I love the fall surgery meeting because it is such a great source of the most up to date information. You get to talk/listen to the actual people involved in the research. The following are some of the “tidbits” from the meeting in addition to the Tanda (11/11/11 blog).
Skin Medica’s Redness Relief cream with 1% 4-Ethoxybenzaldehyde was shown to provide a 44% improvement in facial redness in 4 weeks. My favorite and most respected product researcher, Zoe Draelos MD, was behind this study so it is a very reliable report.
There is another eyelash product, RevitaLash, which was developed by an eye doctor initially to treat cancer patients including his wife. The most active and controversial chemical in it is similar to the one in Allergan’s Latisse. I have had a lengthening of my lashes with Latisse to the point of having to carefully trim them. I have reduced my use to 2-3 times per week and the amount by half without affecting the growth I have achieved. Pam, our aesthetician, has been using LiLash and her lashes have become so thick and long with an upward curl that she no longer needs to use her eyelash curler.
As a physician, I think we need to have regular eye exams, not continue with any product if it is causing irritation, follow the instructions in the package, keep the applicators and skin clean and report any side effects to the manufactures. As a female, I’m very happy to have lashes similar to the teenage male patients in my clinic. Sometimes life isn’t fair.
An update on the topical neurotoxin which in the second year of phase III trials looks very promising. While it will never replace the effectiveness of Botox or Dysport, it will be able to be used under the eyes and possible eyelids which hasn’t been the case with injectables. It is hoped that it will be useful for very sweaty palms and soles of the feet also.
The Canadians were singing the praise of an even denser hyaluronic acid filler called Voluma from Allergan. It sounds like it will be similar to Sculptra in the way it will be used for facial volumizing.
While there are several treatments for acne scars, there are no magic answers. There is possibly an underlying abnormal healing response in the first place. Multiple treatments are required for a 50-60% improvement.
Dr. Danny Vleggarr, of Sculptra fame, continues to explore the 3 dimensional changes in the aging face. I was really amazed at the differences between male and females. For females, the lower face is more narrowed and recessed. For males, the upper face compresses in. The bottom line is that where we place the fillers will be different. There was another report where very dilute Sculptra was injected into the central chest “crinkles” and lasted up to two years.
LaViv (azficel-T) takes a patient’s own tissue (skin from behind the ear) and grows a “very personal” filler with the patients own fibnoblasts to be used for facial lines and folds.
Phase III trials are starting on ATX-101, a fat dissolving injection. It will treat small areas only, such as the chin. It generally takes four treatments; one month apart and certainly won’t replace liposuction.
Dr. Ann
Thursday, December 1, 2011
Wednesday, November 23, 2011
The Tanda - New from CDLC
Highlights from the ASDS (American Society of Dermatologic Surgery) annual meeting.
The Tanda
When I saw the Tanda on the silent auction table it triggered a memory of several laser meetings where red light was discussed for treating inflammation (redness) post laser treatments. Here was the same technology in a home devise and was marketed by Young Pharmaceutical, a respected medical skin care company. Once I won the bid, I headed to the exhibit hall to talk with the formulating chemist and scientific brain who founded Young Pharmaceutical. He was surprisingly enthusiastic which was an unusual demeanor for this intellectual, formal, East Coast man. He showed me a treatment pattern that he had developed for the device so it would cover the face, neck, center of the chest and the backs of the hands in 7 ½ minutes, three times a week and was sharing the changes he was noticing in his own skin. I was encouraged to follow the treatment with his vitamin C antioxidant if done in the morning or the retinol product if used at night. The treatment turned out to be very easy but, as always, I think you need to be very careful around the eyes. I added my nose to the areas to be treated not only because of my rosacea redness but the pore size from Hades. To my complete surprise, I noticed definite smoothing of my skin and pore size the morning after my third treatment. I used my prescription strength tretinoin instead of the retinol after each treatment without any problems. I am looking forward to talking with other derms and my patients as to their experiences with this technology. There is also an interchangeable blue light treatment head. This treats acne and would be great for those of us who still suffer well into adulthood. Red for beauty, blue for zits or in other words, red for mom and blue for teens.
