Cosmetic and Aesthetic Dermatology FAQ

Family Medical Care White Salmon WAWhen I was young, without a wrinkle or a line, I remember thinking to myself I WILL age gracefully. I will accept my lines and wrinkles that slowly appear on my face over time as marks of a life well lived, of decades spent laughing, sobbing, and everything in between.

But here I am, years later with every overhead light that shines down and spotlights a newly formed line or deepening crevice on my face, helping to remind me of my age. And instead of seeing these “age reminders” as I thought I would when I was much younger, I just feel like I look old and tired rather than happy to see a map of my life staring back at me. It’s not that I want to look younger, but my visible lines annoy me now as much as blemishes did when I was an angsty teen. I am suddenly reminded that I’m caught somewhere in between old age and young. But unlike a blemish that disappears in a few days hopefully without a mark left, my lines just get worse over time.

Now, I’m sure I notice my lines and wrinkles more than anyone else does. In fact, I’m positive because the man I see most, my husband, barely notices them {or he’s just being nice}. My frustrations led me to investigate using Botox, fillers, and the like as an answer to my lines and new wrinkles. And for me, and many of my clients it has become an important part of our regular beauty routines.

But just as with any other beauty products, one thing doesn’t work for everyone. I think there’s a trial and error component to all products and if it works for you, then do it and if it doesn’t, try something else. My goal is to empower you to feel good about yourself and live a healthy life. If our aesthetic medicine options can help you do that then we’ve reached our goal!


