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The Skinthusiast
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Category: Physician Assistant

Dermatology PA
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So You Want to be a Derm PA?

on October 13, 2019
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This topic is likely my most asked about. So many of you are on your own path towards a career…

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    the_skinthusiast
    Instagram post 2197617293981644285_4518084886 If you’ve ever had burning or stinging when applying a product, you know how uncomfortable it feels. There is quite a bit of misconception out there regarding what denotes sensitive skin. Furthermore, at a given point your skin may actually become sensitized for various reasons even if you are generally considered a “resistant” skin type. Sensitive skin is associated with much frustration and even decreased quality of life. So understanding your skin type, sensitivity and finding the right products is very important. Sensitive skin is not always associated with visible symptoms and therefore is difficult to “test” for. There are a few different classification systems when it comes to sensitive skin but for the purposes of this post, I will discuss the one used in my personal practice. Using the Baumann Skin Typing System, sensitive skin can be characterized into 4 subtypes: acne, facial flushing and vasodilation or flushing rosacea, burning/itching/stinging and lastly those who are prone to contact and irritant dermatitis. It is of course possible to suffer from multiple sensitivities at the same time. In the absence of any of these sensitivities, we call this a resistant skin type. Furthermore, even those who do not suffer from any of the above conditions or symptoms can become sensitized. I see this commonly when someone starts using a retinoid without any direction or overuses active acids or scrubs. We often see these patients coming in complaining that the products they’ve used for years are all of the sudden causing irritation and stinging when applied. At this point they may even complain that washing with water alone is uncomfortable. In these cases I instruct them to stop using all products and generally recommend a very mild, creamy hydrating cleanser and basic barrier repair moisturizer… I personally love VMV hypoallergenics for both sensitize skin types and those who are currently sensitized. Of course they stop all their retinoids and other active products until the barrier is repaired and they are free of symptoms. You can also see this sensitization after traveling to dry or cold climates, on certain medications, or after certain procedures or
    Instagram post 2196859943431593450_4518084886 When I was home for Thanksgiving someone close to me mentioned how much she loves my instagram account and refers to it when she’s looking for a new product or having a skin issue. It was so heart-warming and honestly made me feel like this is all worth it! That is exactly why I started this account. I was seeing so much misinformation on social media regarding skin care, regimens and skin conditions. Day after day I watched as bloggers recommended whatever PR products they were being sent and viewers (suffering from acne, dry skin, rosacea, etc) clung to their advice in hopes it would finally be the thing to save their skin. At the same time, I understand that not everyone has access or the means to see a provider regularly for their skin. Now, instagram is NEVER, under any circumstance, meant to be used for medical advice. It can, however, be a place of education when it comes to skin care, ingredients, products, and giving you the tools you need to properly care for your own skin. It’s also hard work. It seems silly but maintaining an instagram account is like having a second job. Luckily, it’s a true passion project for me which makes it exciting and a little easier. So, all of this to say that I hope if you’ve found yourself here that these posts are bringing you value and helping you to understand your skin and skin care even better. As always never hesitate to ask me any questions you have or inquire about any topics you’d like me to cover below! Fellow instabloggers... why did you start your accounts?
    Instagram post 2196121227998053807_4518084886 As you all know I believe that great skin care is the foundation to looking and feeling “naturally gorgeous”. However, once you have the basics down, there is no shame in wanting to look a bit more refreshed or seek preventative treatments. Since posting today about my beautiful patient and her neutrotoxin treatment (check her out in my stories) I wanted to answer some commonly asked questions! Do I do Botox? Yes. I have used all of the major neurotoxin brands out there. I treat my forehead and in between my eyebrows about every 3 months. I do my crows feet once a year or so. I started getting neurotoxin treatments when I was 24 years old. All of this varies per individual as we all have different anatomy. Does it hurt? NO! It is honestly so quick and easy. We use numbing cream and ice to make you super comfortable. What’s the downtime? Minimal to none. You will be able to see the injection points for about 30 minutes after the treatment. Most of my patients go right back to work after. It is possible to have some minimal bruising which is usually easily covered with makeup. Stay tuned for a post on things to avoid prior to your neurotoxin or filler treatment to minimize your risk of bruising. How many units will I need? I love this question. There is no way to be able to tell how many units someone will need without first seeing them in person and evaluating their facial anatomy. How long until I see results? You can expect to begin to see results at around 5-7 days. You can expect full results at 10-14 days. Will I look like I’ve had something done? In the right hands with the right dosing, you should experience softening or elimination of your lines while still maintaining some natural movement. If you would like to forgo any movement at all, more neurotoxin can be added at a follow up appointment in 2 weeks if determined appropriate by your provider. I personally prefer my patients (and myself) to have some movement so that their expressions appear natural. However, if you are still creasing and making lines, the dose needs to be increased as the goal is to soften and eliminate dynamic wrinkles. Cont in the comments...
