Thursday, March 1, 2018

Simply Your Skincare - (Yes. It's This Easy)

Let's keep this really simple... It’s time to streamline your bathroom cabinets and nightstands to de-stress and fully enjoy your morning and nighttime skincare routine. Many patients share that they look forward to those few minutes of applying lotions and potions because it often times is the only moment during their otherwise busy day that they can focus on themselves. Your skincare routine is an opportunity to take a deep breath and feel content with the knowledge and comfort that you are doing something that’s both productive and feels good. Some patients express that they are overwhelmed and don’t know what to do, how to do it, why they are doing it, etc. This confusion discourages them from being consistent, which is key for beautiful skin. This article is for those patients! Let’s be honest, though, even the best of us could use a little guidance when it comes to keeping things simple. I am happy to help you get organized to refresh your routine and bring it back to life!

Step 1: Clean The Junk Drawer

Whatever it is, if it’s over two years old and if you haven’t used it in the last few months - chalk it up as a loss and toss it. If it’s something you really love, replace it and get back in the habit of using it regularly. Otherwise, make a mental note that from now on, you are investing in quality over quantity and not wasting time or energy by allowing unnecessary evils like a collection of pore-clogging/funky-smelling/possibly-expired free samples invade your drawers. No more clutter in your mind or space. If you’re still not sure what to do, ask yourself these questions: do I love it, do I use it, do I have more than one and can I get another that’s more efficient?

Step 2: Edit The Basics

Once upon a time, there were a few fix-it-all products: cold creme and astringent. It actually makes me so sad that two favorites from my childhood have lost their place in our daily lives. But, there’s a reason for this. When makeup was extremely heavy on the skin, women used cold creams to remove stubborn residue. Cold creams create a lipid layer on the skin that clogs pores while astringents contain alcohol to break up this lipid layer. You can use either of these on occasion, but neither is best for skin for long term maintenance and neither can address your skin's real needs: truly cleaning the skin based on your specific chemistry without ingredients that actually devitalize and eventually cause premature aging over time. No, thank you! 

Here are the important, but quickly dismissed basics: 
Cleanser. Toner. That's all you really need to know. People dismiss them, but they matter because they set the stage for everything that follows. 

The necessities:
This is where you ask yourself: what is each product’s duty? Does it work? Regardless of your skin type, each person MUST HAVE proper exfoliation and hydration. We’ve talked about this before, but here’s a recap. 

Each skincare routine should have:
1 Cleanser 
1 Toner 
1 Eye Cream (starting in your early 20s) 
1 Active (starting in your mid-20s)
1 Moisturizer

And, I have to add just one more - A NECK CREME! This is what I consider to be a new staple that is an absolute necessity. All too often, the neck is neglected; yet, it is the first area to show signs of aging and is the most difficult area to treat once the damage is done. A neck creme like Necktar will address all of the leading causes of aging in this specific area. (Since of all the "must-haves," this may be foreign to consider, please read more about Nectar HERE.)

Without these, you’re losing major points in the age prevention and skin maintenance department. Some skin that is compromised, like acne and blemish-prone or orange-peel texture or aging, may require a few other specialty products to help correct whatever is compromising the quality of their skin; but, this is mostly it! And, if you’re super low-maintenance, I’ll let you skip the toner - even though all of these things work together for your best result.

If you have any questions for your skincare routine, give us a call at (888) 570-6777 or e-mail Elizabeth A. Cardarelli at

Wednesday, February 15, 2017

5 Unforgettable Reasons To Never Skip "Toner" After Cleansing Your Face

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5 Unforgettable Reasons To Never Skip Toner

Toner is the most underused and misunderstood skincare product; yet, it can make all the difference. 

