This is the next thing in non-surgical aesthetics. It involves taking a small piece of skin from behind the ear [“punch biopsy”] and growing your cells in a culture medium. This produces millions of new cells. Then, these cells are returned back to you with an injection into the skin.
It’s going under the working name of “LAVIV” therapy by Fibrocell Science. Preliminary studies for wrinkles and acne scars have been promising. The company has done Phase 2 and Phase 3 studies, which were placebo controlled, multicenter and randomized [keep in mind…they were not double blinded!]
109 patients received Fibrocell treatment several weeks apart. There was a 43% cosmetic response vs. 18% placebo.

My Take: This is still some time off in the future. If it does work, it will work for fine wrinkles and mild acne scarring. It won’t build the volume that fillers do, but may have a role as an adjunct to filler work. Cost is another issue, and I imagine this won’t be cheap!

What is cellulite? My research has yielded some answers to this question. Cellulite is caused by a loss of collagen in the dermis and as a result the fat herniates upwards through the dermis and causes the lumpiness on the skin. It has nothing to do with “toxins” or “poor lymphatic flow” or other such nonsense. In fact, the study which I published in the Journal of Cosmetic Dermatology, which is a peer-reviewed medical journal, has shown that, quite uniformly, that women with cellulite have lost collagen in the dermis. In fact, earlier biopsies performed at Rockefeller University have also confirmed this finding. It has nothing to do with your weight, your shoes or clothing or anything else like this. It’s all about collagen.
So…what can be done? Collagen boosting creams do have some role here, but in my opinion, they work best if done in conjunction with some technology
Here’s a run down of the technologies which I think work: Intense Pulsed Light: for mild cellulite and light skin
Accent: About a 30-50% improvement in the texture of the skin and appearance
Smooth Shapes: All the advantages of the Velashape but it has a diode laser that targets fat.

Just remember….results can always vary and it’s impossible to predict who may and who may not get a response. Also, if it “sounds crazy”, it probably is!

Let’s face it. When it comes to acne scarring, very few things can really help, at least in my experience. A study out of Korea has shown that when “Fractionated Laser” [Fraxel, Affirm, CO2 lasers] are done for acne, in combination with subcision [which involves using a tiny 29-Gauuge needle and going under the scar], in conjunction with localized chemical peeling, the severity of the scarring decreased by 50%! That is an excellent outcome!. The fractionated laser, such as the Affirm, is excellent in improving the shallow acne scars. In the study done, 3-4 treatments were done. After the lasers were done, clients underwent peeling and subcision twice, 2-3 months apart. The peels used were quite “strong”, up to 100% TCA peels, which is much stronger than that used in the “South Beach” Peel.

AFFIRM LASER FOR SCARS

Non-ablative lasers, such as the Affirm, are safe and effective for treating scars. A study just performed by Dr. Vasily and published in the Journal of Drugs in Dermatology 2009. The study has shown an excellent improvement in 40% of scars and a good improvement in 30% of scars. A majority of scars that were more than 10 years old still responded. The aesthetic response was correlated with positive changes in the tissue [“histology”]

Photodynamic Therapy for Acne

This is a very useful treatment for acne, and one that can be used when you have “failed” the typical treatments that are used to treat it. What can you expect in terms of results? According to the Journal of the European Academy of Dermatology and Venerology 2009 has shown a 70% decrease in the “inflammatory” acne and a 66% decrease in the “non-inflammatory” acne. Also known as “PDT”, it is not for everyone and it requires you to really listen to the post-treatment instructions!!!

Taking Care of Your Skin in the Winter

The most important thing to remember is that you must use a moisturizer frequently for it to work, as well as continuing your sunblock because of UVA radiation. UVA radiation, which ages the skin, is constant throughout the year. Also, because the winter’s cold can irritate the skin, it is important to keep up your water intake! The sensitivity to the cold can make you more sensitive to chemical peels and microdermabrasions, but you can still do these procedures with proper attention to details. I advise my clients to be careful with over-exfoliation, especially when the skin has been beaten down by the cold. Also, just remember, just because its natural doesn’t mean it’s good. There is medically accepted term as “sensitive skin” and we all need to understand that this is a marketing term more than anything else. In truth, we all have sensitive skin!

Welcome to our March 2010 health update, where I list this month’s new findings in Medicine and Aesthetics. As always, this does not replace an actual medical visit and it is not intended for use in making important personal medical and treatment decisions. This is a “jump board” for information only.