    Instagram post 2195472469497141424_4518084886 The terms “natural” and “organic” are thrown around frequently and often used to convince consumers that products are superior and healthier for you. In the last few years, we have been seeing this increasingly in the beauty and skin care industry. Unfortunately, in the US there is lack of formal regulation of these claims on product labels and what these terms actually mean. Furthermore, just because something is organic, natural, or botanical certainly does not mean it is suitable for application to the skin. In fact, many botanical ingredients and essential oils are known skin irritants. However, there are many unconventional ingredients I love in a skin care routine! If you’re interested in simplifying your regimen and beauty cabinet, put down the lemon juice and coconut oil and take a look at a few all-natural ingredients safe to put on your skin! 1. Jojoba oil- Both a humectant and an occlusive, this oil is expressed from the Simmondsia chinensis plant. It is rich in fatty acids and triglycerides and is naturally antibacterial and anti-inflammatory. I love to you use jojoba as a precleanser/makeup remover. 2. Manuka Honey- We all know by now that bees are an integral part of our ecosystem. Honey has been used for centuries for its wound healing properties and can still be found today in wound care centers across the country. It has antiseptic, antioxidant, anti-inflammatory and antimicrobial activity. Plus, it’s also a natural humectant. 3. Tea Tree oil- The Australian plant Melaleuca alternifolia is the source of tea tree oil. This oil is toxic when ingested orally, however shows promising results when applied topically. It has been shown in clinical studies to effectively treat acne and fungal infections. 4. Cucumber- Another good option for sensitive skin, this anti-iflammatory ingredient can temporarily help puffy eyes and dark circles. Cucumber also has skin lightening effects; although like many of these ingredients further research is necessary. Stay tuned for a post on clean-focused beauty and skin care brands I can get behind!
    Instagram post 2195226991220014767_4518084886 H O L I D A Y Giveaway⁣ ⁣ I’ve teamed up with some dermatology PAs (and fellow #girlbosses), and this holiday season we’re giving away a few of our favorite things! 🎁⁣ ⁣ One winner will receive the following:⁣ @eltamdskincare Foaming Facial Cleanser⁣ @facileskin Essence Ultra Hydration Booster- Hyaluronic Acid Serum⁣ @obagimedical 20% Professional-C Serum⁣ @eltamdskincare UV Elements SPF⁣ ⁣ To enter:⁣ 🎁 Follow⁣ @chelsierogers_pa⁣ @the_skinthusiast⁣ @xo.healthy⁣ @thepolishedpa⁣ ⁣ 🎁 Tag 3 friends in the comments⁣ 🎁 Like this photo⁣ ⁣ Contest will close Wednesday, 12/11 at midnight. Winner will be announced Thursday.🎄✨ US only.
    Instagram post 2194663113872585991_4518084886 Hearing from you all in my DMs about how much you love your product recommendations (skin care and otherwise) makes me so happy! There’s nothing I love more than hearing that you love a product! I can definitely tell which ones resonate with you when I review my analytics at the end of each week. Hint: Vitamin C, SPF and yoga pants are always a hit! So, I thought I would start showing YOU which products my community is loving each week with a new stories segment: “This Week’s Most Wanted”! As far as skin care product recs remember you can ALWAYS check my blog theskinthusisatblog.com for recommendations on how to determine which products may be right for your skin type. As you know, not all products work for each skin type so it’s always a good idea to check these blog posts for reference. I put so much time into creating guides and product recommendations for you guys because I honestly enjoy it and want these things to be accessible to everyone!
