Collagen 101

Let’s start with collagen first. This protein comprises 30% of your body’s protein. It is the powerhouse behind your skin’s strength but also your bones, ligaments, tendons, blood vessels and gut lining. Young vibrant skin; strong, healthy bones; powerful, injury resistant muscles- they share the attribute of abundant collagen molecules.

We start our lives programmed to make LOTS of collagen. In the skin, special cells called fibroblasts create collagen molecules from amino acids and beautifully process these long chains into triple stranded fibrils. In our twenties, we take these tireless dedicated fibroblasts for granted. But somewhere in the mid-thirties, the balance of making and breaking down collagen begins to tip toward collagen loss. 

In our skin, we lose roughly 2% of our dermal collagen each year. As the decades advance, there are telltale signs of critical losses: the first wrinkles clock in during the late 30’s, sagging in the jowls and cheeks in the 40’s and 50’s, vertical lines on the chest are 60’s surprise. The biggest shock seems to be what happens next and seemingly overnight: a diffuse crepiness of arms, legs, abdomen, knees and more.

Why the increased breakdown? Chronic sun exposure, inflammation anywhere in the body, stress, poor diet and nutrition are factors leading to collagen damage. The microscope shows this damage convincingly. What once looked like bright pink orderly arranged wavy fibers of dermal collagen in twenty year old skin now looks like amorphous chewed bubble gum two decades later.

Collagen Building 

OK, where’s the optimism here, you ask? It’s this:  everything we do and recommend for your skin at GPD is focused on promoting healthier, more abundant collagen. Every laser and radiofrequency treatment delivers energy into the dermis, signaling the fibroblasts (our collagen producing cells) to ramp up collagen production. The antioxidants, sunscreens, peptide molecules, and growth factors we recommend help to lessen the ongoing daily loss of collagen by preventing damage/breakdown while simultaneously stimulating more fibroblast activity. Every filler has been shown to positively influence our skin and increase collagen output. Look at the picture below for proof: it is a close up view of our patient’s fibroblast after filler treatment. You can see hundreds of new collagen fibers seen lengthwise (blue arrow) and on end (red arrow)!

Collagen Peptides

Most recently, we did a deep dive into the science of collagen peptides as a dietary supplement. These are fragments of the collagen molecule and they contain all the building blocks (aka amino acids) that your fibroblasts need to fuel their productivity of collagen. Published studies show the benefit of daily ingestion: increased hydration, improved elasticity, and a decrease in fine lines- as early as 4 weeks in. To reap these benefits, we recommend your collagen peptide powder has at least 10 grams of protein per serving. This ensures that the amino acids can reach an adequate level in your body after ingestion. Also, the glycine content in the product must be higher than the other amino acids by a factor of two to three. The reason for this is simple math. Every third amino acid in the collagen molecule is a glycine which allows the long chain to twist upon itself to form the triple helix fiber which will beautifully support your skin! There are many products available, but suggestions are Live Conscious Collagen Peptides, Great Lakes Collagen Hydrolysate (Trader Joe’s), Vital Proteins, and Maxi-health Collagen Powder.

Mix the powder into whatever you drink in the morning. Follow a healthy diet to ensure adequate vitamin and mineral intake. Vitamin C, zinc, and copper are also necessary for collagen production. Finally, protect your skin’s collagen from sun damage with a daily sunscreen. Your fibroblasts will stay busy and your skin, happy!

Reports recently in the press discussed three patients who developed facial swelling or lip swelling within 1-2 days of receiving their vaccine. We wanted to take the opportunity to teach about delayed soft-tissue filler reactions and share what this may mean for patients who have had soft tissue fillers injected. These injectables should not be confused with Botox or Dysport injections.

There are currently two FDA-authorized COVID-19 vaccines: Pfizer and Moderna. Both are two-doses separated by a few weeks. Although there are two vaccines, to date, there have only been reports of transient swelling with the Moderna vaccine. It is certainly possible with the Pfizer vaccine; however, it was not reported in the Pfizer trial.

What actually happened to these patients who got swelling?

Of the 15,184 patients who received at least one dose of the Moderna vaccine, three patients reported swelling. This is a rare reaction that yields a likelihood of occurring to 0.02% (2 out of 10,000 people) of those who are vaccinated.  The three patients were women. The first reported case was a 51-year old woman who had filler within two weeks of getting vaccinated and developed facial swelling two days after her first dose. The second case was a 46-year old woman who had filler six months earlier and developed swelling one day after her first dose. And lastly, a 29-year old woman who had multiple lip fillers developed lip swelling two days after receiving the vaccine. Of note, this patient had previously developed lip swelling with the flu vaccine. All three patients experienced transient swelling which resolved without any lasting effect.

I had Botox – does this apply to me?

No, the described reaction has only been reported amongst those who have received soft-tissue fillers not Botox, Dysport, Xeomin, or Jeaveau.

Why would fillers react this way and is it any specific filler that I have received?

