffuse redness and broken blood vessels of rosacea.  IPL has become the first line of treatment for both pigmentation and melasma in Asia and is widely used for these in the U.S. as well. There isn't really a cure for melasma, but combining IPL with skin products containing 4% hydroquinone and an occasional medical grade chemical peel, you can successfully treat melasma. IPL can also be used both alone or as a light source for photodynamic therapy (PDT) to treat acne. I prefer to use IPL, chemical peels and a few targeted skin products to treat acne before I refer to dermatology for Accutane. We also use our IPL device for hair removal on the face, especially on the upper lip and chin.

One big advantage of IPL is it can be used all over the body and is very popular for the chest, arms, back, shoulders and hands. I have always touted that your hands will tell your age, regardless of the age of your face! In the U.S.,  IPL is very popular for the treatment of Poikiloderma of Civatte, which is actually dilated blood vessels in the dermis and pigment deposition into the dermis. It is most common on the neck and chest. IPL can treat both problems of poikiloderma.

Most people need 4-6 treatments depending on the severity and type of condition we are treating. Treatments may be 1-4 weeks apart depending on whether we are treating rosacea, melasma or for hair reduction. IPL is sold in packages of 4 for $400. Give us a call to schedule your appointment today!  501-228-6237

Why SculpSure for Fat Loss?

In contrast to CoolSculpting that utilizes a freezing technology on fat, SculpSure treatments are delivered by a laser system that heats up your fat cells. SculpSure directs the laser into your stubborn, fatty areas, heating and emulsifiing the fat cells, essentially melting them. Once the fat cells are melted, they are naturally excreted by your body. In addition, the heat from the SculpSure treatments encourages collagen and elastin production in the treatment areas. This encourages healthy and young tissue growth, leaving the treated area not just thinner, but more firm and youthful as well.

Below are before and after pictures at 6 weeks from patients at Sei Bella.

Abdomen is the most requested area, but we have also treated arms, bra fat, flanks, love handles, inner and outer thighs, front and back of thighs, banana roll, and above the knees.

Use your Secret Santa card to get 20% off a treatment! Many people just need one treatment in an area, but Dr. Trussell can give you a better idea once she sees you. You will lose fat for 12 weeks, but you lose the most fat in the first 6 weeks. SculpSure is fast! SculpSure is permanent! SculpSure is non-invasive! It's cold outside now, but you can start getting your body summer ready! Give us a call! 501-228-6237

Testosterone.....Men AND Women Need It!!

Continuing on with my recent hormone blogs.....let's talk about testosterone today.

In men testosterone is responsible for sperm production and for secondary sex characteristics. In women testosterone regulates sexual desire and helps maintain bone and muscle health.

It is a well known fact that testosterone decreases with age in both men and women. Men age 30-70 lose 1-3% of their total testosterone production each year. Women age 30-40 lose 50% of their testosterone production.

Symptoms of decreased testosterone in women include:

• fatigue
• mood swings, anxiety, depression
• insomnia
• decreased libido, vaginal dryness
• brain fog, memory loss
• weight gain especially in the belly
• decreased muscle mass
• joint pain
• night sweats
• migraine/menstrual headaches

Symptoms of decreased testosterone in men: 

• fatigue
• decreased muscle mass and weight gain especially in the belly
• erectile dysfunction and decreased libido
• "man boobs"
• irritability, depression, anxiety
• joint pain
• sleep problems
• memory loss

Lots of myths surround the use of testosterone in women. So be informed and make note of the facts!
 

• testosterone is the most abundant biologically active hormone in women
• testosterone does not "masculinize" women unless some huge supra-physiologic dose is used
• testosterone does not deepen a woman's voice
• testosterone therapy actually increases scalp hair in women
• testosterone is cardioprotective and adequate levels actually decrease the risk of heart disease 
• testosterone decreases anxiety and irritability
• testosterone is protective to the breast and DOES NOT cause breast cancer

At Sei Bella we offer bio-identical hormone replacement therapy with pellets. Pellets are inserted in the fat of your butt under the skin every 4-6 months depending on when your symptoms recur. The procedure is very quick and painless. It doesn't even require any stitches, just a steristrip. Hormone pellet implants were developed in 1939 for women who had radical hysterectomies and they have been used in Europe, the United States and Australia ever since. 

Bio-identical hormone pellets are actually derived from sweet potatoes and are the size of a grain of rice or smaller. They have the exact same molecular structure as the hormones our own bodies used to make. They provide a steady stream of hormones in your blood stream (no peak and trough). Dosing is very individualized based on your lab work, age, height, weight, symptoms, etc. And since they are placed under the skin of your butt they last for 4-6 months.

