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July 27, 2015
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                                                              Fear of Botox!

Many women and men have considered whether they should have Botox (by which I mean, Botox Cosmetic, Xeomin, or Dysport) to improve lines and furrows or harsh facial expressions. Some are fearful about having that first treatment. Recently I have even seen articles in the press wherein celebrities have been quoted as saying they have never and would never have Botox, or, if they have had Botox, that they would not do it again. This has perplexed dermatologists who know some of those celebrities did in fact have the procedure and were delighted with the results.

Some patients, celebrities included, do fib about having Botox. In part this is because we all wish to be thought to be naturally beautiful. People fear that they will be judged as vain. They fear that others will not understand that in our culture our job may depend upon a perception of self-confidence, effortless competency, health and vitality, or that others will not understand the real distress of projecting different emotions than one actually feels. For celebrities, there is fear that directors or producers will be dubious of an actor's ability to express a full range of emotions, or fear a change in facial expression over the course of filming.

When Botox is performed skillfully, the ability to express a full range of emotion remains intact. The brows can lift with conversation and retain a normal arch without being depressed or arched freakishly. Also, facial expressions do not change dramatically over time. This result requires an advanced injector with years of experience who has an intimate knowledge of facial anatomy and function, and who understands that the dosing and pattern of injection varies from patient to patient and evaluates each patient's anatomy and muscular function carefuly prior to deciding upon the treatment plan for that patient both for that day and into the future.
Fear of Botox has developed because when Botox is performed without skill and knowledge, the results can be very bad.  And in the hands of unscrupulous individuals who have injected counterfeit substances, the results can be worse than bad:  the results from this unlicensed, unapproved treatment with counterfeit products have ranged from lack of effect to dangerous side effects. The unfortunate patients who have had counterfeit treatments, or even just treatments by inexperienced individuals with unexpected or undesired results, stand out, but we don't see the far more numerous patients who have had a great result, because these results are invisible when performed well.

Botox has been used for many medical issues with great safety and success. Botox Cosmetic has been proven to help depression. Botox has been successfully employed to prevent migraines and excessive sweating, and to treat muscle spasms, strabismus, torticollis, facial hemiparesis, overactive sphincters, and much more. Used for aesthetic purposes, it also improves self-confidence and makes one feel more in control and eases the distress of having one's emotions misinterpreted.

I will suggest to you what I would tell a member of my family or my closest friends: choose a board-certified dermatologist or plastic surgeon who has had years of experience and extensive and advanced injector training, who has a detailed knowledge of static and functional facial anatomy, who performs the procedure many times each week, and who can explain to you why she or he is recommending a particular pattern of injection. Here is a radical proposition for your consideration: with rare exceptions, because of the ongoing training, knowledge, and experience required to provide great results, this is not a procedure that should be performed by a dentist, gynecologist, family practitioner, ear nose and throat specialist (ENT), internist, nurse practictioner (NP), or physician's assistant (PA), nor with a discount or in a spa or 'Botox party.' If you feel that you are being rushed through the procedure or the doctor is in a hurry, it may not be the right place for you.

If you have found someone who is qualified, and there are many who are, it shouldn't be necessary for you to be vigilant about checking for counterfeit substances, but if you want to know how to do so, please see the video called5 Questions to Ask Before Choosing Your Botox Injector on Sheryl Clark MD's youtube channel , which shows real bottles of Botox, Dysport, and Xeomin, and tells you how to spot a counterfeit bottle.

If patients become more educated and sophisticated in choosing the right provider, perhaps a day will come when they won't feel they have to lie about having had Botox.

What are your thoughts on this topic?

Sheryl Clark MD
Assistant Clinical Professor and Attending in Dermatology, Weill-Cornell School of Medicine and The New York Presbyterian Hospital

                                   9 Reasons We Bruise Easily

I would like to share this post by Dr. Mercola about why we might bruise easily, and what to do to prevent it and to treat it when it happens.  Just a couple of tips:  Vitamin K cream is helpful both in preventing and treating bruises.  Also, the most common causes of bruising in my practice are aging, thinning of the skin from chronic sun exposure, and taking medications such as aspirin, Plavix, Coumadin, Naprosyn, and Aleve, or supplements such as vitamin E, fish oil, garlic, gingko biloba, and St. John's wort. Alcohol also inhibits platelet aggregation and can make you more prone to bruising.

