Exercise your Skin

Our motivations to stay fit wax and wane - perhaps there’s an event coming up, or a realization that those favorite jeans have become skinny jeans even if they were never meant to be. We realize that if we want our body to be it’s best, we need to exercise.

Just like the rest of our body, if we want our skin to look it’s best, we need to exercise it, too. Without stimulation, our skin loses more collagen than it makes. Every single year.

This doesn’t need to happen. Just as people of any age can exercise, feel better and be healthier; people of any age can exercise their skin, grow more collagen and have a healthier, more beautiful appearance. This isn’t a dream. Research out of Stanford shows that those who commit to 2-4 easy treatments a year look younger at the end of the decade-long study than they did at the beginning. You read that right - people in the study looked BETTER even though they were 10 years older!

When people come see us, they usually want two things. One is to look better now, and the next is to keep looking better over time. The secret to both is committing to a few treatments a year - much like you commit to exercise or getting your teeth cleaned for your health.

Fall is the perfect time to do it. In fact, anytime you’re ready to do it is the right time. It’s like exercise or anything else. The hardest thing is deciding to start. But when you start seeing the changes, it all becomes so very worthwhile. Just do it.
Call us at (775) 298-1750 or email us here
and start exercising your skin. The person you see in the mirror 10 years from now will thank you.



Jowling at the Moon - October 2014 Newsletter

Gentle readers, forgive me again for my long absence. As most of you know, I’ve gone corporate. Aside from the fact that this has taken me away from you, my gorgeous patients, it’s had a few other nasty side effects. I’m suddenly having all sorts of fancy business dinners (nice!), a lot of fast food meals in the car (not so nice!) and far fewer home cooked meals with my baby, the talented Dr. Gelber (the hardest part!). In addition to crushing my dreams of ever fitting into slim cut trousers and shirts, I now have a little more going on in the chin department. Or should I say, chins department?



That's right ladies- I'm beady in the eyes, sparse in the hair, and heavy in the chin. But not alone. Rebecca tells me that after sun damage, the number one area patients want to improve is their jowls, neck and the area under the chin. Even for those who are quite fit (erm - not me these days) some of us are genetically cursed to carry the burden of extra chub in this area.

[Editor's note, since so many people think that's a real picture... it's photoshopped. I'm not that fat. Yet, anyway. Give me time to work on it]

Over the last few years, Rebecca has demoed device after device, trying to find the best solution that will achieve great improvements. Unfortunately, despite abundant slick advertising promises, we haven’t found a non-invasive solution which consistently gives people the results they want. This has left many patients with no option for improvement except a lower face and neck lift. These usually give nice results, but it's a pricey and invasive solution.

Rebecca has offered liposuction in this area for several years now, but there are very few patients with skin tight enough that just removing fat leaves gives a perfect result, and we’re not in the business of leaving our lovelies with turkey gobbles.

Enter the best solution we’ve found - laser lipo. Our anniversary is coming up, and somehow the good doctor convinced me that the most romantic thing I could possibly get her would be another laser. I've been practicing for twenty years to hone my skills at "acquiescing to whatever she wants", and boy, have I outdone myself this time. Now Rebecca, and her patients, have a shiny new laser that helps melt fat and tighten skin in a fast, gentle, minimally invasive procedure. It’s the best laser out there, and Rebecca’s bouncing off the walls with excitement.

Anyway, my picture and the ones below are extreme examples, but if this is an area you’ve wanted to improve - even if Rebecca has told you there hasn’t been a great option our office could offer you, well, things have changed so give us a call. This may be just the thing you’ve been looking for, and we’d love to see you in!

Hugs, Matthew





* Pictures courtesy of Marc Salzman, MD, and Roger Hogue, MD. Thanks guys!

See Dr. Gelber have her own Forever Young anti-aging BBL Treatment!

Here's a short video showing what a Forever Young BBL treatment looks like with Dr. Gelber as the model. Not only can this treatment improve brown spots, broken capillaries, flushing and stimulate collagen production, but research out of Stanford University showed that doing 2-4 of these little or no-downtime procedures per year can slow down, or even reverse skin aging.  

Rebecca FYBBL youtubes

Benjamin Button Loves Lasers

Have you ever gone on a diet? I have, many times. I worked and worked and worked, deprived myself of all the carby treats that gave me so much happiness. I've sweated on treatmills, gone to sleep early just so the misery would stop, suffered some more... and eventually got where I wanted to be. The compliments rolled in, and I was happy to be back in my skinny clothes and not blush if I had to go out during swim suit season.

And then something would always happen with my treacherous belly. Bread baskets, for example, or ice cream. I'd slowly slip into old habits and wind up back in the Land of Broken Dreams and Shattered Hopes.


If you are in the same boat with a diet, all I can offer is encouragement and a rice cake. But with your skin, it doesn’t need to be this way. Unlike your belly, your skin will never be tricked by Haagen Dazs.

Many of you have already started a journey of improving your skin health with Dr. Gelber at Tahoe Medical Spa. In fact, many of you have done some pretty big treatments to make real changes. Please, please don’t let your efforts go to waste. You don’t need to do that much to maintain your skin, keep it healthy and actually slow down skin aging until it almost stops.

