THE SKINNY SCHWEIGER DERMATOLOGY QUARTERLY
GOODBYE SUNSHINE THE BEST TREATMENTS AND PRODUCTS TO ERASE SUN DAMAGE
Lasers: A Userâ€™s Guide From anti-aging to acne scars, news on the best lasers for treating every skin issue
Get Glowing For Fall The expert tips and tricks you need to know for a gorgeous glow all season long
IN THIS ISSUE
Off Your Treatment
When You Mention The SkinNY
THE HOT LIST The most innovative new skincare treatments and products you need to know about right now, pg. 4 - 5
A CLEAR PICTURE A clear complexion is not only possible, but it’s easier to obtain than ever before. What you need to know about treating acne, pg. 6 - 7
GOODBYE SUNSHINE Ready to bid a final farewell to summer? Our providers share the best methods for erasing sun damage, pg. 8 - 9
BEAUTY DIARY Danielle Daughteridge, PA-C, shares her tried and true beauty secrets and hotspots, pg. 10 - 11
LASERS: A USER’S GUIDE Lasers are an amazing tool. With so many different lasers to choose from, we ask laser specialist Dr. Sue Ann Wee on which lasers are best to treat every skin type and issue, pg. 12 - 14 Schweiger Dermatology Group is an experienced CoolSculpting provider. We will tailor a customized CoolSculpting treatment plan designed to meet your personal needs. Contact us today!
THE GLOW Our providers give their best get glowing tips, products and treatments for fall, pg. 15
LUNCHTIME QUICKIE: MICRONEEDLING
Call (844) DERM DOC today Schweiger Dermatology Group 18+ locations in the Tr-State Area
to schedule your CoolSculpting consultation, or visit www.schweigerderm.com
Results and patient experience may vary. While CoolSculpting is safe, some rare side effects may occur. As with any medical procedure, only your CoolSculpting provider can help you decide if CoolSculpting is right for you. In the U.S., the CoolSculpting procedure is FDA-cleared for the treatment of visible fat bulges in the submental area, thigh, abdomen and flank. Outside the U.S., the CoolSculpting procedure for non-invasive fat reduction is available worldwide. ZELTIQ, CoolSculpting, the CoolSculpting logo, the Snowflake design, and Fear No Mirror are registered trademarks of ZELTIQ Aesthetics, Inc. © 2016. All rights reserved. IC1916-A
Allison Santhouse, PA-C explains why this low-tech treatment is in such high demand for perfect skin seekers, pg. 16
NEIGHBORHOOD SPOTLIGHT New Rochelle’s Merry Thornton, PA-C gives an insider look at where to eat, sweat and beautify in this happening ‘hood in Southern Westchester, pg. 17
Fall 2016 Letter from Schweiger Dermatology Group’s Founder It’s hard to believe summer is over! As we transition into the fall season, many people take the cooler days as a sign to stop wearing sunscreen. But the reality is that UV damage can take place any time of year, regardless of the temperature. Using sun protection should still be an integral part of your skincare routine. Skin cancer rates are rising, not dropping. Another healthy practice is scheduling your annual skincare routine, which I encourage everyone to do. Fall is an ideal time to correct any residual damage from the sun and start anew. I hope everyone takes the opportunity to get on the path to their ideal skin-whether it be a clear complexion or an anti-aging regimen that will last for many years to come. We have many new and exciting treatments as well as some top notch new providers at SDG. I hope to see you in one of our offices soon!
Eric S. Schweiger, CEO and Founder of Schweiger Dermatology Group
The Hot List THE L ATEST BUZZ-WORTHY COSMETIC TREATMENTS AND SKINCARE PRODUCTS TO GET YOUR SKIN LOOKING GORGEOUS ALL SEASON LONG. Vintner’s Daughter Active Botanical Serum
Vintner’s Daughter founder April Gargiulo applied the fine wine making principles she learned from her dad to skincare for the creation of her first product, a singular face oil that has received some serious buzz in the beauty world. The product is made with all non-toxic ingredients, but uses the whole plant so ever y drop is dense with nutrients and actives that come from all the trace minerals found in the plant. “Women are moving toward naturals, but they’re still going to turn to dermatologists for the heav y lifting,”
says Gargiulo. “The product happens to be non-toxic but has efficacy and is supportive of more aggressive treatments, such as lasers and other inoffice treatments.” ($185; vintnersdaughter.com)
This new pain-relieving vibrating tool is getting a lot of love on Instagram. The sleek looking device decreases discomfort during cosmetic procedures by distracting the pain sensors in the skin by both cooling and vibrating. “We apply it to nearby skin when injecting and the sensor y ner ves in the skin are distracted by the
cooling vibration, masking the pain of the needle sticks,” explains Dr. Rachel Nazarian, who has successfully been using it on patients coming in for fillers and Botox. “Many celebrities have been using it to make their cosmetic procedures more comfortable with their dermatologist, and I think our patients deser ve the same VIP ser vice!”
La RochePosay Active C10
Vitamin C has major antiaging and antioxidant benefits. The new La RochePosay Active C10 is an ultralightweight cream clinically proven to reduce the look of fine lines and winkles, boost radiance and soothe skin. It contains La Roche-Posay’s highest concentration of Vitamin C to
help fight free radical damage that results from UV radiation and environmental damage. Also in the mix are hyaluronic acid, vitamin E and the brand’s signature Thermal Spring Water, all working together to lock in moisture and leave skin glowing, without feeling greasy or shiny. ($52.99, drugstores nationwide)
Cover FX Click Stick
From the brand that makes the most amazing concealers, comes three customizable and portable new beauty tools. The Click Stick is a dual ended sleek looking sleeve that holds two Cover Fx Clicks. The Clicks are available in shades that Correct, Cover and Enhance the skin. Depending on the Click
you choose, you can neutralize sallow skin, cover dark circles and hide redness. (coverf x. com)
We love the texture of this super hydrating cream-to-oil treatment. With one application, skin looks healthy and dew y. Made with Abyssinian Seed Oil and Shea Milk, and omega-rich botanical lipids that deeply hydrate the skin. Natural, reflective minerals give the skin a luminosity that diffuses light for a brighter appearance. The special GLOWBIOTICS balancing complex protects, defends and strengthens the skin’s immune system. (glowbioticsmd.com)
TNS Eye Repair by Skin Medica
The ultimate eye treatment for the eye area post summer sun damage! This super-luxe dream treatment contains growth factors and peptides to improve and prevent fine lines and wrinkles, while brightening, hydrating and firming the delicate under eye skin. It’s the next best thing to an eye lift! (skinmedica. com and sold at Schweiger Dermatolog y Group Smithtown)
A clear complexion is within your reach. What you need to know about the latest acne news and treatments right now.