Dr Ann
The Tanda
When I saw the Tanda on the silent auction table it triggered a memory of several laser meetings where red light was discussed for treating inflammation (redness) post laser treatments. Here was the same technology in a home devise and was marketed by Young Pharmaceutical, a respected medical skin care company. Once I won the bid, I headed to the exhibit hall to talk with the formulating chemist and scientific brain who founded Young Pharmaceutical. He was surprisingly enthusiastic which was an unusual demeanor for this intellectual, formal, East Coast man. He showed me a treatment pattern that he had developed for the device so it would cover the face, neck, center of the chest and the backs of the hands in 7 ½ minutes, three times a week and was sharing the changes he was noticing in his own skin. I was encouraged to follow the treatment with his vitamin C antioxidant if done in the morning or the retinol product if used at night. The treatment turned out to be very easy but, as always, I think you need to be very careful around the eyes. I added my nose to the areas to be treated not only because of my rosacea redness but the pore size from Hades. To my complete surprise, I noticed definite smoothing of my skin and pore size the morning after my third treatment. I used my prescription strength tretinoin instead of the retinol after each treatment without any problems. I am looking forward to talking with other derms and my patients as to their experiences with this technology. There is also an interchangeable blue light treatment head. This treats acne and would be great for those of us who still suffer well into adulthood. Red for beauty, blue for zits or in other words, red for mom and blue for teens.
Dr Ann
Thursday, September 22, 2011
Photo Aging and 3-Dimensional Rejuvenation
In the August 2011 Cosmetic Dermatology journal there was an excellent article entitled “Photo aging and 3-Dimensional Rejuvenation” by Nels Kruger, PhD and Neil S. Sadick M.D. I really liked how it was presented noting that aging and sun damage isn’t just one dimensional so we need to approach the “slowing down” of those changes by treating each affected skin layer. I want to share this approach with you via the treatments available at CDLC.
Type 1 Rejuvenation. Think of the very top layer of skin (epidermis) as your “tablecloth”. With use it becomes spotted, discolored, finely wrinkled, dull looking, even “thread bare” in some areas. This is where microdermabrasion, superficial skin peels, dermaplaning and a good home care program comes into play. Non ablative lasers help with the discoloration (both red & brown) such as age and sun freckles and broken blood vessels. Just as some table cloths require multiple spot treatments and/or long soaks, you will see continued improvement and maintained improvement if multiple superficial treatments are preformed regularly. We love the combo peels: Mini Melanage, Gloss and the VI Peel, dermaplaning and the SilkPeel microdermabrasion.
Type 2 Rejuvenation. This is the “table pad” layer where our dermis, with its fibrous network of collagen, elastin, glycoaminoglycams, veins, arteries and nerves all support the overlying epidermis. This layer is vulnerable to unprotected long term UV radiation particularly UVA. Care requires regular use of topical UV protection by sun block and/or clothing, the tretinoin creams, antioxidant and DNA repair creams. Repeated non ablative laser treatments such as CDLC’s Gemini laser and medium depth chemical peels.
Type 3 Rejuvenation. This reminds me of treating an old sun exposed wicker table. In the skin, the focus is not only on the broken-down collagen fibers in the deep dermis but actual volume loss which occurs from UV triggered lipoatrophy, the downward migration of the cheek fat pads and the receding of the facial bones (the eye sockets sink, the jaw & chin recede). This rejuvenation requires the ablative lasers such as the fractionated CO2 lasers. At CDLC, this is called the Pixel which is the name of the hand piece that fractionates the CO2 laser beam into pinpoint wounds. The wounding is necessary to stimulate the growth of new collagen more deeply. We have learned to address the volume loss with fillers of various density depending on the amount of loss and the area involved. Generally this primarily involves the upper cheek area and around the mouth (although it has been fun to smooth nose irregularities, plump up earlobes and soften jowl lines.)
Type 1 Rejuvenation. Think of the very top layer of skin (epidermis) as your “tablecloth”. With use it becomes spotted, discolored, finely wrinkled, dull looking, even “thread bare” in some areas. This is where microdermabrasion, superficial skin peels, dermaplaning and a good home care program comes into play. Non ablative lasers help with the discoloration (both red & brown) such as age and sun freckles and broken blood vessels. Just as some table cloths require multiple spot treatments and/or long soaks, you will see continued improvement and maintained improvement if multiple superficial treatments are preformed regularly. We love the combo peels: Mini Melanage, Gloss and the VI Peel, dermaplaning and the SilkPeel microdermabrasion.