FAQs About Botox, Dermal Fillers & Skin Rejuvenation Treatments

What is Botox cosmetic?
Simply put, Botox is an injectable substance that is designed for specific muscles to temporarily reduce wrinkles. The effect is often dramatic, taking years off the face and restoring a more rested appearance. Botox relaxes the muscles that create unattractive wrinkles by blocking motor/neuron impulses, while leaving natural and attractive facial expression intact. Botox cosmetic has been used by millions of people around the globe, and has a thirty-year history of medical use. The medical grade version of Botox is a modern miracle for many disease processes that create involuntary spasticity such as muscular dystrophy (including in children), crossed eyes, neck spasms, migraine headaches and more.
Doesn’t Botox have side effects?
Like any medical treatment, Botox has a full disclosure of potential side effects. While these side effects and adverse reactions do exist, they are very rare. Botox is used in carefully selected doses for aesthetic improvement in persons in good health. Botox for medical use is used in far greater amounts in patients with varying degrees of health.
How much do I need?
Each case is highly specific and non-transferable… As far as cost goes, it is reasonable to assume around $300.00 to $400.00 for a basic treatment. We encourage you to call us for a consultation to learn exactly what treatment plan is right for you. We think however, that you will find White Salmon Family Practice rates to be highly competitive.
What are Dermal Fillers?
As we age, we lose collagen and elasticity in the skin, which causes deep folds and sagging.  Dermal Fillers are biocompatible, injectable hyaluronic acid gels that create lift and add volume to key areas of the face that show signs of aging. They are selectively injected into the dermis with a fine needle; the results are instant. Many clients enjoy a youthful look by filling in the folds around the mouth, restoring cheek height, refreshing lips and other areas. At White Salmon Family Practice we choose to use the Juvederm line of fillers as we have found results dependable and compatible with our client needs. At your consultation, we will go over your options and help you achieve the results you are looking for. As far as cost goes, dermal fillers are sold by the syringe and range in price from about $500 to $900 depending on the products selected.
How long do fillers last?
Because each face is so very different, each outcome varies. Most fillers advertise they last up to one year, however; this depends on the initial amount, age of the client, desired results and the depth of the folds and wrinkles. In general, Botox will last about 3 months plus while fillers can last between 9 months to 2 plus years, depending on the products you used.
I don’t want to look fake. I SERIOUSLY don’t want “celebrity” lips! Won’t my lips appear too large after filler?
First things first. YOU AND YOUR PREFERENCES are our first concern. We take a step by step, approach, involving you during the entire process. We do NOTHING without your prior permission. We inject in small doses and seek your opinion as we go along. Done properly, no one needs to advertise his or her secret to looking young. Many clients decide to keep their choice of treatment very private, that’s why White Salmon Family Practice Aesthetic Medicine specializes in a natural look.
Do people bruise after dermal filler treatments?
Any time a needle is injected into the skin, there will be a chance of bruising. To decrease your chances of bruising, it is good to avoid blood thinning agents such as ibuprofen and aspirin for one to two weeks prior to your appointment. HOWEVER, we ask you to consult with your primary care provider before changing your medications. At your consultation, ALL benefits and risks will be discussed in detail.
Can I work out or continue my normal routine after treatment?
Most of the time, you will be able to continue your normal routine; there is really minimal “down time” for injectable treatments. We recommend, however, not to do highly vigorous exercise for 6 hours after treatment, as well as to avoid direct sun exposure. It is best to keep the head upright for 4 hours to allow the product to settle into the designated areas. It is best to discontinue the use of Retin A for three days before and after treatment, as well as to avoid deep exfoliation treatments for three days before or after treatments. A soothing facial is fine. You can apply makeup after treatment as you normally would. All of your concerns regarding activity will be discussed during your consultation.
What about chemical peels?
If you are looking to shrink pores, improve skin texture, tackle acne scars, even out pigmentation, minimize fine lines and create a radiant glow, consider a chemical peel with ViPeel. We recommend a good chemical peel three to four times a year (generally seasonally) to revitalize lackluster skin. It is not recommended to get a peel during the summer months.
What is Microneedling?
Automated micro-needling is an exciting new skin therapy innovation for dramatically minimizing fine lines and scars. Also called Collagen Induction Therapy (or CIT), micro-needling is a non-surgical resurfacing procedure that creates a controlled injury underneath the skin’s surface to stimulate the body to naturally produce collagen and elastin. Micro-needling is a safe, chemical-free and minimally invasive technique for stimulating collagen production. Collagen and elastin give skin its texture, structure and appearance. As we age, these compounds break down from sun and environmental damage leading to dry, thin and wrinkled skin. Micro-needling is a mechanical method for reversing this breakdown. The result is plumper skin and diminished appearance of scarring and wrinkles.
How does it work and what are the benefits?
While there are several forms of micro-needling available, here at White Salmon Family Practice, we use the most advanced medical-grade, automated micro-needling device on the market. The micro pen device we use is fitted with a sterile, single-use, surgical-grade cartridge that contains tiny micro-point needles. The pen has a high-speed motor that enables us to work quickly and efficiently. The device we use also guarantees consistent results that many other methods of skin needling cannot deliver.
You will see visible changes from the treatment over the course of several days and weeks. Results can continue to improve up to 6 months after a treatment as collagen production continues. Benefits include diminished appearance of fine lines and acne scars, reduced pore size and an overall improvement in texture and tone.
How long does it take to recover?
Immediately after the treatment, your skin will be bright red like an intense sunburn. The total healing time depends on the intensity of your treatment. On average, our clients have some redness for 2 to 4 days. For some clients, the redness is gone in as little as 24 hours.
How often should I have needling performed?
The number of sessions you’ll need depends on your goals. For mild to moderate acne scars, you’ll see the most benefit with three to four treatments. Deeper scars and dark pigment marks may require up to five treatments. We suggest at least 4 to 6 weeks between treatments when doing a series. Many of our clients have the treatment done every 6 to 12 months for skin resurfacing maintenance and better absorption of anti-aging serums and products.
What else do you provide to help with preserving my skin?
We have a complete line of MEDICAL GRADE skin cosmetics. We have researched the market and feel that the SKIN CEUTICAL line of skin care is the ultimate and affordable line for our clients. We do stock a limited amount (customer favorites) of the line but can order any product you wish from their line.
Do you provide discounts or specials?
YES! Typically, a couple times a year, we receive promotional packages from our Botox and Derma Fillers supplier “Allergan Manufacturing”. These packages allow us to pass on substantial savings to our clients. They are usually of limited duration but are generally significant in savings to clients. We also endorse a tiered pricing program. Our regular clients receive a discount on services compared to first time or one time purchasers. Clients using Botox or Fillers are also enrolled in Brilliant Distinctions and receive additional discounts on services over and above discounts extended by White Salmon Family Practice.