ACZONE IS WORTH GOING TO THE
DIFFERIN IS FDA APPROVED FOR OTC Big news for treating acne without a prescription. The popular Rx topical acne medication Differin is now available in over the counter form. Differin, or adapalene (its medical name) has been available as a prescription for years. “It’s a pretty fantastic retinoid anti-acne gel,” says Dr. Rachel Nazarian. “This type of retinoid, which works better and faster then “retinol” an over-the-counter version, has never been available to the public without a prescription. Now with its FDA approval it is available in drugstores.” This medication has been shown to be effective in treating a blackheads, whiteheads, and even cystic lesions of acne. People using Differin need to be cautious though, because it can cause irritation, dryness and redness, especially when first beginning use. The best way to start using is to apply
a tiny amount at night once a week. As long as your skin is not showing too much irritation you can gradually increase use to nightly. “Overall, this is an exciting move in making effective acne medications more accessible to everyone,” says Dr. Nazarian
COULD SKIM MILK BE AN ACNE CULPRIT? A new study published in the Journal of the American Academy of Dermatology linked skim milk to the occurrence of acne in teens. So what does this mean for you? “Dairy itself may have hormones in it from the cows, and it may trigger the human body to produce its own inflammatory hormones and cell-signaling molecules. These hormones and signals in
the body can lead to increased oil production and increased inflammation in the skin,” says Dr. Jeremy Fenton. “While it isn’t entirely clear the mechanism by which dairy may cause increased acne, a faster rate of absorption into the body may create a more exaggerated effect and spike in hormones. You can liken it to the difference between eating whole wheat versus white bread. White bread doesn’t contain the fiber that slows down digestion, and this leads to more rapid spikes in hormones, such as insulin.” So rather than cut out milk altogether, try swapping it for whole milk along with practicing an acne-fighting skincare regimen and see if your skin reacts positively.
DERMATOLOGIST There’s a new prescription acne cream getting a lot of attention thanks to Kate Bosworth’s confession of being an avid user. It’s called Aczone and it’s made by Allergan, the same company that makes Botox. This lightweight gel containing the topical antibiotic dapsone, is a nonirritating alternative to other acne-fighting ingredients. It comes in a 5-percent concentration for use twice daily or a stronger 7.5-percent dose for once a day use. It’s ideal for those with sensitive skin types or for acne patients who haven’t had much luck with other topical acne products. Ask your Schweiger Dermatology Group provider for more information on Aczone.
Could skim milk be causing your skin to break out?
5 Lifestyle Tips for Managing Your Acne by Dr. Karen Hammerman
1. GET MORE SLEEP:
Stress increases glucocorticoid production, which can lead to abnormalities in skin structure and function.
2. EXERCISE: Exercise helps cut stress, which may contribute to acne
outbreaks. Physical activity also helps your skin by increasing your blood circulation, which sends more oxygen to your skin cells and carries cell waste away. But keep in mind that sweat from exercise can also lead to breakouts by irritating your skin. So it’s important to shower right after a workout.
3. DRINK WATER: Increasing the amount of water you drink is a great way to flush out internal toxins and hydrate your skin from the inside out. Research has shown that drinking water significantly increases blood flow throughout the body and skin.
4. DE-GREASE YOUR PHONE: Cell phones are hotbeds for germs.
Throughout any given day your phone can be exposed to thousands of bacteria, which spread from your fingers (via texting) to your face (via talking) and vice versa. In addition, the heat produced by your phone can help bacteria to multiply. To keep the germs from landing on your face, wipe the surface of your phone with a little hand sanitizer each day. It’s best to use headphones.
5. USE OIL-FREE HAIR PRODUCTS:
“Pomade acne” is a breakout caused by hair-care products including conditioner, shampoo, gel, and hair spray. This form of acne occurs when oils from styling products seep into skin, usually around the hairline, and trap acne-causing bacteria in pores.
BID A FINAL FAREWELL TO SUMMER—AND SUN DAMAGE—WITH THESE TOP SUNSPOT REMOVAL TREATMENTS. No matter how diligent you were with your sunscreen over the summer months, it’s inevitable that some sun damage occurred during those long, sunny days. Most people under-apply their SPF and the end result appears on your skin. “Age spots— or solar lentigines—arise from the effects of the sun over time,” explains Dr. Sue Ann Wee. “Other features of sun damaged skin include coarse skin texture, wrinkles, pigmentation, telangiectasias (spider veins), and laxity.” So how best to undo the damage? Thankfully, there are many viable options that help turn back the clock and deliver a complexion that looks like it was sitting in the shade all summer long. But where to start? “I’d start with something basic first, such as microdermabrasion and a chemical peel,” says Dr. Marina Peredo, of Schweiger Dermatology Group in Smithtown. If that doesn’t
work, Dr. Peredo advises bringing out the big guns with an IPL (intense pulse light) to rejuvenate and fractionated resurfacing laser to help with collagen production. Here, three ways to tackle sun damage and leave you with a brighter complexion.
SUN DAMAGE REMOVAL OPTION 1: L ASERS AND LIGHT TREATMENTS According to Dr. Wee, one of the most effective lasers to remove brown spots are the q-switched pigment lasers. However, many patients desire to treat age spots more comprehensively which is why the non-ablative fractional lasers, Clear and Brilliant Permea and Fraxel Thulium are key tools for improving age spots in the setting of general sun damage. A series of Clear and Brilliant Permea treatments can treat mild age spots gradually with virtually no downtime.
“Clear and Brilliant Permea is a great introductory and affordable laser for patients who have early sun damage but is probably not aggressive enough to treat more significant sun spots,” says Dr. Wee. “Fraxel Thulium is a higher energy non-ablative fractional laser that can clear most age spots in one to three treatments while making the skin more healthy and radiant. For the above lasers and light devices, I typically recommend monthly treatments that are tailored to each individual until age spots are significantly improved.”