1. Toners Boost Your Immune System:
The body is naturally armored by its acidic mantel which is its first defense against germs, bacteria, viruses and anything else evolved enough to damage the immune system. Each and every time you wash your body, you strip your skin of this acidity AND it takes up to 8 hours for your body to rebuild this protective layer. To speed up this  process and restore your body's pH, as well as hydrate your lipid mantle... use toner*!  Toner isn't just for your face, you can use it for your entire body...even your hair. Go crazy, indulge your immune system and spray a thin layer all over after each shower! (Get a toner enriched with different vitamins and essential oils for add benefits). Fun Health Fact: to stay healthy while traveling, you should never bathe the day of boarding a plane or bus. Instead, bathe the night before to ensure your acid mantle is restored enough to  protect you! 

2. Toners Make The Most Of Your Money:
One of the greatest benefits of using a toner is that it prepares your skin for your other products. Even after cleansing, your skin can still have minerals and hard water deposits which block your other products from penetrating the dermis. Toners eliminate and dissolve any impurities that are left on your skin which allows your serums and moisturizers to  penetrate deeper; thus, optimizing the benefits of each and every product that follows your toner. When you don't use toner as a part of your skincare regime, you're wasting  money on all of your other products because you're not allowing them to work to their fullest!  Stop doing yourself a disservice, and TONE UP!

3. Toners Heal Skin and Neutralize Free Radicals:
Toners worth using contain beta carotene proteins, which you usually hear about when talking about the foods that are healthiest for you, such as cruciferous vegetables. Beta carotenes are important because they protect your from and neutralize free radicals, which are pollutants known to age and cause damage to skin. Toners are also infused with vitamins, minerals, and antioxidants that make them naturally antiseptic to help heal minor scratches and soothe inflammation; thus improving your overall appearance within seconds and within the first steps of your skincare regime. 

4. Toners Provide Shaving Relief:
Shaving creams use alcohol to soften hair so that it can be shaved. Unfortunately, alcohol drys skin; thus, defeating the purpose of shaving! For the best shave for you face or body, for both men and women... Use your toner (without alcohol or exfoliating ingredients such as glycolic) as an aftershave. Toner will close exposed pores, hydrate, and soothe irritations caused by shaving! 

5. Hydration, Hydration, Hydration:
Does your skin ever feel tight after washing your face? That's because your skin is dehydrated! Same goes for itchy,scaly skin in the winter. Hydration is the key component to having a "healthy glow" that you desire. Don't wait! Use toner before applying your moisturizers to provide extra hydration to even the driest alligator skin.

*FUN FACT: Toners and astringents are different: Astringents were created during a time when women used cold creams to remove extremely heavy makeup. Cold creams create a lipid layer on the skin that clogs pores while astringents contained alcohol to break up this lipid layer. Do not use any toners with alcohol as an ingredient as it defeats the entire purpose of toner because alcohol dehydrates the skin and damages living skin cells. Also, some toners designed for acne contain ingredients like glycolic...only use these for the face or back, but not the rest of your body. 

**Additional Tip for Using Toner: always wait for skin to completely dry before applying other products. 

What do you think? For us, this only scratches the surface... 

Article written by Samantha M. Harders, Business Development Manager:
IG: @averygrahamskincare

Tuesday, December 13, 2016

But What Does That Mean? An ABC Guide To Understanding Skincare Ingredients

But What Does That Mean
A Quick A-B-C Guide To Understanding Skincare Ingredients 

Understanding what's in skincare can be confusing. Just reading a description like, "the potent Alpha Lipoic Acid in our Skin Perfecting Creme, a clinical treatment moisturizer, helps Vitamin E self regenerate within your own skin cells" doesn't fully express the depth of significance and benefit to skin. Here is an abridged "ABC" guide to how key vitamins and nutrients impact skin, so that you can feel extra excited about your skincare regime as you wake this morning!

