Introduction

Dermal Fillers have become incredibly popular, with over 2.6 million people having received them in 2018 (the number is very likely much higher today). With that has come the inevitable rise in vascular occlusions caused by intravascular injection. Most aesthetic injections are performed with hyaluronic acid (HA) fillers, which are reversible with hyaluronidase. Accordingly, there has been a surge of interest in and use of ultrasound for the diagnosis and treatment of vascular occlusions, as well as for vascular mapping prior to injection. As a radiologist turned aesthetic injector, I have been following this trend very closely. My background: I am board-certified with 16 years experience in diagnostic ultrasound and ultrasound-guided procedures. After 7 years in aesthetics, I am finally able to apply some of my imaging expertise to my current practice.

There are currently 4 portable hand-held ultrasound systems available on the market at a relatively low cost ($2500 to $6900) considering the historical cost of standard units in the past (a GE or Philips system when I was a resident in the 90’s could run well over $300K). In this review I’ll explain the main features, advantages and drawbacks of the following devices:

• GE V-Scan Air
• Clarius (L-15HD and L HD L-20)
• Philips Lumify (L-12-4)
• Butterfly

The main criteria for this review are critical features needed to diagnose and treat vascular occlusion caused by hyaluronic acid filler in addition to vascular assessment prior to and during dermal filler injections. The use of these devices for other purposes is mentioned but is not the priority of my recommendations.
Critical features for ultrasound use in aesthetics: (I consider the following features a must-have)

• High-quality diagnostic images
• Color doppler to evaluate vessels
• Long duration of imaging time: potential for treatment of occlusions to take many hours
• Ease of use

Clarius

Design

The first hand-held device I evaluated was the Clarius. Clarius offers two US probes at this time– either of which could be used in aesthetics. The L-HD15 (up to 15 MHz) had a standard footprint and the HD L-20 (higher resolution up to 20MHz) has a slim footprint (similar to a hockey-stick). The first thing that stood out about the Clarius is that it feels like holding a brick. This thing is BIG and HEAVY. If you were operating this device for any length of time your hand and arm would fatigue quickly. The device itself is very large for an US probe. Though the L-20 has a slim footprint, the probe itself is the same huge size as the HD-15. Why is that odd? The slim footprint that the high-res hockey sticks are designed with have a very small handpiece so as to not get in the way of needle procedures or the patient’s anatomy. They are great for getting into small areas where things are in the way– say the nasolabial fold near the nose. The Clarius handpiece is missing this important feature.

Image Quality and Doppler

Image quality of both devices is excellent. Do you need the higher resolution of the 20MHz? In my opinion no. There is no added diagnostic value. Unless you are specifically looking for that smaller footprint, there would be no advantage. And having done more US-guided procedures than I could possibly count, the larger issue is that enormous handpiece. As with all 4 of these devices, the Clarius offers high-quality color doppler for evaluating flow. For an extra $1000 you can also get power doppler– but this really provides no benefit over standard color doppler and in my opinion is not necessary for aesthetics.

Battery Life and recharging

Battery life with the Clarius is about 60 minutes with 90 minutes to recharge. Importantly– the battery is detachable (this is actually part of the reason the probe is so bulky and heavy). This is critical if you have to scan for any length of time– especially for occlusions. With the Clarius, you can have a backup battery ready for when your probe conks out. Since lysing an occlusion can take hours– and there have been reports of cases lasting over 24 hours, albeit without ultrasound assistance– one vital feature is having a probe that will go the distance. With a recharge time of 150% of the battery life, you might run out of battery anyway if you only have 1 back up. But you can always have 2!

Ease of Use

The software design for the Clarius is intuitive and simple to use. The device is wireless, and communicates via bluetooth to any phone or tablet. The handpiece itself is limited by its bulk and weight– twice the weight of a standard ultrasound probe like the GE and 4 times the weight of the Philips Lumify. Unless you’re a football player, this will be a major limiting factor for any physician actively using this in practice.

GE Vscan Air

Design

There is a lot to love about the GE Vscan Air. It has a unique design, built with a Linear transducer at one end and a curved array at the other end, all within a single cordless device that weighs the same as any regular ultrasound probe. This makes it ideal to use for many practices with a wide range of diagnostic ability for almost any body part. For an aesthetics-only practice, however, the curved array is completely unnecessary. For a radiologist like me, it is almost irresistible! I scanned my whole abdomen, just for fun! But really– you won’t use that feature for aesthetics.

Image Quality and Doppler

At 12 MHz, the resolution is slightly lower than the Clarius. To my eye, the images were slightly fuzzier, but the diagnostic quality was excellent. Color Doppler on the GE is excellent as well. There is no power doppler, pulsed wave or even M mode at this time, but again, these are features not needed for aesthetics.