Medical FAQs

Thank you for checking out our Frequently Asked Questions. As a Family Nurse Practitioner, my passion really is in helping to educate my patients on what they could be doing to stay healthy and supporting them in choosing to keep a healthy lifestyle. In addition to making sure my patients are up-to-date with appropriate screening tests, I spend a lot of time trying to inform my patients and talking about lifestyle choices. Many chronic diseases can be prevented or managed with a healthy lifestyle.

The following questions, from my patients, are common concerns I hear almost every week. We thought that by sharing some insight into these questions, that it may help others with the same concerns. Obviously each subject is vast and I have only highlighted some baseline information. I am always happy to discuss any of these questions or others with you in greater detail, or to refer you to qualified resources for you to research these issues on your own.

Check back frequently as I update these questions regularly. Also, if “you” have a question you would like posted on our website please let me know, we are all in this health thing together and learning from others concerns can be just the spark it takes to motivate you or a loved one to further investigation.

These questions and answers are meant as patient general educational materials. They are not intended to replace personal visits to our office. Please consult with me if you have a specific medical condition. We will do our best to provide you with information that will help you make your own health care decisions.


Frequently Asked Questions

Do I need a Doctor or Physician if I use a Nurse Practitioner as my primary Care Provider? What is the difference between a physician a doctor and a nurse practitioner?
The short answer is that doctors/physicians study diseases and how to cure them while nurse practitioners study people and how to heal them.

The more detailed answer is that a doctor or physician is a person with formal education and training in medicine, i.e. in the treatment of diseases using drugs, procedures and/or surgery. Nurse Practitioners have very similar educations but their focus is diagnosis and health management. Studies have also found FNP care to be at least equivalent and, in some cases, superior to physician care.

NPs make ideal primary care providers because of their holistic and wellness orientation that emphasizes health education, risk identification and reduction, and preventive care through lifestyle modification.

Doctors and Nurse Practitioners are similar in that both diagnose, treat and manage acute and chronic diseases, order and interpret labs and diagnostic tests and prescribe medications. A nurse practitioner is a registered nurse with formal education in the care of the sick plus advanced education and training in the diagnosis, treatment and management of common and chronic illnesses.

Physicians and NPs are different in how they are educated and in their philosophical approach to care. Physicians are in school longer and their focus is on the study of disease. Many if not most NPs are already skilled and experienced RNs before going on for advanced education and training in advanced practice. NPs care for patients in all aspects of their lives. Many physicians choose specialties in which to practice because of their knowledge of disease states.
As partners in your healthcare, Nurse Practitioners:

  • Practice under the rules and regulations of the state in which they are licensed
  • Are Nationally Board Certified
  • Are recognized as expert healthcare providers
  • Provide healthcare services in all states and in many other countries around the world
  • Order, perform and interpret diagnostic tests such as lab work and x-rays
  • Diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, infections and injuries
  • Prescribe medications and other treatments
  • Manage a patient’s total care
What are custom compounded, bio-identical hormones? Are they safe?
The term “bioidentical hormone” doesn’t really have a standard medical definition. In general, it’s taken to mean hormones that have the same chemical and molecular structure as hormones produced in our body. Currently there are FDA-approved versions of bioidentical hormones, and there are alternative, custom-prepared varieties, made in specialized “compounding” pharmacies. What I learned from the medical experts at the workshop is that the advertising and promotion of the custom-compounded hormones is misleading many women into thinking that they are safer and more effective than the FDA-approved treatments and this isn’t the case and in fact it’s very likely to be the opposite. Groups including the American College of Obstetricians and Gynecologists, the Endocrine Society and the North American Menopause Society have raised questions about the safety and use of custom-compounded hormone therapy, except in special cases — for instance, when a patient is allergic to an FDA-approved drug. They have even gone further by calling for action to alert consumers that there are commercially available, FDA-approved bioidentical hormone replacement options. The point was made that taking custom compounded hormones is a bit like trying to make your own penicillin at home by letting an orange peel grow blue fungus in your pantry, and then scraping off about a teaspoon … as opposed to taking a 500 milligram tablet of penicillin.

