Turning Back the Clock – For Women Only!


It is no secret that women have it harder.  First, we get monthly periods well before we need them. Then, we go through pregnancy with its hormone spikes, body stretching, and delivering an entire human being out of a tiny opening.  Just as we are trying to bounce back, menopause strikes to slow us down. The body region hit the hardest is, of course, the female genitourinary system.

Women experience vaginal itching, dryness, irritation, poor lubrication, pain during intercourse, urinary incontinence, and stretching of tissues.  This complex of symptoms is now called the Genitourinary Syndrome of Menopause (GSM). However, many of these same issues can occur before menopause due to childbirth, breast feeding, or after cancer treatment.

Vaginal health has a tremendous impact on quality of life – physically, psychologically, and sexually.  It can affect comfort, confidence, and romantic relationships.

Treatment options have traditionally been limited to hormone therapies and invasive surgical procedures, both of which carry undesirable risks and side effects. In recent years, minimally invasive laser treatments previously used to treat various gynecologic diseases have been found to also be effective for vaginal rejuvenation.

The most exciting device in this arena is the Juliet by Cutera.  Juliet is an erbium laser that takes 20 minutes to revitalize both the internal and external vaginal tissue.  The process involves 2 passes: The first delivers micro columns of laser energy that stimulate regeneration of collagen and elastin, strengthening the structure of the inner vaginal wall.  The second pass delivers gentle heat to improve vaginal tone and flexibility. There is minimal discomfort and little downtime. A series of 3 treatments at 4 week intervals with yearly touch ups is recommended.

Various studies published in medical journals have shown significant improvement in symptoms of GSM and suggest that vaginal erbium laser may be a safe and effective treatment for this indication. Women who have had Juliet treatments report life changing improvements in lubrication, sexual discomfort, vaginal firmness and tone, leakage of urine when sneezing/ coughing or laughing, labial tightening, and external skin appearance.

With Juliet, women now have an alternative to taking hormones or having surgery when it comes to turning back the vaginal clock! And, don’t worry – nobody has to know about it!

Your Guide to Pregnancy Acne


Pregnancy is supposed to be a magical time full of hope and wonder.   For some people, it is also full of pimples and cysts. Hormone changes responsible for creating a human being can also activate pathways that cause breakouts.  In some cases, women suffered from acne previously but were controlled on medications that needed to be discontinued. Other times, breakouts happen to people who never had acne.  Either way, pregnancy acne is no fun and here’s how to handle it.


  1. Make sure your skincare is not part of the problem.

Skincare really matters.  Many women embark on the journey to motherhood understandably wanting to be as chemical free as possible.  This means they eliminate their good ole Cetaphil moisturizer and purchase natural products that contain oils, waxes, or shea butter.  Unfortunately, these ingredients are often pore clogging and can cause or worsen breakouts. When choosing cleansers and moisturizers, be careful to select non-comedogenic and oil free products.


  1. What, and what not, to use.

During pregnancy, the typical acne treatments containing retinoids, benzoyl peroxide and salicylic acid are best avoided.  Products that contain alpha hydroxy acids and sulfur based are considered safe and effective.

Azelaic acid is a naturally occurring antibacterial that also has keratolytic, comedolytic and antioxidant activity.  This means it kills acne causing p. Acnes bacteria on the skin surface. In addition, it loosens skin cells so they don’t clog pores, reduces inflammation, and decreases hyperpigmentation.

Glycolic acid is another naturally occurring alpha hydroxyl acid derived from sugarcane.  It works by speeding up the process of exfoliating dead skin cells and eliminating excess oil.  This helps reduce pimple causing clogged pores and encourages new, fresh skin cells to come to the surface.  

Sulfur based products have antimicrobial effects and are effective in drying out excess oil.  While they are effective, most preparations have a strong, unpleasant scent that limits use in pregnant women who are hypersensitive to stinky smells.


  1. Get in with a dermatologist sooner rather than later.

If you are suffering from pregnancy acne, your dermatologist should be your best friend. First of all, there are forms of folliculitis that can mimic acne.  Early diagnosis and proper management can save a lot of frustration. Also, dermatologists offer face saving extractions, cortisone injections, and if necessary, pregnancy safe prescriptions and procedures to help your acne.  

