MEASURING VIBRATION EXPOSURE TO WHEELCHAIR USERS IN THE COMMUNITY. Yasmin Garcia BSa,b, Jonathan Pearlman PhDa,b, Steve Hayashi BSa,b, Juan J. Vazquez MSa,b, Rory A. Cooper PhDa,b, aHuman Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA; bDepartment of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; cDepartment of Physi
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Skin Care ServiCeS
PLASTIC SURGERY CLINIC
Medical grade products combined with education are essential in uncov- ering your skin’s true potential. The following available products will aide in your skin’s rejuvenation, function, and protection.
retin-a or tretinoin Cream
A derivative of Vitamin A, Retin-A is the most effective anti-aging topical on
the market today. It encourages your skin to function as it should. Retin-A comes in three strengths and is used to stimulate cellular turnover. It sheds the surface layer (stratum corneum) of the skin while thickening the epider- mis. This process strengthens your skin, softens fine lines and wrinkles, and produces a youthful, healthy glow. Retin-A is also known to improve tex- ture, elasticity, and increase blood circulation as it maintains even cell growth. Most patients believe that they are allergic or “too sensitive” to use Retin-A because of normal side effects that occur in the first four to six weeks of use. This active prescription can cause dryness, itching, redness, flaking, and pho- tosensitivity, though the benefits largely out weigh the brief and controlled side effects. Strength and frequency of this product should be monitored and determined by the patient’s skin type and level of tolerance. alpha hydroxy aCidS
A family of natural compounds found in fruit, sour milk, and plants. These
acids are beneficial in treating photo-aging, acne, and prevention of fine lines. Although not as effective as Retin-A, these acids offer significant exfo- liation benefits for patients ready for a maintenance skin care program or do not want to experience the side effects of Retin-A. hydroquinone 4%
Suppresses pigment formation in your skin. Pigment, often called sun spots,
age spots, liver spots or freckles, are caused from sun damage, free radicals, and hormones. Hydroquinone will not bleach your skin but will keep your skin from producing more unwanted pigment. This is why it is always impor- tant to use Retin-A in conjunction with Hydroquinone. Retin-A will exfoli- ate your established pigment and Hydroquinone will prevent reoccurrence or suppress new pigment from forming. Most patients are not satisfied with results if they use Hydroquinone alone. We offer two formulations of Hy- droquinone so we are able to treat deep and superficial hyperpigmentation. Hydroquinone will assist in achieving even skin color. Strength and frequency of this product should be monitored.
The most popular form of anti-oxidants include Vitamin C, Vitamin E, and
Idebenone. These antioxidants neutralize and protect the skin from free radi- cal stress. Free radicals are oxygen atoms that attack by attaching themselves and compromising the membrane. We come in contact with free radicals every day through pollution, sun exposure, poor diet, smoking, and alcohol. Free radical damage over time will cause collagen collapse, loss of elastin, and hyperpigmentation. The formulation of these protective products is impor- tant. Delivery of vitamins into the skin is difficult and must remain stable. L-Ascorbic Acid (Vitamin C), Alpha Tocopherol (Vitamin E), and Idebenone are considered the strongest and most effective active ingredients today but should come from a reputable skin care line to ensure their delivery. They come in many strengths with stronger percentages sold only through a physi- cian’s office. Topical anti-oxidants should be included in every patient’s home SunbloCkS
It should be emphasized that only a broad spectrum sunblock will provide
sufficient protection from the sun. Broad spectrum sunblocks protect both UVA (aging) and UVB (burning) rays. Active ingredients such as titanium dioxide and zinc oxide provide protection from both UVA and UVB rays. Sun Protection Factor (SPF) is a rating given by the Food and Drug Admin- istration. This rating only applies to the burning rays not the aging rays. The majority of premature aging is caused by over exposure to the sun. Patients should use a broad spectrum SPF30 or greater sunblock every morning. Sun- block is only active for three hours, so re-application is crucial for protecting CleanSerS and tonerS
Cleansers and toners prepare the skin for treatment products with a vari-
ety of active ingredients to remove make-up, lift impurities, gently exfoliate and balance our natural pH (potential for hydrogen). Patient preference and lipid levels should be taken into consideration when choosing a cleanser or moiSturizerS
Moisturizers should be based on their ability to attract water and provide a
barrier to keep moisture in. Our moisturizers are carefully formulated with multi-functional ingredients that nourish and protect every skin type. Our plastic surgeons, along with our aestheticians, are dedicated to
helping you make smart skin care selections in order to achieve healthy,
beautiful, life-long skin. We will individualize and monitor results in a
medical grade skin care program that will meet your skin’s needs and
your lifestyle. Please ask to speak to an aesthetician today or make an
appointment by calling 214-645-2353.
