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Lawrence A. Schiffman, D.O., FAOCD - Board Certified Dermatologist


7 Underlying Causes of Adult Acne

Published February 26th, 2020 by Thepracticeagency

Acne’s commonly seen as a teenage problem.

Oily skin, clogged pores, and inflamed facial breakouts are never ideal.

However, the struggles cease as those troublesome teenage years are left behind and you enter adulthood…Right?


In reality, acne is the bane of many adult lives too. Indeed, up to 55% of people between 20 and 40 years old suffer from at least low-level adult acne.

The common belief that acne’s a teenage ailment causes further complications. Adults who suffer from it can experience even greater levels of stress and shame.

Are you struggling with an adult resurgence of long-forgotten acne? Do you want to know the reasons behind it in order to find a solution to the problem?

Let us help.

Read on to learn 7 primary causes of acne in adulthood.

1. Clogged Pores

Any discussion about the etiology of acne is incomplete without mentioning pores.

You’ve almost certainly heard of them before. These tiny openings around the hair follicles on your skin can cause all sorts of problems when they get clogged.

Now, the glands you find in each pore naturally release oil (sometimes referred to as sebum).

In theory, the oil actually helps protect your skin and keeps it feeling nice and soft!

The trouble is that it can also cause pimples when too much of it is created. Throw dirt, bacteria and dead skin cells into the mix and you’ve got a recipe for trouble. These all end up clogging your pores, which leads to skin problems such as acne.

In some instances, then, the solution to adult acne is basic skin-cleansing processes. Keeping your skin clean and exfoliated should unclog pores and reduce the chance of breakouts.

2. Rising Stress Levels

Nobody in the world would struggle with acne if clearing it was as simple as exfoliating!

For many people, there’s usually more going on behind the scenes.

Stress, for example, might be the true cause of the problem.

Now, we all get stressed at various times in life. But excess stress levels can have a host of negative repercussions. Acne is one instance of an ailment that worsens with stress.

Cortisol is at the heart of the problem. This so-called stress hormone interacts with your bodily processes and can cause skin conditions to get worse.

Limiting your exposure to stress, then, might represent the solution to your adult acne.

3. Hormonal Changes

Hormones are another common complicating factor behind acne.

Indeed, they’re the root cause of many a problem in life! It just so happens that they can also be behind any recent influx of acne.

Progesterone, in particular, can be the culprit.


Because increases in progesterone are known to increase the production of sebum.

For instance, people often notice worsening symptoms of acne on their period, when pregnant, taking hormonal birth control, or going through menopause. The (possible) reason? Because progesterone production is known to increase at these times.

4. Oily Products

Think about all of the healthcare lotions, potions and products you use each day.

There’s a chance they might be responsible for your flare-up of acne.

Many people fail to realize that their skin and hair-care products, for instance, contain oil.

The addition of oil to skin that’s predisposed to excess sebum production is understandably problematic. For teens and adults alike, then, avoiding these products is a sure-fire way to see acne improvements.

Pores are more likely to remain unclogged, which should improve the situation.

Noncomedogenic is the technical term for oil-free products. Stick to lotions, creams, moisturizers, face-washes, and so on, of this nature and you’ll reap the rewards.

5. Over-Washing

As we’ve seen, clogged pores are at the heart of any acne flare-ups.

For this reason, many people assume (correctly) that staying clean is key to fighting it. Unfortunately, it’s all too easy to ‘over-clean’.

Desperate to get rid of their acne, some people cleanse and exfoliate as often as possible.

They might scrub their faces vigorously, use powerful skin-care products, and do so multiple times a day. Sadly, this approach can actually backfire.

Skin gets too dry and starts creating extra oil in order to compensate for what it’s lost. Pores end up more clogged; pre-existing inflammation can become even more aggravated by the harsh treatment.

Now, everybody’s skin is different, which means you need to find what works for you. In general, though, washing once a day with a gentle chemical exfoliant should suffice.

6. The Environment

We’re always hearing about the negative impact of humans on the environment.

In terms of adult acne, though, it’s the environment that can potentially impact us. That’s right, pollution in the atmosphere is another possible cause of acne (especially in cities).