Type 2 Rejuvenation. This is the “table pad” layer where our dermis, with its fibrous network of collagen, elastin, glycoaminoglycams, veins, arteries and nerves all support the overlying epidermis. This layer is vulnerable to unprotected long term UV radiation particularly UVA. Care requires regular use of topical UV protection by sun block and/or clothing, the tretinoin creams, antioxidant and DNA repair creams. Repeated non ablative laser treatments such as CDLC’s Gemini laser and medium depth chemical peels.
Type 3 Rejuvenation. This reminds me of treating an old sun exposed wicker table. In the skin, the focus is not only on the broken-down collagen fibers in the deep dermis but actual volume loss which occurs from UV triggered lipoatrophy, the downward migration of the cheek fat pads and the receding of the facial bones (the eye sockets sink, the jaw & chin recede). This rejuvenation requires the ablative lasers such as the fractionated CO2 lasers. At CDLC, this is called the Pixel which is the name of the hand piece that fractionates the CO2 laser beam into pinpoint wounds. The wounding is necessary to stimulate the growth of new collagen more deeply. We have learned to address the volume loss with fillers of various density depending on the amount of loss and the area involved. Generally this primarily involves the upper cheek area and around the mouth (although it has been fun to smooth nose irregularities, plump up earlobes and soften jowl lines.)
Friday, August 5, 2011
Psychology & Me
In May, I had the opportunity to attend my husband’s national meeting of the Association of Psychological Science. When Roger decided in his mid life to go back to school for a PhD in Psychology, we had fun teasing him about it not being a “real” science. This was, of course, ignoring several weeks where he was immersed in the anatomy, physiology and chemistry of the brain and learning a lot more information than was available during my med school days. There were many studies presented at this conference and not only do they use a complex descriptive language, they have many more variables to control in these studies. It was fascinating but I still haven’t found the answer as to why many of us are so self critical of our appearance. It is true that as females we grow up surrounded with the focus of beauty and fashion. As a physician, I wish we grew up with the focus on health and the value of who we are as “a person”. I know this is unusual for a doc who enjoys providing aesthetic “treats” for people but I sometimes wish I could nurture the self awareness and joy of discovering the person who exists under that skin.
What's New in Cosmetic Dermatology?
What’s new in cosmetic dermatology? Chemical peels are being rediscovered. I was first introduced into this area in the late 80’s when alpha hydroxys were discussed by Doctors Van Scott, Yu, and Dietre at our dermatology conferences. Glycolic and Salicylic acids helped sun damaged and acne prone skin without the significant downtime needed for the medium and deep peels. Lasers then pushed to the forefront but now chemical peels are coming back with exciting new combo variations which include some of our deep peel chemicals (phenol, trichlorectic) but in much lower strengths. While there is peeling that occurs after the peel, it is much more superficial (like a mild sunburn) and can be timed to coordinate with a person’s social schedule. The key here is to do a series of 4-6 treatments, 2-4 weeks apart and to be on a good home care program to maintain the improvement. I think the boomer generation is finally understanding that our years of fun in the sun took a toll on our skin. The chemical peel is our “resurfacing” tool and is much easier than redoing grandmother’s dresser. Check out Young Pharmaceutical’s Gloss peel and Melanage peel, Caleel’s VI peel, SkinCeuticals Pigment Balancing peel, Skin Medica’s Rejuvenize peel, Envy Medical’s SilkPeel and the new kid on the block, Ascend Pharma’s Apeele peel.
Dr. Ann
Dr. Ann
Wednesday, July 20, 2011
Receive Better Results with a Series of Treatments
When I first started blogging, Amy, our website support guru, said people tend to be good at first and then often taper off in their dedication. She was very “right on” although I have “written” several in my head while out running.
The one regular writer that I know is Dr. Ed Lack in Chicago who writes phenomenal derm related blogs (http://blog.metropolitanmds.com). He has one of those active brains that love to explore and sometimes challenge the status quo. He is a recent past president of the American Academy of Cosmetic Surgery and a very fascinating person who happens to have the same fractionated hand piece for his CO2 laser that I do. He is one of my favorite mentors and is very good at reminding my “want it now” mind set that we will see more results if we commit to a series of treatments 1-6 months apart and let the “wounding” of the skin do its “thing” of collagen rebuilding.
I have had a recent reminder of the truth of this fact from one of my favorite long term patients with acne scars. We have tried many different types of treatments over the years and now after the 3rd fractionated CO2 laser treatment the patient is being asked about the cause behind the “looking so good” comments received. Nothing completely turns back the effect of multiple birthdays but a series of CO2 laser treatments certainly helps soften the skin texture changes.
