Omahamedspa’s Blog

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As a physician of 25 years, I had never heard of the “Hcg Diet” prior to 2007.   But when I listened to personal stories of how well it worked, I decided to try the Hcg Diet for myself.  I modified the diet to allow for additional calories, more food selection, and fewer rules to follow.  5 weeks later I had dropped 20 pounds!  It was the easiest weight loss program ever.  The Hcg seemed to curb my appetite and assist in mobilizing unwanted fat deposits.  My energy level eating healthy food in a Low Calorie fashion was surprisingly good!

With the changes that I made to the old Dr. Simeon Hcg Protocol I decided that my version of this diet needed a new name.  Dr. Simeon chose the expression Very Low Calorie Diet (VLCD) to describe his strict 500 calorie per day diet.  I chose the term Low Calorie Diet (LCD for short) to describe the addition of 20-40% more calories per day – in other words no less than 600 calories, and up to 700 calories per day.

I gave my LCD the name “The OWL Diet” since it originated in Omaha Nebraska, USA.  OWL stands for “Omaha Weight Loss”.

I literally wrote the book "The OWL Diet"

I also learned that although I felt my eating habits were excellent, I was taking in too many calories per day, and specifically too many fat and carb calories.  With the Hcg OWL Diet, my wife and I learned to prepare meats differently, cook with less oil, and do without desserts.  By following the program, we learned the keys to keeping the weight off – or what I call the “maintenance program” of healthier eating.  We are now able to enjoy all of the foods that we ate before, but with less frequency, or in moderation.

The other surprise for me was my incorrect assumption about the role exercise plays in losing weight.  Doctors typically advise “less intake of food, and more output of energy through exercise” as the keys to weight loss.  What I now know is that exercise is a slow (and even poor) way to lose weight.  Exercise drives your appetite.  We reward our hunger with food calories, that in many cases are greater than the calories we just burned off exercising.  Now, of course exercise is good for you, but it is not suited to this program.  After you reach your healthy weight goal, then we encourage everyone to resume an active lifestyle, and regular exercise.

We brought the Hcg OWL Diet to the clients of Omaha Med Spa, and the results have been outstanding.  I have adjusted the program to permit a broader selection of meats, fruits and vegetables.  At 600-700 calories per day the body then burns fat to generate additional energy – the result is an average weight loss of 15-20 pounds per month.

OWLDiet

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Hcg is human chorionic gonadotropin, and is produced in large quantities by pregnant women.  When given in low doses to men and women (125 per day), we rarely see any side effects, and the hcg allows people to lose weight rapidly, while remaining able to function at their jobs and day-to-day activities.

Hcg is not absorbed orally (when swallowed).  The traditional method of receiving hcg is by once daily injection.  This is the format that I used, and all of our initial clients used.  The shots are easily given into the thigh muscle, with minimal discomfort.  I did try 2 forms of “sub-lingual” Hcg, that is administered under the tongue twice per day.  We found the “sublingual” method cumbersome, and the absorption was inconsistent.  Although some people felt appetite suppression with sublingual, others did not.   As a result, we do not offer the sublingual format.

At Omaha Med Spa, we are the first in the Mid-West to offer a new and effective way to administer Hcg – it is called “Transdermal Cream”.  The cream is applied to the skin of the inner forearm once per day.  The cream is odorless, and is readily absorbed.  Doctors have known for years, that transdermal delivery of hormones is highly reliable, so it is no surprise to me that the cream works as well as the shots!  In addition the cream can be stored at room temperature, whereas the shots have to be refrigerated.

Starting the Hcg OWL Program includes a one hour private consultation with myself.  We review your medications and medical history, as well as previous attempts to lose weight.  After measuring height and weight, we look at the BMI (Body Mass Index) chart and agree on your weight loss goal.  We also arrange for you to have blood testing – a TSH thyroid test, Complete Blood Count and Chem-14 metabolic panel.  We spend a lot of time talking about the actual diet, and review the Hcg OWL Diet consent form.  I then train you in self injection, or the proper application of the cream.  You are then seen weekly for a weigh-in, problem solving, and support.   Your monthly program cost includes one month of prescription hcg shots or transdermal cream, filled by Kubat Compounding Pharmacy in Omaha.  Your first month cost also covers the cost of lab testing by Quest Labs in Omaha.