Battery Life and Recharging

According to GE, the Vscan Air battery lasts 50 minutes– but in my hands this was closer to 40 minutes. Recharging is wireless and recharge time is 60 minutes. The battery is built-in, so you can’t have a back-up battery. This is where the GE falls short for aesthetics: for treating occlusions, you must have a method of imaging over longer periods of time than 40-50 minutes. So, unless you have a second probe, you’re out of luck.

Ease of Use

The GE has a huge leg up on the Clarius for ease of scanning. The probe feels great in the hand and at half the weight, it shouldn’t tire you out (if only the battery could last that long). The software for the GE is the least intuitive of the bunch, but it is adequate. It can be used with any phone or tablet, so it is very versatile. However, I had to pair the device every time I used it, even on the same tablet. I’m not sure why this would be necessary, and I found it to be annoying and introduced a delay each time I used it. So, as much as it was absolutely delightful to scan with the GE, they have some work to do on the interface to make it more seamless.

Philips Lumify

Philips makes 3 Lumify probes for different uses. I evaluated the L 12-4 which goes up to 12MHz, like the GE. They also make separate curved array and linear phased array for other applications, each probe for the same price. The Lumify has a very different design– it is corded and runs off the power of the device it is attached to. Thus it has no battery. At first I thought that this would be a drawback but it turned out to be an advantage.

Design

The Lumify is amazingly lightweight (since it has no battery)– at less than a quarter pound it is half the weight of the GE and feels comfortable and nimble in the hand. It is also a slightly smaller footprint than the GE or Clarius L HD-15 making it very easy to use on the face. Though it does have a cord, I found it not to be a problem while scanning. Perhaps this is because I am used to having a cord that is present on all of the major systems I’ve ever used. Regardless, I don’t think this is a detriment to scanning.

Image Quality and Doppler

The Philips has excellent image quality. Despite having a frequency identical to the GE, I found the images to be crisper– not significantly different from the Clarius. The color doppler was excellent and easy to adjust. It happens that a patient walked in my office with a full-on occlusion (from filler placed elsewhere!) and we were able to evaluate her blood flow with ease with the Lumify. It was this experience that cemented my belief that the higher frequency of the Clarius does not help diagnosis or treatment of vascular occlusions.

Battery Life and Recharging

The Lumify is powered by the device to which it is attached. Philips recommends a Samsung tablet, which puts out plenty of power and will last over 6 hours on a single charge with continuous use. This is a tremendous advantage over the rechargeable probes. You can always plug the Lumify into a different tablet if you actually needed to use it that long. The disadvantage is that the longevity will depend on what device you’re using. Android tablets are all different and Philips does not supply data on how long each different device would last. And apple devices do not put out enough power to run it at all. The Lumify will work with an iOs device– but you’ll need a battery pack to go along with it– which itself has its own battery life. The Lumify battery pack for the apple devices lasts 2 ½ hours and has a recharge time of 3 hours, and of course you can have a backup battery as well. Either way, the Lumify is the winner hands-down as far as battery life.

Ease of Use

The Lumify was by far the easiest of the handhelds to use. The app launches automatically and is completely intuitive. The demo didn’t come with any instructions, but none were needed. I was up and running in seconds. With the lightweight maneuverable handpiece and easy interface, the Lumify felt like a natural extension of my hand.

Butterfly

The Butterfly is all over social media marketing directly to the consumer. This device is a completely different technology that uses an array of sensors on a chip rather than true piezoelectric crystals that traditional ultrasound devices use to produce the images. With one handpiece, they are able to reproduce the equivalent of the linear and curved array probes. The result is a very versatile device with relatively low-resolution images. I’m including it in this discussion because of its ubiquitous presence and its availability as a portable low-cost ultrasound imaging system. However, I find the images lack the diagnostic quality one needs for superficial, soft tissue and vascular imaging. Its size and weight are comparable to the GE. It is corded, but unlike the Lumify, it runs off of an internal battery, like the GE. The battery life is 120 minutes with a 300 minute recharge time. So it will scan for longer, but there is no backup battery.

Butterfly does not require a membership to function, but many features including image storage are turned off without one. The membership currently ranges from $200 to $1200 per year, so this cost offsets the cheaper price of $2500.

Because the images are moderate to poor, the Butterfly is not well-suited to aesthetics applications. However, it can easily be used in a pinch if one is available. And if all you want is to invest the least amount of money to have an ultrasound only for emergency occlusions, you could consider it. But if you use it and learn about ultrasound imaging at all, over time you’ll wish you had bought a better device.