In dry skin, the sebaceous glands are inactive or do not produce enough
sebum for adequate moisture levels. Patients that experience dry skin usually have dehydrated skin, small pores, thin skin, and are more prone to wrinkles and fine lines. Products should be gentle and non-stripping. They should also provide a stronger barrier to protect and retain moisture level. CleanSerS
• Obagi: Gentle Cleanser
• Phytomer: Gentle Cleansing Milk or Cream
• SkinCeuticals: Cleansing Cream or Gentle Cleanser
• Vivité: Daily Facial Cleanser
• Obagi: Toner
• Phytomer: Comforting Toning Lotion or Rosée Visage • SkinCeuticals: Revitalizing Toner anti-oxidantS
• Allergan: Prevage MD (Prevage is sold over-the-counter and is not as
• Obagi: Professional C Serums, 10%, 15%, or 20% • Phytomer: Energizing Oxygenating Serum moiSturizerS
• Phytomer: Thermo-Protective Cream, Ultra-Moisturizing Nutrient
Cream, Precious Renewing Night Cream, or Sublime Youthful Firming Day Cream • SkinCeuticals: Emollience or Renew Overnight Dry• Vivité: Night Renewal Cream SunbloCkS
• Obagi: Physical UV Block SPF32
• SkinCeuticals: Physical Defense SPF30, Sport SPF45, and Daily Defense anti-aging/CorreCtion/prevention
• Obagi: Tretinoin Cream, .05% or .1%
• Obagi: Exfoderm or Exfoderm Forte • Obagi: Blender and Clear 4% Hydroquinone • Phytomer: Smoothing Age Defense • SkinCeuticals: Intense Line Defense dry and SignifiCantly photo damaged Skin
Due to the thinness of dry skin, it is recommended that aging and corrective
products chosen should start more conservative until the skin learns to toler- ate the active ingredients found in Tretinoin Cream, Exfoderm or Exfoderm Forte, and anti-oxidants. Bleaching suppressants such as Clear and Blender will not effect moisture levels and should always be included when treating photo damaged skin. The SPF should be higher and offer a more emollient consistency. Often dry skin patients will need a moisturizer prior to applying their sunblock when using corrective products. These products are specifically selected to your degree of dryness and tolerance. Each prescribed skin cor- rection product can be increased or decreased in usage and amount to reach your desired goal. This is why communication with your plastic surgeon or oily Skin
Oily skin is characterized by overactive sebaceous glands. Skin is thicker and
has large, sometimes congested pores. Due to oil on the surface, the skin will appear shiny. This skin type tends to fall or droop with age. It is important to use products that are strong enough to remove and help control oil through the day. Oil-free products are always a great choice for this skin type.