SEE THE LIGHT Lumecca Intense pulse light is a light treatment that can also dramatically improve brown age spots while also reducing red vessels. “Intense pulse light treatments have the added benefit of also gradually reducing
telangiectasias,” says Dr. Wee. For more extensive sun damage, Fraxel Dual laser can comprehensively treat the brown discoloration and textural issues in photoaged skin.
SUN DAMAGE REMOVAL OPTION 2: CHEMICAL PEELS “A chemical peel works by exfoliating or removing the top layers of the skin and rejuvenating the layers underneath,” explains Lisa Pitter-Sandler, PA-C from Schweiger Dermatology Group’s Deer Park office in Long Island. “The fall is an ideal time for a chemical peel to try to erase the summer sun damage and revitalize your skin.” Even darker skin tones can use chemical peels. “A mild to moderate chemical peel is a smart choice for darker skin types because it is a quick and safe way to improve many skin conditions, including dyschromias (pigmentary disorders), acne, complexion and texture,” she says. Peels can contain one or more ingredients, so it’s very important to find a dermatology provider who will choose those ingredients and strengths carefully. “I enjoy using salicylic acid, lactic acid, glycolic acid, resorcinol and hydroquinone in
combination or individually,” says Pitter-Sandler. “One of my favorite peels is the vitalize peel, which can be used on any skin type safely and effectively.” Typically after the peel, patients feel an immediate tightening of the skin, then they start to peel either that day or a day or two later. “The amount of peeling is usually proportionate to the depth and strength of the peel. After the peeling process, you will see a reduction of pigment with tightening of the skin less blemishes and a smoothing effect on the skin,” says Pitter-Sandler. “I put my patients on a regimen after their peels to give them a lasting effect.”
SUN DAMAGE REMOVAL OPTION 3: AT HOME CARE “Fall is the perfect time to repair any “accidental” summer sun damage with high quality anti-oxidants, to re-texturize, build and maintain collagen and moisturize for the drier air quality,” says Marilyn Caezza, cosmetic concierge of Schweiger Dermatology Group in Smithtown, Long Island. See sidebar to the right for Marilyn’s product recommendations.)
MARILYN CAEZZA’S FAVORITE AT-HOME PRODUCTS TO TREAT SUN DAMAGE ARE: • Total Defense & Repair by SkinMedica, which contains three powerful antioxidants to help correct past damage while providing broad spectrum and infrared protection. • Reactive Serum by Neocutis, which contains Vitamins C&E, EGCG (the active ingredient found in green tea) and creatine to repair free radical damage. • Defenage Power Trio consists of a mask, cream and serum. Powerful peptides called “defensins” awaken the master stem cell to make new skin. Noticeable improvements are achieved in a few short weeks. • Retinol Complete by Revision corrects the appearance of and prevents the formation of fine lines and wrinkles, gently exfoliates and brightens skin. • TNS Essential Serum by Skin Medica contains growth factors, peptides and antioxidants that work together to stimulate collagen production. • Dermal Repair by Skin Medica intensely hydrates and replenishes moisture with high levels of lipid soluble antioxidant vitamins C and E. It also contains a hyaluronic acid derivative that can retain up to 40 times its weight in water on the surface of the skin.
(All products mentioned can be purchased at the Schweiger Dermatology Group Smithtown office or by calling 631-721-9225)
Which cosmetic procedures are part of your beauty routine? I suffer from both acne and rosacea, which I feel is controlled with chemical peels and Laser Genesis, so I try to do each monthly if I can find time. I have been getting Botox for over five years to help prevent the lines I was forming on my forehead and crow’s feet. I’m an expressive person! I’m all about still having some movement with my Botox and want it to look natural. My husband never knew I had it until I told him a few months ago. That’s the way it should be.
Danielle Daughteridge, PA-C shares her tried and tested beauty and skincare must-haves, including her secret for combating acne and rosacea.
What’s your beauty product secret weapon? Neocutis Lumiere Eye Cream - I’ve tested so many eye creams and this one is by far the best. I use it twice a day to upper and lower lids to minimize fine lines, plump and hydrate the skin, reduce puffiness, and help the appearance of under-eye circles.
Favorite lip color/lip product? I typically use Aquaphor during the day. If I want a little color I’ll add Nars - Turkish Delight, a soft light pink gloss.
Favorite nail color? OPI - Steady As She Rose, it’s
the perfect nude color all year round. I made all of my bridesmaids wear it for my wedding.
Who cuts your hair? It took me many years to find someone I trusted in the city. Vanessa at Fox and Jane, the Brooklyn location. She also does the best color!
What foundation do you use? I try not to wear foundation if I can help it. In the morning I use Neocutis Micro-Day, my allin-one cream, with SPF, antioxidants, and hyaluronic acid for hydration. It helps with fine lines as well as helps to firm my skin. Sometimes I add a little Bare Minerals bronzer
to my cheeks if I want a little color.
Which cosmetic procedure do you think ever yone can benefit from? Laser Genesis is one of my go-to procedures for everyone. It stimulates collagen production to prevent fine lines and wrinkles, works to shrink the appearance of pores, helps with mild acne scarring, and decreases redness from rosacea. I feel like just about everyone can benefit from it’s effects. The best part - no downtime! I suggest a series of treatments (5-6) a couple of weeks apart for the best results.
What healthy habits do you practice for beautiful skin? I make sure to wash my face morning and night (no matter how tired I am) and apply topical prescription Epiduo gel a few nights a week to target fine
good time to clean up sun spots and pigmentation. My favorite procedure for fall is IPL, an intense pulse light laser that targets the dark spots from sun damage as well as redness from rosacea. Although it can be done any time of year, fall is best because there is typically less risk of sun exposure, which is crucial to healing properly and preventing new sun spots from forming.
Favorite green juice? I like homemade green juice with kale, apple and carrots. I add a little lemon juice to brighten it up.
What advice do you give your cosmetic patients who want to turn back the clock? My goal is not
necessarily to make someone look 10 years younger but to look like a better version of themselves. I never want other people to know they’ve had something done, just to say “wow, “I MOISTURIZE AND WEAR MY you look well-rested.” SUNSCREEN EVERY SINGLE DAY My advice for cosmetic YES, EVEN IN THE WINTER. “ patients is to start slow and build overtime with lines and wrinkles and prevent procedures for natural looking results. acne. I moisturize and wear my sunscreen every single day - yes, even in the winter. Your can’t-live-without-
it skin care product? What skin treatment do you recommend for fall skin? Fall is a
Neutrogena Ultra Gentle Face Wash. It’s hydrating and won’t strip oils but is able to take off my eye makeup. I recommend
it to most of my patients, especially the ones using acne products that may be drying for their skin.
