Advice - Kim Nichols MD

Tatiana Bido , Special Projects Editor 

If it seems like every day you’re hearing about another celebrity pregnancy, it’s probably because you are. Following the news that Kim and Kanye West have a baby on the way, the announcement that Khloé Kardashian is expecting and the much-rumored pregnancy of Kylie Jenner, 2018 is bound to bring a year of nonstop baby announcements. Add Chrissy Teigen, Miranda Kerr and Eva Longoria to the mix and we have a whole year’s worth of “how I got my pre-baby body back” revelations to look forward to. When all is said and done, the crop of new moms will have a slew of post-pregnancy changes to contend with, but luckily, they’ll also have the latest cosmetic treatment options to target the most common post-pregnancy concerns.

We reached out to top aesthetic doctors to find out which of the latest cutting-edge post-pregnancy treatments are best to help patients restore their pre-baby bodies.

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Microneedling with Platelet-Rich Plasma (PRP)

What It Is: “A topical numbing cream is applied to the treatment area. The patient’s blood is drawn, spun and the PRP is separated and prepared for use. The numbing cream is removed. The area is then treated with passes of microneedling with PRP. The procedure takes about 30 minutes.”
What It Does: “This treatment improves acne scarring, melasma, fine lines and wrinkles and is also a favorite procedure for new moms with post-pregnancy bodily stretch marks.”
When Can You Do It: “Platelet-rich plasma is derived from the individuals blood, so this is very much a natural treatment. Because this treatment is organic and free of any chemicals, depending on the individual, PRP can be done throughout the pregnancy.”
How Long You Can Expect Results to Last: “About one year, but it can depend on your skin type and skin condition, as well as other health factors. Maintenance treatments are suggested every six to 12 months for best results.”

—Greenwich, CT, dermatologist Kim Nichols, MD

Nonsurgical Fat Reduction on the Abdomen

What It Is: “CoolSculpting and SculpSure are nonsurgical body contouring procedures and address stubborn and localized fat deposits that do not respond to diet and exercise. CoolSculpting uses freezing technology to freeze fat, while SculpSure uses heat to melt it away. Both promise up to a 25 percent reduction in fat cells in the target areas per treatment.”
What It Does: “While effective at reducing a patient by several inches in problem areas (the abdomen, flanks, thighs, arms, etc.), it’s important to note that these procedures do not address lax or excess skin like a tummy tuck does.”
When Can You Do It: “We typically recommend that patients wait at least three to six months post-baby and post-breastfeeding before considering either of these procedures.”
How Long You Can Expect Results to Last: “Both CoolSculpting and SculpSure require multiple treatments, but with both procedures there is no downtime. You can expect to see results between eight to 12 weeks. Once the fat is destroyed in that area, it is gone for good, as long as you maintain your weight.”

—New York plastic surgeon Stephen T. Greenberg, MD

Abdominal Skin Tightening

What It Is: “Exilis Elite, a nonsurgical skin-tightening treatment for loose, saggy and wrinkled skin.”
What It Does: “Using infrared and monopolar radio frequency, Exilis safely heats the skin’s deep layers to initiate more collagen production. Treatments usually last under an hour, and unlike traditional treatments, there is no downtime, bruising or pain.”
When Can You Do It: “Six months after delivery and get as close to your pre-pregnancy weight as possible.”
How Long You Can Expect Results to Last: “The patient will need a minimum of four to six treatments and optimal results can be expected within three to six months of your last treatment.”

—Pittsburgh plastic surgeon Marc Liang, MD

A Tummy Tightening and Laser Resurfacing Regimen

What It Is: “When weight gain is not much of an issue and the skin is only modestly loose, I start my patient on a nonsurgical tummy tightening regimen. We treat our patients with a combination Infini by Lutronic and fractional CO2 laser treatments.”
What It Does: “The Infini by Lutronic utilizes a 49 micro-needle matrix system to deliver radio-frequency energy under the skin, directly working on the collagen layer to shrink the skin on the stomach. We found that this combination yields a much better skin tightening result than either modality alone.”
When Can You Do It: “This nonsurgical treatment regimen could be started as early as three months after giving birth to a baby.”
How Long You Can Expect Results to Last: “The result may yield the best results after six months and can last for quite a few years. We usually recommend repeating the procedures at least once in the following months to enhance the outcome.”

