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Testosterone – key facts to know

The use of testosterone supplementation in men and women has gained a lot of attention in the last few years.  Clinics for men and women have popped up everywhere.  Inevitably, the consumer is bombarded with advertising and claims.  This leads to a lot of confusion for the consumer trying to figure out if this treatment is for them.

To try and make sense out of the messages, I offer a few points for your consideration. Here is my take on testosterone (the use of “T” refers to testosterone), written in a Q an A format:

Who Gets Low Testosterone?

The short answer is all of us.  Both men and women see a gradual drop in testosterone levels usually starting after age 30.  For women the levels drop even quicker after menopause as the ovarian production of testosterone falls right off.  The long answer to this question is “How do you define low testosterone?”  The “normal range” for testosterone as reported by labs is very broad for men and women.  The range of “normal” takes into account men and women over a range of adult ages.  Most men feel their best at the upper range of normal.  Most post-menopausal women feel their best at or above the upper range of normal.  If your regular doctor runs a blood test on your T levels you may well be in the “normal range.”  But this does not define your optimal range.

Is Testosterone Safe?

There is a healthy trend towards using bio-identical hormones, exact copies of the hormones that men and women produce.  The theory is that bio-identical is more natural and therefore safer.  The problem with this statement is that there is no significant body of scientific evidence to back it up.  We do know that use of equine (horse) estrogen such as Premarin has been linked to a higher risk for breast cancer.  The oldest available form of testosterone is injectable, and it is not bio-identical.  Injectable testosterone has a long list of warnings and potential side effects.  Today many men and women receive bio-identical cream, gels or pellets.  Pellet therapy has become very popular for all the right reasons, but there is a total lack of long term studies to show how safe (or unsafe) it is.  The last significant published report on testosterone was done at Veteran Affairs and it showed an increased risk of heart disease in men taking any form of testosterone therapy.  The study had many potential flaws, and the accuracy of the results can be questioned.

I believe the honest practitioner using bio-identical T should tell patients that “we don’t know the long term safety.” Yet I see many offices, clinics and med spas claiming that testosterone pellets will protect their heart and brain.  There simply is not the evidence to make those claims. Ultimately the decision to use T therapies comes down to a “risk benefit analysis.”  If you try testosterone and your quality of life improves then you may choose to continue therapy even though long term safety is unknown.

What is better? – Creams, Gels, Shots or Pellets?

Shots have been around the longest, and each injection lasts an average of 2 weeks (this can vary greatly).  The shots are in an oil base and must be injected into buttock muscle.  Typically the cost of T injections in the office or at home are covered by insurance companies.  Shots are not bio-identical and this is a potential safety concern.  After an injection of T, blood levels go high and then taper over the next 2 weeks – meaning that the levels are not even or stable, but follow a “peak/trough” or “roller-coaster” pattern – which is less than ideal.

Creams and gels containing T are applied to various body areas and absorbed across the skin.  Absorption of T by this method varies greatly between individuals.  Children and pregnant women should not be exposed to testosterone, so care must be taken to avoid direct contact with the creams or gels.  Brand name topicals can be very expensive, whereas compounded products are affordable.  The biggest problem that I see with cream/gel topical T is that men function best with blood T levels that are 10 times higher than women.  It is often difficult for men to absorb enough T topically to actually raise their levels.  If you are placed on topical T therapy, make sure the doctor repeats your T levels to see how you have responded to the treatment.

Pellets are bio-identical T that are placed just under the skin in the fatty area of the buttock.  Pellets slowly dissolve away to nothing, so they do not have to be removed.  As T pellets slowly dissolve, they release testosterone in a continuous fashion “24/7″ achieving steady levels of T day and night (clearly this is desirable).  The pellets last an average of 3 to 6 months (average of 4 months).  The pellet dose should be based upon body weight.  The heavier a man or woman is, the higher the dose of pellets.  Dosing of T pellets in women range from 50-125mg, whereas men do best with over 1,000mg per treatment.  Pellets are produced in different strengths, so the number of pellets placed during a procedure will also depend on the pharmacy that produces them.  Patients with pellets enjoy the fact they do not have to fuss with topical creams or gels, and avoid painful injections every 2 weeks.  For all these reasons, I only prescribe testosterone in a pellet form.

How do I select a provider for T Pellets?