Your favorite body moisturizer? Cerave lotion in summer; Cerave cream in winter. I’m a drug-store product kind of girl.
How do you de-stress? I love to do Pilates and run with my husband. I am training for a half-marathon so my long training runs through Central Park or up the Hudson River allow me to decompress and enjoy the city.
Best beauty advice you’ve ever heard? Start a topical retinoid early and wear your sunscreen every day.
The one skincare tip you tell all your patients? When I was training I was taught: ”Wear SPF all year long. It’s not about temperature, it’s about UV Radiation” and I pass this along to all of my patients. It’s amazing how many people think it’s only important in the summertime. If my patients are wearing SPF 30 daily I’m happy.
A User’s Guide Laser specialist Dr. Sue Ann Wee tells us all we need to know about the latest and greatest lasers to rejuvenate, resurface and completely redo your skin.
One of the best things to happen to skin in modern times is the advancement of laser therapy to treat pretty much every complexion issue under the sun. Fraxel laser may be the best known of the bunch, but there are many other types of skin lasers dermatologists have at their disposal. Here, we speak to Dr. Sue Ann Wee about what lasers can do to help you achieve the complexion of your dreams. WHAT’S THE BEST LASER FOR ACNE SCARS?
SAW: Acne scars can worsen in appearance over time with photo aging of the skin. Both non-ablative (no open wound) and ablative (open wound) fractional lasers can be used to improve acne scars. Fractional lasers deeply treat tiny columns of skin, leaving surrounding skin intact, and stimulate collagen and tissue regeneration to smooth acne scars and skin texture.
Depending on the type and severity of acne scarring and the patient’s skin type, I typically perform between three to six treatments of Fraxel Dual non-ablative laser or one to three treatments of fractional ablative CO2 laser. Fraxel Dual is the most popular laser treatment in my practice due to effective results, minimal downtime, and high safety profile. Fractional ablative CO2 lasers can also produce 40-50 percent improvement in few treatments (usually 1-2) but they do require more downtime to heal.
DO YOU HAVE ANY OTHER TOOLS TO TREAT ACNE SCARS?
SAW: To treat the pink or red discoloration of acne scars, I use the gold standard treatment, the pulsed dye laser (V Beam Perfecta). I perform monthly treatments and typically 3-4 treatments achieve significant reduction in the redness. Hyperpigmented acne scars, in my hands, typically respond very well to Fraxel Thulium. I can also treat acne scars with different tools such as micro needling devices combined
with hyaluronic acid or platelet rich plasma, promoting tissue remodeling. Micro needling devices are typically less costly than laser and other devices. When appropriate, I also may use intralesions steroid injections, topical trichloroacetic acid, hyaluronic acid fillers, and/or punch excision to treat acne scarring.
ARE THERE TREATMENTS SCARS?
SAW: An exciting new tool in the treatment of acne scars is the Fractora RF device by Inmode Aesthetic Solutions, which features a matrix of tiny needles that deliver radiofrequency energy down tiny pins into the skin. This device can deliver tiny zones of deep fractional ablation at select depths and gently heat skin under and around the tiny ablation zones to regenerate collagen formation deep in the dermis.
WHAT’S THE BEST LASER TO TREAT HYPERPIGMENTATION?
SAW: Clear and Brilliant Permea and Fraxel Thulium lasers are nonablative fractional lasers that are effective at removing superficial brown pigmentation. Intense pulse light devices such as Lumecca are very effective at removing superficial hyperpigmentation as well; however, IPL must be limited to lighter skin types. Melasma is a specific type of hyperpigmentation that is challenging to treat as it can always recur. I use a comprehensive treatment approach that may include conservative laser treatment in my patients with melasma.
is also now a class of devices that utilize radio frequency that can be “color blind” to treat wrinkles, scarring, laxity and other textural problems in darker skin types. For darker complexioned patients who want help with scarring, wrinkles, hyper pigmentation and general discoloration, I tailor a treatment program that includes the use of low energy non- ablative fractional resurfacing lasers such as Fraxel Dual and Clear and Brilliant. For tightening skin in patients with darker skin tones, I can use the Titan,Thermage, Ultherapy, or Fractora and Forma device.
WHAT’S THE BEST LASER TO TREAT AGING SKIN?
WHAT LASER DO YOU USE FOR HAIR REMOVAL?
SAW: There are many lasers and devices that effectively treat aging skin, and an in- office consultation is necessary to design the best treatment regimen to address a patient’s aging skin in the context of their medical history, preferred downtime, and goals. In general, fine lines can be treated effectively with Clear and Brilliant laser resurfacing, typically performed 3-4 weeks apart. The number of treatments depend on the patient’s extent of sun damage and goals. For moderate wrinkling, I use the Fraxel Dual laser, usually between 2-6 treatments. This laser is incredibly popular because it comprehensively treats other signs of sun damage such as discoloration and it is proven to make the skin healthier. If patients have moderate to severe wrinkling, then fractional ablative procedures such as fractional CO2 and Fractora radiofrequency device can be performed.
WHICH LASERS WORK BEST FOR DARKER SKIN TONES?
SAW: People with darker skin have more melanin in their skin. This can pose a challenge for lasers that target melanin, such as many hair lasers, intense pulse light devices, q-switched pigment lasers. However, there are lasers with longer wavelengths that may bypass epidermal melanin and therefore be safer for treating patients with darker skin. There
SAW: Our practice has one of the most reputable hair removal lasers on the market called The Gentle Max Pro laser. It features a long pulsed Alexandrite and Nd:Yag laser and in experienced hands, it can safely treat unwanted hair in patients with all skin tones.
WHEN TREATING WRINKLES, WHEN DO YOU RECOMMEND A LASER TREATMENT OVER AN INJECTABLE?