The one regular writer that I know is Dr. Ed Lack in Chicago who writes phenomenal derm related blogs (http://blog.metropolitanmds.com). He has one of those active brains that love to explore and sometimes challenge the status quo. He is a recent past president of the American Academy of Cosmetic Surgery and a very fascinating person who happens to have the same fractionated hand piece for his CO2 laser that I do. He is one of my favorite mentors and is very good at reminding my “want it now” mind set that we will see more results if we commit to a series of treatments 1-6 months apart and let the “wounding” of the skin do its “thing” of collagen rebuilding.
I have had a recent reminder of the truth of this fact from one of my favorite long term patients with acne scars. We have tried many different types of treatments over the years and now after the 3rd fractionated CO2 laser treatment the patient is being asked about the cause behind the “looking so good” comments received. Nothing completely turns back the effect of multiple birthdays but a series of CO2 laser treatments certainly helps soften the skin texture changes.
Thursday, April 28, 2011
SkinCeuticals Triple Treat
Dermaplaning, Chemical Peel, Cryotherapy: SkinCeuticals Triple Treat
It all started with a phone call from someone who had moved from New York City asking if our office offered dermaplaning. I was aware of what it was and had even tried it on myself with the regular scalpel blade. Not a good idea! One of the main reasons the New Yorker and I were interested was for facial peach fuzz type hair. During the 1st step, the dermaplaning tool not only gently exfoliates but also removes this fine facial hair. The next step is to pick one of four chemical peels. These chemical peels are used to revitalize photo damaged skin, fade dark spots, improve skin tone and laxity, increase radiance, diminish fine lines, wrinkles and pore size. The peels vary by their active ingredients which include glycolic acid, salicylic acid, lactic acid, citric acid, usmic acid, vitamin C and niacin. Our training and experience helps us pick the best for each patient’s skin issues.
The final and very popular step is the cryotherapy. This not only feels good but increases skin cell turnover and calms the skin by stimulating an anti-inflamatory response. With a series of cryotherapy treatments, the skin has a radiance which comes from smoother texture and increase cell turnover.
The bottom line: This gives us a new upgrade in the old and reliable chemical peel approach to advanced skin care.
Dr. Ann
It all started with a phone call from someone who had moved from New York City asking if our office offered dermaplaning. I was aware of what it was and had even tried it on myself with the regular scalpel blade. Not a good idea! One of the main reasons the New Yorker and I were interested was for facial peach fuzz type hair. During the 1st step, the dermaplaning tool not only gently exfoliates but also removes this fine facial hair. The next step is to pick one of four chemical peels. These chemical peels are used to revitalize photo damaged skin, fade dark spots, improve skin tone and laxity, increase radiance, diminish fine lines, wrinkles and pore size. The peels vary by their active ingredients which include glycolic acid, salicylic acid, lactic acid, citric acid, usmic acid, vitamin C and niacin. Our training and experience helps us pick the best for each patient’s skin issues.
The final and very popular step is the cryotherapy. This not only feels good but increases skin cell turnover and calms the skin by stimulating an anti-inflamatory response. With a series of cryotherapy treatments, the skin has a radiance which comes from smoother texture and increase cell turnover.
The bottom line: This gives us a new upgrade in the old and reliable chemical peel approach to advanced skin care.
Dr. Ann
Thursday, April 7, 2011
Building a Skin Care Regimen
It really tickles me when I find an article in my professional journal that confirms my thoughts and conclusions on a particular subject. This just happened in the February, 2011 issue of Practical Dermatology. The article, “Building the Skin Care Regimen: Choosing the Right Ingredients,” by Vivian W. Bucay M.D. strongly paralleled the information in my “core four” handout that I use in the office when asked for a good skin care regimen.
Dr. Bucay lists:
1. Sunscreen
2. Topical antioxidants
3. Retinoids
4. DNA repair
My list is:
1. Sunscreen
2. Retinoids
3. DNA repair
4. Clarisonic for cleansing
In seven pages, Dr. Bucay tackles summarizing the science behind her choices and provides a table listing her favorite products which are primarily available in physician’s offices.
I love the Clarisonic Skin Machine for its ability to gently but very thoroughly get the skin clean so when you do use your retinoids and antioxidants they have a better chance to be absorbed. The size of the molecular structure and it’s stability in a product has been a big obstacle to using antioxidants topically. (There are several docs who feel its best just to eat them if you can; i.e. fruits and vegetables. Have you heard that one before?!!)