Summary

I highly recommend the Philips Lumify for use in aesthetics. For ease of use, high-quality images and the ability to scan for hours, this light elegantly-designed hand piece is the ideal solution for imaging in the aesthetic setting. Because of the heavy bulky design, the Clarius is not recommended, but otherwise is a reasonable solution for image quality and a replaceable battery. The GE is beautifully designed, but its low battery life and no energy back-up option makes it unsuited to treat vascular occlusions. The Butterfly will do in a pinch if the family practice down the hall has one to spare, but it is not recommended for aesthetics.

If they are all getting Emsculpt on Bling Empire, it must be great, right? Body Sculpting has become very popular, and what’s a better indication of trendiness than appearing on reality TV? But what about the science? Should you believe the hype? [Aside: If you haven’t seen it, Bling Empire is a reality TV version of Crazy Rich Asians. Totally ridiculous but quite entertaining.]

Now that we have some experience with the Emsculpt Neo, we can talk about how it is different from other devices and from the original Emsculpt, and how results differ too. We’ve had to field lots of questions and can tell you definitively that the Neo, with its combination of HIFEM muscle stimulation and RF heating is a huge advance, placing it far ahead of any other device in the body sculpting world.

The original Emsculpt uses High Frequency Electro-Magnetic (HIFEM) muscular stimulation to cause massively strong contractions – called supramaximal because they are stronger than the muscle contracts in any normal physiologic condition. Emsculpt delivers over 20,000 of these supramaximal contractions in 30 minutes. No amount of cross-fit can equal that. The Emsculpt studies showed that HIFEM alone can produce on average a 16% increase in muscle and a 19% decrease in fat with 4 sessions.

Radiofrequency (RF) is a great tool to heat and melt fat. At Glow, we have many years experience with Vanquish ME and Exilis Ultra, both of which use RF. We have used these devices in combination with Emsculpt to get the best results. RF works by heating the fat cells causing damage and ultimately cell death. Emsculpt Neo has RF built in to the paddles, deploying both HIFEM and RF simultaneously. The question I had when first looking at the Neo is how does it improve results over using these technologies separately? Is there a benefit from simultaneous treatment? Will we still need those RF devices? The answer is yes and yes, as it turns out. Here’s what we have found.

The addition of RF heating improves the yield for both muscle and fat. It was not surprising that RF improves the fat loss— RF has a strong record killing fat. It turns out that warmer muscles are stronger and provide more effective contractions. This increases the yield on muscle as well. The official studies of the Emsculpt Neo show a 25% increase in muscle and a 30% decrease in fat, a marked improvement over HIFEM alone. We have seen this borne out in real life experience.

How do the other machines fit in? As always every body is different, and treatments have to be designed around each individual. Emsculpt Neo has paddles that are focused in one area about the size of the center belly fat. We use Vanquish ME because it can reach all the way from one love handle to the other, and it can also treat both the inner and outer thigh at the same time. We have found that for those areas, combining Emsculpt Neo with Vanquish ME gives us the absolute best results. Exilis Ultra can be used in many different areas that the other devices can’t reach, and it also tightens skin. So for some bodies, these devices are very helpful in achieving the desired results.

We are adding the latest before and after images to our gallery on the website here. We have found a very high patient satisfaction with our suite of body sculpting treatments, in which the Emsculpt Neo has now taken center stage. Feel free to contact us with any questions.

What can you do to Improve the Under Eye Area (Tear Troughs)?

The area under the eyes suffers a double-whammy when it comes to aging. This skin is the thinnest in the body, so as the dermis thins out, the first place you notice it is under the eyes. Often we notice in our 30’s and think “wow I look like I’m really tired.” On top of that, as we age we lose the little fat pads in our face that make us look so round and youthful as kids– and the first one to go is that fat pad under the eyes. The result can be an angled divot under the eye covered with wrinkly skin, long before the rest of the face shows signs of aging.

So what can you do about it? That’s the number one question that brings people into our office. After years of experience, we have put together the treatments that work best. Here I’m giving you the low-down on these common treatments:

Filler

For volume lost in this area, filling it back up with hyaluronic filler can be a dramatic improvement. When you see that depression or divot, not only do you see a hollow with a shadow across it, but the overlying skin has less volume to cover and thus looks more wrinkly. We use a cannula technique to gently fill the volume lost. The effect is immediate. There is always some swelling with fillers that lasts a few days, but less with this area than others.

PRFM (Platelet-Rich Fibrin Matrix)

Many people have heard of PRP (Platelet-Rich Plasma). This is serum derived from your own blood, rich in growth factors. It has been used in orthopedics for decades, and we have been using it for facial rejuvenation and hair growth for about 6 years at Glow. PRFM is activated PRP, same growth factors but the platelets are activated with calcium. When injected, it forms a gel that concentrates the factors in one place. PRFM has been used to build up the natural tissues in the under eye area as well as elsewhere in the face. We use a similar cannula technique to place the PRFM in this area. Several treatments are needed, and the results happen over several months.