Basically, the major difference between FDA-approved hormone products meeting the definition of bioidentical, versus custom-compounded products is that the former are regulated by FDA, tested for purity, potency, and efficacy, and sold with FDA-approved product information that includes boxed warnings. No large, long-term studies have been done to determine the effectiveness, safety, or adverse effects of custom-compounded bioidentical hormones.

The most troubling aspect is that the adverse events most commonly associated with custom compounded hormones, are likely to occur only after years of use, and the patient may not connect the event with the hormones they have been taking. These adverse events might include breast cancer, strokes, blood clots, uterine cancer and heart problems.

Compounding pharmacies have traditionally fallen under the jurisdiction of state regulators. To date, only 188 out of 7,500 US compounding pharmacies have accreditation by the Pharmacy Compounding Accreditation Board, which requires compliance with strict regulations and periodic renewal.

Medical providers prescribing compounded products may be personally exposed should there be an adverse event resulting from a product that neither the prescriber nor compounder can prove was the correct dose of the specific product and was free of contaminants. Possible consequences include the invalidation of their malpractice insurance, personal liability, and criminal prosecution.

As I have said many times, one of my primary goals in my practice is to support patient education. If you are considering taking or have been on custom compounded bio-identical hormones, I would encourage you to talk to me or your current health care provider to visit your situation. Your long-term health and welfare are of utmost concern to us here at the Practice. I would be happy to discuss the various concerns, options and latest findings with you. Call us at 509-493-1470 to schedule an appointment. Let’s talk!

What is HPV (Human papillomavirus) and should I or my children be vaccinated?
HPV is a virus that is spread by skin-to-skin contact, including sexual intercourse, be it vaginal, oral, anal sex or any other contact involving the genital area. Condoms do not provide complete protection because condoms do not cover all exposed genital skin. Contrary to opinion, people DO NOT become infected by touching an object, such as a toilet seat.

Of the nearly 14 million people, including teens, who become infected annually, most of them have no signs or symptoms.

In the United States, HPV vaccination is recommended for ALL girls and women between the ages of 9 and 26 years of age. Boys need HPV vaccination as well to prevent HPV infections that can cause cancers of the anus, penis and the mouth/throat area.

Vaccinating children early helps protect them before they are ever exposed the virus.

Sex has become painful, should I be worried?
Certainly there can be many reasons why sex may have become painful for you, however one of the most common issues I see in my practice is ATROPHIC VAGINITIS (or vaginal atrophy). This condition generally affects women who have been through menopause or women whose ovaries were removed, those who are taking certain medications or are nursing.

There are many treatments available to help reduce the symptoms of AV, generally using hormone estrogen. I encourage most of my patients to use vaginal estrogen which can come in a variety of forms such as creams, tablets or flexible rings.

If you are suffering from painful sex, I urge you to discuss it with me or your primary care provider. There are treatments that can help!

I am on blood pressure medication; does that mean I have to take it for the rest of my life?
First of all, high blood pressure is a serious condition that puts you at risk for heart attack, stroke and kidney disease. It can be serious and should not be taken lightly. If your provider has prescribed blood pressure medicine, the most important thing you can do is take it.

Some people have a genetic predisposition to high blood pressure and some people may be able to control it through life style changes.

Will you have to take BP medication your entire life? That can depend on a lot of factors. You have a good deal of control over your BP. To lower it:

  • Lose weight (if you are overweight)
  • Eat a low fat diet that incorporates lots of fruits and vegetables as well as low-fat dairy products
  • Reduce your salt consumption
  • Do something active for at least 30 minutes a day preferably 5 or more days a week.
  • Cut down on alcohol (if you drink more than 2 alcoholic drinks per day).