My program costs $499 for the first four week cycle.  Additional 4 week cycles are $300.

I also include the use of a high quality B complex vitamin, Potassium to prevent muscle cramps, and a Calcium with Vitamin D supplement.

Vitamin B-12 is also helpful for boosting energy, and is available by injection at the med spa.

Carter Abbott, MD  -  Omaha Med Spa  -  Phone 402.614.5556

Latisse after several months

Latisse became available in Feb 2009, when the product was FDA approved to grow your own natural eyelashes longer, darker and fuller.

Here are the key points to keep in mind:

Latisse is a prescription medication.  It requires consultation with a doctor.  In the state of NE Latisse is no longer available at your doctors office – it must be dispensed by a pharmacy.

Latisse comes in a kit with a bottle holding 80 to 90 drops, and 60 disposable wands for application.  One drop of Latisse is applied to the tip of one disposable wand.  Apply Latisse at night, after removal of eyemakeup.  The wand is applied along the margin of the upper eyelid, where the eyelash hairs grow from.  Do not apply Latisse to the ball of the eye.  One drop is enough for adequate coverage of both upper eyelids.   By using one drop of Latisse for each eye, you will not see quicker results, but you will use up your bottle of Latisse drops twice as fast.

By blinking, Latisse is transferred to the lower eyelashes as well.  The upper eyelashes are always longer than the lower eyelashes.

Most new users will report longer eyelashes after about 3 weeks.

Continue daily use until you have achieved the eyelash length that you want – this typically takes 3-4 months.

At this point if you don’t like the look of longer eyelashes, stop Latisse and your eyelashes will return to their previous length.  If you are like most women, and love the longer eyelashes, then you will need to use Latisse on a maintenance basis.  Most women report that using Latisee 2 or 3 days per week is adequate to to maintain the benefit.

You may use Latisse if you have permanent makeup (permanent cosmetic).  If you have glaucoma, check with your eye doctor before considering the use of Latisse.

Pharmacies set their own price for Latisse.  As of Jan 2012, pharmacies in Omaha are charging anywhere from approximately $100 to $130 dollars for Latisse (kit with bottle of 80090 drops and disposable application wands).

One kit will last about 80-90 days.  Once you are using Latisse for maintenace, a kit for last 6-9 months.

Side effects of Latisse include:

Risk of an allergic reaction – your eyes become red and itchy, causing you to stop Latisse

The skin up the upper eyelid may get darker (hyperpigmentation) and that change may be permanent.

Latisse may not work for you – but the response rate is approximately 85-90%.

I have found that Latisse users consistently benefit from longer eyelashes.  Darkening and thickening of hairs is less common.  Use mascara to thicken and darken your eyelashes.

Their may be hair follicles in your eyelid that are dormant (inactive).

This could occur due to illness, thyroid imbalance or cancer treatments.  Latisse may recruit the inactive follicles to become active again, and start growing eyelash hairs!  This may give the appearance that your eyelash hairs are fuller.

Carter Abbott, MD – Omaha Med Spa -42.614.5556

Botox is a toxin – is it Safe?  Botox is a natural purified protein derived from botulinum toxin.  It has been safely used for more than 2 decades.  The safety profile has been well established, and has kept Botox in the enviable position of being the #1 nonsurgical aesthetic service in the United States.

How do I select a “provider” for Botox services?  In Nebraska, Botox may be administered by physicians, Nurse Practitioners and Physician Assistants under direct physician supervision, or by a Registered Nurse under direct order of a physician.  Try to evaluate the skill of the injector by asking how long they have been performing Botox services, and how they were trained.  Experienced injectors should be able to show you actual “Before and After” photos of their clients.  Talk to friends and find out how they rate their Botox experience.  Don’t be afraid to ask questions – a competent provider will be more than comfortable to tell you about their skill level and experience.

The price of Botox varies between locations – Why is this?  Botox is a very expensive biological product to buy.  To save  money some doctors are buying Botox from Canada and the UK.  This activity is illegal and a practice that I do not endorse.  At Omaha Med Spa, we purchase Botox directly from the US manufacturer, Allergan.  When I order Botox, it arrives the next day by FedEx and is shipped on dry ice.  That way I am assured of the quality of the product that I purchase for my clients.  I am pleased to show clients the bottle of Botox that I have used for their treatment – this confirms the authenticity of the product – that it is not an imitator and it is not illegally imported.

