Your story is one my staff and I hear on a regular basis. The good news is that it is never too late to start looking after your skin. The first thing to do is make sure you are using an effective skin care program at home in conjunction with daily protective sunscreen (minimum SPF 30). You would be very surprised at how effectively a good pharmaceutical grade skin care line can improve the skin. The second thing is to understand the three ways that the skin visibly ages – 1. skin becomes uneven and dull with large pores and rough texture and fine lines, 2. skin begins to sag through depletion of collagen and elastin and 3. the skin loses volume due to reduction and descent of fat cells in the face. Unfortunately there is no single treatment that addresses all of these issues which means that for best results you should do a combination therapy approach to treating the skin.

Treatments like chemical peels, Clear+Brilliant (a.k.a baby Profractional), Micro Laser Peel/Profractional and IPL photorejuvenation aim to even out skin tone, reduce the appearance of fine lines and pores and generally give your skin a clearer, smoother and brighter appearance. Botox can also reduce lines caused by muscles such as those between the brows, forehead lines and crow’s feet.

To address skin sagging which can start to show around the jawline and under the chin you should treat with either Thermage or SkinTyte. This helps to rebuild existing collagen and stimulate future collagen growth to maintain and improve your skin’s tightness and firmness.

Lastly, injectable fillers such as Restylane and Juvederm can replace lost volume in the face which can start showing itself in the lines that run from the corners of the nose down to the corners of the mouth. Left untreated these lines will deepen further and with time you eventually see previously rounded cheeks begin to hollow and flatten.

If you want to aggressively change and improve your skin then you can certainly do a combination of all three kinds of treatments during the same time period. If you would like to go slow we can guide you as to the best place to start. Also, for any of you readers out there who haven’t quite made it to this point, my best advice is to use as much preventative medicine as you can at home – antioxidants and sunscreen in the daytime and chemical exfoliants, peptides etc at night to firm and smooth the skin. Botox is also great at preventing dynamic lines and wrinkles from forming. And remember, it is so much easier and more cost effective to do smaller, less invasive treatments and corrections as your skin just begins to show the signs of aging rather than wait to the last minute.

The introduction of Thermage CPT to our service menu seems to be creating quite a buzz in our office. Skin Tyte and Thermage are non-invasive treatments designed to prevent premature sagging and wrinkling of the skin while tightening facial and body skin with no downtime. Both are great for anyone between the ages of 35-65. Neither are a substitute for plastic surgery. Both use energy to heat dermal skin tissue and cause a reaction in the skin’s collagen. Both also have built in cooling systems to protect the skin’s surface and to make the treatment comfortable. There are a few differences though.

SkinTyte uses infrared energy to create heat causing a contraction of existing collagen (like shrink wrap) while at the same time stimulating new collagen growth. This change occurs over the course of time (around 3-6 months) and promotes tighter firmer skin. A series of 6 treatments should be done (one a month) with a maintenance treatment once every 3-4 months.

Thermage uses radio frequency (RF) energy to create heat in the dermal tissue to cause the same contraction and stimulation of collagen (over 3-6 months) as Skin Tyte. However, RF is more efficient at delivering the heat required to cause denaturation or remodeling of the skin’s collagen and as a result only one treatment is needed with results that can last up to 2-3 years.

Those are the differences in a nutshell. Both are great at providing results but you may decide to choose one over the other for different reasons. If you would like to discuss this with one our staff over the phone or in a consultation please feel free to give us a call 739-7546.

This sounds a lot like angular chelitis also known as perleche. This is basically an inflammation of one or both corners of the mouth that can cause lesions or cracks. Most people think this is just caused by overly dry skin, however, perleche is actually caused by a yeast or fungi. It is aggravated by moisture which is why licking the corners of your mouth makes this condition worse. At home treatments can be done by applying an anti-fungal or yeast cream 3-4 times daily. After each of these applications apply a little Vaseline as a protective barrier. This should help heal the lesions within a week, if not see your family doctor. And don’t forget, not licking the area is really important!