I personally have been getting hormone pellet therapy for almost 4 years. I certainly have had no adverse effects and they changed my life. My mood is better. I can sleep! And I don't have all the soreness and muscle recovery I used to have after a long run or workout.

Call for your consult! Start feeling like yourself again before the holidays! 501-228-6237

Anne R Trussell MD

owner/physician

Literature sources:

North American Menopause Association

Davison SL, Bell R, Donath S, Montalto JG, Davis SR. Androgen levels in adult females. Journal of Clinical Endocrinology & Metabolism 2005;90(7):3847

Kaufmann JM, Vermeulen A. The Decline of Androgen Levels in Elderly Men. Endo Rev 2005;26:833-76

Gray A. et al, Mass. Male Aging Study, Journal of Clinical Endocrinology & Metabolism, 1991; 73:1016

Glaser R, Dimitralakis C., Testosterone therapy in women, Myths and misconceptions: Maturitas 74 (2013) 230-234

Mishnell 41, Greenblatt 49, Thom 81, Stancyk 88

Synthetic vs. Bio-identical Hormones

Bio-identical hormones are exactly the same molecules as the hormones we used to produce. Synthetic hormones are similar but have a different chemical structure than our naturally occurring hormones and bio-identical hormones as you can see in the picture above.  Synthetic hormones can cause unpleasant and even life-threatening side effects because they interfere or block proper hormone receptor function in our bodies.

Let's talk about progesterone......
Progesterone is very active and beneficial for breast tissue because it blocks estrogen stimulation of the breast, thereby decreasing breast cancer and breast cancer risk. It prevents the lining of the uterus, the endometrium, from overgrowing and becoming cancerous. Surprisingly, progesterone also decreases the risk of heart disease and helps protect your bones to some extent.

Now let's go over progestins (synthetic progesterone)......
Progestins are a class of progestogen compounds synthesized to act like progesterone does in the body. They DO NOT however reproduce the same actions of natural progesterone in the body. Provera or medroxyprogesterone when added to estrogens will prevent overgrowth of the uterine lining, but it can cause an increase in breast tissue proliferation and cause cancer due to estrogen receptor stimulation. This is why the Women's Health Initiative Study that I mentioned in my last blog was halted early. Women taking synthetic progestins, had a much higher rate of breast cancer than those who did not take them. Synthetic progestin does not protect the heart either.

The dangers of synthetic hormones have been discussed in medical literature for years. In 2007 the lead article in The Journal of the Federation of American Societies for Experimental Biology, stated "There is a crucial difference in the way bio-identical progesterone and synthetic progestins affect the androgen receptor". (E. Friedman). In 2008 the E3N Cohort Study reported on 80,377 women that had been followed for 8.1 years.This study verified that hormone replacement therapy using medroxyprogesterone (Provera) was dangerous and resulted in a 48% increase in the rate of invasive breast cancer compared to the control group! But possibly more importantly, they confirmed that bio-identical hormone replacement therapy does not increase the risk of invasive breast cancer.

Going back to 2005 a meta analysis of 196 studies concluded that: "physiologic data and clinical outcomes demonstrate that bio-identical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bio-identical hormones remain the preferred method of hormone replacement therapy."

I hope this blog has touched sufficientlyon the need to avoid synthetic hormones, and in this case synthetic progesterone (progestins, Provera, medroxyprogesterone, and many others). Bio-identical hormones are preferred, hands down. #progesterone #htca #bhrt #bioidentical #menopause

Anne R Trussell MD
owner/physician
Sei Bella Med Spa
501-228-6237

Literature sources:
Anderson, Carl W., and Ettorre Apella 2005, Postranslational modification of p53: Upstream signaling pathways. In the p53 Tumor Suppressor Pathway and Cancer, New York

Fournier, Agnes, Franco Berrino, and Francois Clavell-Chapelon 2008. Unequal risks for breast cancer associated with different hormone replacement therapies: E3N Cohort Study. British Cancer Research and Treatment 107 (1):103-11

JAMA 2002;288(3):321-333

Menopause and Safe Hormone Replacement

Everyday 3500 women enter menopause. Natural menopause usually occurs between the ages of 43 and 55, which means we could live half our life in menopause! Our hormone levels can start dropping 15 years before that, so we should not wait until we actually stop having menstrual cycles to seek treatment. And 20% of men are in andropause by the age of 50. The symptoms are not fun!!