Another unfortunate activity to “cut costs” is to dilute the Botox – another activity that I do not endorse.  Botox should be priced and sold “by the unit”.  At my med spa, if I agree to inject 40 units, my clients can be assured of getting the correct amount.

With the release of Dysport, an alternative form of botulinum toxin, we are unsure how the price of Botox will change, if it changes at all.

Finally, some doctors discount Botox to entice you to come in to their office – they may even offer it to you at “cost” in the hope that you will agree to a more expensive surgery or laser treatment.  They may delegate the procedure to one of their staff who are less experienced.

When you choose a provider for Botox, do not just shop for price.  Shop based on service, outcome and physician reputation.  At Omaha Med Spa, Botox is my #1 injectable service.  Ask me about our in house opportunities to make Botox more affordable for your budget.

How does Botox ease “Frown Lines”?  The muscles between the eyebrows and above the nose are called Procerus and Corrugators.  If you look in the mirror and put on a frown, you can see how these muscles are depressors – that is to say they pull the skin down and towards the midline.  The result is wrinkling of the skin, causing lines known as the “11′s”.  Over time these lines can become deeper. Injecting Botox into this area we relax the muscles and ease the formation of lines or wrinkles.  The goal is to create a more youthful, rested look.  I work with you to preserve facial expression for a natural look.   Family and friends do not need to know you have had Botox, but they will notice the difference!  The number of injections in this area ranges from 3 to 8 and the # of units injected is anywhere from 15 to 50.

Will it Hurt?  With modern injection technique most of my patients rate the discomfort of injections at 1-2 on a pain scale of 1-10.

Will I Bruise?  Bruising is uncommon, but may occur.  Care needs to be taken by the injector to avoid small veins, such as occur at the site of Crow’s Feet injections.  Most bruising is small, no larger than 1-2mm and is easily concealed by mineral foundation.  After all Botox services, we offer complimentary makeup with our jane Iredale line of cosmetics to conceal any areas of redness.

Tell me again about the “Four Hour Rule”  My 4 hour rule is simple  – for 4 hours after Botox is injected I want you to keep your head above the level of your heart.  I want the Botox to lock in to the exact muscle site where I place it – and after 4 hours migration will not occur.  But if you were to go home and lay down (or perhaps going shoe shopping and trying on many pairs of shoes!), then gravity could cause Botox to migrate and cause muscle relaxation in an undesirable location.  So have Botox at least 4 hours before bedtime, and don’t work out for the next 4 hours – and you will be fine!

How soon do I see the benefit and how long will Botox last?  Botox takes an average of 3 days to “kick in”, but will vary person to person with a range of 2-7 days.  The average duration of benefit is 3 months, but may be as short as 2 months or last as long as 4 months.  With additional Botox treatments, many people notice that it will start to last a bit longer.

I am looking in a mirror – what other areas can you help me out with?!  Well, if you raise your eyebrows, you are now using the frontalis muscle – a very thin flat muscle that connects your brow to the scalp.  This muscle elevates (your brow rises with movement) and causes horizontal lines across the forehead.  By injecting many areas with small amounts of Botox (1-2 units), the muscle is relaxed.  I would never inject the frontalis on it’s own, as it could cause a “heavy brow”.  When combined with relaxation of the “frown lines”, the result is dramatic!

Now look at your eyebrows.  Are they even – if not, we can even it out with Botox.  Do you have an arch in the outer third of each brow?  If not, that too can be enhanced.  Or do you find that the brow is getting heavy, and you cannot see as much of your upper eyelid?  If so, a “chemical brow lift” may be the answer, and an alternative to surgical blepharoplasty.

Now look at the sides of they eyes – do you have lines radiating out – these are called “Crow’s Feet”, and are easily treated with Botox.  The # of injections may range from 1-4, and the # of units per injections average 3.

Now put on a big smile.  Do you have a “gummy smile”?.  This is treated with Botox in a key location – one injection per side of only 1-2 units.

Do the corners of your mouth drop?  Injection of the muscle we abbreviate DAO will help bring up the corners of the mouth.