An extraction procedure is a medical grade facial, where a dermatologist uses a sterile tool called a comedone extractor to remove clogged pores.  Since clogged pores turn into pimples, it is beneficial to eliminate them!

Cystic pimples begin underground, can be painful, and often leave marks behind.  Fortunately, a tiny dose of liquid cortisone can be injected into cysts to decrease the inflammation and shrink them quickly.  Cortisone shots contain a minute amount of dilute cortisone. Since there is very limited systemic absorption, it is considered a safe option throughout pregnancy and while nursing.

Other pregnancy safe procedures include blue light facials, microdermabrasion, and glycolic acid peels.  If prescriptions are necessary, there are options such as topical and oral antibiotics as well as prescription strength azelaic acid.

Pregnancy acne is unavoidable for some women.  However, it can be treated and improved safely by optimizing skin care, incorporating alpha hydroxy acids, and working with a trusted dermatologist.

A Breakthrough in the Treatment of Acne Scarring


Acne breakouts have a huge, negative impact on body image and self esteem.  Even after the pimples and cysts are gone, many patients are left with scarring that continues to affect their quality of life.  The good news is that technology continues to advance and the treatment of acne scars is safer and more effective than ever, with better lasers, microneedling, and the latest breakthrough: Secret RF (Radiofrequency) Microneedling.


Microneedling has become one of the mainstays of minimally invasive scar treatment.  It involves using fine needles to create numerous controlled, invisible puncture wounds called “micro-injuries” in the skin. These micro-injuries break up scar tissue and stimulate the body’s natural wound healing response to rebuild the tissue in a more organized (i.e. less scarred) fashion.  Now, the power of microneedling has been amplified with the addition of radiofrequency, revolutionizing how we treat acne scarring.  Radiofrequency is a type of energy that heats tissue and stimulates production of new collagen and elastin. When combined with microneedling, RF is directly delivered to the scarred, problem areas below the skin.


Cutera’s Secret RF is an FDA cleared RF microneedling device that utilizes 25 or 64 gold tip needles to create controlled micro-injuries and precisely deliver radiofrequency.  This device was designed to be totally customizable meaning: Your dermatologist determines the depth of needle penetration and the intensity of RF delivered based on your skin type, the treatment area, and the severity of scarring.  Since it is so customizable, it is safe in all skin types.


At Spring Street Dermatology, patients numb for at least 40 minutes with a strong anesthetic called BLT (benzocaine, lidocaine, tetracaine) to ensure maximal comfort.  The treatment itself takes 15 to 30 minutes depending on the area to be treated.  Afterwards, skin is rinsed with saline and a healing moisturizer is applied.  Most patients report a warm, sunburn like feeling afterwards that dissipates within 4-5 hours.  By the next day, minimal redness, swelling, minute scabs and gridlines can be seen.  At this point, make up can adequately cover the healing process, which takes 1-2 weeks in most cases.  A series of treatments is recommended bases on the degree of scarring.


If you suffered with acne and are left with scars, Secret RF is the breakthrough you have been waiting for.   By combining the power of two modalities, microneedling and radiofrequency, this device delivers unprecedented results without compromising safety.

Baby Botox


For most of us, somewhere between the ages of 25 and 35 is the sweet spot.   It is when the very first fine lines have begun to appear but have not yet had the chance to develop into full fledged, deep set wrinkles.  We used to notice these lines only when we made certain facial expressions. But now, we start to see them even when our faces are perfectly still – and we don’t like it one bit.  Enter: Baby Botox.


Our muscles of facial expression contract to make us raise our eyebrows, squint, scowl, purse our lips, and smile with our eyes.  Over the years, the muscles strengthen and cause the skin to crease. Creases turn into fine lines and then deepen into wrinkles. While age is a big factor, having an expressive face, sun exposure, smoking, and genetics all play a part in when and how much we will wrinkle.  The antidote – Botulinum Toxin is injected into muscles to relax them. And relaxed muscles no longer crease the skin, allowing fine lines to fade into the sunset.


