Mosquito Protection and the Zika/Chikungunya Virus Threat

Using Bug Spray

Even though this is not a cosmetic subject it is one that concerns us all. The threat of all the diseases and malformations caused by the Aedes species mosquito is getting closer to home.
Many of you already know that I have been a victim of this mosquito while on a trip to Columbia a few years ago. I contracted chikungunya, another illness caused by a mosquito from the same species. It was not an easy six months. This mosquito is becoming a threat to us all and I think it is very important to know how to protect ourselves against it.
Mosquitos love stagnant water so make sure you empty all outdoor containers after it rains and avoid spending too much time unprotected close to ponds, bird baths, and even lakes. The Centers for Disease Control recommends to use as repellant products which contain any of the following: DEET, picaridin, IR3535, oil of lemon eucalyptus or paramethane-diol.
Many of us are concerned with the toxic effect of DEET. The Agency of Toxic Substances and Disease Registry a well as the American Academy of Pediatrics advises that the use of products which contain 20-30% of DEET are safe to use by adults and children. Among the products available on the market are the OFF products like, OFF Deep Wood product, Family Care Smooth and Dry ,and Skintastic Family Care by S.C.Johnson and Company. In case you do not feel comfortable using a product which contains DEET, you can look for a product which has 10-15% picaridin like Sawyer Picaridin Insect Repellent (Sawyer) or Natrapel8Hour (Tender Corporation).
For children with sensitive skin you can try impregnating their clothes with permethrin or just buy for them permethrin treated clothing. For those traveling in areas which are infested by the mosquito, you may also want to purchase hats with netting, shirts with long sleeves and impregnate your clothing with permethrin. Make sure you sleep in beds which have protective nets and carry a repellent which contains DEET.

Facial Pores: The Road to Flawless Skin


Park Avenue Medical Spa remains one of the few centers in New York, and Westchester with an impressive experience in skin care treatment. Our focus has been on improving the appearance the skin from the young acneic to the aging skin. Very often I consult women or men with problem skin, enlarged pores, or acne who have consulted many dermatologists or other skin care professionals but never had a proper skin evaluation or treatment. A home care treatment to include topical and systemic therapy is only one part of this complex therapy.

Recently I came across an article discussing facial pores, the definitions and treatments and I decided to share it with you since beautiful, radiant skin starts with treatment of your pores.

What really is the pore? Well it is simply the opening of the pilosebaceous follicle. They generally measure .02mm in diameter but can be as large as .3-.6 mm, the so called “blackhead embedded skin pores”.

Possible causes for enlarged pores are primarily related to excessive sebum production, genetic predisposition, sex, acne, or seborrhoea. There is unquestionably a direct relationship between the sebum output and pore size. The sebum secretion is generally increased during ovulation showing a clear hormonal dependence. Hormonal changes can trigger increased sebum production and acneic outbreaks.

Generally, we see larger pores on the nose, cheeks, and the so called T-zone, clearly related to the areas of increased sebum secretion.

Pore size is associated with age as well. Matrix proteins decrease with age and photoaging. Such loss results in decrease dermal integrity and perifollicular structural support which in turn leads to skin fragility, increased pore size and sagging seen with advanced age.

In summary enlarged facial pores are related to high sebum production, decreased elasticity around the pores, and increased hair follicle volume.  Other causes include, recurrent acne, sex hormone imbalances, poor skin care habits, or improper skin care regimens and sun exposure.

The treatment must address the causative factors.

The first step however should always be a good pore cleaning. This treatment must be performed by trained medical aestheticians and will require a few steps to assure there will be no inflammation or infection which will result in scarring. You cannot achieve good results without proper cleaning of the follicle to express the sebum, and “black heads” (this term is used for dried out old sebum which clogs the pore.)  Once we ensure that cleaning is done regularly we will recommend a skin care program to include products which are known to decrease sebum production, like retinoids. Hormonal therapies may be indicated where there is also excessive androgenic activity. Spironolactone alone or in combination with oral contraceptives may be necessary.

IPL therapy, Blue Light with or without aminolevulinic acid can decrease sebaceous glands and decrease pore size.

Skin elasticity can be improved with non ablative or ablative RF microneedling devices.

Hair removal is another way of reducing pore volume mostly in those individuals with thick, coarse hairs.

Botulin toxin in intradermal injections is also used to decrease sebum production and pore size.

In conclusion, proper facial cleaning combined with proper skin care, laser therapy or systemic medication (if indicated) will give you clear, smooth skin.