Do you have vertical lines on the upper or lower lip?  Bt relaxing the orbicularis oris muscle, these lines are softened.

For a personalized Botox plan – call me for a free consultation.

Carter Abbott, MD – Omaha Med Spa – Ph 402.614.5556

Many clients decide to move forward and have a service performed, only to find out that “the timing” is not going to work for them.

Here are some considerations to ponder…

Sclerotherapy can be performed any time of the year, but the spring is the most popular.  The reasons are twofold.  First of all, compression with either a medical grade stocking (such as Ultraline 20-30mmHg) or Ace bandages leads to higher rates of success in eliminating the veins.  I advise that compression be applied in the med spa prior to going home, and left on overnight for the first night.  The morning after sclero, the stockings or Ace wraps are removed, and you can shower, shave and use lotion,  but the compression needs to be reapplied (“on in the morning, off at night”) for a minimum of 3 more days, and sometimes longer.  If we are in to the hot weather season, wearing compression can interfere with your wardrobe, and can be hot and unpleasant.  Secondly, there is bruising after sclero (the veins collapse, die, and form a bruise, that is cleared away over days to months) – so plan to allow time for healing to occur.  We all heal at different rates.  Although some people are comfortable in a swim suit 2 weeks later, allowing 4 weeks would be a better plan.  After sclero you can use self tanners to disguise any bruises that occur.

You can not have sclerotherapy performed if you are pregnant, due to a higher risk of developing blood clots.  For the same reason, do not have sclerotherapy within one week of prolonged air or car travel, where you will be sitting for prolonged periods of time.  Finally, do not have sclero within 2 weeks of any surgical procedure.

With any Injectable Service (Botox Cosmetic, or Dermal Fillers) there is always a risk of bruising.  You can reduce this risk by stopping “blood thinners” for 1-2 weeks prior to the procedure.  The medications to consider stopping include aspirin (ASA), Ibuprofen (Motrin, Advil), Aleve, and many other medications that are prescribed for arthritis and inflammation.  The supplements Vitamin E and Fish Oil also increase the risk of bruising.  If you take a blood thinner for medical reasons, this needs to be discussed with your doctor prior to stopping any medications.

Having stopped blood thinners, and even with perfect injection technique, there is a risk of bruising (some people naturally bruise more than others).  We sell a “bruise kit” (Jane Iredale Corrective Colors), that helps to disguise the bruise, but if you are going to be very concerned with bruising around friends and co-workers, you might consider taking a day or more off of work.

The “downtime” with a Chemical Peel will vary with the peel selected, how you react to the peel, and how comfortable you are in the public with skin that may appear red, dry, tight and with peeling – effects that may last anywhere from 1-10 days.  Talk to your provider, and start slow – do one layer one one solution, or a mini-peel.  With any chemical peel that you choose, avoid bright sun exposure for 1-2 weeks, and wear adequate sun screen daily.

IPL (Intense Pulsed Light) is a great service for the face, decolletage and hands to ease brown pigment, and reduce rosacea.  IPL also results in softer skin, and stimulates collagen to ease fine lines and wrinkles. IPL is best done on light colored skin, and when there is no tan.  Tanned skin will raise the risk for redness or burning with IPL, and should be avoided for at least 2 weeks prior to treatment, and between IPL treatments.

The “Four Hour Rule” with Botox Cosmetic is very important to follow.  For four hours after injection, the head must be kept above the level of the heart.  This means no laying down for 4 hours.  For this reason, we do not perform Botox services late in to the evening.  (The reason for this rule is to prevent gravity from causing Botox to “drift” away from the intended injection site.  After 4 hours, Botox is locked in to the muscle).

Remember too with Botox, that it takes time to “kick in” – typically 2 to 3 days, with peak wrinkle relaxing effects at 2 weeks.  And then it wears off – on average in 3 months.  Timing for Botox is therefore important around the holiday seasons, and for special events (weddings, birthdays, reunions), to ensure you are looking your best for special occassions.

Bruising with Botox is uncommon, but as with any injection, may occur.  The risk of bruising is greater around the eye for Crow’s Feet, and for the  Chemical Brow Lift.

