Morpheus8 - treating underlying causes of aging

Morpheus8 is a new subdermal adipose remodeling device (SARD) that fractionally remodels and contours the face and body. Penetrating deep into the skin and fat, this morphs the aging face of body into a more desired smooth and sleek appearance, for all skin tones.

Stimulates collagen production of the underlying layers of the dermis

Penetrates deeper than any other device, treating layers up to 4-5mm deep the deeper layers of the skin

Can be used to treat wrinkles, acne scars, stretch marks, unwanted fat, surgical scars and more.

WHAT AREAS CAN BE TREATED?

Face

Neck

Chest

Abdomen

Back

External vaginal area

Any area of the face and body that exhibit wrinkles, laxity, unwanted fat, or scarring are suitable for treatment.

HOW MANY TREATMENTS WILL I NEED?

A series of 3 treatments optimizes results, with many patients choosing to repeat a single treatment yearly to keep up with the aging of skin over time.

HOW QUICKLY WILL I SEE RESULTS?

Visible results can be seen within a few days, but between 1-2 months more noticeable results appear. Improvements continue up to six months after treatment.

HOW LONG SHOULD I WAIT IN BETWEEN TREATMENTS?

4-6 weeks

WHAT IS THE BENEFIT OF FRACTIONATED ENERGY?

Fractionated RF energy is a scientifically proven method to reduce wrinkles and rebuild collagen and fat. It is minimally invasive, using a matrix of micro pins to renew deeper layers of the skin with almost no patient downtime.

CAN ANYONE USE MORPHEUS8?

The benefit of Morpheus8’s color blind technology is that it can be used on all skin types.

The unique properties allow even darker tones to be treated.

CAN THIS BE USED IN COMBINATION WITH OTHER TREATMENTS?

Yes, Morpheus8 can be used in the same treatment session, or a few days after other treatments.

WHEN CAN I PUT MAKE-UP ON AFTER TREATMENT?

Since patient downtime is minimal, makeup can be applied 1 to 2 days after the treatment. Patients should expect to see micro lesions a few days after treatment, slight redness and/or bruising for up to 1 week depending on treatment parameters.

WHAT KIND OF POST PROCEDURE CARE IS REQUIRED?

Patients should moisturize the treatment area, avoid active skincare ingredients and direct sun exposure for 5 days. It is also recommended that patients use a good, broad spectrum sunscreen every day. In addition to reducing their future risk of skin cancer, sunscreens also reduce wrinkles and slow the aging.

Vegan/Cruelty free skincare and cosmetics

I recently had the privilege of being a guest on a podcast of dear friend and colleague Dr. Yami on Veggie Doctor Radio discussing the topic of vegan and cruelty free skin care and cosmetics. She asked some fantastic questions, and since I know some individuals prefer the written to the spoken word, I thought I’d summarize some of our conversation here.

We chatted a bit about my vegan journey. The very brief version is that I began my nutritional journey of whole food plant based eating about 4 years ago. Although my intense love of all things skincare began just over 6 years ago, my transition towards considering the items in my skincare and beauty routine, in terms of the impact they have on animals, has been within the last year. This means I am still learning, and still have a lot to learn.

So what does cruelty free and vegan even mean when it comes to beauty?

Neither means anything if it’s just slapped on a label. Much in the same way as “natural” as a claim, neither cruelty free nor vegan are terms regulated by the U.S. government. This means companies can - and do - inaccurately use those terms without risk of lawsuit. 

The term “cruelty free” means an item is not tested on animals. Some companies claim cruelty free because they themselves do not test on animals, but they do pay another company to come in and test on animals. Other companies test individual ingredients on animals, but do not test the final products on animals. Still others are technically cruelty free, don’t test ingredients or products on animals, but do sell their products to mainland China. Unfortunately China requires skincare products to be tested on animals by law.

I have found ethicalelephant.com and logicalharmony.com to both be excellent sources for discovering what companies are cruelty free, since website descriptions can be a bit deceiving.

There are also specific certifications to look for if you’re interested in whether a product is cruelty free, such as the leaping bunny certification.

