Q & A
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What is your primary approach to treating varicose veins?
My primary approach is to holistically look at the patient and find out all the things that are contributing to their disease and educate them as to what they can do to improve their condition, and also what they can do in the future to prevent any further development of the disease.
Q1
What inspired you to specialize in skin and vein care?
To be honest, when I was in medical school, I actually started having unexplained severe leg pain and also episodes of fainting, and nobody could figure out what I had. When we finally discovered that it was varicose veins, I was shocked. Number one, that that could cause such a significant problem in someone so young. But that actually, in America, we really didn’t have a good handle on how to take care of this problem. And I got very interested, not just in my own case, but also in treating patients in my practice.
Q2
What are the most effective treatments for spider veins?
The most effective treatment for spider veins is still the gold standard, which is sclerotherapy with any kind of solution. You can use either saline, sotradecol, polidocanol. I have found in my practice that using laser for superficial veins on the legs really isn’t a good method. Still, sclerotherapy seems to be the best. Now, that does not mean that for larger veins, like varicose veins, we can’t use lasers inside the vein. But for superficial veins, gold standard sclerotherapy, little injections with a concentrated solution to make those veins go away.
Q3
What are the differences between Botox and Xeomin?
Botox and Xeomin are neuromodulators. What that means is they actually anesthetize the signal from the nerves to the muscles, and they don’t allow your facial muscles to contract and that way reduces your lines and wrinkles. They last for about six months.
Botox is the original and it has a longstanding history. Xeomin came out about seven years later and it has none of the proteins that Botox has. So it is a more purified form of Botox.
Patients that are very concerned about their health and are purists, that don’t want extra proteins and don’t want extra side effects actually prefer Xeomin. In patients that have been using Botox for a long time and Botox doesn’t seem to have as much of an effect, when we tried the Xeomin, we could actually recover and get the same results that the patient originally got with Botox.
Q4
What results can patients expect from laser scar treatments?
Depending on the cause of the scar, we have different modalities for trying to get rid of it. So if the patient has keloids and they’re darker complected, we will initially start using steroids to reduce the scar and then use laser to flatten to get rid of the color. In other patients, we directly can use the laser and it will smooth out. No laser will take care of a scar in one treatment. Patient needs to be aware, it’ll be multiple treatments, but the results are very, very cosmetically pleasing and there is no downtime, and there is no pain.
Q5
How do you evaluate if a patient is a good candidate for laser skin rejuvenation?
Well, first thing we need to do is see the patient’s lifestyle. Depending on their diet, how they use sunscreen, and how they take care and how they follow directions at all determines whether or not they’re going to be successful with our treatments. So if the patient is non compliant or wants to be in the sun without sunscreen, they’re not going to do well. Also, patients that are darker complected have to understand that when we do laser rejuvenation, we have to go slower with them, so that they can get great effects.
Q6
What recommendations do you give to maintain facial treatment results?
For patients we have a whole category of products that we have brought to the practice from the four corners of the Earth. So there are different products that we recommend to patients depending on their skin type, their age and how their lifestyle is. If they don’t follow up with maintenance home care, they’re never going to get great results. This is not a one and done. So patients have to understand that they have to have a commitment to their skin care. You know, it’s not just about looking good, it’s about feeling good. It’s about going to that school reunion and just wowing everybody with what you look like. It’s about getting that job promotion because people think that you have energy and you look young enough and you have enough stamina to do the job.
So it’s not just about how you look, it’s about what this means to your life. And it has to be a fully encompassing. You have to follow diet. You have to eat better nutrition. You can’t be eating processed foods and expect your skin to be great. You can’t be drinking. You can’t be up all night and not sleeping. So it’s a full fledged holistic approach to get the best skincare you can.
Q7
How can hormonal treatments improve patients' quality of life?
Oh my goodness, hormones are amazing! And unfortunately the medical society has kind of not given hormones the due that’s necessary. We understand how wonderful insulin is in a diabetic. But what people don’t understand is that if you don’t have estrogen, you won’t have fluffy, beautiful skin. If you don’t have progesterone, you won’t be able to sleep at night. If you don’t have testosterone, you won’t have good muscle mass. So imagine that I took away your air and your water. You wouldn’t last too long, would you? It’s the same thing with estrogen, progesterone, and testosterone.
The problem is that the effects are slow and so people don’t notice it. A lot of patients will come in and say, you know, I don’t know what happened, doc. I looked great, I had great muscle mass. I had great stamina, I had a great sex life and then I turned 40 and 50. And I’m not just talking women, even men. And they said, everything changed. My skin got different, my hair fell out. I just had no stamina. I was always in a bad mood. Hormones are amazing, but you have to go to people who are really well trained and believe in them. You have to choose a patient that’s not going to abuse those hormones once you write them the prescription.