One product name that is consistently favored by derms for themselves and their patients in the antioxidant category is SkinCeuticals CE Ferulic.
New to the lists of core products is DNA repair. It is the brain child of Daniel Yarosh PhD and was first available as Remergent DNA Repair and more recently as Celfix DNA Youth Recovery. The later company has published an impressive study of 100 patients using the product twice daily plus sunscreen. The patients showed a 40-50% reduction in sun damage spots as documented in their UV photos. I have been faithfully using it once a day for the past two years and have definitely seen an improvement of the “brown” on my neck. Dr. Yarosh wrote an interesting book entitled “The New Science of Perfect Skin/Understanding Skin Care Myths and Miracles for Radiant Skin at Any Age.” It is so packed with information that it has become more of a reference book. With the copy right in 2008, some of the over the counter products will be in their 4th generation of marketing terminology but the basic information will still be there. Dr Yarosh also is introducing genomics or understanding of the human DNA code as a tool by which next generation products will be developed. A very exciting hope for us sun damaged sun bunnies.
If you would like to read Dr. Yarosh's book "The New Science of Perfect Skin", it is available at Gere Library.
Dr. Ann
Dr. Bucay lists:
1. Sunscreen
2. Topical antioxidants
3. Retinoids
4. DNA repair
My list is:
1. Sunscreen
2. Retinoids
3. DNA repair
4. Clarisonic for cleansing
In seven pages, Dr. Bucay tackles summarizing the science behind her choices and provides a table listing her favorite products which are primarily available in physician’s offices.
I love the Clarisonic Skin Machine for its ability to gently but very thoroughly get the skin clean so when you do use your retinoids and antioxidants they have a better chance to be absorbed. The size of the molecular structure and it’s stability in a product has been a big obstacle to using antioxidants topically. (There are several docs who feel its best just to eat them if you can; i.e. fruits and vegetables. Have you heard that one before?!!)
One product name that is consistently favored by derms for themselves and their patients in the antioxidant category is SkinCeuticals CE Ferulic.
New to the lists of core products is DNA repair. It is the brain child of Daniel Yarosh PhD and was first available as Remergent DNA Repair and more recently as Celfix DNA Youth Recovery. The later company has published an impressive study of 100 patients using the product twice daily plus sunscreen. The patients showed a 40-50% reduction in sun damage spots as documented in their UV photos. I have been faithfully using it once a day for the past two years and have definitely seen an improvement of the “brown” on my neck. Dr. Yarosh wrote an interesting book entitled “The New Science of Perfect Skin/Understanding Skin Care Myths and Miracles for Radiant Skin at Any Age.” It is so packed with information that it has become more of a reference book. With the copy right in 2008, some of the over the counter products will be in their 4th generation of marketing terminology but the basic information will still be there. Dr Yarosh also is introducing genomics or understanding of the human DNA code as a tool by which next generation products will be developed. A very exciting hope for us sun damaged sun bunnies.
If you would like to read Dr. Yarosh's book "The New Science of Perfect Skin", it is available at Gere Library.
Dr. Ann
CPR Training
We just finished an in office CPR training/practice code blue, thanks to Lancaster County Medical Auxilary volunteer, Joan Kiple R.N.
My trustworthy brain likes to turn to mush with the tension of trying to follow all of the steps. It was so much more comfortable to be in my own office with Joan’s quiet and gentle support. I am thankful that the technique is evolving to mainly chest compressions and using an AED if available. There were several references in the American Heart Association training manual to the time consumed by trying to check pulses and give effective breaths while the brain was needing the blood to be pumped. By focusing on just chest compressions more of us will be able to help and (maybe) be helped.
Please consider taking a class or checking out a DVD at the library. I did find one at Gere Library entitled “Complete CPR” by American Safety Emergency Medical Training. John Klatt was the trainer and was excellent in explaining the rationale to the various steps and situations. While filmed in 2008, he made several references to the thinking behind the new guidelines. You can also find many (5,340) sources if you google, new guidelines for CPR.
Please take the time for an update and remember (Ann), don’t bend your elbows.
Dr. Ann
My trustworthy brain likes to turn to mush with the tension of trying to follow all of the steps. It was so much more comfortable to be in my own office with Joan’s quiet and gentle support. I am thankful that the technique is evolving to mainly chest compressions and using an AED if available. There were several references in the American Heart Association training manual to the time consumed by trying to check pulses and give effective breaths while the brain was needing the blood to be pumped. By focusing on just chest compressions more of us will be able to help and (maybe) be helped.