SAW: Wrinkles are an inevitable fact of aging. They come from three main causes: muscles of facial expression, the breakdown of collagen and supporting structures in the skin, and from the effect of volume loss that we experience as we age. Often, the first sign of aging shows up as forehead lines or subtle wrinkles between the eyebrows or around the eyes. In this case, small amounts of botulinum toxin are effective to relax the muscles of facial expression that are the root cause of these lines, thereby not only improving the lines but also preventing the lines from getting deeper. If the wrinkles are coming from volume loss, then I will also use injectables such as hyaluronic acid fillers to artfully restore volume loss. For example, the nasolabial folds (better known as “laugh lines”) are largely a side effect of loss of volume in the cheek area. So, rather than just
filling in or applying a laser to that line, I can improve the actual nasolabial fold most naturally by restoring volume in the cheek, under eye area, and under the nasolabial fold area.
HOW DO YOU DETERMINE WHICH LASERS TO USE?
SAW: In general, for very early photo aging and superficial wrinkles that start in the 20s and 30s, I find that a gentle infrared fractionated non-ablative laser like Clear and Brilliant is a great “starter” laser and has virtually no downtime. If wrinkles are moderate or more severe, then infrared fractional lasers with more energy such as Fraxel Dual is an excellent choice. These infrared lasers have a long wavelength and thus can penetrate more deeply and trigger collagen formation in the dermis of the skin where it matters most. For severe wrinkling and associated lax skin, fractional ablative (or cutting type) lasers and devices such as fractional CO2 laser and Fractora laser can be used. However, determining the most appropriate laser for an individual requires a comprehensive evaluation in the office where I can evaluate an individual’s skin type, skin tone, medical history, dermatologic issues, acceptable downtime, and goals.
FRAXEL IS PROBABLY THE BEST KNOWN BRAND NAME OF LASER. WHAT DO YOU LOVE ABOUT FRAXEL?
SAW: Fraxel is one of the most wellstudied lasers and is regarded as the gold standard non-ablative infrared fractional laser. It has a proven safety track record, and a multitude of clinical studies also prove that it improves wrinkles, scarring, sun damage, and other textural problems. Fraxel is the first ground-breaking fractionated infrared laser, which means that the laser can deeply treat tiny columns of skin (called micro thermal zones) while leaving the immediate surrounding skin intact. This fractional technology means highly effective treatments with minimal downtime and exceptional
safety profile while more effectively improving wrinkles, sun spots, scarring and coarse texture over a few treatments.
WHAT TYPES OF SKIN ISSUES DOES FRAXEL EFFECTIVELY TARGET?
SAW: The Fraxel Dual Restore laser features two extremely effective non-ablative infrared lasers in one machine. The 1550nm laser can target
but with well-planned laser and device treatments, significant improvement in their skin can be achieved.
IF SOMEONE IS NOT READY TO GO FULL FORCE INTO A FRAXEL TREATMENT, WHAT DO YOU RECOMMEND FOR THEM?
SAW: For patients with early signs of photo aging, I recommend starting with the Clear and Brilliant laser, which is a gentle laser that delivers tiny pixels of infrared laser light into “Lasers can be started at almost any age the skin to boost the skin’s own depending on the condition that we are collagen production resulting in treating. ... In fact, many laser and other revitalized skin with smoother devices show greater tissue remodeling texture and tone. It’s a great antiresponse in younger age groups.” aging strategy to start in the 20s and 30s when the skin first starts to show mild signs of sun damage textural problems like wrinkles and and photoaging. scarring while the 1927nm laser can treat hyperpigmentation, sun spots and WHAT ARE THE MOST actinic damage very well. I love that I COMMON MISCONCEPTIONS can easily switch between both lasers in one machine to comprehensively and ABOUT LASER precisely target brown spots, wrinkles, TREATMENTS? scarring, and other sun damage and SAW: Some people think that lasers textural problems within the same will thin their skin. Lasers give very treatment for the same patient. controlled injuries to the skin that allow Furthermore, I can precisely tune the for boosts of collagen formation and laser to keep treatments safe and as tissue remodeling in skin. When the effective as possible across all skin appropriate laser treatment and laser colors. Another advantage is that I can parameters are selected by a laser use the Fraxel Dual laser to treat broad dermatology expert, this is untrue. areas of sun damage, discoloration, and However, lasers are simply tools and if scarring like the arms, shoulders, and used incorrectly by an inexperienced back. practitioner, then there can be an increased risk of complications.
WHO ARE THE BEST CANDIDATES FOR FRAXEL?
SAW: I determine the best candidates through an office consultation so I can closely examine each individual’s skin type and tone, medical and medication history, preference for downtime, and goals. The best candidates are motivated to improve the health and/ or appearance of their skin and can follow pre and post laser instructions before and after their treatments so that the best results can be achieved. The best candidates also understand that perfection is not a realistic goal
WHAT’S THE DIFFERENCE BETWEEN A LASER TREATMENT AND A LIGHT TREATMENT?
SAW: Lasers utilize a single wavelength of light that match a precise target or chromophore. Laser light can be concentrated and amplified to precisely focus a narrow beam of light. Light treatments such as intense pulse light utilize a broad spectrum of light wavelengths. Your dermatologist who has expertise with these devices will
know when a laser vs. light treatment is most appropriate for your skin concern.
WHAT AGE IS A GOOD AGE TO START FOR LASERS?
SAW: Lasers can be started at almost any age depending on the condition that we are treating. For example, port wine stains that cause red discoloration can be treated during infancy. Acne scarring can be treated in teens. And superficial wrinkles can be treated as early as the 20s and 30s. In fact, many laser and other devices show greater tissue remodeling response in younger age groups.
WHAT’S YOUR PERSONAL FAVORITE LASER?
SAW: One of my personal favorite lasers is the Fraxel Thulium laser. It’s a wonderful laser because I can use it to treat sun damage and discoloration across all skin types. It is also FDA approved for treating precancerous spots, so it’s great to be able to have a treatment that makes the skin more healthy while improving the visible signs of sun damage. My favorite device is the Forma and Fractora device. The Forma has become very popular amongst my patients for its no downtime and painless tightening of skin and the Fractora has become one of my go-to devices for treating acne scars in my patients who are still suffering from acne breakouts. Dr. Sue Ann Wee is a board-certified dermatologist who has advanced fellowship training in laser and cosmetic dermatology. She is a top-ranked dermatologist who specializes in laser and cosmetic dermatology at Schweiger Dermatology group and has been recognized as a New York Super Doctor 2013-2016. She sees patients in the new Broadway location near Columbus Circle.
