A recent article in Dermatologic Surgery suggests that injectors (and patients) should be aware of the effects of needle size on the properties of fillers. Various types of fillers (monophasic and biphasic) were injected through 30G needles and the size and properties of the fillers were analyzed after they had been injected through the needles.  

Both monophasic (e.g. Juvederm products) and biphasic (e.g. Restylane) fillers were affected by the smaller needle size. They were affected in terms of the size of the extruded particles and in the properties (G’) of the extruded particles. Interestingly, biphasic fillers seemed to be affected more than monophasic fillers. In addition, larger particles seemed to be affected more than smaller particles as we would intuitively expect. 

Injectors should consider the size of the needle being used to inject fillers (especially biphasic fillers and fillers of larger particle size) as this might affect the performance and durability of the filler.

Reference: 

Soft Tissue Filler Properties Can Be Altered by a Small-Diameter Needle. Dermatol Surg 2020 Sep;46(9):1155-1162.

Nuceiva is the newest neuromodulator on the market for the treatment of glabellar frown lines. Whereas Botox is referred to as abobotulinumtoxin A, Nuceiva is referred to as prabotulinumtoxin A.

Similar to other brands such as Botox, Xeomin, and Dysport, Nuceiva™ works to smooth out creases in the face by decreasing muscle contraction.

It has been approved by Health Canada and the FDA.

Marketed as Jeuveau by a company called Evolus in the United States, it originated with a South Korean company called Daewoong. Nuceiva™ was authorized for sale by Health Canada in August of 2019 and was subsequently officially brought to the Canadian market by Clarion Medical Technologies in October 2019. It is also available in the European Union.

Nuceiva™ usually lasts about 3 to 4 months although this varies from person to person. A study published in Dermatologic Surgery in 2019 showed similar efficacy to Botox.

Bleach baths are a controversial therapy for patient with atopic eczema, also known as atopic dermatitis (AD). In recent years, there has been an increase in the use of bleach baths to decrease the severity of the eczema. However, a recent review showed that while bleach baths did seem to decrease the severity of atopic eczema, it was no more effective than water baths alone. There has been a lot of research into the effect of bleach baths on Staphylococcus bacteria and it seems like the concentration of bleach used in bleach baths may not be high enough to kill bacteria. There may be other anti-inflammatory properties that have yet to be discovered.

With all of the conflicting data out there, the best summation is probably what was stated in the latest Canadian consensus statement on pediatric atopic eczema: “bleach baths have not been consistently shown to improve outcomes in AD and may be used at the discretion of the treating health care provider.”

Reference:
Lansang P et al, Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg.2019;23(5):32S-39S.

Pulsed dye laser (PDL) is a very effective treatment for redness of the face due to enlarged blood vessels. It has proven to be very safe and effective. However, there is some discomfort from the laser pulses and while most patients have no difficulty tolerating treatment without any anesthetic, some patients do find it difficult to tolerate. Topical anesthetic can be used to decrease the discomfort of laser treatments but there has always been the question of whether the vasoconstrictive properties (i.e. constriction of blood vessels) of the anesthetic might have an adverse effect on outcome if you are trying to get rid of blood vessels.

A recent study by Chunharas et al in April of 2020 (Lasers Surg Med. 2020 Apr;52(4):307-314) demonstrates that topical anesthesia with lidocaine and tetracaine do not interfere with the efficacy of pulsed dye lasers. This is great news for those who want to receive treatments with pulsed dye lasers.

Thank you for your patience! As Phase 2 is set to open on June 12, 2020, we are happy to announce that we are reopening as well! We have been following the Chief Medical Officer of Health instructions and have therefore not been able to see any of our patients since March 16, 2020, except for skin cancer patients and those with urgent needs.

We are happy to announce that we will be booking appointments for all those we had to cancel over the last few months, as well as accommodate those on our wait list. We look forward to see you back again! We thank you for your patience and understanding as we ourselves need to go through our phased approach to booking.