Menopause impacts 25 million women worldwide each year. Most of you know the symptoms.....hot flashes, night sweats, mood swings or depression, sleep problems, fatigue and no sex drive. Those are just the ones I hear most commonly. Menopause is also associated with an increased risk of cardiovascular disease, dementia, and osteoporosis. Men with low testosterone have the same risks and experience fatigue, depression, moodiness, loss of muscle mass, erectile dysfunction and low libido.

We need estrogen! It has 400 functions in the female body. Estrogen deficiency is a state of accelerated aging.  In a 2013 study, researchers estimated that over the past decade 18,600-91,600 postmenopausal women, ages 50-59 who have had hysterectomies may have died prematurely because they were not given estrogen!

WHY NOT?!

Well, in 1991 a large trial called the Women's Health Initiative was begun by the U.S. National Institute of Health. The study was stopped early due to a 41% increase in stroke, 29% increase in heart attacks, 26% increase in breast cancer and a 100% increase in the rate of blood clots. So all doctors were cautioned about hormone replacement in menopause, and to use the lowest dose possible to control symptoms and to only continue treatment for 5 years at the most. There were HUGE flaws in this study. The estrogen being given to women was synthetic, made from pregnant horse urine. These compounds have about 40 different estrogens, none of which bind to the estrogen receptors in our body correctly. Furthermore, some of these women were treated with artificial progesterone as well (progestins or medroxyprogesterone). Women on these synthetic progesterones had the highest rates of breast cancer. If you're taking Premarin or Prempro or other synthetic hormones, then you are exposing yourself to these risks. Just because they are FDA approved, doesn't mean they are safe!

Fortunately we have very safe, effective ad convenient alternatives to synthetic hormones. Bio-identical hormones are not only "natural"; bio-identical means they are EXACTLY like the hormones we used to produce. They bind to our bodies' hormone receptors EXACTLY like the hormones we used to produce. They DO NOT increase our risk of cancer, stroke, blood clots nor heart attacks. As a matter of fact, bio-identical hormones are protective against these things! Specifically testosterone replacement does not cause prostate cancer in men! The French Cohort Study published in 2002 followed 3,175 postmenopausal women taking bio-identical hormones for 9 years, proving there was no increased risk of breast cancer. There are many more studies out there proving the same facts. Most of us have heard about bio-identical creams, which are very safe. But at least in Arkansas, bio-identical hormone pellets are not as widely known about. In Texas, pellets are standard of care.  I personally have had pellets for almost 4 years. I love them! 

The process is simple. You come in for an office visit with me and I take a complete medical history. You have a panel of lab drawn. When that lab is available in about a week, it is entered into the HTCA computer formula, along with your medical history and symptoms. A dose of hormones is then generated which I can adjust as I need to. The prescription is then sent to Well's Pharmacy who ships your pellets that have been calculated specifically for you. The pellets, which are the size of a grain of rice and smaller, are then inserted by me into the fat of your bottom in a quick, painless in- office procedure. It truly takes all of 2-3 minutes to insert them. Your pellets will last 4-6 months and gradually dissolve. When symptoms return, you know it's time to tell me you are ready to be repelleted. Bio-identical hormone pellets are safe, convenient and effective, not to mention healthy! And although this blog has mostly focused on menopause, pellets are very popular in men as well!
 

You can read more on my website at www.seibellamedspa.net.
Give us a call today and get your appointment set up to start feeling better. 501-228-6237

Anne R Trussell MD
owner/physician
Sei Bella Med Spa

#menopause #andropause #bioidenticalhormones #bioidenticalpellets #bhrt #htca #lowT #hormonepellets #hormonereplacementtherapy
 

Literature sources:
de Lignieres, B., et al "Combines hormone replacement therapy and the risk of breast cancer in a French cohort study of 3175 women." Climacteric, 2002 Dec; 5(4):332-40

Friedman, 2013

Bain J, Maturitas 2010; (66):16-22 Kaufmann JM, J Clin Endocrinol Metab 2001;26:833-78

North American Menopause Society

Birge,S, "The use if estrogen in older women," Clini Geriatr Med 2008: 19(3):617-27

Studd, J.W.W., Cardozo, L.Stanzyck, & Thom

Sarrel, et al, "The mortality toll of estrogen avoidance: An analysis of excess deaths among hysterectomized women aged 50-59 years." American Journal Public Health 2013: July 18

Let's Review the Thyroid

I've talked about hypothyroidism in the past, but I thought now would be a good time to review this again. It seems I've had an inordinate number of patients lately who have hypothyroidism. Some I've found through their HTCA lab work when working them up for bio-identical hormone pellet replacement therapy. Some I've picked up on when they come in for weight loss consults, and others have sought me out specifically to evaluate their thyroid.