You may be wondering why fillers would cause swelling but we know that anything that upregulates the immune system – whether it be a bacterial or viral infection, dental procedures, or any vaccination – may cause a delayed soft-tissue filler reaction. We have learned that certain filler products are more immunogenic than others and cause delayed reactions in approximately 1% of patients injected. Namely, the specific technology known as Vycross, found in Voluma, Vollure, and Volbella, has been associated with this delayed swelling. As a result, we at Gramercy Park Dermatology have not used any products in this family of fillers since March 2017. (Humphrey et al. J Amer Acad Dermatol, 2020, pp.86-95.)

 I had filler in the past year, should I not get vaccinated?

You should not delay getting vaccinated.

If I know that I am going to get vaccinated, when should I plan my filler appointment?

For those patients that know when they’re going to get vaccinated, they may wait two weeks before and after vaccination to have soft-tissue fillers injected.

In summary, we do not anticipate any of our patients will experience this rare reaction. However, we have expertise in treating delayed reactions such as the ones described in the vaccine trials, and we know that this is a transient sign of a normal intact immune system. As board-certified dermatologists, we are adept and ready to handle any filler reaction to the vaccine.

Here at GPD, we are obsessed with antioxidants, so when we think about the absolute essentials of a skincare regimen, vitamin C is always included.  Here is everything you ever need to know about:

• which vitamin C you should choose 

• when you should apply vitamin C, and

• the multitude of reasons why you need ascorbic acid in your life (and on your face, neck, and hands). 

Vitamin C is important for all age groups and skin types

Vitamin C is scientifically known as ascorbic acid.  We humans don’t naturally produce enough vitamin C to reach the skin because we lack a necessary enzyme. So, if you want the benefits of vitamin C, you have to apply it to your skin. Bonus: it is also one of a handful products that may be used through pregnancy and nursing. 

Vitamin C has far-reaching benefits

As an antioxidant, vitamin C squelches free radicals from sun and other damage – free radicals are particles that cause inflammation. Vitamin C not only stabilizes and protects collagen from degrading, it stimulates an increase in collagen production. Think thicker, collagen-rich skin. One of its lesser recognized effects, vitamin C decreases melanin formation. This means decreasing pigmentation, or evening out skin tone. These can be pigmentary changes driven by aging or  hormones such as in melasma. Patients often describe this as a brightening effect – there is enhanced skin radiance. 

Apply in the morning, under sunblock

There are many products that include ascorbic acid in their nighttime formulations, however, it’s best use is first thing in the morning underneath sunblock. Vitamin C should not be coupled with retinol or niacinamide as their pH levels are incompatible. Apply vitamin C first then layer on your moisturizer and sunblock. It will serve as a safety net against damage from UV rays that penetrate past your sunblock. It is also a second layer of defense beyond your sunscreen, protecting your skin cells from other harmful agents besides UV radiation.  Vitamin C can be a liquid solution, a gel, a powder mixed in with your moisturizer, or a serum stored in ampules or delivered via a dropper.

Store your vitamin C in a temperature-controlled spot with minimal light

Vitamin C is prone to oxidizing or going bad with exposure to light or air. A vitamin C product will naturally darken in color as it oxidizes (reacts to oxygen).  Store your vitamin C in a temperature-controlled location with minimal light – but not so far away that you forget to use it! And if your product does not darken with time, it may not have the active C you think it has.

Now you know what to do – which should you use? There are many options. Often, vitamin C is pricey mostly because of the difficulty in formulating and packaging a lasting product that you can use before it oxidizes.  We’ve inserted topical vitamin C options at every price point below. If you already  have a vitamin C product, make sure that it has 8-20% ascorbic acid. Also, the list of ingredients should be relatively short. More ingredients mean that the vitamin C is unlikely to stay stable with all its co-ingredients. 

At the drugstore

L’Oreal Revitalift – easy to find, gel

La Roche-Posay Vitamin C Serum  - easy to find, liquid serum 

Online

Elizabeth Arden Vitamin C Ceramide Capsules – individually-packaged ampoules, easy for travel

Kiehl’s Powerful-Strength Line-Reducing Concentrate - 

Summer Fridays – CC Serum – green product

SkinCeuticals Serum 20 – acne or rosacea-prone skin

SkinCeuticals C E Ferulic – dry skin

SkinCeuticals Phloretin CF – melasma or pigmented skin

Physician-Office Dispensed

Skin Better Science Alto Defense –in a pump ; vitamin C, E, ferulic, glutathione, and niacinamide, plus others! Can be purchased online as well : https://skinbetter.pro/gramercyparkdermatology.

Posted by Dr. Panta Rouhani Schaffer

Not your mother, Mother Nature

True, these beautiful up-close viral images attract my attention and speak to the exquisite design of Mother Nature.

But how she allowed this tiny piece of genetic material to become so destructive is hard to understand. Patients have heard me lament about viruses for years: they are wimpy little pieces of RNA and DNA, and yet they’re capable of taking over our sophisticated, much larger machinery.

The COVID-19 virus is a mere 30,000 genetic units or base pairs. The human genome has 3 billion, which means that COVID-19 is 100,000 times smaller. In perspective, if the viral genome is the width of a nickel, your DNA would be as long as nearly 2000 football fields.