Dirt, fumes, smog, and exposure to the sun all combine to clog your pores. You essentially end up with a layer of pollution on your face! Make sure you get rid of that grime build-up to allay the onset of acne.

Think about wearing sunscreen whenever possible too. Why? Because harmful UV rays are another possible contributor to acne. Better still, you protect the skin of your face more generally as well.

7. Your Diet

In scientific terms, the jury’s out on the impact of diet on acne.

Yet many people swear that the food they eat has an effect on it.

It’s common to hear that oily foods such as pizzas, burgers, and fries are to blame for outbreaks. However, everything from chocolate to caffeine is also held accountable on occasion.

The key is to track the food and drink that seem to trigger your acne. Monitor their effects and consider cutting them out if the evidence is compelling. Of course, speak with your GP first before making any significant dietary changes.

Time to Tackle Adult Acne

Contrary to popular opinion, acne isn’t the reserve of teenagers.

In reality, adult acne is incredibly common too. This oft-distressing ailment affects millions of people around the world. Are you one of them?

Hopefully, this article will help you identify its cause(s) and take steps to address the problem. Are you in Miami and looking for professional skin support?

Contact us today to see how we can be of service.

An Ounce of Prevention: 8 Ways to Prevent Skin Cancer

Published January 20th, 2020 by Thepracticeagency

We all want healthy, glowing skin, that is free of sun damage, many of us also love the sun. The warm feeling on your skin combined with the energy it gives us. It’s no surprise that people love being outdoors, enjoying a warm, sunny day.

Unfortunately, the sun can also cause harmful skin damage and even skin cancer if we aren’t careful.

While it isn’t always possible to prevent cancer, there are certain sun precautions we can take and prevention methods that can keep damage to a minimum while soaking up the sun.

This guide has eight ways to prevent skin cancer and still be able to enjoy the outdoors.

Apply Sunscreen

While no one can say for certain how to prevent skin cancer completely, doctors can say with certainty that applying sunscreen is a must when you are spending time in the sun,

Applying sunscreen doesn’t just mean putting a little on in the morning before going out into the sun either.

In order to keep your skin safe from harmful sun damage and sunburn, you need to apply at least one ounce of sunscreen to fully cover yourself about 15 minutes before going outside to be properly protected according to the American Academy of Dermatology

You also need to reapply sunscreen every two hours. Don’t forget to put it on again after sweating or getting out of the water as well.

Always try and use a sunscreen that is SPF 30 or higher as well. Remember to apply sunscreen to the top of your feet, your head, neck, and your ears. The back of your hands tends to get forgotten as well.

Wear Protective Clothing

When you’re outdoors and in the sun, wearing protective clothing is a must. Wearing protective clothing can help you keep the sun off of your arms, legs, and face. Protective clothing includes rash guards with UV protection, hats, long sleeves, pants, and sunglasses.

If you will be outdoors walking, hiking, or running, even if it is hot out, you’ll want to cover your skin in a breathable material that will protect you from the sun’s harmful rays.

Wear sunglasses as well to protect your eyes. If your feet will be exposed, cover those with closed-toed shoes when hiking to avoid a painful sunburn on your feet.

Stick to the Shade

When you’re planning on being outdoors and in the sun, try and seek some shelter from the sun when you can. If shade is available, take it at least part of the time.

If you’re looking to hit the pool or the beach, try and bring an umbrella or use one if they are available.

Being in the shade means you’re covered from being directly in the sun and the shade will keep you better protected.

Wear a Hat

Hats can do wonders to protect you from the sun. Not only will a hat protect your eyes but it will also protect your scalp and your face.

Men especially are prone to sunburn on the top of their heads and back of their necks if they don’t have hair to protect them.

When you’re out in the sun, wear a protective hat that has a wide enough brim to keep your face and neck covered.

Avoid Tanning Beds

Tanning beds are just asking for trouble. According to The Skin Cancer Foundation, there is absolutely nothing safe about tanning. 

In fact, just one visit to a tanning bed increases your risk for melanoma by 75% before the age of 35. No tan is worth that percentage. Stick to lotions, sprays, and make-up for a sun-kissed look without the risk for cancer.

Don’t Get a Sunburn

Getting sunburn is one of the worst things you can do for your skin. To avoid getting a sunburn, make sure you wear sunscreen and always reapply. Wear a hat, try and get some shade and wear protective clothing when you can.