• Obagi: Foaming Cleanser or Daily Care Foaming Cleanser
• Phytomer: Oligopur Purifying Cleanser tonerS
• Obagi: Toner
• Phytomer: Eau Marine
• Obagi: Professional C Serums, 10%, 15%, and 20%
• Phytomer: Energizing Oxygenating Serum • Vivité: Daily Antioxidant Serum moiSturizerS
• Obagi: Therapeutic Moisturizer
• Phytomer: Shine Control Moisturizing Fluid or Balance Emulsion
• SkinCeuticals: Renew Overnight Oily
• Obagi: Healthy Skin Protection SPF35
• SkinCeuticals: Daily Defense SPF20 anti-aging/CorreCtion/prevention
• Obagi: Tretinoin Cream, .05% or .1%
• Obagi: Exfoderm or Exfoderm Forte • Obagi: Blender and Clear 4% Hydroquinone • SkinCeuticals: Intense Line Defense oily and SignifiCantly photo damaged Skin
Oily, thicker skin tends to need a more aggressive approach when treating
photo damage. Using higher strengths and frequency of Tretinoin Cream and Exfoderm is usually tolerated and more effective by this skin type. It will also aide in pore congestion and size. Anti-oxidant percentages should start at a moderate level and then be increased. A light serum consistency is normally selected in anti-oxidants. This is due to oily skin patients appreciating the absence of a thick or a heavy feeling on their skin. Bleaching agents such as Clear and Blender come in a lotion form but are rapidly absorbed by the skin and do not leave a “film” on the skin. Clear and Blender should always be pre- scribed to oily skin types when treating photo damage. Higher sun protection factors should be selected with photo damaged skin in a lotion form. These products are specifically selected to your degree of oil production and toler- ance. Each prescribed skin correction product can be increased or decreased in usage and amount to reach your desired goal. This is why communication with your plastic surgeon or aesthetician is essential.
NORMAL SKIN/COMBINATION SKIN
These skin types range and vary between dry and oily. For instance, you can
have an oily T-zone and normal to dry circumference or the level of oil can depend on what time of year it is. Balance is the key to these skin types by choosing products that are not too strong or too mild. Patient preference plays a large part in selection as well.
• Obagi: Gentle Cleanser
• Vivité: Daily Facial Cleanser tonerS
• Obagi: Toner
• Phytomer: Eau Marine or Rosée Visage • SkinCeuticals: Revitalizing Toner anti-oxidantS
• Allergan: Prevage MD (Prevage is sold over-the-counter and is not as ef-
• Obagi: Professional C Serums, 10%, 15%, and 20% • Phytomer: Energizing Oxygenating Serum • Vivité: Daily Antioxidant Serum moiSturizerS
• Phytomer: Instant Moisture Cream or Ultra-Moisturizing Nutrient SunbloCkS
• Obagi: Healthy Skin Protection SPF35 or Physical UV Block SPF32
• SkinCeuticals: Physical Defense SPF30, Daily Defense SPF20, or Sport anti-aging/CorreCtion/prevention
• Obagi: Blender and Clear 4% Hydroquinone
• Obagi: Tretinoin Cream, .05% or .1%
• Obagi: Exfoderm or Exfoderm Forte • Phytomer: Smoothing Age Defense • SkinCeuticals: Intense Line Defense normal/Combination and photo damaged Skin
Corrective treatment for this skin type should be moderate. Thickness of skin,
oil, and moisture levels will determine proper strengths. Staying balanced is key. Choosing a higher strength of Tretinoin Cream might mean select- ing Exfoderm over Exfoderm Forte or prescribing the more mild Tretinoin Cream in conjunction with Exfoderm Forte. Lotion or serum formulated anti-oxidants are practical for this skin but should start at low percentages until tolerance is determined by your aesthetician. Bleaching suppressants are crucial with any photo damaged skin. As with all skin types that have significant photo damage, SPF should be high and texture based on moisture level and patient preference. Each prescribed skin correction product can be increased or decreased in usage and amount to reach your desired goal. This is why communication with your plastic surgeon or aesthetician is essential.
It is important to remember that all skin types and conditions are differ-
ent and should be discussed with your plastic surgeon and/or aesthetician.
Many products have active prescription strength ingredients that require
knowledgeable instruction to be safe and effective.
Extended Use Microbial Challenge and Disinfection Study of the CLAVE® Connector Introduction ICU Medical, Inc . of San Clemente, California has beenfunnel unit, and the filter membrane was then incubated inmanufacturing and marketing the CLAVE Connector sinceSCDB for seven days or 168 hours at 32-35°C. Any microbial1993. New standards in IV therapy are being directed towardscon