Laser Resurfacing

Fractional non-ablative lasers can resurface the skin to make it smoother. In addition, the laser heats up the skin, triggering it to make its own collagen. The laser also lifts pigment in the skin to help get rid of dark circles. Laser resurfacing can be a key part of treating the under-eye area because it is important to build collagen in the skin and smooth out the fine lines and wrinkles. Treating the volume loss alone is just half the battle. The laser treatments help address the skin itself.

Eye creams and serums

The skin under the eyes is special because it is so thin to start with and is in a very sensitive area. The skin here often needs more moisture than other skin in your body, and sometimes even develops pigment that isn’t present elsewhere. We offer several eye topicals that have different anti-aging ingredients. Adding eye creams to your regimen will provide antioxidants and ceramides to protect the skin and ingredients to plump the skin, trigger collagen and decrease dark circles.

What does Off-Label mean?

As with many aesthetic procedures, the use of filler and PRFM for the tear trough area is off-label. What does off-label mean? It means that the FDA has approved the product or treatment for some other indication. Then doctors develop new treatments with an FDA-approved product. For example– a certain filler is FDA-approved for placement in the cheeks and it is then used to fill hollows elsewhere in the face. Once these new treatments are developed and in use, rarely does the company that makes the product pay for studies to get official approval for an already FDA-approved product. Thus there are many products and procedures in use by doctors that are “Off-label.”

What is the best sequence of treatments for the under-eye area?

At Glow Medispa, we have been working on developing an under-eye package that includes all of these treatments. This new package includes a filler treatment, two PRFM and LaseMD Ultra treatments and our favorite eye serum from Sente. As with everything that we do, we customize treatments to meet the specific needs of each patient.

Think you might be a great candidate? Call us or come in for a consultation if you think you might be interested.

Emsculpt just got even more amazing. The new Emsculpt NEO is as big a game changer as Emsculpt was just a couple years ago. You may have already tried Emsculpt– it has been the number one body sculpting treatment in the aesthetics industry since 2018 when it first came out. BTL, the company that makes Emsculpt, developed it to use along with Radiofrequency (RF) devices Vanquish ME and Exilis Ultra for body sculpting. Here’s a quick review of how these work, and why Emsculpt NEO is going to completely change the way we do body sculpting.

RF devices are able to heat the skin and the fat– to tighten the skin and kill the fat. Vanquish ME selectively tunes to the fat in order to heat it enough to destroy fat cells. Exilis Ultra heats from the skin down, but keeps the surface cool enough to penetrate into the fat. RF devices are great at tightening the skin and melting fat, but did nothing for the underlying muscle.

Then BTL invented Emsculpt. It uses powerful magnetic waves that cause supramaximal contractions of the muscle. Supramaximal means that these contractions are way more than what you would normally do in any vigorous workout. These contractions are more powerful than your brain can make your muscle do. Emsculpt does this about 20,000 times in a half-hour treatment. Though intense, it doesn’t hurt. The result is a stronger, more sculpted muscle. In the studies done to validate Emsculpt, it was found (amazingly!) to kill fat as well. The only thing it didn’tsculpt NEO, Author: Kate Dee, Fat Reduction, Body sculpting, do was tighten skin (that’s why we still need Exilis). And it also couldn’t get to the love handles and leg fat (that’s why we still need Vanquish).

So why is Emsculpt NEO different? It offers two treatments in one. It combines the muscle treatment of Emsculpt with RF at the same time. The RF in the NEO is the same frequency that Vanquish uses to tune to your fat. It also heats up your muscles, and it turns out that Emsculpt muscle-building is even more effective on warm muscles. So the NEO can not only build muscle and kill fat, but it does so even better than Emsculpt or Vanquish or Exilis can do on their own. There have been 7 published studies of the new Emsculpt NEO. The results showed marked increase in muscle mass and decrease in fat on MRI, CT and Ultrasound. On average, there was a 25% increase in muscle and a 30%reduction in fat 1 month after a series of treatments. This is like having Emsculpt and Vanquish in only 30 minutes per treatment (this used to be a 2-hour appointment).

Emsculpt NEO is currently FDA-cleared to treat the abdomen, buttocks, thighs, arms (biceps and triceps) and calves. The Emsculpt NEO protocol is a series of 4 30-minute treatments. We are also working on a new protocol for the thighs (finally a treatment that actually works for saddle bags!).

We are excited to be able to offer the new Emsculpt NEO at our West Seattle office. As before, our full suite of body sculpting services will be available, so we can treat almost any body contouring challenge. Emsculpt continues to be available at our Kirkland location. For a full list of services at each center, see our brochures online: West Seattle and Kirkland.