Ask the following questions:  Who inserts the pellets, what is their degree and how were they trained?  Do they follow sterile procedures including use of sterile gloves, drapes and skin preps?  I have found that many providers do not take care with sterile technique with the result that infection of the area may occur.

What is the Cost of T Pellet therapy?

This will vary greatly between offices and different states.  Many offices that perform T Pellet therapy are doing so under a licensing agreement with a national company such as Bio-T, SottoPelle, HRC or Midwest Restorative Health.  These offices are obligated to charge a higher fee as part of their agreement.  At Omaha Med Spa I order my own pellets from a local compounding pharmacy, and run my own protocols and program.  The result is that my T pellet therapy is affordable.  The cost of T pellet therapy is generally not covered by insurance companies.

I want to have more children.  Is testosterone safe for me?

When men are given testosterone therapy their sperm count and fertility will drop.  In general, when they stop T therapy their counts and fertility should rebound, but there is no guarantee of that.  If you are a man and you feel quite certain that you want to father more children, I suggest you defer your treatment until you are done having your family.

Women must use a reliable form of contraception while they are on testosterone therapy.  If you become pregnant while on T, your baby may be at risk.

Carter Abbott MD

 

 

 

 

 

 

 

Voluma – what you need to know

Voluma is the latest “dermal filler” to receive FDA approval and became available to the public at the end of 2013.

What is Voluma made of?  Voluma is part of the Juvederm family of fillers.  All Juvederm products contain hyaluronic acid.  Your body responds well to the placement of hyaluronic acid (HA) as it is also naturally present in the skin.  Juvederm products are all clear gel products that are produced synthetically.  Hylauronic acid gel fillers vary from each other based on the percentage of HA that is present, and also how tightly they are crosslinked.  The greater the cross-linking and the higher the percentage of HA – the longer it will last in the body.  Fillers with a very low % of HA include Belotero and Restylane.  These 2 gel fillers are low in viscosity and easy to inject (great for beginner injectors) but have the huge disadvantage that they do not last as long in the patient (average of 3-5 months at best).  Juvederm is the #1 filler for a good reason – it lasts longer.

How long does it last? The duration of benefit will vary greatly between individuals.  Voluma received FDA approval to be injected into the “mid-face” which means the upper and mid cheek areas.  When it is placed properly and an adequate amount of product is used, it may last for up to 2 years.  That will not likely be the result for most patients who limit their injection of Voluma to one syringe.  As a new product in the USA we will have to wait and see what our patients say about this.  My belief is that most people will still see benefit at one year, and some (lucky ones) will see benefit at 2 years.

How is it injected?  Like all dermal fillers, Voluma is injected using sterile needles.

How will it change my appearance?  Voluma adds instant volume to the mid and upper cheek areas.  Most women lose the attractive youthful curve of the upper cheek as part of the aging process.  By restoring this curve and adding cheek volume, patients look younger and more feminine again. Voluma is also the first dermal filler that has the capacity of lift as well.  This means that the jowl and lower cheeks receive a subtle but noticeable lift.  Anytime we can lift, it is always a good thing!  This is a non-surgical solution that helps people look about 5 years younger.

What happens on the day of the procedure?  Every doctor and med spa is going to approach this differently.  I have years of experience injecting fillers, and I have evolved techniques to minimize discomfort and the risk of bruising.  At Omaha Med Spa, “before photos” are taken of the face, especially at an oblique angle.  Following that, your face is cleansed to remove makeup and bacteria from the surface of the skin.  Careful note is made of any asymmetry that is present (is one cheek fuller than the other, or higher than the other side?).  We offer “numbing cream” which is applied to the skin and works quickly (within 5-10 minutes) to numb the skin.  Numbing cream is then removed and the skin cleansed a second time.  All Juvederm products can be purchased with the “XC” designation which refers to the presence of lidocaine in with the filler.  XC was a huge step forward for all Juvederm products as injection discombort is greatly reduced.  All of the Juvederm that I use has “XC”, and contains lidocaine.