So who’s in charge here? We are. Humans. Our science will prevail:  vaccines are on the way; some medicines may already be helpful in stopping COVID-19 from attaching to our cells and directing our DNA.  There may also be treatment to slow or prevent the fibrosing lung disease that is responsible for the unimaginable mortality rates.

And who can control its spread? We can. Humans. We can behave as if each one of us already has the virus and self-isolate. Some of us may not have symptoms, and the infectious period can last up to 3 weeks. Only our vigilance can control the spread, buy time for science to succeed, allow our health care systems to refortify.

Maybe Mother (Nature) was just trying to remind us of our strengths. Intelligence and perseverance. COVID-19 is just following what its coding tells it to do. We are smarter, and have choice and will.

#NoMatchforHumans

.

So you’ve noticed dark spots, or hyper-pigmentation, on your face or body.  Today, we share with you the use of the quality-switched neodymium yttrium-aluminum-garnet laser, abbreviated as the Q-switched Nd: YAG.

Hyper-pigmentation, which is simply the result of uneven distribution of melanin, requires two initial steps before successful treatment: 

1. Identification of the most likely cause or trigger.

2. Identification of the laser that will most effectively clear the undesired spots or patches.

There are many causes of hyperpigmentation:

• sun-exposure

• skin irritation or skin allergies

• medication

• stains from inflammation in the skin

• hormonal due to either birth control or pregnancy.

At Gramercy Park Dermatology, we have purposely selected multiple lasers with different wavelengths and mechanisms of action to address each individual case of hyper-pigmentation.

A lovely young woman presented to us with controlled skin lupus. Her actual skin condition was treated and now in remission but it left her with undesirable dark patches on her chest. She had skin biopsies and multiple laser test spots to help identify the best course for treatment. The Q-switched Nd: YAG yielded the most impressive test spot.

The Q-switched Nd: YAG uses acoustic waves to break up deep pigment that is too large for our body to process. In this pictorial depiction, you see the laser light and the sound waves of the Q-switched Nd: YAG breaking up the deep pigment, allowing the patient’s body to finally clear the residual hyperpigmentation from her skin condition.

The Q-switched Nd: YAG is non-invasive, without discomfort, and without downtime. Four laser sessions later, her chest was restored to its baseline. Using the science of sound waves, the Q-switched Nd: YAG laser delivers an innovative solution for hyper-pigmentation.

Before and one month after my PRP treatment.

When you work in the aesthetics world, you get to test a lot of products and procedures, and I’m game for most things. Last month I volunteered for our latest procedure, platelet rich plasma (you might know it as the “vampire lift”). I had my blood drawn first, and then a portion of that blood was used for both injection into a scar on my cheek and for topical application along with microneedling. The whole process took less than 30 minutes

Now for the best part...the results! My face had NEVER responded so quickly and positively to one single treatment as it has with PRP/microneedling. Over the next two days, my face peeled quite a bit but all the while remained very bright and healthy looking. My pores are much less noticeable and my skin feels firmer. I have not had to wear as much foundation as before and can get away with  Elta tinted sunscreen and feel good about my skin. My husband even noticed that my skin glows and others have mentioned it as well. I strongly believe the PRP really helped my skin feel alive and restored it to a much better level of health and fitness. I really look forward to my second treatment and promise to keep everyone updated!

See below for more information on how Platelet Rich Plasma can help rejuvenate your skin with its many growth factors:

Posted by Dita Muca

Winter skin dryness is a total skin problem, including hair, nails, and lips! We now have two unique lip fillers to hold water in and continuously hydrate your dry cracked lips all winter long!

Before (top) and immediately following treatment with Volbella

Our newest lip filler, Volbella , will hydrate lips and provide volume. If you’ve ever dreamed of having a naturally fuller lip without the trout-pout, now’s the time. Volbella is a light-weight hyaluronic-based gel with anesthetic already in the syringe. What’s unique about Volbella is the use of patented Vycross technology that crosslinks the hyaluronic acid, providing greater lift without the swelling and making it last longer – up to a year in fact!

Posted by Dr Panta Rouhani Schaffer

Why spend money and time on skin products and treatments if you’re not taking care of your skin’s greatest asset- its DNA.  One way to protect your skin's DNA is with daily SPF, but I’m even more excited about a recent Australian study confirming the benefits of oral Nicotinamide aka Vitamin B3 protecting skin cells from ultraviolet rays. The study strongly shows that Nicotinamide... 

• Enhances skin DNA repair in skin cells and pigmented cells
• Boosts immune protection of the skin
• Increases ATP energy in skin cells
• Decreases pre-cancerous lesions by 35%
• Prevents new skin cancers, especially in high-risk patients

I’m definitely on board; I begin my daily Nicotinamide and  “DNA love” today! Although best results come with twice daily 500mg Nicotinamide (any form), if you’re a once-a-day vitamin popper like me, start with 500mg in the morning. But bump it up for beach time!

Damian DL. Martin AJ. Halliday GM. Nicotinamide for Skin Cancer Chemoprevention. The Melanoma Letter,  A Publication of The Skin Cancer Foundation. Vol 34, Spring 2016.

Posted by Dr. Linda K Franks