If you are interested in restoring a youthful appearance without surgery, the natural results of Sculptra may be the perfect solution for you.

What is Sculptra Aesthetic?

Sculptra is not a filler.

Why start with what Sculptra is not? Many people think Sculptra is a filler, but it is more like Opposite Filler. If you google Sculptra, you will find prominent blog posts that refer to it as a filler. This is simply not accurate.

Sculptra is a powder that we dissolve in water for injection. It is made out of Poly-L Lactic Acid or PLLA. PLLA is absorbed and ultimately eliminated by the body over time. It has been used since the 1970’s, originally to make absorbable sutures for surgery. That’s 50 years of experience — more than any filler. During the 1990’s, Sculptra was introduced into facial aesthetics, originally to treat facial wasting associated with HIV lipodystrophy. It worked so incredibly well that it soon made its way to elective anti-aging treatments.

Sculptra works by stimulating the production of collagen in and under the skin, filling out areas of volume loss and tightening the tissues. The results are a very natural youthful appearance that slowly evolves over time. After injection we see a gradual improvement over 1-2 years. In contrast, when you place filler into the face, the body immediately starts to break it down, and it will be 100% gone in a year. That’s why Sculptra is the Opposite Filler. Sculptra is more of a long-term investment. Results are not immediate. If dermal filler is like renting a beachfront villa in Hawaii, Sculptra is like building a home there for the same price– it just takes a year to build.

What’s the treatment like?

Sculptra is dissolved in water first, usually a few days before it is used. Lidocaine is added to it to numb the areas being treated. We also use a topical anesthetic for the skin. There is minimal discomfort during the injections. The skin is then quite puffy from the water– which is absorbed over the next couple days after the treatment. Then the sculptra gets to work stimulating collagen. People often see a difference within a month or two– but the results keep happening over a 1-2 year time frame. Most people have 4-6 vials placed over 2-3 sessions about 1-2 months apart.

What areas can be treated with Sculptra?

Sculptra is my go-to treatment for temples. Hollowed out temples can really age your appearance. Sculptra is the safest solution for this area and is long lasting. Sculptra is great for augmenting the cheeks and lower face and works really well in softening the nasolabial folds and marionette lines. It can also be used to strengthen the jawline.

Who benefits most from Sculptra?

If you have volume loss in your face or temples, then Sculptra is a great option for restoring a youthful appearance to the skin. We often combine Sculptra with skin tightening treatments like Genius RF, since most of us have a combination of skin laxity and volume loss. These two treatments are the secret to our signature GlowLift. We love Genius and Sculptra because they both build your own collagen, yielding long-lasting results.

We have more information about Sculptra and Genius on our web site. If you have questions or would like to come in for a consultation, you can always call us or schedule online here.

PRP has become a very popular treatment to jump start hair growth in men and women who are suffering from classic adult-pattern thinning and also sudden hair loss seen after pregnancy, illness or postmenopausal years in women. PRP is Platelet-Rich Plasma, and it entails drawing your blood, spinning that blood down in a high-speed centrifuge, concentrating the platelet portion of the serum (platelet-rich plasma) and then injecting this PRP into the areas of hair loss. In the last two years, many of us have moved to PRF– Platelet-Rich Fibrin. This is activated PRP, and acts as more of a time-release for the growth factors that are in PRP. We are constantly making improvements.

We have been doing this for years at Glow Medispa and have seen some pretty impressive results. But here is the issue: Platelets contain all sorts of peptides, cytokines and other growth factors, some of which support hair regrowth, but many which are actually throwing existing hairs into resting phases instead of promoting growth. So results from PRP can be variable, as every person’s mix of peptides and cytokines is different. It also requires a blood draw and multiple scalp injections. Yes, we can get you through it but a lot of people just don’t enjoy being human pincushions.

Keralase Reviews

We are excited to introduce KeraLase treatment: Kerafactor Serum combined with Lutronic LaseMD laser system. The Kerafactor Serum is a proprietary blend of growth factors that are specifically selected and concentrated into small nano‑liposomal carrier particles for easy penetration of the skin. These are those peptides that specifically support increased blood supply and the transition of resting hairs into the actively growing phase of hair growth for optimal results. The most potent peptides are up to a 1000X more concentrated than found in platelets. Kerafactor leaves out the peptides found in PRP that inhibit hair growth. The result is a much more powerful mix of growth factors that specifically stimulate hair growth that is much more effective than PRP.

There is no blood draw and there is no pincushion needle-poking like with PRP. We facilitate complete penetration with using the LaseMD system to create small penetrations in the skin of the scalp for even better distribution of the Kerafactor Serum. Treatments are scheduled every four weeks for a period of three to six months.