—Arcadia, CA, plastic surgeon Art Yu, MD

The Drainless Mommy Makeover

What It Is: “Typically after pregnancy, surgical procedures addressing the abdomen and breasts are most popular. Most commonly I perform a breast augmentation and/or breast lift combined with a tummy tuck and/or liposuction of the waist. One of the biggest advances is being able to offer a drain-free alternative with a new technology called TissuGlu. Also, during surgery I use Exparel, a pain medication injected at the time of surgery.”
What It Does: “Using TissuGlu during a Mommy Makeover allows my patients to have an easier recovery without drains and a speedy return back to normal activities. Exparel is long-lasting nerve block that greatly reduces postoperative pain. So, the combination results in less pain, less downtime and faster healing.”
When Can You Do It: “A new mother can undergo these treatments once her body is done changing. If the patient plans on having more children, I typically do not recommend any procedures for the abdomen until she is done having children.”
How Long You Can Expect Results to Last: “The results are permanent, but of course as we age our body changes. Typically, I see my patients the day after surgery and the follow-ups schedule routinely after.”

—Irvine, CA, plastic surgeon Andrew Smith, MD

The Surprising Skin Care Product That’s Banned in Most Schools

Alison Simon lives in California, a state, by everyone’s assessment, gets a lot of sun. But when it comes to the issue of sun protection at her daughter’s preschool, it’s not so cut and dry.

“My understanding is that it is considered a non-prescription medication, so a consent form is required in order for teachers to apply it. It’s a licensing requirement,” Simon says. “I believe they request sunscreen be supplied by each family and labeled to counter against any possible skin reactions. So if the kid breaks out in hives, they can say, ‘we only put on what you gave us to put on.’”

Emily Sacks is in a similar situation. She lives in the equally sunny state of Florida and says that, for her two boys, it’s a liability issue that has to do with the teachers and counselors being liable for poor application. “It’s a bit different at camps because of the activities; students can bring sunscreen, but counselors still can’t apply it.”

“Personally, I’d rather have some 14-year-old counselor reapply for my 5-year-old than he attempt to do it himself and get burned,” she says.

Like a lot of parents, both mothers see the “must” in applying (and reapplying) sunscreen, but the benefit of it being used in schools is still a point of major contention—as most states have actually banned it, which leaves a lot of parents in a “scary position,” Greenwich, CT, dermatologist Kim Nichols, MD, says. “There have been recent cases of children who have been severely sunburned at school because they were not allowed to wear sunscreen.”

As Norwalk, CT, dermatologist Deanne Mraz Robinson, MD, explains, schools consider sunscreen to be comparable to an over-the-counter medication, such as acetaminophen or ibuprofen, and will not allow students to use it without a doctor’s note. Plus, as Dr. Nichols points out, schools often ban sunscreens “due to risks to additives in sunscreens that may cause allergic reactions.”

What’s more, there may be stipulations about not allowing someone else to help apply sunscreen on your child, Dr. Mraz Robinson says. “But there are states that are recognizing the need to change these rules given the known dangers of the sun. Arizona has a bill in its house that would allow students to use sunscreen without a doctor’s note while on school property or at a school-sponsored event. The bill also would allow school boards and camps to pass policies allowing employees and volunteers to help students apply sunscreen with parental consent. California, Oregon and Texas already have passed laws to allow sunscreen at school.”

If you do the math, while it’s a tiny win, it’s not the majority, and that’s what has a lot of derms concerned.

“It’s really disappointing that sunscreen has been banned from schools across the country. Unprotected sun exposure is dangerous, and some studies would say that up to 90 percent of your total lifetime sun exposure occurs before the age of 19! Clearly, this is an important time to practice safe sun,” says Omaha, NE, dermatologist Joel Schlessinger, MD.

“Any more than two blistering sunburns can actually increase a person’s melanoma risk by as much as 10 times later in life. Sunscreen can easily prevent sunburn, skin cancer and other harmful sun damage. But one application before school isn’t enough to protect your child’s skin all day, especially if they go outside at recess. For optimal protection, sunscreen should be applied at least 15 minutes prior to sun exposure and reapplied every two hours,” he adds.

Dr. Mraz Robinson recommends that if you don’t live in one of the states where it’s OK to bring sunscreen to school, to send sunscreen with the appropriate documentation for application and use from your physician—something she knows first-hand from personal experience. “I send my children with a sun shirt with SPF 50 and a sunhat to wear during recess/time outside. These physical means from protecting them from the sun can be very beneficial. I also send types of sunscreen that my children can easily apply. For example, I love mineral powder with SPF such as Colorescience brush-on sunscreen. My children can easily apply it and it is a great broad-spectrum SPF 50.”

“The best thing you can do as a parent is educate yourself about the sunscreen laws,” Dr. Schlessinger says. “Find out what your local laws are and how sunscreen is regulated at your child’s school. Call your child’s school and ask questions. If a doctor’s note is provided, will your child be allowed to keep the sunscreen in his or her backpack or will it need to be kept in the nurse’s office? Who is allowed to apply the sunscreen to your child, especially when he or she cannot easily reach all areas of exposed skin?”