    Instagram post 2193938947766607775_4518084886 Feeling inspired after the #CCvisionsummit with @createcultivate . If you ever have the opportunity to attend one of these events I HIGHLY recommend it. I was skeptical and not sure if I would find it worth the price but I can tell you that it was incredible to hear from so many inspiring women! I took away SO many pearls from today. One of the most inspiring was from @mrsadriennebosh on a particularly inspiring panel... she said: it’s the last month of the DECADE if not now then when?! So, whatever you’re on the fence about, nervous to move forward with, feeling like you’re not quite ready for... just do it! You’ll never feel “ready”! Beautiful mural by @haveanicedayy_
    Instagram post 2191612265550534482_4518084886 What would I do if I wasn't a PA? I was inspired by @botoxbybridget 's post this am to think about what I would want to do if I wasn't a Dermatology PA! As many of you may already know I was a political science major on the pre-law track for the first 2 and a half years of undergrad. I was studying for the LSAT when I decided, wait... I don't actually want to do this. Whoops. 16 year-old me had decided that law was a respectable career, and hey I loved to read and argue politics so why not? I went full steam ahead and never really stopped to think if a career as a lawyer was how I wanted to spend my life. Thank goodness I figured it out before I was stuck in a career I didn't like. Rewind even further back.... in grade school and most of high school before reality set in... my heart was set on becoming a fashion and lifestyle editor. I wanted to write for a big magazine and tell my readers about the hottest spring trends and best new skin care products. Honestly, I think this would still be my second choice in career if I wasn't a Dermatology PA. **Images of Anne Hathaway being showered in Chanel anyone? 😂 Now here we are, I've landed on my dream career. I get to talk about skin care ALL DAY with my patients then come home and talk some more to my followers. I think I've found the absolute perfect balance and get to do what I love every single day. I feel so lucky! 💕 What would you do as a second career?
    Instagram post 2186617035646430601_4518084886 Ohhh eye cream.... If you’ve seen the skin care giveaway I’m participating in on my last post (GO ENTER!) you know that the product I’m donating is an eye cream! So let’s talk about why it’s an essential product in any skin care regimen. You may think that an eye cream is just for your nighttime regimen and meant for the last step in your routine. Well, I have all my patients on an eye cream BOTH morning and night and the very first step after cleansing. Why? The delicate skin around our eyes needs moisturization twice daily to prevent and soften the appearance of fine lines. Many eye creams have great active ingredients as well to target various eye issues such as dark circles, puffiness, redundant and crepey skin, etc. Another reason I always recommend an eye cream after cleansing is to protect the eye area from prescription acne medications and retinoids that may follow. And don’t worry, if you want to use your retinoid around the eyes it will still penetrate through the eye cream! **make sure to only use a pea-sized amount of your retinoid to cover your entire face. So while an eye cream may not be high on your list, it’s still a very important skin care product in my opinion! I rotate between 3 different eye creams and tend to use the lighter ones in the morning and thicker ones in the evening! Head over to my stories to see the eye creams you’ll always find on my skin care shelf!
    Instagram post 2185932140934815551_4518084886 In the spirit of Thanksgiving, I’ve teamed up with a few skin care boss babes to gift one lucky follower a gift of our favorite skin care products! We want YOU to know how thankful we are that you’re following along! 🦃 To enter: 1. Like this photo 2. Tag 1 friend in the comments and tell them why you are thankful for them! 3. Follow @lizetteludwig_rn , @botoxbybridget , @breanawheeler_np ,& me @the_skinthusiast For a bonus entry share this post to your story! Winner will win all four products and will be chosen Saturday 11/30! *open to US residents
    Instagram post 2185169193513809756_4518084886 A little baby tox today for this beauty... I often get asked what age is appropriate to start anti-wrinkle injections. The answer is.... it depends. For some, injections may be indicated at a much younger age than others depending on anatomy and muscle strength. The key here is to start getting these treatments BEFORE you see deep wrinkles forming to get ahead of it. Do you notice lines forming when you make expressions? It’s time to make an appointment and have a discussion! Once you’re here we can talk about your options. For this beauty we do some “baby botox” (a low dose of anti-wrinkle injections every couple of months) to prevent aging and smooth dynamic wrinkles while still maintaining natural movement. We have some great specials going on in our Miami office for the Holidays! A total of $175 off your Jeuveau treatment? $150 off when you get an area of Botox plus one syringe of filler with Brilliant Distinctions? Take your pick 😉
    Instagram post 2184588337749505679_4518084886 Are gel manicures safe? I posted on this awhile back, but was inspired by @brownskinderm post to resurrect the topic... especially because the Holidays are a popular time to hit the salon. Gel manicures have been climbing in popularity over the last 5-10 years. They are convenient, long-lasting and aesthetically pleasing. If you’re going to spend the money and time to have your nails done, of course you want an option that lasts 2 weeks, right? However, there are a few pitfalls to the gel manicure. One: as we know, it’s not healthy for our skin to be subjected to repeated UV light and know that regular gel manicures will contribute to aging hands. Hands often show our age quicker than elsewhere on the body because they are ALREADY exposed to more than average UVA light due to activities like driving. Add the concentrated UVA light required for gel manicures and we can infer the rest. Plus, let’s not forget the even scarier effects of UV radiation... melanoma and non-melanoma skin cancers. Lastly, I’m sure you already know that the gel process damages your nails just from your own experience. A small study of 5 participants showed that gel manicures and removal resulted in an objectively measurable decrease in nail width. Also noted was onychoschizia or separation of the nail from the nail plate. Personally, I opt for one of the gel-like, long-lasting at home polishes without light or treat myself to a regular mani in the salon. If swearing off gel manis is too much for you to bare… at least opt for some really cute UV protective gloves to wear under the light to protect the skin on your hands!