Keralase Treatment Cost

Studies looking at hair counts, hair density and shaft diameter show much more dramatic improvement as compared to PRP and the cost per treatment is the same as PRP.

Our hair loss program has progressed over the years, and we believe that KeraLase hair restoration treatment will be a complete game-changer. If you are interested in learning more, please give us a call or schedule a consultation.

Our most popular body sculpting service is now available in Kirkland and West Seattle!

Ever since 2008, I have really wanted Michelle Obama arms. When Emsculpt was first FDA-approved in 2018 and arrived in our spa weeks later, I asked the company, “When will you have applicators for arms?” I have always been fit, but no matter how much I lift weights, I have never been able to achieve that toned look that turns heads when you wear a tank top. Until now. For the first time in my life at almost 52 years old, I am finally getting compliments on my arms.

BTL, the company that makes Emsculpt, worked on those applicators for over a year. To maximize the effectiveness in the smaller arm (and calf) muscles, they made the hand pieces smaller and curved to focus the magnetic waves in the right place. Working out the positioning and best practices for the settings was a long process. The result of this effort is a treatment that delivers the same 20,000 pulses in only 20 minutes per muscle. For the arms, we are able to treat both the triceps and the biceps muscles separately, both building muscle and killing fat. The treatment itself takes a longer than the abdomen or buttocks, which are each 30 minutes with a simpler set up. We treat the Biceps and triceps muscles for 20 minutes each, and positioning takes a little longer, so the total time per visit is one hour to treat the arms. (Don’t worry — we have kept the price the same as for abdomen or buttock despite the longer visit.)

We have found the arm treatment to be very effective. Your experience will depend partly on how toned your muscles are to start with. The larger the muscle, the more intense the contractions during treatment. When I do it, I come away feeling like I just fought a 40-minute boxing match. I do find it a little more intense than the abdominal or buttocks treatment. The experience is intense but not painful. You will feel stronger almost immediately. As always, the fat destruction happens over a longer time frame, with most of that process evident after just 1 month, but the total fat melting time is up to 6 months as with other fat-melting procedures.

As always, at Glow we are most concerned with providing safe treatments that are clinically effective. Before FDA approval, studies were done to prove effectiveness using MRI to objectively measure muscle mass and fat. The MRI was performed at 1 month following the series of 4 treatments, done 2-3 days apart over a time period of just 2 weeks. In the arm studies, on average there was 17.1% increase in muscle mass in the Biceps, a 10.2% increase in the Triceps and a 12.8% decrease in arm fat. For calves, the studies showed a 14.6% increase in muscle mass and a 9.9% decrease in fat thickness. These measurements were done at 1 month. Follow-up studies have yet to be published, but if they parallel the previous Emsculpt studies done for the abdomen and buttocks, we expect to see continued fat loss up to 6 months post-procedure.

If you have ever coveted Michelle Obama arms, this treatment is for you! Emsculpt is available at both our centers in Kirkland and West Seattle. Call us or schedule a consultation here.

Vitamin D is critical for your health. Most people do not get enough sunlight to make a healthy amount of Vitamin D, and on top of that we are also told to wear sunblock to prevent skin cancer and aging! What should we be doing, exactly?

What does Vitamin D do?

● Regulates the levels of calcium and phosphate in the bloodstream
● Promotes the mineralization and growth of bones
● Critical role in the immune response, allowing the killer T-cells to defend against infections
● Modulates the expression of genes that regulate cell proliferation, apoptosis, and differentiation, playing an important role in cancer incidence. Epidemiology suggests links between vitamin D deficiency and most cancers, including breast and colon cancer
● Reduces systemic chronic inflammation.

Getting Vitamin D from the Sun

The amount of sun needed for adequate Vitamin D production by your body depends on how much melanin you have. Light-skinned humans need about 20 minutes of unfiltered sunlight over large portions of their bodies to get enough Vitamin D on a daily basis. The darker your skin, the more sun exposure you require, up to 2 hours for very dark skin. Very few Americans get this kind of sun on a daily basis, and as we know, the sun also contributes to aging and, alas, skin cancer. For Vitamin D, you absolutely do not need more than this. If your skin is red, you’ve had too much, and any excess will contribute to a burn or tan, but will also contribute to aging and cancer. Most people in the world do not get enough sun to provide adequate Vitamin D.

Foods with Vitamin D

There is a lot of Vitamin D in wild salmon, mackerel, herring, catfish, cod liver oil, beef liver, cheese and eggs. Unfortunately, it takes large volumes of these items in our diet to supply enough Vitamin D for your health. So, eat them with abandon, but you’ll have to take some additional supplements.