Q8
What precautions should be taken before and after injectable treatments?
When patients come in for injectable treatments, especially for sclerotherapy, they have to be careful what they put on their skin. They have to be careful about their sun exposure, and they can’t have any other treatments like laser or chemical peels. But if the patient follows what we need to do, the treatment is pretty straightforward and the side effects are minimal. If you follow what we’re doing. And most importantly, you’ve got to be careful with the sun and use a sun protectant after we do the treatment.
Q9
How do you address acne and acne scars with laser treatments?
Acne scars are treated depending on their appearance. Deeper scars may need further treatment with things like microneedling and laser may not be enough. For most patients, laser can reduce the depression of the scar and get rid of the redness and have the skin look more uniform.
Q10
What benefits does red light therapy offer?
Red light therapy, also known as diode therapy, offers a huge amount of benefits. We’ve known about red light therapy anecdotally, but now scientifically, we’re able to prove that red light stimulates the circulation of red blood cells, increases oxygen into the skin, increases the elastin production, increases the collagen production, and actually reverses the clock. So people can come in for a small treatment half an hour, where we put the red light on them and every week as they come in for their treatments, they see that they get younger and younger and younger.
Q11
What are the differences between Juvederm and Restylane?
Restylane and Juvederm are actually the same product. They are derivatives, a hyaluronic acid, but depending on how you prepare them, you can change the consistency. Just like you can have an egg white which can be liquidy, and if you boil a little more, it gets a little firmer. And if you hard boil, it gets solid. Hyaluronic acid can be prepared in a way that it can be more liquid or more solid. The more solid form is used to fill in deep lines and wrinkles, the less liquidy form. The more liquidy form is used to kind of fluff up the skin. So depending what you want to correct, you can decide to use a different form of hyaluronic acid and many companies use it. I don’t really have a preference. They work pretty well. It’s more important to know the consistency of the product than actually the name of the product.
Q12
What is the process for removing sun-induced brown spots?
We remove sun induced brown spots by a variety of methods. One of my favorites is to use chemical peels. We have chemical peels here that are designed for different age groups, different skin types, and different skin colors. The other thing that we can use is we can use Microneedling, we can use radiofrequency, we can actually use some different chemical peels. And we also have some take home products that the patients can use. So we can get everybody to get rid of those nasty little, annoying little brown spots that we get from the sun.
Q13
How does mesotherapy help in treating cellulite?
Mesotherapy helps because it actually can stimulate the collagen fibers to constrict. It can also increase the circulation to the area, and a lot of times patients have cellulite because they actually are low in hormones or they have excess estrogen. So different treatments that we can use in mesotherapy can help with the appearance of cellulite.
Q14
What techniques do you use for non-invasive facial rejuvenation?
I have several techniques that I can use for a noninvasive facial rejuvenation. One of my favorites is to use red light therapy. Another one is to use radiofrequency. another one is to use actual laser therapy on the skin. We also have devices that help contract the muscles on the skin, firm the skin up. So there’s various modalities that we can use to really get you there without having to cut or do anything really aggressive.
Q15
What is photodynamic therapy, and for which conditions is it most effective?
Photodynamic therapy is a treatment where we take alpha levulinic acid, put it on the skin, allow it to soak in after an hour and then use a special blue light that actually stimulates a chemical reaction underneath the skin. It is great for resistant acne, but better it is used for something called sebaceous adenoma, where people get these little bumps all over their skin that look like pimples, and they try to get rid of them and they try to squeeze them but nothing comes out. There is nothing that treats the skin better for sebaceous adenoma, which is very, very common and people mistake it for acne, than photodynamic therapy.
Q16
How do you personalize treatments for each patient?
I personalize my treatments for patients. because I went to a wonderful school, Boston University School of Medicine. Where we were taught to treat the patient not as a disease, but as a expression of everything in that person’s environment.
So when I look at a patient to decide what kind of treatment I want for them, I need to know what their nutrition is like, what kind of environment they are socially. You know, how emotionally involved they are at home, how stressful they have – are they taking care of a sick child? Do they have time to do treatments? So I decide all those things in coming up with a customized protocol for each patient.
For instance, if I have a mother of six, I can’t give her a treatment plan that she has to use 3 or 4 creams a day. You know, whereas if she is a stay at home wife with only one child, I can use something more complicated for her. If I have someone who is working out in the field, you know, as in exposed to the sun, I have to then add sun protection to that person’s regimen.