Cold winter months combined with increased indoor temperatures, hot baths etc are all factors that can cause our skin to become dry. Plus, dry skin is much more sensitive and susceptible to irritants which is why we sometimes get redness, burning and in some cases dermatitis when we apply products that never used to seem to cause any problems before. The goal here is to normalize your skin’s barrier function. The first step is to discontinue any possible irritants such as products with AHAs, BHAs, retinoids, exfoliants, alcohols, soaps etc. These types of ingredients shouldn’t be used unless you have a healthy skin barrier. The second step is to make sure to use a hydrating cleanser no more than twice a day and apply a fragrance free, cream moisturizer morning and night, especially after bathing (or any time the face gets wet) to seal in moisture and prevent dehydration of the skin. Once the burning feeling in your skin goes away, then you can slowly get back to some of your regular products. One simple analogy we like to use is that you never throw fertilizer on a wilting, dying plant to try and bring it back to life. This is just going to burn the roots and do more harm. You need to water the plant first and nurse it back to life before adding fertilizer to help it grow and look better. The same is true for your skin. Only healthy functioning skin will respond properly to your anti-aging products. Of note, if you are still experiencing irritating, red, flaky and/or patchy skin you may have developed dermatitis or eczema for which you should see your family doctor for a possible topical prescription.

All sunscreens contain filters that block, deflect or reflect UV rays. There are sunscreens that are purely chemical, some that only contain physical blocks and those that combine the two types of ingredients. All sunscreens need to be applied 15-20 minutes prior to going outside.

Chemical sunscreens use ingredients that protect the skin from UV light by absorbing UV rays and converting them to harmless heat energy that is dispersed throughout the skin. These sunscreens tend to have a lighter texture and feel.

Physical sunscreens use natural minerals such as zinc oxide and titanium dioxide. They protect the skin like a shield and reflect UV rays away from the skin. Physical sunscreens are great for everyone but especially for young children, sensitive and/or allergic skins. In the past this type of sunscreen had a tendency to make the skin look white however, some of the newer versions of this type of sunscreen offer formulations that may be tinted (depending on the brand) and are micronized which makes them more cosmetically appealing.

For more info on sunscreen see our Safe Sun tips in this newsletter. And if you would like some sunscreen recommendations for your skin please contact one of our helpful staff or drop by our anti-aging boutique.

Alpha Hydroxy Acids (AHAs) have been used in skin care products for many years and are still some of the most effective ingredients used to improve the appearance of the skin. Of all the AHAs, Glycolic Acid has the smallest molecule which allows for the best penetration into the skin. Basically glycolic acid unglues the dead skin cells that have a tendency to clump on the surface of the skin leaving it dull, discolored and rough. By using appropriate levels of glycolic acid you can exfoliate these dead skin cells to reveal newer, brighter and smoother skin underneath. Glycolic acid can improve a multitude of issues such as oiliness, acne, congestion, uneven skin tone, large pores, rough texture, acne scarring, hyperpigmentation, fine lines etc. Studies also show that regular application of glycolic acid can help stimulate collagen production.

Unfortunately, 4% is not really strong enough to give adequate improvement. You really need at least an 8% AHA starting off. Levels of 8-10% can be found in the drugstore. Once your skin has adjusted to the drugstore products a level of 15% can be found for purchase in some medical offices. Supplementing your home skin care products with medical grade in-office glycolic peels can be even more beneficial and can take your skin’s improvement to a whole new level. These chemical peels come in a variety of concentrations up to 70% glycolic acid. Done regularly (every 4-6 weeks) they are an excellent way to maintain your skin.

Don’t forget though, that whenever you use any anti-aging products or treatments designed to remove dead skin you become a little more susceptible to sun damage and therefore you should always prevent new damage by using a daily product with sunscreen that has an SPF 30 or higher.

Botox is a great treatment for smoothing out lines and preventing them from getting deeper with time. It’s meant to treat dynamic wrinkles which tend to be around your eyes, between your brows, across your forehead, down the neck and sometimes on your upper lip. The key to not getting a frozen look is to make sure that you are being treated by an experienced injector who has a conservative approach. Our goal is to inject the minimum amount of Botox needed to correct lines while providing a 3-4 month result without giving you that plastic, frozen look. Our Nursing Director, Jackie Connors has been injecting Botox and Filler (Restylane, Juvederm etc) daily for 10 years. She would be more than happy to sit down with you to discuss your needs and a treatment plan.