“Vegan” skin care products, by definition, do not include any animal products or byproducts. You may think, as I did for years, “what animal products could possibly be in makeup?” Or as I was once told by a chuckling professor when asked about vegan skincare products, “Ha! It’s not like we’re grinding up meat and putting it in skincare, they’re basically all vegan!” 

(False, by the way. I mean, it’s true we’re not grinding up meat and putting it in skincare. But we are smashing up beetles and putting them in eyeshadow. And we are crushing up pearls and fish scales and putting them in lotion. And we are shaking up snails and putting the goo on our faces. And putting shark liver in our moisturizer, and beeswax in our lipstick, and cows fat in our shampoo. It’s kind of a lot.)

There are certifications you can look for if you’re searching for vegan products at the drugstore as well. PETA cruelty free and vegan, and certified vegan are two to look for. 

Can a product be vegan and not cruelty free? Sure. 

For example, a brand that does test on animals may, for whatever reason, formulate a product that happens to be free of animal products and by-products. That product is vegan but is not cruelty free. They may even accurately market and label it as “vegan.”

Another product may be vegan and the brand may be “cruelty free” but they may sell their products to mainland China where it will have to be tested on animals prior to being sold. 

Can a product be cruelty free and not vegan? Abolustely.

This happens significantly more often than the other way around. Many brands don’t test on animals, but do include products with animal ingredients.

So where to start if you’re interested in transitioning some of your products to vegan and/or cruelty free options? My advice is to start with whatever you run out of. I don’t believe in wasting what you already use. You already bought it, assuming you enjoy it, use it up. I happened to run out of my mascara first - Smashbox superfan mascara. I entered the phrase “Smashbox cruelty free” into google and found on logicalharmony.com the great news that smashbox is a cruelty free brand. Luckily, logicalharmony also had an extensive list of all smashbox vegan products, superfan mascara included.

But what if I was searching for a brand that didn’t specifically come up on either of those websites? I discovered a very useful website doublecheckvegan.com. 

You can copy and paste the ingredient list from literally any skincare product, and it will output what ingredients may be derived from animal sources. Armed with this information, you can either search the brand website for information about where they source their ingredients, or email/DM them to ask about those ingredients. I have found companies much more responsive to an email asking “Is your glycerin sourced from animal or plant sources?” Then an email asking, “Are your products vegan?” 

If you’re starting out and building a skincare routine it’s much easier to just stick to brand or products you already know to be cruelty free and vegan. But if, like me, you have an entire bathroom full of products you absolute love, it’s worth it, and not *that* much more work to find out for yourself if the product is vegan/cruelty free.

So what brands are cruelty free and have great vegan options?

Some lines that I have used and enjoyed at least some of their skincare products include: 

Avene (cruelty free and entirely vegan except 2 products that contain beeswax, so far everything of theirs that touches my face is lovely)

Youth to the People (especially enjoy their superfood facial cleanser)

Biossance

Elf

Herbivore (don’t be fooled by bakuchiol though, the data is not there yet)

Pacifica

*Shout out to Derma-E which is I’ve heard good things about but never tried

For makeup:

Charlotte Tilbury (all cruelty free, some vegan options - a personal fave of mine includes her Hollywood contour wand)

Milk makeup (currently trying a cream blush which I love and a nice subtle mascara)

Urban Decay (all cruelty free, some vegan options, love their 24/7 eyeliner in the color “zero”)

Anastasia Beverly Hills (All cruelty free, some vegan options, use the Brow wiz daily)

Coverfx

Dose of colors

Limecrime

Elf

Listen, most of the “some vegan options” from these cruelty free makeup brands comes from the carmine they use as the red coloring in eyeshadow. Somehow we can make diamonds in a lab but we can’t make blendable, long-lasting red eyeshadow with good color payoff without beetles.

What a weird world we live in.

Are you a doctor?

Are you a doctor?