Diabetes Care:

When it comes to Diabetes, doctors like to follow the “A1c” level as a means of determining if the blood sugar has remained in acceptable ranges. In a recent report, it seems that an A1c level less than 7.5 increases death rates among diabetes. This is probably due to that fact that hypoglycemia [low blood sugar] carries a real risk.

Osteoporosis/ Fosamax Nightmare?

Fosamax is a prescription drug used for osteoporosis. It is part of a class of drugs called Bisphosonates. These class of drugs are used to treat osteoporosis. They may also be associated with lower rates of breast cancer, though they are known to have side effect of producing osteonecrosis of the jaw. Now, a new concern is that the bisphonate drugs may paradoxically increase the rate of bone fractures…the exact thing they were supposed to prevent. There have been reports of atypical fracture of the femur bone. These seem to occur in folks taking these meds for more than 5 years. Two thirds of those that got fractures had them on both sides. Yikes! This risk has not been seen with Evista, which is a NON-bisphosphonate drug and the one that seems to decrease the risk of breast cancer. Some thought is that those on Fosamax may want to take a drug holiday after 5 years, or switch to Evista.

Colon Cancer Screen:

Wouldn’t it be nice if you could swallow a capsule and have it take pictures all the way down the tract when it was time for a colon cancer screen? Colon cancer is a preventable …if you get screened in time. The test of choice is a colonoscopy. I am not a fan of virtual colonoscopy because of the radiation exposure. A wireless capsule would be great…..but…..data presented at the 13th World Congress of Gastroenterology found the capsule was only 39% sensitive as a test when it came to imaging the colon. So…it’s not ready for Prime Time yet.

Green Tea and Lung Cancer:

Chemoprevention is a hugh topic in medicine and the quest for natural products that can actually decrease your risk of various cancers has been disappointing. With that perspective, another study has shown that current and former smokers who do not drink green tea have a 13x more likely risk of developing lung cancer vs. those who consume at least one cup a day. It seems to be the polyphenols in green tea. Of course, it would be stupid to think that you can still smoke and drink green tea and all will be good in the world. If you want to decrease your risk, you must stop smoking. Period.

Paxil and Tamoxifen Warning:

Women who take Paxil and Tamoxifen were up to 90% more likely to die of their disease vs. those who did not take this combination. This was a population study in Canada. Paxil is part of a class of drugs called SSRI’s. As a class, it is known to inhibit “P450 2Ds”, which is an enzyme which is needed to convert Tamoxifen to endoxifen. These results only seem to be seen with Paxil, not with the other SSRI’s. It may be due to the fact that Paxil is an irreversible inhibitor of this enzyme. So MD’s are therefore now recommending non-SSRI anti-depressants when some one is on Tamoxifen.

I want to thank Dr Fink for allowing me to be a guest blogger today. I started reading his blog and saw that he did not have any posts about why his patients come to him, and why they feel safe with him. I asked… he said yes,…so here I go… I have been a patient of Dr Fink for over 5 years. He has not only been able to help me slow down the process of aging with an amazing daily non- invasive skin care regiment along with a few yearly treatments of fillers. Dr Fink is also my Internal Medicine Doctor for many, many, reasons but primarily because the Doctor is ALWAYS IN! He really gives new meaning to bedside manner.

Aside from over 20 years of experience, Dr Fink’s practice reflects his diverse training and personal experiences. A clinical instructor in aesthetics, Dr Fink has taught Botox, Fillers and Laser throughout the US, Australia and Asia. In as such, he has performed or supervised thousands of cases. Further, Dr Fink maintains an active Concierge practice in both Internal Medicine and Pulmonary, providing a wide range of care and second opinions. His office is NOT a medical spa, and his philosophy has always been to invest in the people and the technology and not the frivolity of a “medspa”. Furthermore, Dr Fink’s office does not offer technologies that he personally feels don’t work, or that work well enough to justify a client spending money on them. Dr Fink continues to consult to the medical spa industry and teach lasers to aestheticians on a monthly basis.

So, if it’s a difficult case that seems to have eluded a diagnosis, or someone that simply wants to know what medical breakthroughs may apply to their case, or a trusting hand to do your Botox, filler or laser procedure, than his office is the place for you.

Dr Fink thanks for allowing me to boast about you and your practice and I will see you next week for my Kiss & Tell Party. If you don’t know about his Kiss & Tell Parties – check it out I promise you and your friends will have a blast and come out looking Kissable!!