I had an internal medicine practice for 20 years and thought I was doing a great job managing hypothyroidism (underactive thyroid). Afterall, I have hypothyroidisim myself. I was always taught that TSH and T4 were all the labs you needed to screen for hypothyroidism. If they were normal and the patients didn't feel well then they were probably depressed or just needed to follow a better diet and exercise regimen. Since becoming a Diplomate of the American Academy of Anti-Aging Medicine, I now know TSH (the pituitary hormone) is not the most sensitive test. A patient's free T3 (active thyroid hormone) is the best clue as to whether or not he/she has hypothyroidism. And most importantly we want hormone levels to be "optimal" not just in the "normal" range. 

There are multiple causes of hypothyroidism, but for the purposes of this blog, let's focus on the ones I see most commonly which are primary hypothyroidism (thyroid failure) and conversion failure of T4 (inactive pro-hormone) to T3 (active hormone). Primary hypothyroidism is pretty straight forward. The thyroid basically poops out. This can be do to an autoimmune process like Hashimoto's thyroiditis, radiation treatments, or just general aging. A number of different factors can impair conversion of T4 to T3 and these include:

• Physiological factors: old age or significant calorie restriction with dieting
• Certain medications:  Amiodarone, steroids, beta blockers and synthetic progestins (by the way.... I HATE synthetic hormones)
• Pathological factors: kidney or liver disease, malnutrition, increased cortisol, postop
• Vitamin deficiencies: Zinc, Selenium and Iodine are essential to normal thyroid function.

Hypothyroidism can also be caused by failure of thyroid receptors on organs in the body to actually take up thyroid hormone. This is often seen in adrenal fatigue and that is a whole other topic for a new blog!

In the 1920's it's estimated that about 10% of the population was hypothyroid. By 1940 that doubled to 20% and increased again in 1976 to approximately 30%. Dr. Jacques Hertoghe, a pioneer in thyroid endocrinology has estimated that by 1990 about 80% of the population had some degree of hypothyroidism. Because of all the genetically modified foods, chemicals, stress, medications and synthetic hormones we are exposed to these days, that estimate is probably pretty accurate.

Symptoms of hypothyroidism are depicted in the photos above. So how do we diagnose hypothyroidism? A good history and physical exam of the patient is always the place to start. After that, some or all of the following labs are indicated.....TSH, T4, free T3, rT3, and TPO antibodies. This is a good place for clinicians to start. Again, we want "optimal" levels, not just "normal". How a patient feels should be the main driver of treatment. Of course we use lab to make sure we do not make someone artificially HYPERthyroid which can have adverse effects on the body, too.

There are multiple medications used to treat hypothyroidism. Most well known is probably Synthroid (or its generic levothyroxine). Synthroid is predominantly T4. I personally prefer Naturethroid, WPThyroid or Armour Thyroid. I take NatureThroid myself. It comes in 13 different doses, is hypoallergenic and is a combination of T3 and T4. I like to have T3 on board first thing in the morning and then the T4 that remains can convert to active T3 through the rest of the day. WPThyroid is for patients with gluten sensitivities. All three are made from dessicated pork thyroid. Regardless of which preparation of thyroid medication you take, I highly recommend brand name only. Since generics can vary by 20% from brand name, that could be a big swing month to month in your metabolism and how you feel. It's beyond the scope of this particular blog, but thyroid hormones can also be compounded with any strength and percentage of T4 and T3 a doctor wants to prescribe. 

And just as a side note....your fur babies can become hypothyroid, too. So if they are fat and lethargic and you haven't been feeding them junk, you might want to ask your vet to check their thyroid. But it's not just about being overweight or fatigued. Optimal thyroid function improves many aspects of our body, not just the ones we can see and feel. It helps lower cholesterol, improves congestive heart failure by helping the heart pump better, decreases inflammatory markers like C-reactive protein and homocysteine, and helps protect the bones from osteoporosis.

This is just a very brief overview of hypothyroidism. Many, many textbooks are devoted entirely to the thyroid and its diseases and metabolism. There are so many other things we could cover, but we'll save those for another day! At Sei Bella we wish you all the best Health|Wellness|Beauty!

Anne R Trussell MD
owner/physician
501-228-6237

SculpSure results from Sei Bella Med Spa

Recent photos from Sei Bella patients. 

www.sculpsureoflittlerock.com

501-228-6237

                                           50 year old female after one treatment of SculpSure

                   54 year old male 6 weeks after one treatment of flanks and lower abdomen.
                                                      4 inches lost with SculpSure

#sculpsure #fatloss #bodycontouring #flanks #backfat

501-228-6237