Expert Tips We rounded up our providers to get their advice on the best methods for glowing, ageless skin. Here, their answers.
DR. PATRICIA CEBALLOS, SDG NEW ROCHELLE AND YONKERS “Apply retinol products or a prescription Retin-A formula every night as tolerated. Retinoids rejuvenate the skin by increasing cell turnover and promoting new collagen. They also even out the skin’s pigmentation by redistributing epidermal melanin. Adding a peptidebased moisturizer to your regimen will further boost collagen building in your skin. Look for ingredients tetrapeptide, glycosaminoglycans, and glutathione. They each contribute different effects to help your skin look and feel its best.”
BRIT TNEY DANBURY, PA-C, SDG FOREST HILL S “Healthy glowing skin is all about a daily regimen and having a healthy diet with lots of water daily. The products I love for the morning include CE Ferulic by SkinCeuticals vitamin C serum followed by Elta MD UV Clear sunscreen. It is important to wear a sunscreen with zinc oxide every day and to reapply when outside for more than 3 hours. At night it is important to wash your face every night before bed. I love the Clear Me Pads with glycolic acid and salicylic acid. After washing a retinoid every night is a must! Taking care of your skin today will give you glowing skin for tomorrow!”
A SHLEY STRONGWATER, PA-C, SDG FL ATIRON “A great product to keep your skin looking bright and clean, is Revision’s Brightening Facial Wash. For an instant radiance booster for the cheeks, try one of Nars Illuminators. La Mer’s Radiant Concealer is my daily go to under eye concealer and one of my favorite investments to always look fresh and lively! The ingredients allow for a reduction of under eye puffiness, lines, discoloration, and pore size. Don’t let that glow fade!”
DR. MARINA PEREDO, SDG SMITHTOWN “The environment changes in the fall. In the summer, I tell patients to use lighter products. When we transition into the fall, the weather gets colder and drier. Since there’s not as much humidity in the air, I tell patients to start using creams. My favorites include CeraVe, Neocutis body cream with growth factors, Revision Nectifirm. The most important thing is to still continue with sunblock use - Elta Md Clear for oily skin and Skin Medica Total Defense which is the Cadillac of sunblocks.”
DR. K AREN HAMMERMAN, SDG FOREST HILL S “Get sleep — it’s called beauty sleep for a reason! Getting a 7-9 hours of quality sleep a night does wonders for your appearance. While you’re getting sleep, your skin rebuilds collagen so it will be smoother and tighter. Also, your blood flow gets boosted to your skin while you sleep, which will make you the proud owner of healthy, glowing skin in the morning.”
Lunchtime Quickie What is microneedling? Allison Santhouse, PA-C: Microneedling is a treatment that uses small needles to induce a controlled skin injury to stimulate collagen production. The body responds to the injury by healing the skin and replacing the microwounds with new collagen and elastin, which are the scaffolding of the skin. How long does the treatment take? AS: It is a minimally invasive treatment which takes 15-20 minutes. Most patients require 20 minutes of a topical anesthetic which makes the treatment virtually painless. This is a great lunchtime treatment with minimal downtime. Treatments are performed one month apart, with approximately three-six treatments total. What does the device look like? AS: The device is the size of a large pen and has tiny needles on its tip. There is no laser or light used during the treatment. The needle penetrates the skin .025-2.5 mm in depth pending the skin condition we are treating (acne scars require higher settings and deeper skin penetration).
How does the in-office device compare to athome models? AS: At home rollers should never be used because they can tear the skin and cause new scarring and infection.
Microneedling is the ultimate “natural” skin care fix and can be done in the amount of time it takes to wait in line for a custom salad. Here, Allison Santhouse, PA-C explains why this low-tech treatment is in such high demand for perfect skin seekers.
What skin issues can a micro needling pen treat? AS: Acne scars (new and old), fine lines and wrinkles, pore size/texture improvement. The Rejuvapen is great for wrinkles around the eyes (periorbital wrinkles). I can typically get much closer to the eye with the microneedle vs. a laser. Within one to two weeks, patients notice skin texture improvement, “the Oscar skin glow”, reduced pore size. Acne scars start to improve over time and after one-two treatments some changes are seen. What treatments complement microneedling? AS: Most of my Fraxel patients alternate with microneedling if they have acne scars. For acne scarring, I typically recommend three to four Fraxel treatments and three to four microneedling treatments for best results. Acne scarring results are significantly better when Fraxel is paired with microneedling and we switch off between the two treatments. The microneedle physically breaks up the scar tissue and preps the skin for the laser to
continue resurfacing the skin and build the new collagen necessary to reduce the acne scars. I also like to use microneedling with the Clear + Brilliant laser. Both have minimal downtime and the results are excellent for texture improvement, sun damage and antiaging. They are complementary treatments and appeal to a younger patient who is not ready for the downtime of a Fraxel. What do your patients love about microneedling? AS: There is a subset of patients asking for more “natural” anti-aging treatments, which do not involve lasers, fillers or neurotoxins. Microneedling has captured the patient looking for a more holistic office procedure. Compared to lasers it is often a less costly treatment and is a good alternative for patients on a budget.
Allison Santhouse, PA-C treats patients at Schweiger Dermatology Group’s new Broadway location in Manhattan.
Where to go, eat and play while in this lively Westchester area New Rochelle, located in Southern Westchester County, is fast becoming a hot spot for food, music, and culture. With its close proximity to Manhattan and its recent addition of several luxury condos, New Rochelle is an extremely desirable area. Westchester Yoga Arts 49A Lawton St., New Rochelle, NY 10801
Channel your inner strength at this community-oriented yoga studio in New Rochelle. The friendly vibe mixed with professional and knowledgeable instructors makes Westchester Yoga Arts a much loved fitness destination. Whether you’re looking to change up your routine or take it to the next level, Westchester Yoga Arts is the perfect studio for yogis of all levels. Ohmmmm.
Jolo’s Kitchen 412 North Ave., New Rochelle, NY 10801
This buzzed about restaurant features an ethically conscious, plant-based menu that will delight vegans, vegetarians, and meat-eaters alike. Ingredients and spices are homegrown and worked into Caribbean recipes that rich in flavor and texture. Make sure to try one of the fresh-squeezed juices as well!