In a person with faint lines and weaker muscles, we can utilize a relatively small dose of Botox to completely eliminate the lines.  Baby Botox leaves the skin appearing smooth, but more importantly, prevents wrinkles from setting in. Since the wrinkles were never allowed to appear in the first place, Baby Botox looks subtle and natural.  While typical Botox lasts only 3 months, people who start early usually enough get significantly more time out of their treatments.


Once a person has crossed over into more prominent musculature and deeper lines, Botox still works (phew!) – but more product must be used and more frequent injections are required.  However, if the deeper lines become etched in, then Botox alone will not do the trick. Additional treatments like fillers and lasers, along with Botox, may be necessary.


We are all getting older, what’s the alternative?  The bottom line is there is an individual choice to be made by every one of us – are we ok with having wrinkles or do we want to avoid them?   If you fall into the camp that believes the best wrinkle is the one you never get – then keep an eye out for your sweet spot, Baby Botox is here waiting.

Your Post-Summer Skin Fix


Ah, summer!  Endless sunny days lounging on the beach and warm sultry nights out on the town.  Or, if you’re like the rest of us New Yorkers, oppressive heat radiating from the sidewalks, stifling close-quartered subway commutes, and profuse unabating perspiration.

However you’ve chosen to spend your summer, it’s a time when most of us increase our sun exposure and daily sweat quota, do some (or a lot of) traveling, and relax our routines.  All of these things can eventually wreak havoc on our skin, leading to dark spots, uneven or rough skin tone and texture, prominent pores, acne breakouts, and an overall dull complexion.

As fall rapidly approaches, it’s the perfect time to start getting your back-to-beautiful skin routine in place.  Good skin care starts with a solid daily routine at home.  It doesn’t have to be complex or time-consuming to be effective.  I am continuously surprised by the number of products patients have previously tried or are currently applying to their skin before they finally make it into the office for a consultation.  Not only can the number and variety of skin care products available in stores be overwhelming for both you and your wallet, they may even be contributing to some skin problems.

For most patients, a basic routine of twice daily cleansing and moisturizing, along with the use of a good sunscreen, are all that is needed to achieve optimal skin health.  In addition, the gradual incorporation of a retinoid in the evenings will address acne breakouts in the short term, as well as fight fine lines and wrinkles, fade dark spots, even skin tone and minimize the appearance of pores over the long term.  An in-office consultation will determine your skin type and allow you to develop a daily skin care routine to address your specific concerns.

In addition to daily at-home skin care, there are also some in-office procedures that can be used to speed results and tackle more stubborn skin concerns.  A few of my favorite options to kickstart your post-summer skin plan include:


Chemical Peels

A chemical peel uses a solution, typically comprised of one or a combination of acids, applied to the skin to achieve resurfacing of the upper layer of skin (epidermis).  Through shedding of this upper layer of skin, a chemical peel can improve the appearance of fine wrinkles, acne, hyperpigmentation, redness, and uneven skin tone.  Most patients will experience redness immediately following the procedure, which can last for one to two days.  This is followed by mild shedding of the skin around days three to five, revealing smoother, softer, more even skin after day seven.  For best results, patients should have multiple treatments, typically spaced three to four weeks apart.


Laser Genesis

One of the best things about this laser treatment is its versatility.  Laser genesis can address a number of skin issues, including fading hyperpigmentation and redness, as well as improving skin texture and minimizing the appearance of pores.  The treatment uses a gentle heating action to achieve results, which is comfortable, pain free, and safe for all skin types.  Following the procedure, the skin may appear slightly flushed, but this side effect is fleeting.  With virtually no downtime, most patients return immediately to work or school following the procedure.   Multiple treatments are needed to achieve optimal results.



Titan is a non-invasive treatment which uses infrared energy to heat the deeper levels of the skin, stimulating collagen deposition and tightening.  Titan is most commonly used as a non-surgical option to address sagging skin over the brow, mid and lower face, “jowls”, or loose skin beneath the chin and neck to create a more youthful, refreshed appearance.  (It can also be used to address skin laxity over the décolletage, arms, stomach, and even on the thighs.)  The procedure has minimal to no downtime, with some mild redness noted for up to a few hours post-procedurally.  Patients can apply moisturizer and makeup and return to normal activities immediately following the procedure.