Once you are sunburnt the damage is already done and it will be too late. You'll want to see a doctor if you're suffering from a serious sunburn. 

Remember to Protect Your Lips

Skin cancer can also start to form on your mouth and lips. To protect yourself from getting skin cancer on your lips, apply chapstick, lip balm, or lipstick that has sunscreen.

Look for a lip product that has an SPF of 15 or higher for the best protection. Make sure you always reply as well and carry it with you on days at the pool or hiking in the sun.

Keep Newborns and Kids out of the Sun

Kids, babies, and especially newborns should be kept out of direct sunlight. While you’re not going to keep your five-year-old out of the sun, your five-day-old should never be exposed to direct sunlight.

To help keep your little ones protected, make sure you cover them in sunscreen and reply often. Every time your kiddo gets out of the water, lather them up again.

If possible, keep your kids under an umbrella or in the shade. Make sure your kids and babies wear hats in the sun and protective clothing whenever possible.

Swimsuits with built-in rash guards are extremely helpful in protecting your kids. There are also rash guard shirts that can be worn over swimsuits.

Ways to Prevent Skin Cancer

Knowing how to prevent skin cancer is the first step to reducing your risk. While the sun is a vital mood and energy booster, spending too much time out in the sun without protection can be dangerous.

Make sure to get your annual skin cancer screening to test for damage and signs of skin cancer each year. 

Knowing how to avoid skin cancer and how to prevent melanoma starts with sunscreen. Wearing sunscreen and making sure you reapply is key.

From there, staying in the shade and wearing a hat, protective clothing, and lip protection can go a long way to helping protect your body, eyes, and lips.

If you’d like to speak with a professional board-certified dermatologist about skin damage, or any concerning skin condition, book an appointment online to help keep you and your skin healthy and protected.

How Often Should You Get Botox Injections?

Published January 8th, 2020 by Thepracticeagency

Are you wondering how often should you get Botox? If yes, you should click here for some important things to understand about Botox.

How Long Does Juvederm Last and Why Should You Try It?

Published November 23rd, 2019 by Thepracticeagency

For everything from plump lips to smooth skin, more people are looking in hyaluronic acid or collagen fillers as the perfect holiday gift. Cosmetic procedures that use fillers increased to 2.6 million procedures in 2016, and the number is still rising.  

However, not every lip filler is created equal. Many people are looking into Juvederm, a cosmetic filler that can improve signs of aging. 

So what is it, and how long does Juvederm last?

Keep reading our guide to learn all about Juvederm before deciding on this cosmetic treatment for yourself!

What Is Juvederm?

Juvederm, also known as Hydrafill, was approved by the FDA in June 2006. It's primarily used as a cosmetic filler to correct moderate to severe facial wrinkles and folds. The Juvederm line includes many products, but only Juvederm 24 and 30 are available in the US.

Juvederm is an injectable dermal filter. It uses a base of hyaluronic acid instead of collagen. Today, Juvederm is used for the cheeks, lips, and around the mouth. 

Each product within this line uses different bonding and concentration of hyaluronic acid. 

The different products can also target specific problems, depending on where they're injected. For example, Juvederm Ultra XC and Juvederm Volbella XC are best used as nonsurgical lip enhancement treatments.

Most procedures only take 15 to 60 minutes.

As of 2016, hyaluronic acid nonsurgical procedures, including Juvederm, were rated the second most requested procedure. The average cost per hyaluronic acid-based filler treatment, such as Juvederm, was $620 at this time.  

How Long Does Juvederm Last?

So how long does Juvederm last? 

It really depends on which product from the Juvederm line you elect to use. The amount of time a filler lasts depends on the:

  • Molecular structure of the product
  • The technology used to create the product
  • Specific Juvederm product
  • The amount of filler used

For example, Juvederm Ultra XC and Juvederm Ultra Plus XC usually last up to a year. These are the original formulations of the Juvederm product line. They're ideal for smoothing fine lines and wrinkles or adding volume to the lips. 

So how long does Voluma last? Juvederm Voluma XC lasts up to two years. It's the first and only injectable gel created to lift and contour cheeks.