Wooden Spoon 16 Division St., New Rochelle, NY 10801
For delicious comfort food in a friendly setting, look no further than Wooden Spoon. They serve fan-favorites such as mac & cheese, burgers, and shrimp & grits, with equally tasty options for the more health-conscious such as the “Spoon Salad” and “The Cali,” a grilled tuna sandwich.
New Rochelle also boasts nine miles of coastline and a variety of parks and nature reserves. We get the inside scoop from Merry Thornton, PA-C who works at our New Rochelle office on some spots to check out: Ward Acres Community Garden Ward Acres Park, Broadfield and Quaker Ridge Roads, New Rochelle, NY 10804
If gardening is your thing but you lack the space at home, rent a plot at the community garden in Ward Acres. You can grow your own veggies while also contributing to the community; six of the plots are donated to H.O.P.E. Community Services Soup Kitchen. Ward Acres also has hiking trails and a dog park.
Glen Island Park 1 Pelham Rd., New Rochelle, NY 10801
Escape from the hustle and bustle of the city at Glen Island Park, a 105-acre park located on the Long Island Sound. It offers beach access, boating, swimming, biking, fishing, hiking, and picnicking. It even has a castle built in the 1800s that was modeled after an ancient Rhine fortress. Westchester residency required for entrance.
Schweiger Dermatology Group, New Rochelle 14 Lawton St., New Rochelle, NY 10801 914-712-2800
Schweiger Dermatology Group opened its second Westchester location in 2015. With a wide array of top-notch dermatologic medical and cosmetic needs as well as surgical services, great skin care is now accessible to Westchester residents.
Merry Thornton, PA-C see patients in our New Rochelle and Yonkers locations and provides both medical and cosmetic services.
Less acne to think about starts with proven results1 • Treats 4 types of acne1,2 • Apply once a day, any time1
ACZONE ® (dapsone) Gel, 7.5% is a prescription medicine used on your skin (topical) to treat acne in people 12 years and older.1
Please see Brief Summary of full Product Information on the adjacent page. © 2016 Allergan. All rights reserved. All trademarks are the property of their respective owners. ACZ70944 07/16
After 12 Weeks
Individual results may vary. Studied in patients 12 and older.1 Illustration of clearing.
37023 Abelson Taylor
Important Safety Information Tell your doctor about all of your medical conditions, including if you have glucose-6-phosphate dehydrogenase deficiency (G6PD) or higher than normal levels of methemoglobin in your blood (methemoglobinemia). Talk to your doctor about any medications you’re using, including topical benzoyl peroxide (BPO). Use of BPO with ACZONE® Gel may cause your skin and facial hair to temporarily turn yellow or orange at the site of application. ACZONE® Gel 7.5% may cause serious side effects, including: • A decrease of oxygen in your blood caused by a certain type of abnormal red blood cell (methemoglobinemia). If your lips, nail beds, or the inside of your mouth turns gray or blue, stop using ACZONE® Gel 7.5% and get medical help right away. • A breakdown of red blood cells (hemolytic anemia) for some people with G6PD deficiency using ACZONE® Gel 7.5%. Stop using ACZONE® Gel 7.5%, and call your doctor right away if you get any of the following signs and symptoms: back pain, breathlessness, tiredness/weakness, darkbrown urine, fever, or yellow or pale skin. The most common side effects of ACZONE® Gel are dryness and itching of the skin being treated. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Learn more at
aczone.com References: 1. ACZONE® 7.5% Prescribing Information. 2. Data on file, Allergan. 2015.
A total of 2161 subjects were treated with ACZONE® Gel, 7.5% for 12 weeks in 2 controlled clinical trials. The population ranged in age from 12 to 63 years, was 56% female, and was 58% Caucasian. Adverse drug reactions that were reported in at least 0.9% of subjects treated with ACZONE® Gel, 7.5% appear in the table below. Adverse Reactions Occurring in at Least 0.9% of Subjects with Acne Vulgaris in 12-Week Controlled Clinical Trials ACZONE® Gel, 7.5% Vehicle (N=2161) (N=2175) Application site dryness
Application site pruritus
Experience with Oral Use of Dapsone Although not observed in the clinical trials with topical dapsone, serious adverse reactions have been reported with oral use of dapsone, including agranulocytosis, hemolytic anemia, peripheral neuropathy (motor loss and muscle weakness), and skin reactions (toxic epidermal necrolysis, erythema multiforme, morbilliform and scarlatiniform reactions, bullous and exfoliative dermatitis, erythema nodosum, and urticaria). Postmarketing Experience The following adverse reactions have been identified during post-approval use of topical dapsone. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Methemoglobinemia has been identified during postmarketing use of topical dapsone (see Warnings and Precautions). DRUG INTERACTIONS No formal drug-drug interaction studies were conducted with ACZONE® Gel, 7.5%. Trimethoprim-Sulfamethoxazole A drug-drug interaction study evaluated the effect of the use of dapsone gel, 5% in combination with double strength (160 mg/800 mg) trimethoprimsulfamethoxazole (TMP/SMX). During co-administration, systemic levels of TMP and SMX were essentially unchanged; however, levels of dapsone and its metabolites increased in the presence of TMP/SMX. The systemic exposure from ACZONE® Gel, 7.5% is expected to be about 1% of that from the 100 mg oral dose, even when co-administered with TMP/SMX. Topical Benzoyl Peroxide Topical application of dapsone gel followed by benzoyl peroxide in patients with acne vulgaris may result in a temporary local yellow or orange discoloration of the skin and facial hair. Drug Interactions with Oral Dapsone Certain concomitant medications (such as rifampin, anticonvulsants, St. John’s wort) may increase the formation of dapsone hydroxylamine, a metabolite of dapsone associated with hemolysis. With oral dapsone treatment, folic acid antagonists such as pyrimethamine have been noted to possibly increase the likelihood of hematologic reactions. Concomitant Use with Drugs That Induce Methemoglobinemia Concomitant use of ACZONE® Gel, 7.5% with drugs that induce methemoglobinemia such as sulfonamides, acetaminophen, acetanilide, aniline dyes, benzocaine, chloroquine, dapsone, naphthalene, nitrates and nitrites, nitrofurantoin, nitroglycerin, nitroprusside, pamaquine, para‐aminosalicylic acid, phenacetin, phenobarbital, phenytoin, primaquine, and