    Instagram post 2184379167934778072_4518084886 Vitamin C. You probably know by now that you should be using a quality Vitamin C. But, Why? Vitamin C is the most abundant antioxidant found in the human skin. But it’s not just a powerful antioxidant… it also promotes collagen production, lightens pigment, has anti-inflammatory properties, and has been shown in clinical studies to have photoprotective properties. Absorption of this ingredient is heavily dependent on a few factors, a critical one being the pH of its topical formulation. The pH of these products must be between 2 and 2.5 to be effective. This low pH is what may give you that stinging sensation when you apply a Vitamin C serum. For this reason, I don’t generally recommend L-ascorbic acid for sensitive skin types. For these types, ascorbyl palmitate may be a better option as it does not require such a low pH formulation. The efficacy of topical Vitamin C formulations is also dependent on the processing and packaging. Exposure to UV light and/or air renders Vitamin C preparations useless within hours. As you can imagine formulating a product in such a way and investing in the proper packing is an expense… which is why you should be wary of very inexpensive “Vitamin C” products. Many times Vitamin C is and should be formulated with other ingredients such as Vitamin E, phloretin or ferulic acid to increase stability. Even more, Vitamin C actually recovers oxidized Vitamin E back to its active form returning the Vitamin E back to its powerful antioxidant properties. Talk about a power couple. These two combined with ferulic acid in a clinical trial showed that they work synergistically (even better together) to provide superior protection from photoaging and skin cancer.
    Instagram post 2182350624136732291_4518084886 The holidays can be a tough time to be healthy. We are bombarded with desserts, wine, heavy dishes and who wants to be that person who sits in the corner not enjoying?! Not me! [Ad] So instead of saying NO to the tasty stuff, I focus on adding IN all the good stuff. Before I head to a holiday gathering I’m making sure to check a few boxes: ✅ Get in some movement- whether it be a workout or just a brisk walk. ✅ Make sure I’ve had plenty of water that day. ✅ Get in my daily dose of fruits and veggies. @dailyharvest makes this last one SO easy and delicious. The smoothies are delivered frozen at peak freshness directly to my door. I get to CHOOSE exactly which smoothies (or bowls or bites or oats) come in my box every month. The flavors are so unexpected but so delicious (swipe for how I whip up almond milk for my favorite DH of the season....the carrot and chia 🤤 ). They take literally minutes to blend up and enjoy. & I go on with my night knowing I have a good foundation for a healthy day and if I indulge in a piece of pie or that last glass of wine, I don’t have to feel so guilty about it! You can use code “theskinthusiast” for 25% off your first box!! 👏🏼 How do you stay healthy during the holidays? #dailyharvest
    Instagram post 2181698610511893881_4518084886 Ever wonder if those cult classic skin care products are worth the splurge? Well, I’ve rounded up 7 of my all time faves for a Splurge-Worthy Skin Care Gift Guide... for yourself or someone very special (and super lucky) this Holiday Season! Head over to Theskinthusiastblog.com to read all about it 😍... and maybe even grab a discount code! 😋
    Instagram post 2180963563701835059_4518084886 I’m having a hard time getting back into a good routine since being back from our mini trip. 🌴 What do you do in this case? Do you listen to your mind & body and rest as long as you want? Or do you say “enough is enough” and force yourself to workout knowing you’ll feel better after? 💪🏽
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