Best,
Denise P

Hormone Vaccine against Breast Cancer?

Researchers are pursuing a vaccine that could trick your body into thinking it’s pregnant. It is well known that short-term exposure in early adulthood to the hormones of late pregnancy and to the hormones of lactation offers a life long risk reduction against breast cancer. Early in the 1700’s, Dr. Bernardo Ramazzini described breast cancer as an “occupational disease of nuns”. Even if we got rid of the “risk factors” for breast cancer, such as obesity, excess alcohol and hormone therapy, we would drop the incidence of breast cancer from 180,000 cases a year to 140,000. That’s not much! What about genetics? In a study published in The New England Journal of Medicine, in a study that looked at “SNP’s”, which are changes in genes that can cause disease, these changes only elevated the risk by 1.5 fold, which is truly not much, as compared to those without single gene mutations. What is it about pregnancy that decreases risk? No one really knows, but the bet is against it being estrogen and progesterone’s.

Wounds that Won’t Heal: WARNING

Poorly healing wounds are a major problem, and it’s often seen in diabetics and people with poor circulation. Negative Pressure devices have been used to aid in the healing of these chronic wounds. Now, the FDA has issued a warning AGAINST these devices. Deaths have been reported, and have been associated with bleeding, infection and other problems. Negative pressure is appropriate for the right type of wound, however. Some of the problems may have arisen because most wound dressings are changed every day, but negative pressure bandages are not. These are the wounds in which Negative Pressure Devices are NOT appropriate:

1. Exposed nerves, or exposed vessels
2. Untreated infections of the bone [osteomyelitis]
3. Dead tissue present
4. Fistulas
5. Wound Infections

Morning Sickness Alert:

Don’t take Nzu, also sold under the names of Calabash clay, Calabar stone, Mabele, Argile, and La Craie. These are sold in health food stores for morning sickness, and have been found to contain high levels of Arsenic and Lead. My Advice: Acupuncture and Ginger.

The Long QT syndrome:

This is a genetic disease that seems to occur more commonly, maybe due to better patient education about it. The story is “a young athlete that died while training.” The family is devastated and lives are ruined. The truth is that we can screen for this. This disease affects the potassium or sodium channels in the heart. These patients may develop symptoms of fainting, tachycardia and eventually sudden death. In general, in addition to the EKG on the patient, we believe it is important to screen the first degree relatives as well, as this is a genetic disease. A “QTc” longer than 450 msec in men and 470 msec in women is considered worthy of more investigation. It is caused by 12 separate genes. WE call these “LQT 1-12”. The “causative mutation” can be seen in 70% of high-probability cases…not “100%”…so a negative gene test at this point in time does not rule out Long QT syndrome. The arrhythmia, or abnormal heart beat, is typically brought out by swimming, exercise and emotions. Those with a mutation of LQT1 are the highest risk for exercise or emotion-induced rhythm problems, and a group of medications called Beta Blockers are used to treat it. Those with mutations in LQT3 are at a higher risk of getting an arrhythmia when they are at rest or sleeping. In addition to drug therapy, certain drugs must be avoided and these can be seen at www.qtdrugs.org.

New Hope for Hepatitis C?

No vaccine. Not yet. But at least there is some drug therapy. Telaprevir [VX 950: Johnson and Johnson] is a protease inhibitor, something that emerged as a result of HIV research. When it is added to the standard drug therapy for Hepatitis C, it leads to a sustained Virological response [less virus] in those who previously failed drug therapy. This study looked at those with HCV 1 and was called the “PROVE3” study. Another weapon in the war against Hep C has been added!

Acne: Which is Better?

Adapalene 0.1% gel or BenzaClin? In a recent study, BenzaClin won. 43% vs. a 20% response. Wow….we have been using this for years already. Keep in mind that Adapalene is a retinoid and may prevent you from having other aesthetic procedures performed!

New Treatment for Cold Sores?

Combining a 5% acyclovir cream, with a steroid cream can prevent recurrent herpes ulcers. This product was recently approved, but not yet named. This product, however, seems to prevent cold sore development and would be the first topical to do so.

Checking Back Daily for more Blog Posts. Looking forward to seeing you soon.

Dr Josh Fink

This event is only open to MD’s, DO’s, RN’s, DMD’s, NP’s and PA’s. Only OUR program offers continued SUPPORT from our instructors when you are done!
Book on-line or contact our Call Center “24/7″ at :
1-888-281-8594
or reach us at:
www.aestheticcertification.com

 A Kiss and Tell Party is an excuse to grab some friends for a bit of pampering, a glass of wine and fun!