Vitamin D supplements

How much Vitamin D do you need to eat to get enough Vitamin D? A good general rule is 4000 IU per day. Ideally, get a blood test for Vitamin D before you start supplements, take 4000 IU supplements daily, and get them tested again after two months. Ideally, your levels should be above 50 ng/mL. If you don’t see enough of a bumpt with 4000 IU, feel free to increase the dosage. Given that we can make around 10,000 IU in well under an hour of sun exposure, supplementation up to that level is well tolerated. Remember the supplement industry is NOT regulated. Make sure you’re using a brand that independently tests their products for purity and potency.

How much Sun Block?

For anti-aging, make sure you use sun block every day on any part of your skin that you care about what it looks like. For most people, that’s your face, neck and decollete. You might want to add your hands, as we get lots of inquiries from older patients about how to remove age spots from the hands. The UV A rays from the sun do not cause burns, but they do cause all the same aging, sun damage, age spots and cancer that UV B rays do. And UV A rays travel right through the clouds and the rain, right through the windows, and land on your skin all winter, even indoors. So wear a high quality sun block on those parts every day of the year.

For anti-cancer— wear sun block on all sun exposed areas of your skin if you are going to have more than 20 minutes of unfiltered sun exposure if you have light skin and up to 2 hours if your skin is darker. If you get a sunburn, it was too much. If you don’t tend to burn but get tan, that is still way more than you need to generate daily Vitamin D requirements, and all the extra UV rays will make you appear old before your time (think Magda in Something About Mary) and increase your risk of skin cancer.

If you need to find a great sunblock, we have multiple options depending on whether you like your product to be moisturizing, physical, water-resistant, dewey or mat, face or body. We try to get all of our patients into a sun block they just love the feel of on their face, so they’ll use it every day. We love the EltaMD family of sun block– there is something for everyone!

Yes, this is all about vaginas. As a doctor and a mom of 3, I’m so over any shyness about the topic. If you’re not in the mood to hear about it, maybe skip this one. If you are like me, this is a topic near and dear to your heart. We have always called our program “Vaginal Rejuvenation.” I was recently told the preferred term is “Women’s Intimate Wellness.” However you package it, an overwhelming number of women suffer from these symptoms eventually, and we no longer have to just put up with it.

At Glow we now have over 2 years of experience with vaginal rejuvenation procedures using the Exilis Ultra Femme 360, and the verdict is that it works and results are surprisingly long-lasting. This helps with changes related to both childbirth and menopause. Vaginal rejuvenation can specifically address:

• Dribbling
• Stretched-out tissues
• Dryness
• Pain during sex

The biggest reason women are having the procedure has been for dribbling post-childbirth, but a close second and third are for tightening and dryness. The Ultra Femme uses a 360 degree wand and radiofrequency technology to heat the vaginal wall and labia. This induces collagen formation, thickening of the vaginal wall, increased lubrication and tightening of the tissues both inside and out. Treatment consists of a series of 3 painless sessions, and we have found that results happen within 1-2 months have lasted for up to 18 months, but most women have needed some maintenance within 1 year of first treatment. In 2 years we have treated over 50 women, and 98% report either improvement or complete resolution of their symptoms and we have had zero complications.

The main benefits of treatment with the Exilis Ultra Femme 360:

• Very high success rate in treating urinary symptoms, dryness, stretched tissues and painful intercourse
• Requires only 3 sessions
• Non-invasive
• Painless
• No Downtime

What is vFit+?

vFit+ is a brand-new device for at-home use that can be used alone or for maintenance after vaginal rejuvenation with the Ultra Femme. It uses red light LED, heat and vibration to stimulate the tissues to increase blood flow. Studies have found a 95% improvement in intimate wellness, 89% increased confidence with intercourse and an 89% increase in sensation. Our own informal investigation has found that vFit+ is a good option for maintaining results from the Ultra Femme and there are anecdotal reports that is can be used as a stand-alone at-home treatment for some of the same symptoms.

vFit+ is recommended to be used for 10 minutes every other day. Results are reported to be within 1-3 months. Do you match any of these patient profiles?

1. Young Adult: exercise and activities and intimate wellness are important to you. Whether you might have a child in the future or not, maintaining sexual health and intimacy are a top priority.
2. Mom: very little time to yourself, starting to address changes in appearance and health. Connecting with your partner is important to you and things have changed since giving birth; Kegels have not worked. Looking for something easy and convenient to help.
3. Perimenopausal: have a little more time to invest in yourself and fighting aging, a strong emotional connection to your partner is more important than ever. Looking to get back the youthful feeling inside and out.
4. Postmenopausal: your mental and physical state don’t quite match and you’d like to restore the intimacy and confidence you used to have.