When patients in my practice are undergoing procedures, we review all of this information with them, and typically recommend arnica gel and tablets both before and during or immediately after a procedure, cold compresses, vitamin K, and sometimes a medication called Biafine. Laser of bruises makes them go away in days rather than a week or two, and my patients receive complementary laser for an bruises that might occur despite all of our precautions.  I will employ a blunt-tipped cannula rather than a sharp needle in those who are prone to bruising as well.  As a result, bruising is no longer a major problem when procedures are performed.See Less Bruising and Discomfort with Filler Injections for more information about cannulas.

Here is an image of a bruise. the left half was treated with laser.


This is how it looked approximately 28 hours later:

Reasons Why You Bruise Easily

May 11, 2015 | 182,992 views


By Dr. Mercola

Any type of traumatic injury, such as a fall, can cause capillaries (small blood vessels) near your skin's surface to break and leak red blood cells. This causes the reddish-purple or "black and blue" appearance of bruises on your skin.

Technically known as contusions, bruises may result from virtually any injury to blood vessels in your skin. As your body begins to heal, and metabolizes the blood cells, the bruise will typically fade to a green, yellow, or brown color before disappearing entirely.

It's virtually inevitable that you'll get a bruise once in awhile, but if you have bruises appearing often and can't figure out why, there could be an underlying reason. You may have simply bumped your arm or leg and forgotten, or it could be something else entirely.

9 Reasons You May Bruise Easily

1. Your Age

As you get older, your skin loses some of the protective fatty layer that provides cushioning against bumps and falls. Your skin also becomes thinner while the production of collagen slows. This means that it generally takes much less force to cause a bruise than it did when you were younger.

2. Purpuric Dermatosis

This vascular condition, which is more common in the elderly, causes thousands of tiny bruises, often on your shins, which may have the appearance of cayenne pepper from afar.1 The bruises are the result of blood leaking out of small capillaries.

3. Blood Disorders

Blood disorders such as hemophilia and leukemia can cause unexplained bruising, often because your blood fails to clot properly. If you have severe and frequent unexplained bruising, it's a good idea to see a physician to rule out such disorders, especially if it seemed to come on suddenly.

4. Diabetes

People with diabetes may develop dark skin discolorations, often in areas where skin touches other skin frequently. These discolorations may be mistaken for bruises, but they are actually due to underlying insulin resistance.

5. Excessive Straining During Exercise

Putting your muscles under excessive strain, such as may occur during heavy weight lifting, can cause blood vessels to burst and lead to bruising. Microscopic tears in your muscle fiber caused by exercise can also cause bruises. In addition, if you engage in sports or vigorous exercise, you may be exposed to bumps and small traumas that cause bruises but not remember the actual impacts.

6. Certain Medications

Medications such as aspirin, anticoagulant medications, and anti-platelet agents reduce your blood's clotting ability and make bruising more likely. Medications including aspirin, prednisone, prednisolone, oral contraceptives, and others may also weaken your blood vessels, which increases the likelihood of bruises.2

7. Family History

If you have close family members that tend to bruise easily, there's a chance you will too (although there are usually steps you can take to overcome this potential genetic tendency).

8. Pale Skin

Pale skin doesn't make you more prone to bruising, but it does make any bruises you do get more visible than they would be on someone with darker skin.

9. Sun Damage

While your body needs regular sun exposure to produce vitamin D (and get a host of additional benefits), excessive sun exposure – especially the type that leads to burning – can cause your skin to lose its pliability and resilience. This, in turn, makes bruising easier and more noticeable.

Your Diet May Be the Most Important Factor in How Easily You Bruise

The reason why most people bruise is that their capillaries are too fragile and essentially are easily torn. One of the best ways to ensure that your capillaries remain strong and flexible is to make sure you have an excellent source of bioflavonoids in your diet. Excellent dietary sources of bioflavonoids include dark-colored berries, dark leafy greens, garlic, and onions.