No. I am not a doctor. I am a Nurse Practitioner who holds a master’s degree in nursing. That means I attended 2 years of college to obtain pre-requisites for nursing school, 3 years of college to obtain my Bachelor’s degree in nursing, then 3 more years to earn my Master’s degree in nursing. I could go on to earn my Doctorate or PhD in nursing, then I could technically call myself “Dr. Knight.” But honestly, even if I earned that title, I find that unnecessarily confusing. I am very proud of my nursing background because I believe it adds to my knowledge and patient care in a unique way.

You’re a Physician’s Assistant (PA) then?

No. I am not a physician’s assistant. A PA will obtain an associates degree, after which they must complete 4,000 hours in a medical setting, and complete the pre-requisites for the PA program they are applying to. A physician’s assistant might have a bachelor’s degree or a master’s degree. After graduation their scope of practice is very similar to that of a nurse practitioner, but must be provided under the “supervision” of a physician. 

So you’re better than a PA? 

No. I am neither “better” than a PA, nor “worse” than a physician. In the same way that any career or profession is marked by education AND experience, medicine is no exception.

So what do I call you?

Call me Kari. Let me know if I can help.

Retin...A?

Retinol, Retin A, tretinoin…are they all they same? Are they different? Do they have to make you dry and flaky? Let me attempt to de-mystify what is, in my opinion, the second most important skin care product for basically every facial skin concern.

First, some science. “Retinoid” is the name of a group of compounds, either vitamin A or derived from vitamin A. There are lots of different versions of this vitamin A compound. To further confuse things, when a person is discussing a particular retinoid, they may be referring to an ingredient (like adapalene or tretinoin) or a brand name (such as Differin gel or Retin-A). As an analogy, a person might say, “I like vodka.” Or someone might say, “I like Grey Goose.” In this analogy “vodka” could be replaced by: adapalene, retinol, retinoid acid, tretinoin, and retinoid esters. “Grey Goose” could be replaced with Retin A, Differin, Altreno, Retin A Micro.

So what does this vitamin A derivative actually do? Retinoids increase cell turnover. It is a misunderstanding to say that retinoids “exfoliate” the skin. While that isn’t completely incorrect, it is incomplete. When we use a retinoid, whether it’s a prescription, over the counter, or medical grade, we actually slough off old dead skin cells and grow in new skin cells at a faster rate. One of the things that happens as we age is that our cell turnover slows. So I’m in my mid 30s, it takes me about 30 days for an old skin cell to slough off and a new healthy skin cell to take its place. I’ve read that when an individual is regularly using a retinoid, that time is cut in half to somewhere around 14 days.

So the prescription stuff works the best, right? Well, we know for sure that it does work. And it works for all kinds of fantastic things.

A 1996 paper found that pre-treatment of UV irradiated skin with tretinoin led to a decrease in collagen breakdown. You don’t want collagen to break down. Collagen is part of what I’m trying to replicate when I place injectable fillers to support tissue and decrease the appearance of aging. So something you can put on your skin to help decrease collagen loss is a great thing. 

A 1990 paper showed increased epidermal thickness after using tretinoin 0.05% for 3 months. This is an interesting one because there’s a circulating myth that retinoids thin your skin over time. That’s related to the misunderstanding of how retinoids work. Yes, there is a noticeable sloughing off of old skin cells. The importance thing to remember is that there is a concurrent increase in the number of healthy, new skin cells that are surfacing. So rather than our skin thinning out with retinoid use, study after study shows that just the opposite is happening. That natural, dreaded thinning of the skin that increases with aging can actually be improved with retinoids.

A double-blinded study in 1991 showed that after 6 months of 0.5% tretinoin a statistically significant improvement in fine wrinkling, hyperpigmentation, roughness, laxity (sagging), and epidermal thickness occurred. There are multiple studies showing that dermal thickness actually increases starting after around 12 months of use. So somewhere between 3 and 6 months the very top layer begins to show signs of increased thickness, around 12 months the layer just underneath that also begins to demonstrate increased thickness. That’s the tough sell of retinoids. They are *not* a “quick fix.”

So that’s it, right? Why aren’t we all just on 0.05% of tretinoin? Well, I can answer that for myself. When I put 0.05% tretinoin on my skin, my face molts. Even 0.025% tretinoin, heck even just over the counter differin gel makes my face melt off. Luckily, there is another way for those of us who have a delicate flower for facial skin. (Or in my case atopic dermatitis, otherwise known as eczema.)