One excellent way to track your blood pressure is to invest in a home blood pressure meter. Making sure you get annual or semi-annual physicals is also a great way to stay on top of blood pressure concerns.

I keep forgetting things, should I be worried?
Many people worry about memory lapses. They fear they’re heading toward a serious condition like Alzheimer’s disease, an irreversible brain illness.
Occasional forgetfulness is a normal part of life that becomes more common as we grow older. In most cases, it’s no cause for alarm—unless it begins to hamper daily activities. Forgetting where you left the car keys is one thing; forgetting what they do is quite another.

No matter what your age, several underlying causes can bring about memory problems. Forgetfulness can arise from stress, depression, lack of sleep or thyroid problems. Other causes include side effects from certain medicines, an unhealthy diet or not having enough fluids in your body (dehydration). Taking care of these underlying causes may help resolve your memory problems.

For some older people, though, episodes of memory loss may be a sign of a more serious problem called dementia. Two of the most common forms of dementia in older people are Alzheimer’s disease and multi-infarct dementia (or vascular dementia).

In Alzheimer’s disease, memory loss begins slowly and gets worse over time. People with Alzheimer’s disease have trouble thinking clearly. They find it hard to do everyday things like shopping, driving, cooking or having a conversation. Medications can help during the early or middle stages. As the illness progresses, though, patients may need more extensive care.

Vascular dementia also causes serious memory problems. But unlike Alzheimer’s disease, the signs of vascular dementia may appear suddenly. This is because the memory loss and confusion are caused by small strokes or changes in the blood supply to the brain. Further strokes can make the situation worse. Taking care of your high blood pressure can lower your chances of getting this illness.

I encourage you to call me or your primary care provider, for an appointment, if you’re concerned that you or someone you know has a memory problem.

I am a small breasted woman; do I REALLY need to be screened for breast cancer?
The short answer…YES! Breast size has NOTHING to do with a woman being susceptible to breast cancer. Breast cancer screening is a way to check breasts for early signs of cancer in women who have NO symptoms.

There are different recommendations regarding what age a woman should be screened. A general rule of thumb is between 40 and 74. HOWEVER, some women are at a higher risk and might need to begin screening at a younger age or may need to continue screening past age 74. It is really based on each individual.

Two common conditions that may put you at a higher risk include:

  • Those patients that carry genes such as the BRCA1 or BRCA2 genes. [BRCA1 and BRCA2 are normal; it is their mutation that is abnormal.]
  • Those who have close relatives who were diagnosed with breast cancer at a young age.

A NOTE ABOUT SELF EXAMS: Many experts no longer believe that breast exams by your medical provider are necessarily helpful for women who have no breast complaints. Most lumps found during provider/patient exams turn out NOT TO BE CANCER. Most experts today DO NOT recommend self-exams, getting a mammogram is the most effective and trusted way to diagnose breast cancer. While some women have concerns about radiation exposure, studies show that the number of lives saved by finding cancer early greatly outweighs the very small risks that come from radiation exposure.

As a primary care provider, I cannot stress strongly enough how important it is that you be screened. It is easy and painless and could very well save your life!

I’ve heard the flu vaccine can cause the flu; do I REALLY need a flu shot?
Getting vaccinated can help keep you and those around you from getting sick. Some people feel the flu vaccine doesn’t work, because they have known of people who received the vaccine and still got sick. I often hear from patients, “The flu vaccine gave me the flu!”
If people get sick after getting the flu vaccine, chances are they do not actually have the flu. Instead, they generally have a cold caused by a virus unrelated to the flu virus, and the flu vaccine won’t help with that.

There are different forms of flu, including the “seasonal” flu, the pandemic H1N1 (or swine) flu, and, the Avian (bird) flu. They are all caused by viruses. The flu vaccines available now do not protect against bird flu.

A NOTE TO PATIENTS: In the United States, practitioners are NOT RECOMMENDING nasal spray vaccine for the 2016-2017 flu season.