First a brief history on dermal fillers.  Dermal fillers are used to add volume (“volumize”) to deeper folds, lines and creases.  Although historically limited to use on the face, they are now also being used on the hands.  The original fillers were collagen from animal sources.  They suffered from not lasting long – 2 months on average.  A human clone of collagen proved to be better tolerated, but still did not last longer.  The best collagen available today is called Evolence.  I do not use it, as it lasts only 6 months (at best!).

Dermal fillers were revolutionized by the introduction of Hyaluronic Acid (HA) Gels – synthetically devived from sugars, they are natural to our body, easy to inject and have a high level of patient satisfaction.  The first HA “out of the gate” was Restylane.  Juvederm came along later, and due to increased “cross linking” it typically lasts longer that Restylane.  As a result, sales of Juvederm have surpassed Restylane.  HA fillers work well in all locations on the face.  Duration of correction varies greatly between individuals, but I find the average to be 6 months in the lips, 9 months for smile lines and nasolabial folds, 9-12 months for oral commissure, marrionette lines and chin areas.

Before Radiesse to Upper Cheek

Radiesse is a relatively “new kid on the block” as a dermal filler.  It has a unique mechanism of action.  The Radiesse that is injected contains calcium spheres (calcium hydroxyapatite to be exact).  The calcium creates a scaffold deep in the dermis.  Your body responds by depositing collagen around that scaffold, and the calcium is slowly absorbed and removed by the kidneys.

The transition from calcium to collagen is seamless.  The potential benefit of Radiesse is that in some individuals it does last longer – on average 1 year, and there have been  reports of Radiesse lasting 2 years!  I suggest you plan on the correction lasting 9 months (that way you won’t be disappointed, and you will be thrilled if it lasts 1 year or longer!).

Radiesse now comes in a variety of sizes (prefilled syringes or vials that are sold to the doctor), allowing flexibility of buying just the right amount of filler that you need.  There may be some confusion for the consumer over pricing, since we now have several sizes to choose from.

The other advantage of Radiesse is that the doctor can mix lidocaine into the filler just prior to injection.  As a “numbing” agent (local anaesthetic) lidocaine will reduce the discomfort of the injection by an average of 50%.

Before Radiesse to Upper Cheeks

What are the drawbacks, if any, of Radiesse?  Well, first of all, it should never be injected in to the lips.  This is not an FDA approved use of Radiesse, and it is not recommended  by the manufacturer.  Furthermore, when Radiesse has been used in the lips, it has shown a strong tendency to form lumps (not a good thing!).  Also, since Radiesse has a consistency of gritty toothpaste, it is more prone to cause some lumpiness, and irregularity.  Over time (weeks to months) this usually evens out for a smooth result.  I also find that in some persons it can feel quite “firm” under the skin, and this can last for several weeks.  As with all fillers, there is a risk of bruising and infection.

After Radiesse for Cheek Enhancement

Overall, Radiesse provides a unique alternative to HA gel fillers, and it useful in the upper and lower cheek areas, as well as softening deep nasolabial folds (on the side of the nose), oral commissures (drops and creases in the corners of the mouth), marrionnette lines (chin), and chin creases and sulci (indentations).  With the option of adding lidocaine, and the different sizes of syringes, it does offer lots of options.

When you ask a doctor or med spa about the cost of Radiesse, make sure you know the size of the vial, and whether they mix lidocaine in with the product at no additional charge.  Finally, make sure they have been trained in Radiesse treatments.

I read an ad in the Omaha World Herald today from a doctor who “specializes” in veins.  As a general surgeon he does have a lot of experience, but I do not agree with some of his assertions.

Myth #1 “Pain is usually the result of use of hypertonic saline which is a concentrated salt solution used for the injection.  It can cause considerable local discomfort and can have a significant incidence of post injection discoloration.”

The Truth - I have injected 1,000′s of spider veins, and I have achieved excellent results with saline.  With competent technique and expertise my clients have minimal discomfort and excellent outcomes.  There is a risk of brown spots occuring after treatment, but the scientific literature and the experts in phlebology agree – the incidence of hyperpigmentation after saline spider vein sclerotherapy is no greater, and may be less, than other used agents.  Statements otherwise are simply false and misleading.

Myth #2 – The ad also asserts “there are very few post procedure restrictions and patients return to normal activities immediately.”