In a 48 week double blinded study in 1995 they actually discovered that 0.025% tretinoin seemed to have similar efficacy as 0.05% and even 0.1% with significant fewer side effects. So researchers have just continued to push the low-dose retinoid envelope ever since. 

A 1997 paper showed that retinol similarly decreased UV damage, and increased collagen production with less transepidermal water loss, erythema and irritation than tretinoin. The only downside? Retinol is unstable, so the packaging and vehicle starts to matter. Retinol derivatives such as retinyl acetate, retinyl propionate, and retinyl palmitate have been developed in an attempt to remedy this issue. Unfortunately, a 1998 double-blinded study showed that retinol derivatives demonstrated no significant benefit over placebo (ie don’t work).

The last thing I’ll mention is a question I get all the time: “do retinoids make me more sensitive to the sun?” The answer is yes and no. There’s not some magic molecule in retinoids that makes your skin more likely to burn. It’s the natural result of the way retinoids work. You are asking your skin to please shed the gross, old top layer of dead skin cells. When this happens, your beautiful, glowing, healthy skin cells emerge. They’re just babies. They haven’t been crumpled and darkened by the sun. So if you don’t want them to turn out just like the skin cells you’ve been sloughing off, you do need to invest in some of the first most important skin care product - sunscreen.

(SKIP TO HERE IF YOU DON’T CARE ABOUT SCIENCE)

OK, so cliff notes? Retinoids can decrease wrinkles, hyperpigmentation (freckles, dark spots), roughness, laxity, and retinoids can increase collagen production and dermal thickness. You can get this effect potentially faster but with increased irritation by using a prescription strength retinoid like tretinoin. Or you can use an over the counter version and likely get similar results with fewer side effects but you’ll have to wait longer. That’s where I’ve found “medical grade skin care” to come in handy for me. I’ve used products like Neutrogena rapid wrinkle repair, and Olay retinal24, both of which my reactive skin tolerated and I enjoyed. But I used them for a couple months and didn’t notice significant improvement in measurable things like hyperpigmentation. I am confident that if I were patient to wait 12 months or more even those low strength retinol products would begin to show noticeable improvement. However, when I use a medical grade retinol I’m able to use a slightly higher percentage with less irritation, presumably because they’re adding fancy things to help mitigate the irritation. So if you know that your skin is not very sensitive/reactive, basically look at the ingredient list and find a retinoid product that lists “retinol” higher up in the ingredient list. I literally turned over a bottle of some retinol at the drugstore the other day and fragrance was listed higher in the ingredient list than retinol. (If you didn’t know, the higher up an ingredient is the more of it is in the actual product.) If you have more sensitive skin or don’t want to deal with irritation, either purchase a retinoid that lists retinol lower in the ingredient list, or adds soothing ingredients to help calm down potentially associated irritation.

TLDR: pick a retinoid and put in on your face.

Be well and love your face,

Kari Knight FNP-C DCNP

What to expect from a skin check

I see many skin concerns, perform many surgical and cosmetic procedures. But one of the most common appointments involves checking a concerning lesion, or performing a “total body skin exam.” 

It is very common to my profession, but most people do not really know what to expect when their health care provider, hairdresser, friend or other loved one, encourages them to “get that checked.” (It never ceases to amaze me how many skin cancers were first spotted by the hairdresser!) 

If it is a new patient appointment, the check-in will involve gathering general medical/surgical background information. I am especially interested in things like family history of melanoma, history of tanning bed use, history of second degree (blistering) burns - especially prior to adolescence. These things all significantly inform the likelihood of a person developing melanoma at some point. In fact, I heard at one dermatology conference that if an individual has two immediate relatives who have had melanoma, and that person has more than 100 moles, that it is a statistical inevitability that they were develop melanoma at some point in their life! On the other hand, I have personally diagnosed and treated melanoma in several patients with no family history of melanoma, no significant sunburns, and no prior tanning bed use, so my preference is to be proactive in having a specialist check any concerning lesions.