Sincerely,

Dr. Nakatsui

Prabotulinumtoxin A

In 2002, Botox (onabotulinumtoxin A) was the first botulinum toxin to gain FDA approval for the “temporary treatment of glabellar lines in adults.”  A recent study published in Dermatologic Surgery reviewed two Phase 2 randomized, multicenter, double-blind, placebo controlled trials with 2100 patients showed that a new version called prabotulinumtoxin A had a similar onset of action, duration of action, and adverse event profile as compared to Botox. On the market currently, we have Botox, Dysport, and Xeomin for the treatment of lines and wrinkles. We may see another agent available soon.

References:

1. Dermatol Surg. 2019 Dec;45(12):1610-1619

Temporary Closure

On Monday, March 16, 2020, the Nakatsui DermaSurgery Centre decided to take a leading initiative and temporarily close operations to help mitigate the spread of COVID-19. This was not an easy decision. In the end, we are confident that this was the best decision to protect our patients, our staff, and our community. We have stopped all non-essential services and are in the process of contacting patients who were scheduled to see us in the next two weeks to let them know what is happening. We will do our best to reschedule everyone as soon as possible once the situation improves. For our current patients who have more urgent medical needs, Dr. Nakatsui will make himself available to see you.

It is important to remember we should not panic as this infection will be well managed for the vast majority of those affected. However, we must assist our health care system by “flattening the curve” and preventing the exponential rise in COVID-19 and reducing the number of serious cases.

We will still be answering our phones and responding to emails for the time being. If you have any questions and concerns, please feel free to contact us at 780-482-1414 or via email at info@nakatsuiderm.com. At this time, we are monitoring the situation daily and will post when we reopen. 

For more information on COVID-19, please check the www.alberta.ca website. In addition, Dr. Nakatsui wanted to let you know about two other interesting links that contain updated information on global infection rates and a comparison between American and Canadian infection rates.

A recent study on SPF published in the Journal of the American Academy of Dermatology (JAAD, 2018; 78: 902-910) demonstrates that higher sun protection factor sunscreens really do provide additional benefit. This study evaluated skiers in a double-blind, split-face, randomized study. In this study, skiers in Vail, Colorado wore SPF 50 on one side of the face and SPF 100 on the other side of the face. They were allowed to do their normal activities and were then evaluated the next day to see if there was any evidence of sunburn erythema. The SPF 100 sunscreen side was found to be significantly more effective in protecting against sunburn.
The study supports our belief that if you are going to be out in a lot of sun, the higher the sun protection factor, the better! Another factor that may be important is that many of us apply far less sunscreen than we should, so you might think you are getting an SPF 50. However, you might be applying such a thin layer that you are only getting the equivalent of SPF 20! Consequently, make certain you apply enough sunscreen to provide adequate protection and if you decide to go to a higher sun protection factor, all the better. Your skin will thank you.

Sunscreen helps protect against the development of sun damage and skin cancers. We have many patients who either worked or played outside for many years and they are now seeing the after effects many years later. If you don’t believe it, go to Australia and see what percentage of people have skin cancer. Skin cancer is not fun. Protect your skin–it will thank you later.

Pumpkin spice everything, leaves falling, and sweaters everyday can only mean one thing:  Fall is here!  This beautiful and romantic time of year can also mean changes in weather and temperature which can affect your skin.  Everyday events that we take for granted, such as stronger winds, can strip away moisture from the skin.  When this moisture is stripped or there are irritants in the air, your skin can become itchy or even a rash can appear!  Here are some basic tips to help your skin retain moisture.  The following are only tips and does not replace seeing a qualified dermatologist.

1. Shorten the time spent in showers and baths.

Not only is it good for the environment to decrease the amount of water used, limiting the time spent in the shower will prevent your skin from losing its moisture barrier.

Closing the bathroom door to keep moisture in the bathroom is a great way to keep your skin moist.

Hot water can irritate the skin.  Try dropping the temperature to a warm setting.