Typically, a well-rounded diet with plenty of organic vegetables and some fruits will be more than sufficient to provide all the micronutrients you will need to prevent bruising from all but the most severe traumas. However, if you bruise easily, the following nutrients will be especially important and if you're not getting enough of them via your diet a supplement may be useful:


Rutin is a bioflavonoid known to strengthen blood vessels. For this reason, it's often used for varicose veins and hemorrhoids, as well as bruising. In fact, a deficiency of bioflavonoids may allow blood vessels to break easier, which is why, if you bruise easily, you would likely benefit from taking rutin.

In one study of people with progressive pigmented purpura, the skin lesions were completely cleared after four weeks of treatment with a rutin (50 mg twice a day) and vitamin C supplement.3


This bioflavonoid, found in citrus peels, is also known for strengthening capillaries. In a study of menopausal women, those who took a daily supplement of hesperidin and vitamin C had reduced bruising.4

Vitamin C

In people with low vitamin C intake, increasing vitamin C has been found to reduce bruising.5 Taking vitamin C along with bioflavonoids like rutin or hesperidin is recommended, as they may improve vitamin C's effectiveness and absorption.6 As reported by the University of Michigan Health System:7

"Even minor deficiencies of vitamin C and possibly of flavonoids can lead to increased bruising. People who bruise easily may benefit from eating more fruits and vegetables, common sources of vitamin C and flavonoids.

Reduce your tendency to bruise by taking a daily combination of at least 400 mg of vitamin C and 400 mg of flavonoids, such as hesperidin or rutin."

10 Natural Remedies to Speed Bruise Healing

The key to avoid bruises is to eat fresh vegetables and fruits regularly.However, if you already have a bruise, nature is full of simple, natural solutions that may help it go away faster. These include:

Arnica oil: Arnica flowers and roots have been used for hundreds of years as an herbal medicine. It has anti-inflammatory properties and also stimulates the flow of white blood cells, which process congested blood to help disperse trapped fluid from your joints, muscles, and bruised tissue.8 Arnica oil is recommended for topical application only and in diluted form, as pure arnica essential oil is very potent and may cause severe side effects. Cabbage leaves: For facial bruises, take the large outer leaves of white cabbage, break the ridges of the leaves and dip them into very hot water. Then apply to the bruise (but make sure they're not scalding hot as you put them on your face). Cold compress: Applying a cold compress to the bruised area can help reduce swelling and pain. The sooner you apply the compress after the injury, the better.
Aloe vera: The fresh gel that comes from the aloe vera plant can help speed up healing from wounds and skin irritations. Calendula: To make a salve, boil one ounce of dried calendula flowers or leaves (or 1/4 teaspoon of fresh juice from the herb) with one ounce of lard. Once the mixture has cooled, apply it to the bruise. This mixture is also good for sprains, pulled muscles, sores, and boils. Fenugreek: To make a poultice, put 1/2 ounce of crushed fenugreek seeds in a small cloth bag and boil it in water for a few minutes. Remove the bag and apply the "tea water" to the area. Make it as hot as you can stand it (but make sure it's not scalding your skin).
Garden Thyme: Put the green plant parts in water and boil them for three to four minutes. Cover the pot and leave it for another two to three minutes. Strain the mixture and add the decoction to your bath water. Soak in it as you would normally. Onion: Apply it raw, directly to the bruise. St. John's Wort: Put 10 to 15 drops of St. John's Wort Oil in water and apply the mixture to the area.
Apple Cider Vinegar: Apply a hot or cold poultice of apple cider vinegar to your bruises. Vitamin K: Topical vitamin K may help to reduce bruising.  