Injectors wear gloves and open a sterile package of Voluma.  Sterile needles are provided with each syringe.  We then apply ice to the area just prior to injection.  Voluma is injected 2 ways.  The first way is to direct the needle at a 90 degree angle to the skin, over the zygoma bone.  As the needle passes through the skin the patient often hears a “crunching noise” which is entirely normal, and they may feel it when the needle tip hits the bone (also normal).  Once the needle is at the correct depth and location, a small amount is injected, and the needle removed.  The injector can immediately assess the benefit from each injection. Voluma requires minimal molding.  The other way to inject Voluma is to place it in the deep dermis, injecting horizontal lines of filler under the skin. By running the lines side by side, and layered in opposite direction, a cross-hatching pattern of filler is achieved.  This is the technique used to add volume over the mid cheek (below the bony zygoma and orbit).  Cross-hatching is then followed by molding to achieve a smooth result.  Any bleeding that occurs with each injection is controlled with light pressure and further application of ice.  Once the injections are completed, the skin is cleansed again, and a thin layer of Arnica Gel is applied.  Arnica is a plant based product that reduces redness, swelling and bruising.  Arnica gel may be continued frequently at home over the next week.  Further icing at home is optional and generally not needed.  Treated areas may feel mildly sore or bruised for several days.  All HA products are “hydrophilic” which means they stay fuller when you drink an adequate amount of water.

What is a fair price for Voluma?  Voluma is priced by the syringe and the charge includes the cost of the product, the office visit, and the injection performed by a trained and experienced injector.  A fair price is $950 per syringe.  As a new product in 2014, we are offering savings to all patients at Omaha Med Spa.  By purchasing 2 syringes of Voluma, a patient can Save a total of $500 off that Regular Price.

What are the risks of Voluma?  As with all injections there will be some mild discomfort at the time of injection, followed by swelling for 1-3 days, and then bruising that may or may not occur.  All of these side effects are temporary and easily managed.  As with any injection, there is also a small risk of infection.  This risk is higher in a person with poorly controlled diabetes, taking steroids (such as prednisone) or is on immune suppressing therapies (such as some of the treatments used for Rheumatoid Arthritis, Crohn’s Disease and Psoriasis).  If infection occurs the area will become red, warm, swollen and tender.  Oral antibiotics will be prescribed and often the Voluma filler has to be dissolved.  Severe infection could result in hospitalization.  There is also the rare risk of an allergic reaction to the filler.  When any filler is injected, we try to avoid veins and arteries – but there is a small risk of filler compressing a blood vessel or filler entering a vessel and travelling to another part of the body.  Lastly, there are reports of “malar edema” whereby the cheek swells when filler is placed.  This is rare, but I have had one case that required attention.  All of these conditions are treatable.

 

Welcome!

Dr. Carter O. Abbott

Dr. Carter Abbott, MD and the staff of Omaha Med Spa offer a range of Nonsurgical Cosmetic options to help you look more youthful.  Aesthetics is what we do!  At Omaha Med Spa you will find professional staff that are knowledgeable and service oriented.  When you are at Omaha Med Spa, you are our guest, and we want you to feel comfortable and welcome!  Dr. Abbott’s staff include his wife Lenore.

Our services include Botox, Juvederm, Voluma, Radiesse, Pelleve, Acne Scar Therapy, Sclerotherapy, Testosterone Replacement and The OWL Diet. Dr. Abbott is a licensed medical doctor who not only owns Omaha Med Spa, he works there full time and dedicates all of his professional time to aesthetics!

Botox safely eases lines and wrinkles.

Juvederm XC and Radiesse will add volume to folds, deep lines, and will redefine your lips.  Voluma is the latest filler to receive FDA approval, and is used primarily in the cheeks to gently lift and recreate an attractive curvature to the cheek bone.

Patient Review – I would recommend Omaha Med Spa for the special treatment of you!  Not only is the Med Spa offering a variety of cosmetic services, but also limited health services.  The staff are accommodating and very interested in you and your health.  They make you feel welcome and will do all they can to make your visit relaxing and informational.  They truly are interested in you, your spa desires and achieving the best possible outcome from the service you select.  It is so nice to walk into a place and be greeted by warm, wonderful smiles.  Thank you!  C.Z. 53yo woman

Sclerotherapy will eliminate spider veins on the legs.

Pelleve is a revolutionary new way to achieve smoother, tighter skin…FDA approved to treat facial wrinkles without surgery!  Pelleve treatments are painless, with no downtime.  Results are seen the same day, and further benefits accrue over the next several months!  Attend for a free consultation to learn more about Pelleve.