Which brings us to another great question, what does concerning mean? What many of us have heard is the ABCDE rule.

(https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/?utm_source=Instagram&utm_medium=SocialMedia&utm_content=Melanoma)

And while I often review the ABCDEs with my patients, what I’m more likely to say is to watch any new lesions very closely, and to let me know if any new or existing skin lesion is growing or changing in any progressive way over time. That can mean an increase in size, a change in shape, a darkening, lightening, or developing a new symptom like bleeding. Really any spot that looks different than it used to is worth having checked.

What will that check look like? I am especially interested in whatever lesion or lesions brought an individual in to the office, but for as many times as the lesion in question ends up to be skin cancer, at least as many times I happen to find a spot somewhere else that is cancerous that the patient did not even know was there. I am especially interested in the scalp, face, back of the neck, shoulders, forearms, and the backs of the lower legs. Although melanoma can appear literally anywhere on the skin (even between the toes), basal cell carcinoma and squamous cell carcinoma are more likely to develop in sun exposed areas.

Do you have to see your primary care provider first? The short answer is no. You can call our office directly and be scheduled without a referral. The long answer is that some insurance companies require a referral to specialty services, so it’s worth checking with your insurance carrier. Kari Knight Dermatology has contracts with Regence, Premera, and First Choice Health, none of which require referral from primary care. Some dermatology practices require a patient to see primary care first and get a referral, so call the dermatology practice you plan to see directly and ask if they require a referral.

Hopefully that helped answer some questions about total body skin checks. Feel free to comment any questions related to skin checks and we’ll do our best to answer. Or for more pressing questions please feel free to call the office!

Be well and love preventative medicine,

Kari Knight FNP-C DCNP

Botox person

“I’m not a ‘botox person’.” 

I 100% understand what is meant by this phrase that I hear, not uncommonly. On the other hand, what is *really* meant by this phrase? When I have thought this myself, and heard it from patients and friends, I think we mean that we aren’t superficial. 

I’m a woman who doesn’t mind getting muddy, camping in a tent, climbing a tree with my kids, showing up at Fred Meyer bare-faced in sweatpants. But in the last 5 years I am also a woman who *is* a botox person. 

I recently had a conversation with a photographer that I respect, and she was sharing about her passion for a particular type of photo shoot: Bordeaux shoots. “We as women wear so many hats. But women are also just beautiful. And underneath the many hats we wear it’s easy to lose ourselves and the awe for what our bodies are capable of.” 

She shared that she has photographed women of all sizes, and especially enjoyed photographing a 70-year-old. 

The conversation really resonated with one of the reasons I love cosmetic dermatology. I have been asked questions about cosmetic injectables by men and women that our culture would stereotypically NEVER consider to be “botox people.” Just like the reasons a person might pursue a Bordeaux photo shoot are varied and personal, so are the reasons a person might consider cosmetic injections. And just like joy and empowerment and artistic expression energizes this photographer, so I am electrified by my passion for my artistic science.

Yes, some people pursue botox and fillers out of a deep sense of insuffiency, a lack of self-confidence, a need to fix something broken. The same way we can turn to diet, exercise, a Netflix binge, or even endlessly helping others in an attempt to fill something empty inside ourselves. Are any of the above things to be discouraged? Not if they are pursued out of a sense of pre-existing wholeness. In the same way, I applaud women who are brave enough to boldly own whatever version of beauty they embody. Our culture has made it shameful to “work too hard” on looking a certain way. Don’t be too glam, too metro. Don’t have heels that are too high, lips that are too red. We also have plenty of shame to dole out to those who have no interest in perfecting the newest eyeshadow techniques, keep up with latest fashion trends, or change the color of their hair bi-annually. Guess what. Some of *these* bare-faced beauties also have lip filler.

Let’s stop with the judgement for other men and women. Let’s stop assuming that there is a specific type of person that we’ll call “botox person.” Let’s support each-other’s journey to age gracefully. Whether or not that happens to include botox.

Be well and love each other,

Kari Knight FNP-C DCNP