How can I reduce or stop some of my medications?
As your primary care provider I am not as gung-ho about “using a pill to solve the problem”. It is very helpful to me if you bring a full list of all medications you are taking (over the counter and prescribed) for a re-evaluation of their necessity. Even if you shouldn’t stop taking a particular medication, we might be able to reduce its dosage. One caveat: Do not stop taking a prescribed medication without first consulting me or your primary care provider. Some medications can be dangerous to stop abruptly and may need to be tapered.
Why am I so thirsty all the time?
Thirst is your body’s way of telling you that it’s running low on water, which it needs to work well. It’s normal to feel thirsty when it’s hot or after you’ve powered through an intense workout. But if you’re constantly refilling your cup without relief, it could signal another health condition.

Dehydration and Diabetes are two common reasons that could have you craving water.

Dehydration means your body doesn’t have enough water to carry out normal tasks, and thirst is the main symptom. It can happen for a lot of reasons, such as exercise, diarrhea, vomiting and too much sweating.
Besides wanting water, other signs of dehydration can include:

  • Dark-colored urine
  • Not needing to urinate as often
  • Dry mouth
  • Dry skin
  • Feeling tired or lightheaded
  • Headache

Thirst you can’t seem to quench is also one symptom of diabetes, a disease in which your body doesn’t make enough of the hormone insulin or doesn’t use it properly. It causes too much sugar (called glucose) to build up in your body. Too much of it in your urine draws in more water, so you urinate more often. That leaves your body wanting to replace the fluid you’re losing. If you are experiencing these symptoms, Diabetes can be evaluated by a simple blood test.

Are the supplements I take worthwhile?
I get this question almost every day. Mother Nature has inspired many life-improving, even life-saving, compounds and substances, but remember that health products and supplements marketed as “natural” are generally not subject to the same rigorous scientific scrutiny as prescription medications – either for safety or effectiveness.

I usually recommend that patients ask me about any supplements they are taking. Some supplements, including herb teas, can also interfere with your medications.

How can I make sure I am up to date on my routine health maintenance?
The medical equivalent of rotating your tires and changing your oil is to keep up-to-date on vaccines and routine screenings, such as mammograms and colonoscopy or sigmoidoscopy, as well as blood panels to measure cholesterol and glucose levels. By keeping up-to-date on routine health maintenance appropriate to your age, gender and health status, you take full advantage of modern medicine and its ability to detect disease or risk factors for disease, early. This gives you a jump start on successful treatment.

Routine maintenance is something that a lot of patients forget about. I often deal with the single, acute issue that brought a person into my office that day or maybe a follow-up for a chronic disease. The main point to remember is that it is much better to prevent a disease than to have to treat it, and if we cannot prevent it, then we need to detect it as early as possible.

What else could I be doing to stay healthy and prevent disease?
It’s no secret that diet, exercise and other lifestyle choices can go a long way to preventing heart disease, type 2 diabetes, osteoporosis and even certain types of cancer. So don’t hesitate to ask me about your body mass index (BMI), alcohol consumption and other lifestyle factors, including interpersonal relationship issues which can affect health and happiness.

Lifestyle interventions may seem simple and common sense, but a majority of people are not doing them. One of my goals is to help people make healthy lifestyle choices a priority and regular part of their life.

There are a wealth of programs to help people eat better, lose weight, reduce stress and become more educated about their health condition. Maybe I can help… all you have to do is ask!

Okay, you told me what you think is the problem so “What’s next?
Come with questions. Leave with a plan.
“I’ve answered hundreds of questions from patients during their visits but, one question stands out for its ability to focus the visit on the issues that matter most: What’s next? Again:
Come with questions. Leave with a plan.

As my patient I want you to leave my office with a road map for what you need to do, work on, or be aware of, between visits. For every diagnosis on your list, you should know what’s next in your treatment plan; how to monitor symptoms or side effects, especially with new medications, and when you should return for a follow-up visit.”
You should know what to expect of me next. Will there be a referral to a specialist? Will I be reviewing medical records from a recent admission to a hospital and adjusting your health plan accordingly?  By fully understanding what comes next, you and I can work as a team to further your health.