This can frustrate many clients who regularly get IPL to manage their sun damage (sun spots, hyperpigmentation, telangiectasia, fine lines etc). In essence, you will never have as much damage for the laser to target as you do in the first and maybe second treatment. While the skin will still improve with every IPL session, it gives the laser less and less target (brown and red) to treat and improvement becomes less dramatic. It is basically the Law of Diminishing Returns. To get the best results from IPL Photorejuvenation you should initially have 3-5 sessions and then have a maintenance treatment as needed depending on how quickly your skin becomes damaged again. The best way to protect your investment is to practice safe sun (wear a hat, sunglasses, seek shade, avoid peak sun times) and use a sunscreen or moisturizer with SPF 30 or higher and use as directed.

Drinking excessive amounts of water won’t do anything to improve your skin beyond keeping it hydrated. Everyone needs to drink enough water to keep the body in top working condition. If your body is dehydrated then your skin (the body’s largest organ) will also be dehydrated. And while dehydrated skin can make you look older, drinking lots of water doesn’t necessarily make you look younger. Water is necessary to keep blood volume moving and carry nutrients to the cells, flush toxins out of vital organs, and to provide a moist environment needed for the mouth, nose and throat. All your body’s organs, including the skin can only absorb so much water before your kidneys take over to get rid of any excess. So the bottom line is that you should drink enough water (or a variety of liquids) to stay healthy, but you can’t moisturize you skin from the inside out. And to keep your skin young? Wearing daily sunscreen (SPF 30 or higher) is the key.

Winter can be tough on hands – cold temperatures, lack of humidity and increased dryness from indoor heat combined with regular hand washing and use of hand sanitizers can leave hands feeling miserable. It may sound simple but you should just find a heavy, unscented and protective moisturizer or balm for the hands and wear gloves when outdoors. This sounds easy but the hard part is remembering to actually use the hand cream frequently (after each hand washing, showers, before leaving the house, at bedtime and as needed in between) which will prevent, dryness and cracks both of which can leave the hands more vulnerable to dermatitis etc. Remember that creams are better than lotions and that applying while skin is damp will help to lock in moisture. I like to recommend Vaseline Creamy, Prevex Protectant and Cetraben.

Immediately begin running cold water over the area or use ice packs for about 15 mins or until pain is gone. Use an antibiotic cream and where possible cover the afflicted area with a dressing as the sensation of air passing over the burn can cause discomfort. If the area blisters immediately seek medical attention.

Simply put, Accutane, also known as Isotretinoin (Accutane, Clarus) is the cure for acne. However, unless there is scarring or cyst formation, physicians usually like to try other treatment options first, such as topical prescriptions and oral medications like antibiotics and/or hormonal medications. If the acne continues to persist after a few months of treatment then it is time to consider Accutane. Left untreated, acne can cause physical scarring to the face and/or body which is extremely difficult and expensive to reduce. As well, teens and adults who suffer from acne can become socially and emotionally withdrawn because of their acne. In my opinion, the benefits of getting rid of acne outweigh any side effects associated with Accutane, which are almost always merely annoying, such as dryness of the lips. For more information on Accutane please contact your doctor.

Every home (and cabins that are too far from a drugstore) should have certain products in their cupboards, especially in the summer. Number one is a UVA/UVB sunscreen with SPF 30+. For allergic skin reactions, rashes etc use a prescription strength steroid as over the counter hydrocortisone is too mild to be of much help. Try not to scratch or pick at the skin. Oral Benadryl can also provide relief from redness and itching. For sunburns apply cold compresses for relief, drink plenty of fluids, use a very light, plain moisturizer to condition the skin and for discomfort use ibuprofen. As with any medical issue, please see your family doctor if the problem persists.