The main benefits of vFit+

• Improved confidence with sexual function
• Increased blood flow
• Privacy: at-home treatment in the privacy of your own home
• Affordable
• Non-invasive
• No downtime

We think that both the Ultra Femme and the vFit+ are fantastic tools for, OK I’ll say it– Women’s Intimate Wellness. If you have any questions about these treatments or whether you might be a good candidate, we are here to help! Please contact us if you’d like to find out more.

How I lost 20+ lbs and became more vibrant and fit at 51 than ever before.

As a doctor, I am trained to be skeptical of people’s stories: they are anecdotal and if the lesson isn’t the result of a randomized controlled trial, it simply isn’t true. I used to believe that. However, I have lived long enough to realize that very few parts of real life have been subject to a clinical trial, and there are still universal truths to be found. For most of my adult life, I believed that “everything in moderation” was the healthy way to go. Physicians don’t get much more nutritional education in medical school than that. If I hadn’t lived my story, I wouldn’t believe it. But here I’ll tell you the story of how I went “paleo” and how really doubling down on the principals of primal living has transformed my life.

I have had a chronic cough since I was a resident in the mid 90’s. I moved to Seattle at age 26 and soon found I had a mild dry cough. I thought I might have had some mild allergy to something in the air here. The cough got worse throughout my 20’s and around 30 I decided to have a work-up. I saw a pulmonologist, gastroenterologist and an allergist. The GI doc put me on a drug to decrease acid in my stomach, since maybe the cough was from reflux. It did not help. The allergist told me I had a mild allergy to cats, but my cough was no worse around cats. The pulmonologist put me on an antihistamine and nasal steroid for “allergies” which I continued to take for 20 years, but the cough was unrelenting, and slowly got worse. Eventually it was a productive cough that I had most of the time, worst at night, so bad that it kept me up at night and I would need chloraseptic spray to numb my throat just to get to sleep. I lived that way for 20 years.

When I was in my mid 40’s, my wife wanted to try a new diet which was very strict (no grains, dairy or fruit) for 6 days and had a “cheat day” on day 7. I offered to do it with her to be supportive. After a few weeks, I realized that the cough that I had learned to live with was almost completely absent during the 6 days, but came back with a vengeance on cheat day. I could not believe it, as neither I nor any of my doctors thought that a cough could be from something you eat. The worst part: my favorite food was a delicious french baguette from Bakery Nouveau in West Seattle (honestly– it is like being in France) and camembert cheese. That’s pretty much all I ate on cheat day. So, suddenly I was facing the sad fact that one or both of my favorite foods was causing the cough. After a short trial, I found it was the bread. And then it all made sense. The symptoms were dose-dependent– the more bread or other gluten-containing foods I ate, the worse the cough would be. (It was particularly bad after Chinese food– who knew there was so much wheat in soy sauce!) That’s when I gave up wheat (and all other inflammatory grains) entirely. About 7 years ago, I went completely Paleo and my cough almost completely resolved.

After going grain-free I did not worry about my overall caloric intake or any component of it, and I continued to drink alcohol– mostly wine. There are lots of Paleo-friendly treats, and I tended to eat some of those (in moderation!) every day. These are grain-free but still high in carbs. My weight slowly crept up around 3 lbs/year, despite never eating bread or pasta and always working out about 3-5 times/week. I had reached a weight that approached my peak pregnancy weight (and I had twins!!!). Finally, my New Year’s Resolution in 2019 was to do a Whole30 in January to try to reset my body. For 30 days I ate only whole vegetables and various protein from meat, fish, and fowl. No more paleo treats, no alcohol, minimal fruit and no dairy. My carbs were below 50g each day. As you might expect, I lost fat– about 7 lbs that month. (As of this writing, I’m back down to my young adult weight). But the most amazing and wonderful thing happened also– I felt huge energy boost and a mental clarity I hadn’t felt my entire adult life. I felt so amazing, I was actually upset that I had never figured this out before. At 51, I suddenly felt better than I ever had.

I found myself compelled to find out everything about nutrition and how our diet and exercise affects our well-being and mental acuity (not just how to become a fat-burning beast, although that part is fascinating too). My medical degree from Yale and 25 years of practice did not provide any new information on nutrition. Since January, I have spent all my free time reading as much as I can on the topic. All that research lead to my enrolling at the Primal Health Coaching Institute to gain a more thorough and intimate knowledge. I did not intend to change my career (yet again) and become a health coaching guru. But even before I finished the 20-week course, I felt I had to do something to change the world. Or at least help a few people feel this great. So, in addition to medical aesthetics, I am now offering health coaching to a few people each month who are interested in changing their lives the way I have.

The new program is on the web site here: GlowFit Health

I hope this inspires some of you to join me!