Omahamedspa’s Blog

Starting around age 30, the testosterone level for men starts to decline.  The drop in levels is slow, but steady, averaging 1-3% per year.  After 20 years, by age 50, many men have levels that are 40-60% lower than when they were younger.  This slow steady decline may result in complaints of:

Fatigue, Loss of memory and mental focus, reduced interest in sexual activity, and difficulty achieving or maintaining a full erection.

Many men are in denial of suffering from one or more of the above problems.  It is often simply blamed on “normal aging”.  To determine an accurate testosterone reading, your doctor will run blood tests.  The “normal range” for testosterone is very wide, to account for the 1-3% decline that some doctors still feel is “normal”.

Andropause does occur to men as a result of the decline in testosterone levels.  Men can receive significant relief from these symptoms by using BHRT pellets!

Pellet therapy for men restores the testosterone levels back to where it was when you were younger.  Pellet therapy is the only form that results in stable testosterone levels that last for months at a time.  There is no need to fuss with testosterone creams or suffer from painful injections.  Pellet testosterone is natural, leading to benefits without the drawbacks of “synthetic” testosterones.

Studies have shown that compared to conventional hormone replacement therapy, pellets are extremely effective for relief of menopausal symptoms, maintenance of body density, improved sleep patterns, improved interest in sexual activity and heightened sexual response.  Pellets have also been used to treat migraine headaches.  Menopausal symptoms that may improve include hot flashed, night sweats, vaginal dryness and frequent urination.

The benefits of BHRT pellets also extends to women from age 30 to 70.

BHRT Pellets are derived from natural plant sources.  They are produced by compounding pharmacies which are regulated facilities.  SottoPelle® has a long standing relationship with a compounding pharmacy here in the United States.  They undergo testing of lots to assure accuracy and safety of all the pellets that are produced.

These sterile pellets are stored in the doctor’s office.  On the day that you receive pellets you will receive local anesthesia that consists of a mild stick and brief sting.  There is no further discomfort as the doctor inserts the pellets just under the skin, behind the hip.  A bandage is applied and you will receive simple “home care instructions”.  The entire office procedure only takes a few minutes.  The pellets will last 3 to 6 months, depending on each person and their activity level.

SottoPelle® is a method of using hormone pellets that are easily placed under the skin that last for 3 to 6 months.  The SottoPelle method was developed by Dr. Gina Tutera MD FACOG who practises hormone replacement in Scottsdale Arizona.  His 30 years of experience is now made available to SottoPelle Trained Physicians® such as Dr. Carter O. Abbott, MD in Omaha Nebraska.

Hormone pellets are a highly effective form of HRT (Hormone Replacement Therapy).

BHRT refers to Bio-identical Hormone Replacement Therapy.  To be bio-identical a hormone must be an exact copy of the hormone that the human body produces.  These natural plant based compounds have the same molecular structure as those made by the human body, so that our bodies can readily recognize them as being natural.  This is a very important concept to understand, because this identical match means that these hormones are safe and effective.

Bio-identical pellets have been successfully used by doctors and patients for over 70 years.  Numerous studies demonstrate that when prescribed correctly, bio-identical pellets can benefit a variety of conditions – including depression, weight gain and osteoporosis.

It is my belief that hormone pellets are superior to pills, creams and injections.  Only hormone pellets release the hormone at a steady rate, and based on each person’s needs.  When the pellets are placed under the skin, small blood vessels grow around them.  When the body needs more hormone release, such as during physical exercise, the blood flow increases and the amount of hormone that is released matches the minute to minute needs of the person.

With pellets there is no need to worry about applying cream once or twice a day.  Swallowing hormones by oral pills requires a higher dose, because the hormone must first past through the liver.  You also have to remember to take the pills every day for them to be effective.  Injections of hormones are painful and cause a rapid surge in hormone levels followed by a decline, much like a “roller-coaster”.

Click on www.CarterAbbottMedSpa.com/specials and find a great deal!

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 spend a lot of time talking about the actual diet, and review the Hcg 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.

My program costs $450 for the first four week cycle.  Additional 4 week cycles are $300.

I recommend the use of a high quality B complex vitamin, as well as 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

As an FDA approved injection to fight wrinkles, Botox has had a virtual monopoly in the US for 10 years.

But now, the FDA has approved Dysport for the same indication.

Both products are biological toxins derived from botulinum.  Both are injected to relax muscles, and ease lines and wrinkles such as frown lines and crow’s feet.

But is Dysport really new?  The answer is a definitive no – it has been on the market in the UK, New Zealand and Brazil for approximately 18 years.  Worldwide sales reveal that Botox is still king – that may tell us something!

Is Dysport better than Botox?  Well that will depend on who you ask, and which clinical study is quoted.  There is a general consensus that in some people Dysport starts to work quicker.

But the bigger question is which lasts longer?  Botox or Dysport?  This is where the info gets rather murky, because different studies show different results.  So the bottom line is that it will vary from person to person.

Which will be cheaper?  That will vary by your choice of doctor.  Botox is measured in “units”, and is sold based of dollars per unit.  Dysport is also measured in “units”, but one unit of Dysport is not the same as one unit of Botox.  The approximate conversion is 1 unit of Botox : 2 to 2 and1/2 units of Dysport.

So as a consumer – “What to do”?  Well, I would say that if you are pleased with the benefits you see from Botox, then stick with Botox.  If however, you find that you need “a lot of Botox” or it “wears off sooner that you would like” – you might give Dysport a try – but keep in mind that it may not work better than Botox (or for you, maybe it will).

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.