Melasma is one of the more challenging skin conditions that a dermatologist may see. It usually manifests itself as dark brown patches located on the central face and is more common in women than men. It is most often brought on by the hormone changes that may occur in pregnancy hence the nickname “pregnancy mask” or the birth control pill but is also quite common in darker skin types. While melasma is a benign skin condition, it can be cosmetically unappealing and can be quite distressing to some people. Although there is no cure for melasma you can help lighten the patches with a variety of products and treatments. The first step is to wear a product that contains a physical UV block (titanium dioxide and zinc oxide) of a minimum SPF 30 (although with melasma the higher SPF the better) every day with frequent reapplications every few hours as unprotected exposure to UV light, even for a very short period of time, can cause these brown patches to darken. Periodic treatments with ProFractional Laser, Glycolic Peels and/or Spot Peels can also be very helpful in fading pigment when done in conjunction with products containing glycolic acid, retinols, hydroquinone and/or vitamin C. See your clinical aesthetician for the best regimen. And remember, melasma is a reoccurring skin condition of the largest organ of your body. One day of unprotected UV exposure can undo months of hard work and expense. It is surprising how many people expect to use one product or have one treatment and expect their melasma to disappear forever. Even if you manage to fade your melasma up to 70%, don’t be surprised at how often or quickly you can get a recurrence of the brown patches. Just as a diabetic has to monitor his/her diet, sugars and inject insulin, melasma is a condition that must be managed on a daily basis.
For more info on melasma and/or how to treat it contact our office to book a consultation with one of our experienced staff – 739.7546.

Despite the possible pop culture reference to all things Twilight and True Blood, the term “vampire filler” is actually a trade nick name for PRP which stands for “platelet rich plasma”. This treatment is what we call Selphyl. Selphyl is injected the same way as a regular filler however it gets this nickname because it uses your own blood. In this treatment, your blood is taken exactly as if you were having a blood test done. It is then placed in a centrifuge that spins the blood separating the PRP from the red blood cells. The PRP is then injected anywhere into the face however the hollows under the eyes and lines around the mouth are the most common areas. Selphy; is meant to help stimulate the production of your own new skin cells and collagen which gives you a very natural look.

For more info on Selphyl and what it can do for you, contact our office to book a consultation with one of our experienced staff – 739.7546.

Many people are under this misconception but this is just a false myth. It may seem like it gets worse but this is not the case. When you shave it is impossible to change the hair in colour, size, density or coarseness. Shaving cuts off all the hair at the very surface of the skin leaving a very sharp, thick tip, rather than a fine tapered end. All the hair then grows back at the same time and at the same rate. This is when the hair feels undesirably coarse and stubbly. However, if you were to let it grow out fully again it would return to its original pre-shave state and would not be any worse. The reason why you should shave the day of laser hair removal is two fold. One is that there is a bigger surface area on the tip of the hair after it has just been shaved providing a bigger target (no matter how microscopic) for the laser. Secondly, by having the skin clear of hair, the laser is better able to target the hair follicle without being “confused” by all the hair (extra target) on the surface. Hair free skin allows the laser to focus its energy through the follicle and not on the surface of the skin which can cause more discomfort. Shaving can definitely enhance the results of laser hair removal.

For more info on laser hair removal please contact our clinic where we would be more than happy to help answer your questions.

Many people are concerned that if they try Botox or stop treatments after a period of time, that their skin will be more wrinkled and look worse than before. This is a common misconception and I simply reassure patients that this will not happen. Botox is designed to relax the muscles that cause lines and wrinkles around the eyes, between the brows and/or across the forehead. This gives the face the appearance of looking more relaxed, less stressed and less tired. Botox essentially stops the clock on aging of the skin where it is injected. Should you decide to stop Botox treatments then the clock is restarted from when it wears off. So if in fact you have had Botox for 5 or 6 years and then stop injections, you have essentially saved those areas from 5 or 6 years of aging and are that much further ahead.

Good skin care is a habit that kids should start as early as their teen years or even sooner if they begin to experience hormone changes and increased oil in the skin. Also, if there is a family history your kids are more likely to develop acne. The teen years can be tough on the skin as changes in hormone levels can cause an increase in oil production that can lead to oily/shiny skin, enlarged and/or clogged pores as well as acne. The skin lining the follicles sheds in large clumps, blocking the opening to the skin’s surface. The excess oil then backs up causing whiteheads and blackheads to develop. Left untreated, acne can cause scars not only physically but also emotionally so I normally treat acne as soon as it appears.

Teens should use a salicylic acid cleanser morning and night to help remove excess oil, environmental pollutants and make up. They can spot treat any individual breakouts with products containing benzoyl peroxide, sulfur or salicylic acid to help spots dry and heal more quickly. Remember that benzoyl peroxide can bleach face cloths, towels, pillowcases and clothing so wash hands after applying. In the daytime it’s a good idea (and habit) to use an oil free moisturizer with SPF 30 or higher to protect the skin from damaging UV rays and in the night time they can use an oil free moisturizer with glycolic or lactic acid to help shed the clumps of dead skin cells that can clog pores and contribute to acne. During the day if your teen experiences a lot of oil I would simply use oil blotting papers that can be found in any drugstore. I do not advise washing the skin mid day in addition to the morning/evening cleanse because this can actually cause over stripping of the skin leading to, believe it or not, more oil production.