Vitamin A:
Repairs damaged connective skin tissue which helps the appearance and formation of wrinkles and fine lines 
Treats acne
Treats blotchiness and hyperpigmentation (brown and red spots caused by either inflammation or sun damage)
Neutralizes free radical damage (caused by pollution and environmental stresses)
Natural sources: carrots, sweet potatoes, kale

Vitamin B Complex:
Treats dry skin
Treats acne
Strengthens nails and helps reduce hair loss
Neutralizes free radicals
Sources: supplements like Vitamedica's Energy Supplements

Vitamin C:
Powerful anti-inflammatory
Skin brightener
Prevents hyperpigmentation (brown and red spots) by preventing enzymes from creating excess melanin
Treats acne
Treats psoriasis (a skin condition caused by rapid buildup of skin cells to form dry, scaly patches of skin)
Treats rosacea (a skin that causes redness and often small, red, pus-filled bumps on the face)
Treats asphyxiated skin (a lack of circulation within skin, most prevalent in mature and sun damaged skin or caused by illness, smoking and pollution in city environments)
Natural sources: tomatoes, citris fruits, densely colored vegetables like red peppers and broccoli

What do you think? For us, this only scratches the surface... 

Article written by Samantha M. Harders, Business Development Manager:
IG: @averygrahamskincare

Tuesday, December 6, 2016

3 Ways Exercise Ages Skin

You may not want to hear it and I hate to say it, but it's true... exercise can seriously age skin. Some of our most active patients, especially men, are the ones who request the most help for skin correction and repair. The key to combatting aging caused by exercise is to understand how different components of a workout affect your skin and what to do to prevent damage! This is what I've noticed and learned over the years...

1. High Impact Sports + Gravity:

Exercises like running (although incredibly cathartic and well appreciated) break down the smallest connective tissues that support the structure of your muscles.  Each “pound of the pavement” forces gravity against you, pulling and tearing your skin towards the ground. Sagging skin caused by this traumatic and cyclic activity is usually most visible on the face, neck, knees, and breasts. Unfortunately, once this type of damage has been done, there is little that can mend it short of more serious treatments with significantly longer downtime. Save your skin by remaining active, but alternating or incorporating more low impact sports and activities such as swimming or walking into your regime. So, "train like a beast, look like a beauty!"

2. How Does A Grape Become A Raisin? 

Exercising and then eating unhealthy, improperly re-nourishing, or failing to hydrate your body after a workout is especially detrimental to skin. As the largest organ on your body, your skin needs you to stack up on more than protein post workout. Loss of essential vitamins & nutrients devitalizes skin. You NEED essential and non-essential vitamins and minerals that only proper food can provide. For glowing and healthy skin, eat the colors of the rainbow - all veggies contain an amount of beta carotene proteins which come from the pigment of the vegetable or fruit... This is one way to re-nourish your skin from the inside-out post workout (which also helps to neutralize free radical damage). Lastly, let me ask, "how does a grape become a raisin?" Dehydration. Even though I shouldn't need to remind you to drink water, allow me to do so anyway: drink more water for supple, beautiful, healthy skin!

3. Sweating = Clogged Pores + Dry Skin 
Although the combination of clogged pores and dry skin may seem contradictory, it's not. It's no secret that exercising can cause you to breakout, especially during summer months when there's no reprieve from the heat and sweat. An improper skincare regime intended to nip the problem in the bud might make everything worse by over drying the skin. But, what can you do about it? Introduce the right skincare into your exercise regime.... Here's how: 

A. Wash your face with either your regular face wash or a more gentle face wash quickly before you exercise to purify the surface of your skin.  Whatever is on your skin before you exercise will sink into your pores as they open throughout your workout.  Avoid cleansing brushes and make-up removing wipes, as brushes can irritate and inflame the skin while wipes usually contain ingredients with fatty lipids and large molecular structures that lay on your skin, which precludes your pores' ability to fully breathe and expel impurities as you sweat.

B. Avoid cross contamination. Sweating allows bacteria to transfer more easily from other people's hands to the surfaces of exercise machines and weights.  Be sure to disinfect machines before and after use, and still avoid touching your skin, even to wipe off sweat from your forehead.  Same goes for your exercise partner: if you touch each others hands or bodies while sweating and working out, avoid cross contamination of bacteria by washing your hands with antibacterial soap before, during and after a workout.  