For more information, please see us in consultation and we can discuss all the options available for you

Temple Volumization

Upload: February 8, 2016
One of the earliest signs of aging is volume loss at the temple. This process will cause a displacement of the lateral aspect of the brow inferiorly and often a hollowness in the temporal region. There are several types of fillers which are used successfully to correct this area. Most of the facial fillers utilized will not cause any untoward effects provided the injector is very familiar with the anatomy and properties of the fillers. The temporal fossa contains multiple layers as well as nerves and vessels. More serious complications , like blindness, can occur if the dermal fillers are injected by an inexperienced injector. Care has to given to the delineation of all the vital structures and proper positioning of the needle away from the major vessels and nerves.  With appropriate placement of the fillers only very mild and transient complications may occur, like bruising, prominence of the superficial vessels, headache or tenderness. Some of the most common fillers are those with higher viscosity. Juvederm Ultra Plus, Radiesse and Scupltra are used routinely and injected with 27g, 25g needle or a cannula to avoid complications. The filler is placed in the periosteal space. Aspiration prior to injections will avoid an intravascular injection. Prior to injections patients must avoid aspirin, non-steroidal anti-inflammatory drugs, ginko, or fish oil. It is always a good idea to discuss any medications or supplements being taken with the medical professional administering injectables.
Hollowing of the temple is a sign of early aging and once corrected will significantly improve facial contours and restore youthfulness of the one’s face.

PRP – Vampire Facial

PRP - Vampire Facial
NEW this fall at Park Avenue Medical Spa. This treatment combines the benefits of microneedling and PRP. Microneedling is a procedure using tiny needles which rotate at high speed and create microscopic skin injuries. This will stimulate the body’s healing mechanism by producing firmer, tighter smother skin. The addition of the Platelet Rich Plasma obtained from your own blood will enhance the process and promote the growth of healthier new tissue. Do not let the term “facial” mislead you and ask about applying this treatment to your neck, chest or hands. It will have the same rejuvenating effects.

What is PRP?
Platelet Rich Plasma is a very active cellular concentrate obtained from your blood. Our processing system will produce a serum with over 1.1 million active growth factors and over 9 million bioactive regenerative cells. This is over 7 times the level found in one’s blood and it is the concentration that provides the desired clinical outcome. These cells present in this potent preparation is specific to your own tissue type and can quickly identify and regenerate your collagen, elastin and any other potent cells need to enhance the rejuvenation process.
Is this treatment safe?

This treatment provides a very powerful mixture of bioactive cells 100% safe and compatible with your own tissues. There is absolutely zero chance of hypersensitivity or allergic reaction. The concentrated serum with your own blood elements will stimulate a natural regeneration of the cells needed to rejuvenate your skin.
How is it applied?

This treatment should only be performed by a trained medical professional. The injection technique is specific to each area, such as radial fanning or linear threading. Other techniques like cross hatching and serial puncture can also be utilized where deemed necessary.
Topical anesthesia is performed prior to the procedure and the injections are done so that there is adequate coverage of all areas of interest and the discomfort is minimal.

How do you prepare for the procedure?

Prior to the procedure you will meet with the physician and have a detailed consultation. We will determine your concerns and how to best address them. We will determine the areas to be injected, and will delineate the best treatment option for you.
Prior to treatment you need to:
1. Avoid blood thinners
2. Hydrate well
3. Avoid NSAIDs

What to expect?

After this procedure you will feel instantly the rejuvenating effects of the PRP.
You may feel a flushing or tingling sensation. This autologous preparation will provide all the necessary factors to stimulate all the elements in your skin or scalp to rejuvenate and regenerate.
This preparation acts as a stimulant for the stem cell and will continue to give results over next weeks and months.

Call us at 914.730.3333 to schedule your appointment.

Product of the Month – Resveratrol by Skinceuticals

Resveratrol is one the most potent antioxidants, unique among antioxidants

Upload: November 17, 2015

The mode of action is different than most other antioxidants. It does scavenge the free radicals which are responsible for aging of the skin but it also promotes synthesis of endogenous antioxidants. The oxidative stress caused by sunlight is well documented and showed to be the principle cause of collagen destruction.
Resveratrol has phytoestrogenic effects, and can provide the skin benefits of estrogen without the side effects. We are all aware of the effects on skin caused by decreasing levels of estrogen in aging women.
Resveratrol through its mechanisms of action can reverse the effects of too much sun exposure or loss of estrogen.
The cosmeceutical combination of Resveratrol with vitamin E and Baiclin sodium as in theSkinceuticals product showed increased skin firmness and elasticity. A very potent anti-aging product as proven by recent clinical studies.