For stubborn mild to moderate acne you can certainly add possible chemical peels (to help speed up skin exfoliation) or blue light (wavelength of light that destroys acne bacteria).

However, if your child begins to develop inflamed acne or cystic acne (large painful lumps under the skin) then I suggest heading straight to your family doctor or dermatologist for medical treatment with possible prescription topicals and/or oral medications. Cystic acne can lead very quickly to scarring which in turn can lead to low self esteem issues. Scarring is also much more difficult to treat than acne itself. If you have any other questions about teens and skin care please do not hesitate to book a consultation with our friendly and expert staff.

The simple answer is no. Sunscreen products (ex. Ombrelle, La Roche Posay, Neutrogena) are already quite emollient which means that they already contain ingredients to soften and moisturize the skin. Adding a second moisturizer may just be redundant unless you have extremely dry skin and the sunscreen you are using doesn’t seem to soothe your skin at all. Or you can simply choose one of the many moisturizers on the market that are SPF 30 or higher. Just make sure that it says broad spectrum UVA/UVB coverage on the label. If you are going to layer a product with your sunscreen you should consider using a serum that contains medical grade antioxidants and peptides such as vitamins C and E, coffeeberry, Kinerol etc. Serums tend to be very light in texture and can have great anti-aging benefits without adding heaviness to your skin. This combination of serum plus sunscreen helps reduce the signs of aging, prevents free radical damage (molecules that break down the skin causing aging and tissue damage) and protects you from damaging UVA/UVB rays. And remember, the Canadian Dermatology Association now recommends a minimum SPF 30 to be used year round.

Intense Pulsed Light (or IPL) and Skin Tyte have two separate goals. IPL Photorejuvenation targets the extra red and brown in the skin which can occur in the epidermis as a result of sun damage, rosacea, melasma etc. It can remove up to 70% of this type of skin damage, evening out skin tone and improving the texture of the skin in as little as two weeks. Skin Tyte targets dermal collagen to promote stimulation and contraction of collagen which leads to increased firmness of the skin. Results can take up to four months as your collagen is rebuilt and strengthened. On the plus side long term, regular IPL can provide some stimulation of collagen to provide some tightening however, this is more of a secondary benefit and not the primary goal. Combining both treatments gives you the best overall improvement in skin tone, texture, firmness and elasticity. It’s like renovating the outside of your house. IPL is like a new paint job and Skin Tyte is like shoring up your foundation.

These red and brown marks are a result of a post inflammatory change in the skin. These complications vary depending on skin type. Fairer skins tend to be left with red spots which occur when the vessels remain enlarged and visibly red. These will gradually fade but can take at least 6-8 weeks. Darker skins tend to be left with brown spots which occur when cells (melanocytes) release more pigment (melanin) which will also gradually fade but can take at least 6-12 months. It is very important to wear daily SPF 30 if you are left with these brown marks as even moderate amounts of UV light will make them last much longer. However, even though these marks will fade on their own with time you can treat them with Intense Pulsed Light if you are impatient and can’t wait. A few sessions of IPL can help reduce red and brown marks much more quickly than waiting it out.

I see this in my practice quite frequently and while it may look like dry skin it cannot be treated with exfoliants or moisturizers. In fact over moisturizing may make it worse.This sounds like a condition called seborrheic dermatitis which is very common, especially in patients who have rosacea or oily skin. This is an inflammatory condition caused by a yeast that builds up in the sebum or oil on the face and is typically seen more in the folds of the skin around the nose, mouth and between the brows. It is also a common cause of dandruff on the scalp. Home treatment includes using a dandruff shampoo (Nizoral, Selsun or Head and Shoulders) to wash the affected areas of the face 2-3 times a week leaving it on 5 minutes each time. If this alone does not help you can add an over the counter product that has 0.5% hydrocortisone daily for a maximum of one week at a time to control flare ups. It is very important not to use hydrocortisone long term as it can thin your skin. If both these treatments do not provide relief then see your doctor for possible prescription topicals such as Elidel or Protopic which can both help settle stubborn seborrheic dermatitis.