C. Use a salicylic cleanser after your workout, while your face is still warm and wet from sweat.  This ensures that the exposed pores can be thoroughly cleansed and closed before contamination can continue from sweat and dirt post-workout.  Salicylic dissolves dead skin cells without causing damage to skin.  Do not use cleansers with benzoperoxides, as this ingredient kills living cells while often over drying out the skin.  Salicylic can be strong, so either use just a little or be sure to use the best moisturizer for your skin afterwards.  

What do you think? For us, this only scratches the surface... 

Article written by Samantha M. Harders, Business Development Manager:
IG: @averygrahamskincare

Friday, July 17, 2015

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Learn From The Master

Feng Shui Master, Bonnie Bailey says, "Mirrors are referred to as the "aspirin" of Feng Shui. They are an expression of water energy and their placement is very important. Always be sure they are reflecting something pleasant and do not distort your image." She then asks, "What does your mirror reflect?"

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Tuesday, September 23, 2014

Meet Our Expert: Kevin J. Cross, M.D.

Demystifying the Breast Augmentation, Part 1      Written By: Kevin J. Cross, M.D.


Since first being introduced over 50 years ago, the modern day breast augmentation procedure has undergone revolutionary changes with regard to the options available to plastic surgeons to shape the breast, the choices a patient has with regard to implant selectionand the public's understanding and perception of the procedure.
The use of silicone breast implants predated saline breast implants by one year.  In 1962, first generation silicone breast implants were introduced and saline filled implants followed in 1963.  For much of the 1990's and early 2000's, as a result of a belief that silicone gel was causing autoimmune and other vague symptoms in women who had them placed, silicone breast implants were banned.  An exhaustive group of studies reviewed by the FDA found that there was no correlation between breast implants and any of those symptoms, however, and in 2006, the ban on silicone implants was lifted. Today, approximately 80% of breast augmentations nationwide, and over 90% in my practice are performed with silicone implants.  While saline implants can still provide a very effective augmentation, and some women choose saline implants simply because they prefer an implant filled with saline, most women choose silicone implants because of the more natural feel offered by the latter.  Though there was once a realistic fear that a leaky implant could lead to silicone spreading into the region around the breast, the most recent generation of silicone implants is filled with highly cohesive, or form stable gel.  These implants can actually be cut in half without any of the implant material leaving the implant shell.  Therefore, even if there is a problem with the lining of the implant, there is no risk of silicone spreading throughout the breast or beyond.  


Breast augmentation procedures take, on average, between one and two hours, depending on whether a lift of the patient's own breast tissue is needed.  Often, the implant itself can be used to provide lift, and different sizes, shapes, and textures are available to customize the implant to provide the most ideal volume restoration possible for individual patients. When a significant amount of natural volume has been lost, however, especially after having children, extra shaping of the breast tissue may be needed.  In my practice, new computer software and imaging devices known as the VECTRA systems are being used to give a patient a complete visual representation of what a breast enhancement will look like on them.  The system images a patient's breasts and produces a very accurate rendering of what changes can be made with implants of different sizes and shapes.  It can even take into account any lifting procedures that may be necessary.  Unlike older technology which I feel was used as a marketing tool by plastic surgeons to try to sell the appearance of an ideal breast image, this new technology provides a very accurate representation of what the patient will actually look like, and allows the patient to move forward with confidence, knowing in advance what the goals of the procedure will be.


Choices that a patient and I make together in the office through a lengthy discussion and exam include size and shape of the implant to be used, whether the implant is going to go above or below the chest muscles, and what incision is used to place the implant.  Most commonly, the implant is placed under the muscle. There are certain patients with breast shapes that are better served with an implant that is placed directly under the breast tissue, but for the vast majority of patients, placing the implant under the muscle provides extra cushioning for the implant and helps create a more natural blend between the edge of the implant and the remainder of the breast and chest, thus creating the most natural shape and appearance.  