Use unscented soap products on your skin.

Gently pat your skin dry with a towel.

Immediately after drying your skin, apply a non-irritating moisturizer to your skin.

2. Apply moisturizers after wash.

Washing your hands will strip away moisture from your skin.  Many individuals, especially those in the healthcare field, wash their hands several times a day.  After washing your hands, lightly pat dry your hands and then immediately apply moisturizer.  This will help keep moisture in your hands.

3. Wearing gloves.

Wearing gloves when outside is not only a fashion statement, it can help protect your hands from the elements!  Gloves can also help retain moisture on your skin.

Gloves also act as a physical barrier between your skin and other substances in your environment, such as chemicals, potential allergens, and objects than can cause little cuts.

4. Choose the right detergent for you.

Find a non-irritating laundry detergent that works for you.  It will take some trial and error to find the perfect fit.  Try using an unscented/hypoallergenic detergent to avoid irritation.

5. Limit time directly in front of the fireplace.

Cozying up next to a fireplace on a chilly autumn day can truly warm the soul.  Just remember fire or any heat source can dry your skin.  Try limiting your time spent directly beside any heat source.  Also, don’t forget that if you are using a fireplace to have a window or door open to allow fresh air to circulate within the home!

6. Humidifiers

Humidifiers are great tools to help bring back moisture into the air and decrease the chances of your skin drying out.

7. Don’t forget the sunscreen

Yes, even with the limited hours of sun and increased cloudiness, wearing sunscreen on open portions of skin is still very important throughout the year!  Many sunscreens will also provide a moisture barrier to help retain that needed moisture.

The autumn season is an incredible time of year.  Don’t let dry skin bring an end to your fun.  If you find that your are experiencing prolonged periods of dryness or even a rash, consult with your Dermatologist!

Do you feel like you look sad, tired, or angry even when you’re not? If so, you are not alone. Some of the most common concerns patients have when they come into the Groot DermaSurgery Centre are that they look fatigued, upset, or depressed, even though they feel well rested, energetic, and happy. For many people, how they feel on the inside is not reflected on the outside. At the Groot DermaSurgery Centre, Dr. Nakatsui can help you understand the cause of your concerns, discuss those concerns, and help determine a game plan to revitalise your appearance.

As we age, skin elasticity is lost and the skin becomes less firm. Years of expression cause wrinkling to form around the eyes and forehead. Excess sun exposure causes changes in skin texture. The natural fat pads beneath the skin that give the face shape begin to shrink and shift, resulting in loss of fullness. Even our bone density diminishes around the cheeks, chin, and temples, resulting in a hollowed appearance. Weight loss causes areas of the face to become sunken and appear less full and youthful. All of these factors affect how we look.

Understanding these anatomical changes is important as it allows Dr. Nakatsui to determine how to reverse them. Understanding how facial muscles work in conjunction with fat pads and bone structure determines where a filler or Botox should be used. Dr. Nakatsui employs a variety of treatment options and techniques tailored to your specific situation and goals. As the concept of aesthetics expands, it is no longer just about treating lines and wrinkles, but rather revitalizing specific areas of the face to meet the end goals of trying to look less fatigued, angry, or sad.

If you would like to book a complimentary consultation with Dr. Nakatsui please contact our clinic at (780) 482 – 1414 or you can book an appointment online following the link below.

For your convenience, Botox and filler appointments, as well as Coolsculpting, Thermitight, and HydraFacial MD appointments can be booked directly online or by calling the office directly at 780-482-1414. There is a $100.00 refundable deposit required to reserve an appointment using the online booking service (please note there is a $20.00 administrative fee deducted from this deposit). If you cannot find a convenient time using the online scheduler, please call as there may be additional appointment times available that are not visible online.

For all other services, please call to schedule an appointment.

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Please note that you WILL receive a confirmatory email upon successful completion of this online request. If you do not receive a confirmatory email, please contact our office by telephone to ensure that your request was successfully completed.