Dr. Nichols’ advice is similar, as she says she recommends a physical sunscreen (i.e. something made with titanium dioxide or zinc oxide) with SPF 30 or more to be applied on children before they leave for school. “And then they should provide hats and other protective clothing to their kids that they can put on before they go outside to play at school.”

On the bright side, she notes, it’s not all doom and gloom when it comes to sun protection in this country. “I’ve heard of dermatology associations, such as the American Academy of Dermatology, offering grants to help schools build a sun-safety curriculum and provide funding to schools to install permanent shade structures for outdoor school locations. More than 320 schools across the nation have since installed a permanent shade structure across the United States!”

Retinol: you know you need to use one every night (or every other night if your skin is more on the sensitive side) in order to stimulate collagen production, decrease the look of lines and wrinkles, even out pigmentation and just have more plump, younger-looking skin in general. But when you’re faced with an aisle (or shelf) full of different products to choose from, how can you tell which one will really do the trick and put your skin on the path to perfection? We asked 11 experts for their favorite picks—ranging rom over-the-counter options to prescription-strength creams and gels—and, simply put, why they work.

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“I recommend SkinMedica Retinol ($93) for my patients who are seeking retinol primarily for anti-aging. It has excellent efficacy without irritation and is well-tolerated, especially in more mature skin. For those who are seeking retinol primarily for acne, I prefer Tazorac, especially in skin of color, as it also improves post-inflammatoryhyperpigmentation.”

– Dr. Vic Narurkar, Dermatologist

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Replenix All Transretinol 3x Smoothing Serum($67) is effective because it has a slow-release delivery system to ensure less irritation. The formula is wrapped in green tea polyphenols, caffeine and hyaluronic acid to soothe skin, and patients with sensitive skin can tolerate the formula. This retinol product leads to softer, smoother, firmer and more evenly toned skin.”

– Dr. John Ness, Plastic Surgeon

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“My favorite medical-grade retinol product is SkinCeuticals Retinol 0.5 ($60). It is time-released, so you don’t get all the medication at once, which makes it milder on the skin. Patients don’t seem to get red like they do with other retinol products. I recommend mixing it with your favorite moisturizer—I like SkinCeuticals Triple Lipid Restore 2:4:2($125), which contains ceramides, cholesterol and fatty acids.”

– Dr. Frank Agullo, Plastic Surgeon

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“Retinol is a form of retinoid, which is a derivative of vitamin A to refine the skin and signs of aging that are often caused from environmental factors. My favorite retinol products for the winter are Avon Anew Clinical Line Eraser with Retinol Treatment($40), and SkinCeuticals Retinol 0.5 ($60) and Retinol 1.0 ($72).”

– Dr. Kim Nichols, Dermatologist

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ZO Skin Health Ossential Growth Factor Serum Plus ($148) by is one of my favorite products because not only does it contain retinol, which allows for an even cell by cell exfoliation, but the use of plant growth factors also helps increase collagen production and encourage healthy skin cell renewal. This is a great ‘starter’ retinol for patients not acclimated to any form of vitamin A. Patients find their skin tone looking more even and a noticeable softening of fine lines.”

– Dr. Benjamin Schlecter, Plastic Surgeon

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“The benefit of using medical-grade retinol is that the percentage of active ingredients is usually higher than what you can purchase over the counter, which will produce faster and greater benefits. I recommend Avène RetrinAL 0.1 Intensive Cream ($69) to many of my patients. It gently softens fine lines, evens out skin tone and texture and restores vibrancy to the skin without redness or irritation.”

– Dr. Daniel Sherick, Plastic Surgeon

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“I like prescription-strength retinoids. I start patients on Renova, which is a low dose of retinol. Once they build up a tolerance and can use it daily, I bump them up to a stronger dose. Retinols are perfect for any anti-aging regimen. They stimulate collagen to help with fine lines and wrinkles and are also beneficial for hyperpigmentation.”

– Dr. Jeffrey Wise, Facial Plastic Surgeon

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“Retinol is a magic ingredient that when absorbed into the skin, transforms into retinoic acid, which has dramatic effects on the overall appearance and health of your skin (anti-acging, acne-clearing, tone-enhancing). I love Neutrogena Rapid Wrinkle Repair Moisturizer SPF 30 ($22) because it works against fine lines during the day but also protects your skin with SPF while helping to brighten discoloration. Retin-A Micro is another one of my favorites because its stronger than your typical OTC retinol. Retin-A Micro is a topical acne agent, but also smooths fine lines, wrinkles and fades hyperpigmentation.”