Juvederm Vollure XC, on the other hand, lasts up to 18 months. This product smooths the skin beneath the surface. It's ideal for moderate to severe facial lines and wrinkles. 

Juvederm Vollure XC is also ideal if you want to add volume to your lips. 

Then there's Juvederm Volbella XC, which can last up to a year. This product is ideal for smoothing vertical lip lines while adding volume to the lips. 

If you're still asking yourself how long your fillers will last, make sure to speak with a board-certified dermatologist. They can review the Juvederm line with you to determine which products best fit your goals. 

How Does It Work?

Now that we've answered how long Juvederm lasts, let's talk a little more about the procedure. 

The active ingredient in Juvederm, hyaluronic acid, will add volume to the facial tissue. Hyaluronic acid is naturally found in the human body and stimulates collagen production, which plumps the skin.

However, our hyaluronic acid and collagen production decrease with age. As a result, we begin to form saggy skin and wrinkles. 

During the procedure, a nurse or doctor will use a pen to mark the areas of the skin you're treating.

Then, the doctor will inject Juvederm into the target area, massaging the area to ensure even distribution. 

If you're concerned about pain, Juvederm injections contain small amounts of lidocaine. This will help minimize the pain or discomfort you might feel as a result of the injection. 

Before Your Treatment

Before your treatment, make sure to speak with a medical professional about your cosmetic goals and expectations. They can help you find the ideal lip filler that aligns with what you have in mind. 

The Juvederm procedure is minimally invasive. Often, the procedure doesn't require much preparation. You can likely have the procedure done the same day as your consultation. 

Before your consultation, make sure to avoid taking medications including ibuprofen, aspirin, or St. John's wort. You'll also need to avoid drinking alcohol or smoking within the weeks before your treatment. Otherwise, you might notice slight bruising following the procedure.

Let your doctor know if you have any sensitivities or allergies before the treatment as well. 

Should I Try It?

There are a few common side effects associated with Juvederm. These include:

  • Itching
  • Minor pain at the injection site
  • Redness
  • Tenderness
  • Lumps

However, these side effects often fade within two to four weeks. 

If you don't receive Juvederm from a medical professional, you might experience more severe side effects. For example, a non-professional might inject Juvederm into a blood vessel. This can cause scarring, blindness, vision issues, and stroke. 

Make sure to find a trained, licensed, and certified medical professional to perform the procedure for you. 

Otherwise, recovery time is often minimal. Your doctor will likely advise you to avoid:

  • Wearing makeup
  • Consuming alcohol for 24 hours after treatment
  • Strenuous activity
  • Sun exposure 

You'll notice the effects right away. Give any swelling a chance to reduce a little.

When deciding whether or not to try Juvederm, make sure to speak with your doctor. They'll review these side effects, as well as any other concerns you may have.

Your Full Guide to Juvederm Lip Fillers

To recap, how long does Juvederm last? It often depends on the product you choose, however, Juvederm often lasts between a year to two years. 

Make sure to consult a professional before electing to receive Juvederm as your choice of cosmetic treatment. 

Want to discuss Juvederm with a professional? Contact us today to explore your options.

Is Botox Worth It? 7 Amazing Benefits of Getting Botox

Published October 28th, 2019 by Thepracticeagency

There is nothing wrong with wanting to look a little younger, and if you are asking the question "Is Botox worth it?", you are not alone. 

Since it's approval in 2002, Botox was the most popular procedure out of over 15.9 minimally invasive cosmetic procedures performed in 2018. In fact, Americans spent a whopping $16.5 Billion on cosmetic surgery in 2018. 

While Botox is primarily known for being an anti-aging miracle, it has come a long way since then. Of course, it is the best choice for reducing wrinkles without having to deal with an invasive and painful facelift.

However, there are actually many other clinical benefits that Botox can help you with, such as sweat reduction, migraine relief, a cure for cross-eyes, relief from muscle spasms, and more. 

Keep on reading to learn more about Botox and find the answer to your question, "Is Botox worth it?"

1. Reduction of Migraines

Did you know that over 28 million people suffer from chronic migraines? It can become so debilitating that it causes nausea, blurred vision, and sensitivity to the environment. 