The Role of PRP in Hair Restoration

PRP for Hair Restoration


Role of PRP in hair loss

There is more supporting evidence of the role of PRP (platelet rich plasma) in hair loss. The mechanism of action is not clearly understood. Some of the research available indicates that the release of growth factors from the platelets at the time of injection into the scalp, can prolong anagen (first part of the hair cell cycle), promote differentiation of stem cells to follicular cells, increase the growth of the dermal papillae and increase cell survival.
All these will result in an increase in hair density, hair count and hair thickness.
We have already noticed that intradermal injection of PRP stimulates collagen, capillary and adipocyte growth in the dermis, thus its application in facial rejuvenation (meso injections or microneedeling ).

Androgenic alopecia is seen in about 30% of men over 30, 50% of men over 50 and it is common in postmenopausal females. It is characterized by genetically determined gradual loss and miniaturization of the normally thick hair follicle.

The cell cycle of hair consists of anagen which lasts anywhere from 2-5 yrs., catagen a few days to a few weeks and telogen lasting about 3 mo.
There is a multitude of causes for hair loss but in our practice we see mostly men suffering from androgenic alopecia and females with female pattern hair loss.
Other causes include nutritional deficiencies, infection, autoimmune causes or genetic.

The treatment is generally directed to induction of anagen, prolongation of anagen, or reduction of the levels of dihydrotestosterone.
The most common treatments, include, Minoxidil which is known to increase anagen, enhances dermal vascularity, and has direct antiapoptotic effects.
Finasteride reduces the levels of dihydrotestosterone and prolongs anagen.
Hair transplants are increasing in popularity. They are recommended for both men and women and now automated. The procedures are well tolerated with practically no down time.

The treatment with PRP is performed once per month. The blood is collected into special tubes which contain a separator gel and it is then centrifuged. This will produce the platelet rich plasma which will then be injected in the dermis in the area of thinning or balding. The treatment is repeated generally two more times at one month interval,
The results can be seen after the first treatment but more often several months after the treatments are completed.
Most patients will notice an increase in hair density, and increase in hair count and hair thickness.
The treatment is recommended for patients who are experiencing hair loss but also for those who underwent hair transplants and want to improve or just maintain what thy achieved.

Recently the “Morning Show” on ABC featured the treatment. You can click on the link below to watch the clip.

For any questions please call us at 914.730.3333 or schedule a consultation to see if you are a candidate for this treatment.

Park Avenue Medical Spa

495 Main Street

Armonk, NY 10504



Micro needling

Upload: September 25, 2015 Dermatology experts recommend microneedling for perioral wrinkles (lines around the mouth, so called #smoker’s lines”), enlarged pores, fine lines, textural improvement.
Microneedling is uses a machine which looks like a pen (thus the word Dermapen) and has at the tip multiple tiny needles. The needles can rotate at different speeds and can travel at different depths in the tissue. The operator can program the device, depending on the end point. For fine lines or pore reduction often times we need only a shallow penetration, as for acne scarring we need a deeper dermal penetration.

The procedure can be done under local anesthesia if the patient prefers and has been often described in the press as “Dracula’s facial”. You may recall the Kardashians and other Hollywood stars who are fans of these treatments.

The downtime is generally minimal and make up van be applied 24 hours after the session.
This procedure produces micro injuries. thereby stimulating collagen production without the risk of post-inflammatory hyperpigmentation. The pinpoint bleeding often achieved indicates dermal penetration which will kick start the wound healing cascade. One can use different serums post microneedeling like hyaluronic acid, PRP (platelet rich plasma), growth factors or others depending on the case.
These treatments can be combined with other procedures for immediate rejuvenation. A total of 4-6 treatments are generally recommended.

Upload: September 25, 2015

Minimize the effects of UV rays with Antioxidants

Skinceuticals polution faceWhen you think you’ve had enough sun, you probably move into the shade. But, according to a new study, that might not be soon enough—because it turns out that sun keeps damaging skin for hours after exposure.
Recent research from Yale University has shown that sunlight does damage DNA over a protracted period of time. We already knew that the UV rays from the sun cause —cyclobutane pyrimidine dimers (CPD), in the skin cells. These dimers, form in the DNA and go on to cause mutations and, sometimes, cancer. It was thought that the damages occurred when the UV light hit the DNA.
The new experiments carried on at Yale, demonstrated that skin cells continue to produce CPDs for up to three hours after they’ve been exposed to UV light.
Further inspection has revealed that the UV light activates two enzymes which combine and then form an electron inside the melanin (the pigment found in our skin cells). The energy dumped into the melanin via this electron is then transferred to the DNA where, it causes the CPDs. Exposure to UV light seems to kick-start the enzymes, which then remain active for several hours. According to the researchers, the same process happens in human skin cells.
Unfortunately it is hard to completely modify our life style and stay out of the sun plus the sun is beneficial for other important metabolic functions.Tria with antioxidants
The good news is that, the studies suggest that it could be possible to block the effects of the enzymes using antioxidants.
We hope to have available very shortly a sunscreen and antioxidant combo to protect but also to combat the after effects of sun exposure.
In the meantime please add to your daily routine antioxidants like Vitamin C, Resveratrol and sunblock. The new TRIA skin laser will increase penetration and enhance the benefits of either product used alone.