So no one patient gets a one size fits all here. I have to know their history. You know, I have to see what’s going on in their home. I have to see how emotional, what their state is, because all these things affect, you know, if a patient doesn’t sleep well, it doesn’t matter what I do for them. You know, they’re not going to get the maximum results. So I customize everything by taking an extensive history with the patient, by listening to what the patient wants, by taking their budget into consideration, by seeing what time limits they have, and also seeing physically what they can do.
Q17
What factors do you consider when recommending Exilis treatments?
I love Exilis because Exilis can be used to literally shrink and contract any part of the skin on your body. I particularly like it because you can use it around the eye area. A lot of people come in complaining about saggy eyes and darkness under the skin, and this does a phenomenal job. It’s not as great as surgery, but I would imagine it’s about an 80% result that can be achieved. But it’s got less downtime, less discomfort, and definitely less costly than a plastic surgery.
Q18
What treatments do you offer for laser hair removal?
We use ND:YAG and an Apogee Alexandrite laser for removal of hair. Depending on the patient’s skin color and how they tan. If a patient, doesn’t have the right laser use, they can end up having extra pigmentation, or they can actually have burning and scarring. So we have to be aware of what the patient’s skin type is, and we use the appropriate laser for them here in this practice.
Q19
How can patients keep their skin healthy after a chemical treatment?
It’s important to use a good cleanser. You do need a toner, although people tell you a toner is not necessary. You definitely need to tone the skin, and you have to use a good moisturizer, and you also have to use a good sunscreen. But it’s not just good enough to maintain the skin, you also want to prevent aging. So you need to have some sort of a vitamin C serum. And you also have to use something that is a light exfoliant. And if you don’t use it every night at least once a week. The other thing is, I’m very holistic and I believe in detoxifying the skin, and I believe in using certain types of mud. We particularly like muds from the Dead Sea. Treatment once a week to help remove the toxins that you get in your skin, basically by being exposed and also by just the foods and things you introduce into your body.
Q20
What options do you offer for removing skin lesions?
Lesions and skin tags can be easily removed in our practice with laser, radiofrequency or they can actually surgically be removed like you do a biopsy.
Q21
What realistic expectations should patients have after microneedling treatments?
Realistically, one microneedling treatment is not going to do it for you. You need to have several treatments done, but patients are really surprised at how with one treatment alone, the skin looks brighter and tighter and they actually feel like their skin feels firmer.
Q22
What financing options are available for patients?
Here in my office, there are several ways that you can take care of your financial obligations. If you pay in cash, we will actually give you discounts. We accept all four major forms of credit cards, and we work with companies who will allow you to get your treatment today and worry about making your payments later.
Q23
You mentioned that varicose vein treatments might be covered by insurance.
Can you explain the process and what makes a person eligible for insurance coverage of this treatment?
Varicose veins and spider veins are the opposite ends of the spectrum. Patients can get sometimes assistance with their treatment through insurance, but a procedure has to be followed. Number one, we have to do an ultrasound to ascertain if in fact there are varicose involved in the formation of the spider veins. Secondly, once we do that, we have to submit it to the insurance and then accept whatever recommendations they have. Sometimes we can appeal decisions.
So many patients come in thinking that all they have is spider veins, but on closer examination and also with a history of the swelling or pain in the legs, we realize that they actually have overriding varicose veins disease and those treatments for those patients may be covered by their insurance. Every insurance company is different, and every insurance company has the ability to decide not to cover a certain procedure.
Q24
How has your practice changed with the adoption of telemedicine during the pandemic?
Yes, I offer telemedicine to my patients, especially after the pandemic and has been very beneficial. In the past it’s been difficult because patients had to come in, get their ultrasounds, and we had to sit down and decide to do the surgery. Now that visit can be done by telehealth so that the patient doesn’t have to come in, drive all the way into my office, and that is covered by their insurance company.
Q25
What are the differences between the available skin rejuvenation treatments?
To rejuvenate the skin, there are multiple methods that we can use here in our practice. We can use something called plasma-sculpt where we take the patient’s plasma, that’s what’s called the PRP, and we can mix it with something called Sculptra and we can inject the skin. That makes the skin younger and firmer, and it can help reduce and eliminate large wrinkles permanently. We can also use radio frequency which would tighten the skin. We can use laser that will lighten and make the skin look better and also improve the appearance. We can also use chemical peels, which not only eliminate fine lines and wrinkles but get rid of marks and spots and actually change the texture of the skin. And we can also do all types of different facial treatments with masks and muds, et cetera. So there’s lots of ways to skin a cat, and there’s lots of ways to keep you young looking at Dr. Navarro.