A Kiss and Tell Party is all about beautiful results, instant results, that will make you look 5 years younger or more!

What is A Kiss and Tell Party?  It’s simple. We make your face kissable with non-surgical aesthetics, you look so good, you tell all of your friends. I will be on hand with my therapists to offer whatever treatments you would like for a couple of hours while you mingle with your friends over a cocktail. You can schedule a Kiss and Tell Party at your home, office or anywhere else you get together with your friends.

 What do we offer at our Kiss and Tell Parties? Botox, Juvederm, Restylane and chemical peels, as well as on the product lines that you may be using. These parties are fun, informative and very affordable.

What are the results of a Kiss and Tell Party? Eliminate those laugh lines, regain the volume in your cheeks, get rid of the crow’s feet and the “11’s”, enhance the lips, smooth the skin, get rid of the sun damage. Find a great skin treatment that will help reduce fine lines and wrinkles. This girl’s night out can make you look 5 years younger or more!

Call us at 914-393-4127 for more information or to schedule your Kiss and Tell Party. It’s a great opportunity to have a night out with the girls and come home looking kissable!

Looking forward to seeing you at a Kiss and Tell Party soon!

Xoxo

Dr Josh Fink

http://www.drjoshfink.com/

   

 Our office treats many individuals with asthma. One of the most important things that I need to reinforce with my patients is that asthma is a livable condition, but, unless it is controlled properly, and patient understand the warning signs of “when the asthma is out of control”, the situation can turn deadly, very quickly. Fortunately, warning signs are usually present before this ever happens, and an asthmatic can have a normal and productive life.

Here are the warning signs I tell my patients about:

1.   Using your Proventyl inhaler more than usual. If you use it once a day, and now three times a day, the inflammation is the problem, and it’s the inflammation that needs to be addresses.

2.   Asthma, a cough or “tightness” that waked you up at night, especially between 3-5 AM is a warning sign.

3.   Shortness of breath that limits exercise more so than usual.

    This is not meant to be an inclusive list, but are 3 of the more common warning signs that I have seen  in 20 years of practice. Most importantly, talk to us about your asthma, and together we may be able to figure out your particular warning signs and show you ways to keep yourself in optimum health and condition.

Although aesthetics are a large focus of my practice, keep in mind I have 20 years of experience in Internal Medicine and Pulmonary Medicine.  I am Board Certified in both Internal Medicine and Pulmonary Diseases, and I have  earned the reputation, substantiated by many of my associates and patients, as being one of the best in differential diagnosis and determining the cause of a person’s problems when many other doctors may have given up.

Arthritis can have many causes. It can be caused by degeneration, aging, being overweight or from an immune disorder, such as Rheumatoid Arthritis. Some of these disorders can be treated with an array of drugs, while others are more frustrating. Patients always ask me about Glucosamine and Chondroitin, or Knox Gelatin. They want to know if these can help. Often, you’ll see these combined with MSM, Magnesium, Calcium and anti-oxidants. My answer here is “I think they are over-hyped”.  The only thing that I have found to work, aside from things like Motrin, is exercise and omega-3 fish oils, which need to be taken in high enough doses in order to make a difference. My patients are usually recommended to take the fish oil from The Sear Zone, which sells pharmaceutical grade fish oil without any Mercury or PCB’s.  Usually 4 pills a day, but the dose may vary if the person is already on a platelet thinning drug, such as aspirin. Fish oils, are in many ways, the new Chicken Soup of medicine.

Your Internist can help tell you what type of arthritis you have, with a physical exam and some simple blood work and possibly an X-ray.  Even with the best treatment, sometimes arthritis can progress to the point of a joint replacement, but in general, we believe in an aggressive approach to treating the underlying disorder before this may become an issue.

The treatment of many different types of auto-immune arthritis has changed over many years, essentially with more aggressive and earlier intervention in the arthritis, especially Rheumatoid and Psoriatic arthritis. The use of “anti-TNF” drugs has revolutionized the treatment of these diseases, though these drugs carry risks, such as an increased risk of infections as well as possibly increasing the risk of lymphoma and leukemia. Some of these drugs have been withdrawn from the market due to the fact that they caused a re-activation of the JC virus in the brain and led to severe neurological effects.  This must be considered before starting any type of aggressive therapy.      

Best,

Josh