Thankfully, receiving a Botox treatment once every three months is now known to reduce or completely eliminate migraines. Injections into the temples, bridge of the nose, forehead, upper back, neck, and back of the neck are the most common for migraine relief. 

2. Fewer Muscle Spasms

Muscle spasms are an uncomfortable condition, and most commonly happen as upper limb spasticity, cervical dystonia, or spasms of the eyelid. This is caused by a range of different conditions such as Multiple Sclerosis, strokes, Cerebral Palsy, or stress.

By injecting Botox into the triggering point of the muscle, it can reduce involuntary spasms and provide a lot of relief. 

3. Overactive Bladder

Unfortunately, about 25% to 45% of women suffer from some degree of urinary incontinence. This can make it extremely uncomfortable to workout, wear certain clothing, or even laugh.

This comes from a variety of causes, such as childbirth, pregnancy, and even menopause. 

Ultimately, this will negatively affect their level of self-confidence and living a less enjoyable life. 

Thankfully, doctors have discovered a way to inject Botox into the overactive bladder, relaxing the involuntary muscles and helping to desensitize the overactive bladder, retraining it to control the urinary output.  

4. Excessive Underarm Sweating

Excessive underarm sweating, or Hyperhidrosis, is an embarrassing disorder with no known cause or cure. It can affect someone's quality of life, limiting the clothes they can wear and their social life. 

By injecting Botox into the muscles responsible for releasing sweat to the surface of the skin, temporarily block the chemicals that stimulate sweat glands.

Finally, those with Hyperhidrosis can finally relax and enjoy their lives without the fear of sweat-stained clothing.

5. Reduce Fine Lines and Wrinkles

One of the most common known treatments for Botox is its ability to reduce fine lines and wrinkles. As we approach the age of 30, our bodies stop producing as much collagen which causes our skin to lose about 1% of its thickness every year. This causes wrinkles and deep fine lines over time, and for some, it can be as early as in their 20's.

Botox contains a naturally occurring bacterium called Clostridium botulinum toxin type A, that when injected into the muscles, causes temporary paralysis. This helps reduce wrinkles by making the muscle under the wrinkle relax and unable to move. Eventually, this forced-relaxing will help the wrinkles to soften and disappear. 

The more Botox someone uses when they are younger, the less they will need to use as they get older. If used over time, it will help to prevent deeper wrinkles from forming.

If someone starts with Botox in their 50's, they are less likely to reduce the deep creases that have already formed. By this time, fillers or facelift procedures may be the only remedy.

Ultimately, the longer you use Botox, the better it will be as you age. 

6. Vaginal Spasms

Vaginal Spasms, otherwise known as Vaginismus, is a painful condition that causes severe cramping of the vaginal walls. This can make something so sacred such as sex a very painful and unenjoyable experience. 

During intercourse, the vaginal walls start to spasm, preventing intercourse entry and causing extreme pain. This can prevent their ability to have children, and completely affecting their relationships, and quality of life. 

With Botox injections into the vaginal muscle tissue every two to six months, it will relax the overactive muscles. This will lead to relief from pain, and improve the patient's life. 

7. Crossed Eyes

Crossed eyes, or medically known as Strabismus, is a debilitating condition that prevents both eyes from looking at the same place at the same time. This is caused by unbalanced muscles that are pulling in opposite directions. 

Eventually, Strabismus can lead to blurry vision, double vision, eye soreness, inability to focus, and lack of depth perception. This could prevent someone from being able to work, drive, or exercise, as well as affecting their confidence levels.

Doctors have discovered a way to reduce Strabismus by injecting Botox directly into the eye muscle. This can completely realign the eyes and reduces the Strabismus by up to 100%!

This can be a painful procedure, which is why there is numbing eyedrops added to the eyes before it begins. Treating Strabismus was actually the original purpose of Botox, before the realization of how many other conditions it can treat.

Is Botox Worth It? Now you Know

Since its discovery in the 1970s, Botox has come a long way. Who knew that this neurotoxin would be so beneficial when administered the right way? 

Now it is being used to treat a variety of muscular conditions and reduce the signs of aging, in other words, could Botox be the fountain of youth?

So, is Botox worth it? Our patients sure think so

If you would like to learn more about what Botox can do for you, feel free to contact us at any time to set up a consultation.

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