Healthy Skin Comes from the Inside

Eating a healthy diet as described in my nutrition plan, which focuses on whole, bioavailable organic foods, is your number one strategy for helping your body detox naturally while supplying the necessary nutrients your skin needs to thrive. In addition to the tips mentioned above to help prevent easy bruising, some foods are particularly effective at promoting beautiful, clear, healthy skin, including:

  • Animal-based omega-3 fats
  • Vegetables: Ideally fresh, organic and locally grown. Fresh vegetable juice is also wonderful for your skin, as are carotenoids, which give red, orange, and yellow fruits their color, and also occur in green vegetables. Studies have shown that eating foods with these deeply colored pigments can make your face actually look healthier than being tanned.
  • Fermented vegetables are even better as they can start with the same vegetables but are converted by bacteria to superfoods, which help promote the growth of beneficial intestinal bacteria and aid in immune balance and digestion.
  • Astaxanthin—a potent antioxidant—has been found to offer effective protection against sun damage when taken as a daily supplement. Some sunscreens are also starting to use astaxanthin as an ingredient to protect your skin from damage.

We are well into summer now, and in the spirit of enjoying all the joys summer has to offer without the downside, I would like to offer:

                       9 tips for Sunscreen Safety

Throw out your sunscreen with oxybenzone. Research indicates that this common sunscreen ingredient has hormone-disrupting effects.

Replace chemical based sunscreens with zinc oxide-based sunblocks. These can have longer-lasting protection without the harmful ingredients. Zinc oxide protects across the entire UVB and UVA spectrum, to an extent unique to all the sunscreen agents. As a physical blocker, rather than a chemical, it is not depleted as the sun's rays penetrate the skin, and may be safer for us and the environment.

Steer clear of super high SPFs. SPFs over 50 do not actually protect any better than a properly-applied sunscreen of SPF 15 or 30, and one might ask, does putting more chemicals on our skin and in the environment really make sense? If a sunscreen with an SPF of 15 is properly applied to the skin of a person who normally would burn in a hour with no sunscreen, that person would not burn until 15 hours of sun exposure (this assumes no sweating or activities that rub the sunscreen off).  There is evidence that super high SPF sunscreens may give you a false sense of security, parodoxically resulting in more burning. Sunscreen should be reapplied every hour to hour and a half, especially if one is sweating, in the water, or rubbing the skin with clothing or towels, and each application to a body with just a bathing suit on requires a full ounce (what would fit in a shot glass).

Avoid makeup in loose powder form claiming SPF protection (containing zinc or titanium nanoparticles). These could create damage because they’re often inhaled during use and the small particles can get lodged in your lungs.

Avoid indoor tanning. People who regularly get indoor ultraviolet (UV) tanning are 74% more likely to develop melanoma (the most dangerous of skin cancers) than people who have never tanned indoors. According to a JAMA Dermatology study, there are more cases of skin cancer due to tanning than the number of lung cancer cases due to smoking.

Dress to protect. Shield your skin’s elastin and collagen from potentially harmful UV light by wearing a hat and sunglasses when outdoors (and other cover-ups when possible). For water sports, I love the rash guards surfers wear.

Get some Vitamin D. Expose your arms and legs to the sun 5 to 30 minutes twice per week without sunblock but only in the morning and late afternoon hours (to avoid the most damaging rays). If you’re fair-skinned, 5 minutes twice per week is all you need. You can also get vitamin D by eating the following foods: Salmon Wild, Fresh – (3.5 oz = 600–1000 IU of vitamin D3), Cod liver oil (1 tsp = 400–1000 IU of vitamin D3) and Shiitake mushrooms, Sun-dried (3.5 oz = 1600 IU of vitamin D2). Almost everyone should get a 25-OH vitamin D level, and start supplementation with the aim of achieving a level of 50 to 75.  For more on Vitamin D, see my Facebook page, Sheryl Clark MD.

Eat antioxidant rich foods. Studies have shown that a Mediterranean diet, one rich in vegetables, fruit and olive oil, as well as certain dietary supplements incuding niacinamide, and carotenoids, can have sun-protective effects and can combat oxidative damage and prevent skin cancer. Helioplex is an OTC supplement that helps prevent sunburn. Talk to your functional dermatologist about your diet and what supplements you might consider.