Now Acne Scar Treatments can be treated at a price point that is affordable for everyone!  Procedures are performed in the med spa after use of topical numbing creams.  Downtime is limited to only 2 days.  Read my web page for more details

Patient Review - I have been a dedicated patient of Omaha Med Spa for years.  Dr. Abbott and his staff have made every visit an outstanding experience for me.  The services offered at Omaha Med Spa are ultimately a way to feel better about yourself, become a healthier person and live a lifesytle that brings being beautiful full circle.  That is what Dr. Abbott has done for me.  I appreciate walking into an atmosphere where the experience is concentrated on giving the patient the best possible care in the industry.  I can honestly say Omaha Med Spa is my only choice for improving the person I am within and feeling a sense of accomplishment by the time I leave.  The staff make me feel comfortable and are truly interested in my personal goals. Dr. Abbott’s knowledge of the industry and his constant drive to improve on procedures with cutting edge technology and chemistry is something as a patient I am proud to be a part of.  When I receive compliments of looking 10 years younger, it reinforces the fact that I have made the right decision in choosing the best med spa. L.S. 44yo woman

The OWL Diet - written by Carter O. Abbott MD

The OWL Diet offers medical grade weight loss – we see an average weight loss of 15-20 pounds per month.  Dr. Abbott has literally written the book, called The OWL Diet, on Low Calorie Dieting, accompanied by either Hcg, Phentemine or both.  OWL stands for Omaha Weight Loss, and is the result of helping hundreds of men and women achieve permanent weight lossSign up with a Friend and Save $100 on Your First Month of The OWL Diet!

Learn More about The OWL Diet – go to www.OWLdiet.com

Patient Review - I have been nothing but extremely pleased with Dr. Abbott and the rest of the Omaha Med Spa family.  I was referred by a friend who was very happy and I was impressed by Dr. Abbott’s background and experience.  I started with “Dr. Carter” when turning 35, at a time when I was worried about wrinkles and preventative care.  Through his services and recommendations I look better than I have in years!  I also completed 2 month on The OWL Diet, lost 30 pounds to reach my goal, and feel wonderful.  The Diet taught me how to keep the weight off permanently, and I know that I have achieved lifelong control over my weight.  I have recommended Dr. Abbott to many of my friends – because I trust him! M.H. 36yo woman

Dr. Abbott has selected Medical Grade Skin Care Products that are affordable and effective.  He will help you choose from a combination of his own Omaha Med Spa Skin Care Line, Epionce and Revision.  Combine them with a choice of Retinoids and Vitamin C serum or silky smooth topicals.  Use Clarisonic Mia to cleanse the skin, ease fine lines and wrinkles and reduce Rosacea.

Anti-oxidant serum

Our Chemical Peels include target a variety of goals – ranging from improved skin texture, lessening brown spots and easing of lines and wrinkles.

Dr. Abbott also performs Liquid Nitrogen Cryotherapy for surface lesions such as warts, pigmented sun damaged, and actinic keratosis.  For skin tags and other lesions, he performs Electrosurgery in the med spa.

We do not bill your health insurance company for office visits or treatments, as all of our services and products are for aesthetic and cosmetic purposes.  We also do not bill Medicare, Medicaid or any insurance carriers.  Payment is made directly by our patients on the day of service – we accept Cash, Check, Credit and Debit Cards (Visa, MasterCard, Discover, American Express).  We do not accept Care Credit.

If you spend $500 or more on the same day (for service, treatments or products)* then you qualify to use Interest Free Financing.  You would sign a legally binding Finance Agreement that allows for automatic withdrawals from your Credit/Debit Card Account.  50% is payable on the day of your visit, then 25% in 30 days, and 25% in 60 days.  Please note that Finance Agreements may not be cancelled and no refunds are permitted.  Overdue accounts are charged interest at the rate of 2% per month, and accounts that remain unpaid for 6 months will go to an Account Recovery Service.  *The OWL Diet has special Financing option – read about them on the web page for The OWL Diet

We look forward to working with you!

We are located at 14450 Eagle Run Drive, one block south of Maple, and beside the BLUE sushi restaurant and Lotus Yoga.  Call us at Phone 402 614 5556.  Email your questions to us at omahamedspa@gmail.com, or reach Lenore at lenorecuddy@hotmail.com.

Check out our blogs as well!  www.OmahaMedSpa.wordpress.com

 

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