Most people do not understand why we stress sun protection at all times. The sun emits ultraviolet radiation which damages the skin causing aging and skin cancer, as well as infrared radiation which makes it warm. In other words it does not have to be warm to have significant amounts of UV radiation hitting and damaging your skin. UV intensity is a reflection of the time of year and the latitude of your location. St. John’s gets the same amount of UV as Paris and Seattle, both of which are at the same latitude on the planet. This is most intense from March 21st to September 21st, and 80% penetrates high cloud cover as well as window and windshield glass. So it can be 3 degrees Celsius and overcast in April and we still get significant UV exposure. This is almost doubled around water, snow or sand, due to reflection. The amount of UV in the fall and winter is lower, but can still be significant. So best to be safe and protect yourself with a good broad-spectrum SPF 30 sunscreen year round. It does no harm, and does your skin a world of good.

Vitamin D is a vitamin whose production in our bodies is stimulated by Ultraviolet B (UVB) light from the sun, and is also derived from food sources such as fish oils. Canadians, due to the relative lack of UVB from the sun in the winter commonly have low vitamin D levels. Many people are concerned that protecting themselves from harmful UV radiation from the sun and artificial tanning sources may lead to low levels of vitamin D. They need not worry as there are many sources of vitamin D. A recent North American panel of medical experts met to discuss this. Their conclusion was to recommend a total vitamin D intake of 600 IU a day from both dietary and UVB sources. This includes taking vitamin D supplements, and 600 IU is enough. Salmon, sardines and other fish oils as well as fortified eggs and milk are also rich in vitamin D. They also concluded that the existing expected normal levels for vitamin D measurements are actually too high. This would make many people artificially appear to have low vitamin D levels when they are tested when they actually have normal levels. What this all means is that taking a vitamin D supplement daily is enough to maintain adequate levels. If you want UVB, then sunshine is the only good source, and 10 minutes exposure 5x per week on the hands and face is enough in the spring and summer. More exposure does not increase vitamin D levels as we can not store any more. It simply damages your skin. Artificial tanning sources, such as tanning beds, emit almost entirely UVA and are therefore not good for stimulating vitamin D. They simply damage your skin and increase your risk of skin cancer without causing significant vitamin D increase. So cover up, wear sunscreen, eat well and take vitamin D supplements of 600 units a day in the Fall and Winter. Remember to take it with a meal as it is a fat-soluble vitamin and needs to be taken with food in order to be absorbed.

No, this is a common misconception. Natural UVA/UVB light exposure automatically triggers your body’s self-defence mechanisms – the production of melanin (brown pigment) as well as a thickening of the skin. It is not a great defense, but the best we can muster – equivalent to SPF4 sunscreen. A fake tan only triggers production of melanin and does not increase skin thickness which is an important response for protection. Tanning beds give people a false sense of security. They emit the UVA radiation allowing your skin to produce melanin or to tan, but they also selectively omit most of the UVB radiation (which causes sunburn). Taking away the UVB rays takes away your body’s natural warning system that tells you that you have been exposed to too much UV radiation. It’s the same as taking the batteries out of your smoke detector. Even if you don’t normally burn and only tan, you are still exposing yourself to increasing amounts of radiation, aging your skin and increasing your risk of skin cancer. To prevent skin cancer and premature aging, I tell all my patients that there is no such thing as a safe tan (unless it comes from a bottle of self tanner, but that provides no protection). Any tan that comes from UV light, whether real or artificial is a sign that your skin has been damaged. Wearing SPF 30 or higher along with sunglasses, hats and protective clothing are the best ways to prevent sun damage.

Dark circles are very frustrating because they are the result of a combination of three problems – pigmentation, enlarged blood vessels and shadowing from wrinkles and puffiness from enlarged fat pads in the lower lids. Unfortunately there is no cure for dark under eye circles. Once you rule out lack of sleep and poor nutrition, dark circles may simply be a fact of life, especially as we age and these three contributing factors become worse. Eye serums and peels may help reduce some of the pigmentation and fine lines that enhance the problem. Specialty eye creams with caffeine can help temporarily to reduce the appearance of under eye circles. Surgical blepharoplasty can remove excess skin and enlarged fat pads.

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