The Tria Age-Defying Laser+Antioxidant System is now available for $650. Call us at 914.730.3333 to find out the best treatments for discoloration, hyperpigmentation, sun damage and age spots.

Anca Tchelebi, M.D.

Why NeoGraft FUE might be the best hair transplant system available

Over the past several decades, advancements in surgical hair restoration techniques have meant much more natural results for patients.  While the traditional, surgical method for harvesting donor neograft hair transplanthairs may be the most widely-known, the NeoGraft follicular unit extraction technique (or FUE) is gaining more traction among physicians and patients alike.  The procedure is painless, results are natural, and no surgery is required to extract donor hairs.

If you’re looking into your hair transplant options, it’s important to understand the difference and speak with a doctor in order to decide what’s right for you.  Here’s what you need to know to make an informed decision on FUE.

NeoGraft is less invasive, but just as permanent

The  traditional “strip method” of hair replacement requires using a scalpel to remove a portion of the scalp and suturing the wound with stitches or staples. Patients tend to experience a slow recovery time, loss of feeling at the incision site, a linear scar on the back of the head, and some post-operative pain.

Many hair transplant specialists have switched over to the automated NeoGraft system because it is the only FDA-approved, low-risk, automated medical device for hair restoration. The process has generally regarded as safe, painless, accurate, and to produce natural-looking results.

The NeoGraft system works by extracting hair follicles from the hair at the back or side of the head, where it is genetically programmed to continue growing, and transplants them to the chosen area through suction technology. NeoGraft can give men and women of all ages a “full hair” look on the scalp, eyebrows, facial area and chest. It can also be used to combat hair loss caused by burns, radiotherapy, chemotherapy, and alopecia.

Seek out an experienced specialist with an eye for detail

A qualified NeoGraft practitioner will have an excellent eye for detail and will understand the many aesthetic subtleties of hair restoration – the distribution of transplanted hairs, the angle growth of the transplants, and the design of the new hairline, for instance.

An automated procedure like NeoGraft can be 50% faster than manual procedures and has a lower risk of error. Be wary of centers that hire technicians with no medical training to perform procedures – it happens surprisingly often. There are plenty of other centers (including ours, in Westchester!) that ensure all clients are treated by highly qualified experts who have undergone advanced training in the NeoGraft hair transplant system and have many years of experience.

Aesthetic Medicine and Popular Perception

botoxNot long ago, Botox was a more stigmatized practice than it is today.  Since 2000, there’s been a 700% increase in botox procedures in the United States– what’s changed?

Simple and safe

Botox has become so successful in part because it is simple. When it’s injected, it blocks the signals from the nerve to the muscle. When the muscle and skin don’t move, you don’t develop wrinkles.

Botox has a good safety-record and most professional practitioners have perfected the delicate procedure, knowing exactly how much Botox to use (and where) to keep the face looking natural. Botox is usually used on the upper portion of the face and dermal fillers like Restylane or Juvederm on the bottom, which can give very good results. Patient comfort during treatment, short procedure times, and full results in 7-10 days have also contributed to the rising popularity of Botox.

Health benefits

Not only does Botox treat chronic wrinkles of the forehead, eyelids, lips and neck, it also helps treat muscle spasms, excessive perspiration and migraines. Studies show that Botox even treats depression by lessening the frequency of negative facial expressions and helping people feel more relaxed. Since the ingredients in botox are degradable, any adverse effects are temporary.

Botox in the media

Modern media and digital enhancement have exposed people to incredibly high standards of perfection. In the past, Botox has been associated with this pressure, but today it is more likely to be known for its safety, reliability and health benefits as a beauty treatment, partly because it has become such a common practice. We’ve all seen the “frozen eyebrows” of the past, but “overdoing” it does not have to be an issue since treatments can look very natural with the proper technique.

Why we love it

Everyone wants to feel comfortable in their skin. Beauty treatments like Botox are not about covering up one’s true self. They are about enhancing one’s natural beauty and reviving one’s youthful spirit, from the outside-in. We’ve all heard that beauty is in the eye of the beholder– aesthetic medicine gives each of us the opportunity to feel beautiful according to our own standards, and this, in and of itself, is a beautiful thing.