Please consider taking a class or checking out a DVD at the library. I did find one at Gere Library entitled “Complete CPR” by American Safety Emergency Medical Training. John Klatt was the trainer and was excellent in explaining the rationale to the various steps and situations. While filmed in 2008, he made several references to the thinking behind the new guidelines. You can also find many (5,340) sources if you google, new guidelines for CPR.
Please take the time for an update and remember (Ann), don’t bend your elbows.
Dr. Ann
Friday, January 21, 2011
Other Pearls from the Orlando Derm Meeting
The enthusiasm for fractional CO2 is still high. The challenge for skin tightening is being explored by bipolar radiofrequency, focused intense ultrasound, “the jury is still out”. The answer to one lecture entitled “Are Face Lifts Obsolete?” is a resounding NO!
The most popular laser treatment is still hair removal. A new diode laser called the Soprano will be a favorite if it really is “much more comfortable”.
There are new fillers and neurotoxins on the horizon and a better understanding of “lifting” rather than filling the valleys of the face.
Chemical peels continue to be popular particularly the superficial ones, which in a series, will brighten and lighten the skin with minimal to no downtime. The salicylic acid peels are the safest for skin of color.
In medications applied to the skin, vehicles matter. It is not just the active ingredients if they are not being delivered to their target. Intuitively and clinically this was obvious but the battles with the insurance companies and pharmacies are continuing to disregard this fact.
The most popular laser treatment is still hair removal. A new diode laser called the Soprano will be a favorite if it really is “much more comfortable”.
There are new fillers and neurotoxins on the horizon and a better understanding of “lifting” rather than filling the valleys of the face.
Chemical peels continue to be popular particularly the superficial ones, which in a series, will brighten and lighten the skin with minimal to no downtime. The salicylic acid peels are the safest for skin of color.
In medications applied to the skin, vehicles matter. It is not just the active ingredients if they are not being delivered to their target. Intuitively and clinically this was obvious but the battles with the insurance companies and pharmacies are continuing to disregard this fact.
Treat the Outer You, Love the Inner You!
Nothing like a delayed flight to give one the chance to regroup and reflect on the last three days filled from 7 a.m. to 8 p.m. with what’s new and “happening” in the world of cosmetic, surgical and medical dermatology. I love going to a meeting like the 8th annual Orlando Dermatology, Aesthetic & Clinical Conference. It keeps my “juices” flowing and a smile on my face! What I am discovering is what was “written in stone” when it was first introduced, is being polished and perfected with exciting new thoughts and techniques. I love being challenged and learning!
What was a little depressing in a few lectures was the picture of Barbie with the 50 year old changes you would see in a sun exposed, blonde, convertible owner. The juxaposition to Barbie is the currently popular Bratz dolls who have “cachetic” bodies, big eyes, big cheeks and big lips. No wonder girls grow into women who have many critical issues with the reflection they see in the mirror and then the Birthday Fairy visits! Women’s magazines, TV ads and the internet aren’t helping much either.
A consistently repeated phase at this meeting was the words soften, not completely gone. Age appropriate, genetics, past unprotected sun/tanning bed exposure, trout mouth, plastic, Michael Jackson’s nose were some of the other phrases. The focus is turning toward our Midwestern values. It’s lucky to have more birthdays, it’s super lucky to have learned to enjoy the inner you. It is ok to treat yourself to periodic maintenance treatments to pleasure yourself but who you are is still the most attractive feature.
What was a little depressing in a few lectures was the picture of Barbie with the 50 year old changes you would see in a sun exposed, blonde, convertible owner. The juxaposition to Barbie is the currently popular Bratz dolls who have “cachetic” bodies, big eyes, big cheeks and big lips. No wonder girls grow into women who have many critical issues with the reflection they see in the mirror and then the Birthday Fairy visits! Women’s magazines, TV ads and the internet aren’t helping much either.
A consistently repeated phase at this meeting was the words soften, not completely gone. Age appropriate, genetics, past unprotected sun/tanning bed exposure, trout mouth, plastic, Michael Jackson’s nose were some of the other phrases. The focus is turning toward our Midwestern values. It’s lucky to have more birthdays, it’s super lucky to have learned to enjoy the inner you. It is ok to treat yourself to periodic maintenance treatments to pleasure yourself but who you are is still the most attractive feature.
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