The Truth - National experts agree that post procedure guidelines should be followed for the best possible outcome.  Although it may be popular with patients to tell them they may resume normal activities immediately, a few simple rules followed for 3-7 days will make a world of difference.  My patients agree.  I am pleased to state that I have had people come to me for a second opinion and stated that “sclerotherapy with Dr. _____ did not work”.  After I treat them, they are pleasantly surprised to get the results they were looking for!

Myth #3 – You do not need to compress the vein after spider vein sclerotherapy injections.

The Truth – Once again, scientific reports tell us that compression improves the outcome.  The goal of sclerotherapy is to inflame the inside wall of the vein, then compress the walls to flatten the vein, in the hopes that it will die (becoming a bruised area that is cleared by the body over several weeks).  Compression with 20-30mmHg stockings or Ace bandages for 3-7 days will most certainly improve the results!

What does microdermabasion mean?   A variety of techniques have been developed to mechanically exfoliate (remove) the outer layer of skin.   The purpose is to stimulate enhanced cell turnover and trigger collagen production.  After one treatment, the skin should be smoother, and look brighter.  With regular treatments, some clients report a softening of fine lines, and easing of brown pigment caused by sun damage. 

You mention different techniques.  What are the differences?   The original equipment (still in use today) utilizes crystals that are airdriven by a pump, and delivered to the skin surface with a wand.  There is a two way passage on the wand.  The operator applies pressure with the wand and the crystals exfoliate skin cells that are then vacuumed back to the machine.   The problem with this method is that some of the crystals get in to the air, and can trigger lung problems for the operator, and for the client.  This is still a common method used in salons, and a visit typically lasts for 20-30 minutes.       An enhancement to the crystal method was the development of the diamond tip wands.  Diamonds are impregnanted on the end of a metal wand, and form a ring around the vacuum.  The operator still applies pressure with the wand, and the machine vacuums away the exfoliated skin.  At Omaha Med Spa, I have chosen to use dermafiles which are hand held files impregnated with diamonds.  The dermafiles are graded from fine to coarse.  Dermafiles are easily cleaned between clients to ensure a safe treatment.  Because the operator has hand control of the dermafiles, we can safely treat all skin types.  The sensation on the face is very relaxing and compares to a massage on the face.  We are also able to exfoliate parts of the upper and lower eyelids, and get very close to the lips without concern of injury (the vacuum of a machine could bruise the eyelids or lips).  The machines are noisy, but with dermafiles you can relax to peaceful spa sounds.   At Omaha Med Spa, microdermabrasions are scheduled for one hour, allowing time for a pleasing experience that includes a calming calamine mask, followed by a soothing “barber towel” application.  We always inlcude a hand massage with this service. 

What is the “down time” with the dermafile microdermabrasion?  There is none!  After the service is completed, your skin will feel soft and polished and you will have a healthy glow.  If your skin is extrasensitive, some additional redness is easily concealed with mineral cosmetic, applied in the spa, before you go home.  For a few days after the dermafile, you may continue to see some fine exfoliation – and that is a great sign!

Juvederm is a dermal filler used to fill folds and deeper wrinkles.  As a hyaluronic acid gel, it performs very well in a wide range of applications, including the nasolabial folds, smile lines, oral commissure ptosis, marrionette lines, chin lines, prejowl sulcus, cheeks, and frown lines.  On average, Juvederm  lasts twice as long as Restylane.  Two forms are currently available in the US – Ultra and Ultra Plus.  Ultra plus is thicker, and is promoted to last longer.

So what is the buzz about Juvederm with lidocaine?  To ease the discomfort of injection, we use numbing shots, or ice, prior to Juvederm administration.  Now the company has formulated Juvederm with the lidocaine built in to the gel.  The result is that as the gel is injected, the lidocaine numbs the area.

Clients will now be able to use ice topically, then proceed with the Juvederm injections.  Dental blocks (numbing) will not be needed – which translates to fewer shots at your visit and less risk of swelling or bruising.

“Juvederm XC“, containing lidocaine is now approved.  I am very pleased with the reduced pain experienced with Juvederm XC.

Restylane is also now offered with lidocaine in the product – called “Restylane-L“, and is available in 3 syringe sizes, offering different volumes per syringe.