Apply a properly-formulated, potent topical antioxidant.  There is considerable scientific evidence that a carefully-manufactured topical antioxidant can, much more effectively that oral antioxidants, protect you from the harmful effects of the sun, while still allowing Vitamin D to be produced from the sun's rays, even when only applied every  few days. Talk to your dermatologist about green tea and vitamin C formulations, such as Citrex and Replenix.

For more information on this and related topics, please visit my FaceBook page,


You can reduce the harmful effects on your body, in terms of increased catecholamines and stress hormones, of missing sleep by taking short naps during the day!

Check out this article:

By Dr. Sheryl Clark
September 02, 2014
Category: Dermal Fillers

As we age, our skin doesn’t always show our youthful energy. Previously, if you wanted to get rid of wrinkles and saggy skin, there weren’t many options available. You might have been told to try out this lotion, or that lotion, but at the end of the day you didn’t notice an improvement.  With advancements in cosmetic dermatology, we have a solution for you.

At our dermatology office, we offer our patients in Upper East Side, New York dermal fillers that can be injected into those crow’s feet, marionette lines and furrows between the brows to take years off your face.  And what is even better is that this can all be done during your lunch hour with no invasive surgery and little recovery time. Let’s take a closer look at the 7 dermal fillers available in our Upper East Side, New York office.

Restylane: A Soft Tissue Dermal Filler

Restylane uses different forms of hyaluronic acid, which is used to replace volume, correcting the lines or wrinkles by plumping and smoothing out the skin depression or areas of fat loss. This dermal filler in the Upper East Side, New York is generally used in the naso-labial folds, marionette lines, laugh lines, jaw line, hollows of the cheeks, nasal contouring, sunken eyes and lip areas.

Long Lasting Results with Perlane

Perlane is similar to Restylane, as it is a long lasting gel that is injected into the skin with an ultra-fine needle. It provides lift and adds volume to help diminish fine lines. The hyaluronic acid in Perlane supplements the body’s age-depleted hyaluronic acid to plump up the lip or to raise the skin and fill in the wrinkle area being treated.

Juvederm: A Dermal Filler with Natural Results

Juvederm is an injectable filler that can improve the appearance of deep facial wrinkles, folds, lines and acne scars. The results are natural and long lasting, which can remain for approximately six months or longer. With very few side effects, Juvederm provides superior results for patients searching for a more youthful appearance.

Radiesse Lasts Longer than Most Dermal Fillers

Radiesse is a soft tissue volumizing filler that lasts longer than other leading fillers. It contains calcium-based microspheres which stimulate your skin to make new collagen and is an immediate correction in a treatment that can be performed over a lunch hour. Radiesse is a next generation volumizing filler that is FDA approved, safe, convenient and long lasting.

Belotero Replaces Lost Hyaluronic Acid

As we age, our skin loses its youthful appearance due to the diminishing production of natural support structures such as hyaluronic acid. Through this, you can experience fine lines and wrinkles. With Belotero—a new Upper East Side New York dermal filler—you can replace lost hyaluronic acid cased by the natural aging process. You will experience very little to no down time associated with Belotero, with most patients returning to their normal, daily activities immediately after visiting our office.

Sculptra Provides Subtle Results Over Time

Sculptra is the first volumizing filler that gives you subtle results over time, rather than overnight. By replacing collagen, Sculptra gives you a more natural looking appearance without giving you away. A full treatment with Sculptra will take, on average, three injection sessions over a few months, and the results can last up to two years.

Voluma: A Unique New Filler with FDA Approval

Also known as Juvederm Voluma XC, Voluma is the first filler approved by the FDA to claim that it can “temporarily correct age-related volume loss in the cheek area of adults over the age of 21.” One of the early signs of aging is volume loss in the face, specifically in the cheek area, which is caused from a combination of fat and bone absorption. Another unique quality of Voluma is that it can last for approximately two years, which is exceptional longevity for a hyaluronic acid (HA).

If you want to learn more about these 7 dermal fillers and volumizing fillers, contact our Upper East Side New York dermatologist, Dr. Sheryl Clark, today or visit our Questions and Answers and our website. We will work with you to determine which dermal filler is the best for your individual needs.

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