quinine may increase the risk for developing methemoglobinemia (see Warnings and Precautions). USE IN SPECIFIC POPULATIONS Pregnancy Teratogenic Effects: Pregnancy Category C There are no adequate and well controlled studies in pregnant women. ACZONE® Gel, 7.5% should be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus. Dapsone has been shown to have an embryocidal effect in rats and rabbits when administered orally during the period of organogenesis in doses of 75 mg/kg/day and 150 mg/kg/day, respectively (approximately 1400 and 425 times, respectively, the systemic exposure that is associated with the maximum recommended human dose [MRHD] of ACZONE® Gel, 7.5% based on AUC comparisons). These effects may have been secondary to maternal toxicity. Nursing Mothers Although systemic absorption of dapsone following topical application of ACZONE® Gel, 7.5%, is minimal relative to oral dapsone administration, it is known that dapsone is excreted in human milk. Because of the potential for oral dapsone to cause adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue ACZONE® Gel, 7.5%, taking into account the importance of the drug to the mother. Pediatric Use Safety and efficacy were evaluated in 1066 subjects aged 12–17 years old treated with ACZONE® Gel, 7.5% in the clinical trials. The safety profile for ACZONE® Gel, 7.5% was similar to the vehicle control group. Safety and effectiveness of ACZONE® Gel, 7.5% have not been established in pediatric patients below the age of 12 years. Geriatric Use Clinical trials of ACZONE® Gel, 7.5% did not include sufficient number of patients aged 65 and over to determine whether they respond differently from younger subjects. Glucose-6-phosphate Dehydrogenase (G6PD) Deficiency Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency may be more prone to methemoglobinemia and hemolysis (see Warnings and Precautions). ACZONE® Gel, 5% and vehicle were evaluated in a randomized, double-blind, cross-over design clinical study of 64 subjects with G6PD deficiency and acne vulgaris. Subjects were Black (88%), Asian (6%), Hispanic (2%), or of other racial origin (5%). Blood samples were taken at Baseline, Week 2, and Week 12 during both vehicle and ACZONE® Gel, 5% treatment periods. Some of these subjects developed laboratory changes suggestive of hemolysis, but there was no evidence of clinically significant hemolytic anemia in this study (see Warnings and Precautions). Rx ONLY © 2016 Allergan. All rights reserved. All trademarks are the property of their respective owners. Based on 72780US10 APC25SX16
ACNE ALWAYS ON YOUR MIND?
ACZONE® (dapsone) Gel, 7.5% BRIEF SUMMARY—PLEASE SEE THE CLINICAL ACZONE® PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION. INDICATIONS AND USAGE ACZONE® Gel, 7.5% is indicated for the topical treatment of acne vulgaris in patients 12 years and older. DOSAGE AND ADMINISTRATION For topical use only. Not for oral, ophthalmic, or intravaginal use. After the skin is gently washed and patted dry, apply approximately a pea-sized amount of ACZONE® Gel, 7.5% in a thin layer to the entire face once daily. In addition, a thin layer may be applied to other affected areas once daily. Rub in ACZONE® Gel, 7.5% gently and completely. If there is no improvement after 12 weeks, treatment with ACZONE® Gel, 7.5% should be reassessed. CONTRAINDICATIONS None. WARNINGS AND PRECAUTIONS Hematological Effects Methemoglobinemia Cases of methemoglobinemia, with resultant hospitalization, have been reported postmarketing in association with twice-daily dapsone gel, 5% treatment. Patients with glucose‐6‐phosphate dehydrogenase deficiency or congenital or idiopathic methemoglobinemia are more susceptible to drug‐ induced methemoglobinemia. Avoid use of ACZONE® Gel, 7.5% in those patients with congenital or idiopathic methemoglobinemia. Signs and symptoms of methemoglobinemia may be delayed some hours after exposure. Initial signs and symptoms of methemoglobinemia are characterized by a slate grey cyanosis seen in, e.g., buccal mucous membranes, lips, and nail beds. Advise patients to discontinue ACZONE® Gel, 7.5% and seek immediate medical attention in the event of cyanosis. Dapsone can cause elevated methemoglobin levels particularly in conjunction with methemoglobin‐ inducing agents (see Drug Interactions). Hemolysis Oral dapsone treatment has produced dose-related hemolysis and hemolytic anemia. Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency are more prone to hemolysis with the use of certain drugs. G6PD deficiency is most prevalent in populations of African, South Asian, Middle Eastern, and Mediterranean ancestry. In clinical trials, there was no evidence of clinically relevant hemolysis or hemolytic anemia in subjects treated with topical dapsone. Some subjects with G6PD deficiency using dapsone gel, 5% twice daily developed laboratory changes suggestive of hemolysis (see Use in Specific Populations). Discontinue ACZONE® Gel, 7.5% if signs and symptoms suggestive of hemolytic anemia occur. Avoid use of ACZONE® Gel, 7.5% in patients who are taking oral dapsone or antimalarial medications because of the potential for hemolytic reactions. Combination of ACZONE® Gel, 7.5% with trimethoprim/sulfamethoxazole (TMP/SMX) may increase the likelihood of hemolysis in patients with G6PD deficiency (see Drug Interactions). Peripheral Neuropathy Peripheral neuropathy (motor loss and muscle weakness) has been reported with oral dapsone treatment. No events of peripheral neuropathy were observed in clinical trials with topical dapsone treatment. Skin Reactions Skin reactions (toxic epidermal necrolysis, erythema multiforme, morbilliform and scarlatiniform reactions, bullous and exfoliative dermatitis, erythema nodosum, and urticaria) have been reported with oral dapsone treatment. These types of skin reactions were not observed in clinical trials with topical dapsone treatment. ADVERSE REACTIONS Clinical Studies Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Schweiger Dermatology Group is a leading provider of medical, cosmetic and surgical dermatology services, under the leadership of Chief Medical Officer, Dr. Eric Schweiger. Cosmetic Dermatology
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OFFICES THROUGHOUT THE TRI-STATE AREA New York City • Long Island • Westchester • Rockland County • New Jersey Midtown 110 East 55th Street New York, NY 10022
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Smithtown, Long Island 260 Middle Country Rd. #208 Smithtown, NY 11787
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