While placing an implant through an incision in the armpit is possible, I discourage most patients, especially patients who have had children, from using this approach.  It is less reliable as far as ensuring implant position and puts the implant at greater risk of complications.  Furthermore, an armpit incision can easily be mistaken for a biopsy incision and is visible even in a tank top or bathing suit.  For the majority of patients, placing an incision that is just a few centimeters long either in the natural under-fold of the breast or at the junction between the pigmented part of the nipple and the remainder of the breast allows for a very discrete incision that fades to the point of being imperceptible and is completely hidden in any amount of clothing or lingerie.  


After a breast augmentation procedure, patients spend a few hours in the recovery room and are then able to go home.  My patients wake up with a bra that we place them in at the end of the procedure.  This bra stays on for two days, after which the patient can take off the bra, shower, wash over her breasts, and start getting back to normal activities.  All sutures are absorbable and a small piece of tape is placed over the incision.  Patients feel a varying level of discomfort after the procedure, but most patients take very little to no prescription pain medicine and are able to get back to exercising within one to two weeks.  The initial discomfort is often described as feeling as if the patient did hundreds of push-ups the day before.  There is soreness in the chest when the patient moves, but relative comfort at rest.    


How long does an implant last? How am I protected if an implant leaks?

Common questions asked by patients relate to the "life expectancy" of an implant, and what happens if there is a leak with the implant.  Generally speaking, the risk of a breast implant leakage is about 1% per year.  This rate is less in the first few years, and increases slightly as the implant ages.  If a saline implant leaks, the implant deflates and the patient notices a decrease in volume on the side that is affected.  If a silicone implant leaks, because of the stability of the silicone, it may be harder for the patient to determine.  While there is no risk to a patient's health from a silicone implant that leaks, an MRI is used to confirm the condition of the implant.  Unlike the original procedure which requires a few days of recovery because the body has to get used to the presence of the new implants, exchanging an old or leaky implant for a new one is a short procedure with very little recovery time.  The three major implant companies in the United States are so confident of the durability of the current generation of implants that they provide a 10-15 year warranty that covers all costs to exchange an implant if there is a leak.  

Will I be able to breastfeed?  What happens when I need a mammogram?

For our younger patients, it is important to know that, contrary to popular belief, it is possible and safe to breast feed after a breast augmentation procedure.  While there is a very small measurable amount of silicone in breast milk in patients with breast implants, it is actually one-hundred times less silicone than what is found in infant formula.  For our patients who are approaching or who are at the age where mammograms are necessary, extra images are needed in patients with breast implants.  Known as the Eklund maneuvers, these extra images allow radiologists to visualize the breast tissue around an implant.  Studies have shown that there is no increased risk of being diagnosed later in the course of breast cancer as a result of having breast implants.  


Having a breast augmentation with breast implants is a commitment that a patient should not take lightly.  That being said, patients often feel that a well performed breast augmentation provides them with shape and balance that they never had in the past, or that the procedure restores form and proportion that was lost either with age, weight loss, or having children.  Patients find that they can wear clothing more comfortably, are able to fill a shirt, gown, or bathing suit more appropriately, and feel more comfortable with their body after the procedure then they ever did prior to the augmentation.  
My goal has been to give a basic understanding of breast augmentation.  With so much information to understand and so many choices to make, a successful patient experience with the most perfect cosmetic breast augmentation result ultimately depends on the dialogue and discussion between myself and my patients. More information is also available on my website: under the virtual consult -breast augmentation section.  In our next segment, I will discuss the latest trend in breast augmentation – the no implant augmentation – where a patient’s own fat is acquired by a modified version of liposuction.  The fat is taken from the areas where it is least desired, and placed into the breast for a natural “autologous” augmentation.

Kevin J. Cross, MD
Cross Plastic Surgery