– Dr. Julie Russak, Dermatologist

When it comes to keeping skin looking young, no beauty ingredient does the job like retinol. The vitamin A derivative diminishes the appearance of age spots, uneven skin tone, fine lines, and wrinkles, explains Kim Nichols, MD, a dermatologist based in Greenwich, Conn. It also shrinks blackheads, boosts elasticity, and reduces redness, inflammation, and pore size.Retinol works its magic through cell turnover, says Suneel Chilukuri, MD, dermatologist and founder of Refresh Dermatology in Houston. “Retinol ensures the newest, healthiest cells rise to the surface while the dull and lifeless cells are sloughed off,” he says.Thing is, that accelerated cell turnover can bring on a case of what some call “retinol uglies”—dryness, flaking, redness, and increased sensitivity. And in the winter, when dry heat, wind, and low humidity are already sucking moisture away from your skin, you may be even more prone to retinol-induced blotchiness.No one wants to put her anti-aging skincare regimen on hold until the warmer weather comes, and with a few tweaks you won’t have to. First, make sure you’re drinking plenty of water to prevent your skin from getting dehydrated (here are seven easy ways to drink more water). Apply moisturizer every morning and night, and those with especially parched complexions can also add a hydrating serum. “In the summer, I use a lighter moisturizer,” says Dr. Nichols, who is also Avon’s Consulting Dermatologist. “But in the winter, I may replace a daily moisturizer with a heavier one. Vitamin E and aloe are effective moisturizing ingredients.” And be sure you’re not applying too much retinol—you only need about penny-size dab for your whole face.Dr. Chilukuri cautions that excessively hot showers and steam also dehydrate skin. “Most of our patients are able to easily tolerate the appropriate retinol throughout the winter,” he says. “In some cases, you may need to decrease the number of nights per week you are using it. You can limit use to two to three nights a week to prevent additional dryness and irritation.”If you’re still experiencing parched skin, buy a lower strength retinol for the cold season. “A .5% rather than a 1% may be the right fit for winter,” says Dr. Nichols. “The frequency and strength varies per age and skin type. Sensitive skin might apply retinol .5% retinol two to three times week, while a man or woman in their forties or fifties may prefer a retinol at 1% four to five times a week.”

However, all retinols should be used under the care of a pro. “It is important to have an initial consultation with a dermatologist or qualified skincare expert to determine the best retinol for your skin,” says Dr. Chilukuri. “Typically, patients can avoid complications such as dry, irritated skin if the proper products are used and introduced correctly. Patients are then more compliant, will continue their regimen, and achieve long-term benefits.”

Try these six retinol products that will keep your skin in shape during the winter.

1

PCA SKIN Intensive Age Refining Treatment

refining-treatment

Photo by PCA SKIN

“My favorite retinol product for the winter contains niacinamide to help decrease redness, improve skin barrier, and reduce yellowing of the skin that occurs as we age,” says Dr. Chilukuri. “This particular retinol is safe for more sensitive skin.”

To buy: PCA SKIN Intensive Age Refining Treatment, $109; dermstore.com.


2

Glow by Dr. Brandt Revitalizing Retinol Eye Cream

revitalizing-retinol

Photo by Dr. Brandt

No sleep? No problem! Fake a full eight hours with this multitasker that tackles dark circles and fine lines, while micronized ruby crystals illuminate.

To buy: Glow by Dr. Brandt Revitalizing Retinol Eye Cream, $55; sephora.com.


3

ZO Skin Health Ossential Advanced Radical Night Repair

advanced-skin-repair

Photo by Zo Skin Health

Delivering antioxidant protection to neutralize damage from free radicals, apply the 1% retinol formula just before bedtime to sleep away UV-damaged and aging, tired skin.

To buy: ZO Skin Health Ossential Advanced Radical Night Repair, $170; zoskinhealth.com.



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StriVectin Advanced Retinol Day Moisturizer Broad Spectrum SPF 30

moisturizer-retinol

Photo by StriVectin

For a daytime dose of retinol, slather this on to also get protection from UV rays. Plus, NIA-114 peptides boost firmness and elasticity.

To buy: StriVectin Advanced Retinol Day Moisturizer Broad Spectrum SPF 30, $99; birchbox.com.


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Avon Anew Clinical Line Eraser with Retinol Treatment

avon-retinol

Photo by Avon

This is Dr. Nichols’ pick since it’s lightweight and delivers speedy results, thanks to its Amino Acid complex that fights fine lines and wrinkles.

To buy: Avon Anew Clinical Line Eraser with Retinol Treatment, $40; avon.com.

Women's Health "Skinfessionals" with Dr. Kim Nichols