That’s right - please do re-read that sentence. There’s amazing research out of Stanford that shows that with 2-4 easy treatments a year, you can slow down skin aging until it almost stops. This is serious Benjamin Button stuff!

bradold bradyoung

See- I care about you lovely wee lassies and will never turn down an opportunity to show you hunky goodness.

When Stanford followed people who did several no-downtime procedures each year for 10 years, the participants looked on average 2 years younger at the end than when they started. That means that if you start at age 50, when you are 60, you could look 48. Really.

The skin didn’t just look better - when dermatologists looked at before and after biopsies, the older skin looked better than at the beginning of the study - less sun damage, less inflammation and more collagen. On genetic testing, the genes turned on when we get old were getting turned off. And the genes that are turned on when we are young and tell us to make new collagen and healthy skin were getting turned on again. This lets me show you dear Benjamin again:


Actually thats Brad in an unrelated picture, but oh - THAT SKIN!

Sorry to be long-winded, but Rebecca strongly feels that this is the most important discovery in aesthetics in the last decade or more and we really want to share it with you. As you know, we don’t rope people in with emails every week touting the special of the day. In fact, we don’t do discounts or specials at all.

But we really want our patients to look their best. Not just now, but 10 years from now. For this reason, we’ve put together discounted annual maintenance plans that let our patients get these anti-aging benefits and continue to improve their skin. For those of you who haven’t started yet, we can build in an initial treatment to jump-start your program in the first year.

Rebecca wants to encourage everyone to sign up for one of these programs. It will do more than botox, fillers and skin care can ever offer you. Our basic plan probably costs less than you spend on skin care and/or facials in a year, and it doesn't have to be a big deal - its a lot like getting your teeth cleaned, or your car serviced. You wouldn't skip those, would you?

If you sign up by the end of the year, not only will you get the discount of the plan, but we’ll also throw in some awesome skincare. If you sign up for a Silver Plan or higher, Gina’s going to help thank you even more by doing a free SkinTyte treatment for you ($350 value) for collagen growth and skin tightening!

Anyway, sorry to make this email a bit promotional and cheesy, but we are promoting this. As I always say, I want people to stop using the name Incline Village and start using the name Foxytown. I want Incline to be even foxier as we all age together. Keep an eye out on our blog - you’ll get to watch Gina give Rebecca her next maintenance treatment and see how easy this can be.

Still reading? Thank you so much! I'm so proud of you. Since you're still here, I will sign my name and then give you one more piece of pulchritudinous delight.

Hugs, Matthew


New Laser Treatment of Toenail Fungus (Onychomycosis)

Do you or someone you know have toenails that look like they belong not to an urbane sophisticate like yourself, but instead to a boxcar-riding hobo? Good news- what was once treatable only with dangerous systemic antifungal drugs can now be addressed with a quick and safe laser treatment.

Contact Tahoe Medical Spa today to find out how they can make your toes beautiful again!

Here are typical results after two treatments - note that once you eliminate the fungus with the laser, you have to wait for the nail to grow out for it to look pretty again. ClearSense BeforeAfter


Pure awesomeness - Dr. Gelber & Patients captured on film!

Dr. Gelber and Tahoe Medical Spa were selected as one of three centers for protocol development for Sciton's new Halo laser system. They flew in a film crew and made these awesome videos of her and one of her patients... check it out! The first is the video they used to launch the product at the American Association of Dermatology conference last week, the second is a demonstration of a treatment. Halo is a new and exciting way to improve your skin, get rid of sun damage, fine lines, and wrinkles, and just plain look healthier. The patients who have tried it so far have LOVED it - give us a call at (775) 298-1750 or email office@tahoemedicalspa.com to see if it's right for you, too.

halo launch preview

Dr. Gelber Lectures in Paris

photo (2) Dr. Gelber was flown to Paris last week to lecture at IMCAS 2014. She spoke about both ultralight and ultradeep laser treatments as well as the anti-aging benefits of the IPL/BBL fotofacial. She has been invited to lecture in Asia, Australia, and Dubai later in the year. I'ts a great honor and we are so very proud of her! What a great honor - we are so proud of her!

Tahoe Medical Spa Offers Advanced Laser Training

I forgot to post this back in October - my wife is a media sensation! The North Lake Tahoe Bonanza published this very nice article about her. -Matthew



INCLINE VILLAGE, Nev. — When Rebecca Gelber opened her private practice at Tahoe Medical Spa three years ago, her only regret was saying goodbye to teaching.

After all, this graduate of Johns Hopkins School of Medicine had been named “Teacher of the Year” at UC Davis in Sacramento before beginning her 10-year stint as a teaching associate at UN Reno.

“Our home is in Incline Village,” she explains, “so it was a lifestyle decision to make the change. I needed to simplify my life by dropping the long commute, for starters.”

Also, after 18 years in emergency medicine, the doctor had lasted longer than most in a specialty known for its high burn-out rate.

“Another personal goal was to work with happy, healthy patients for a change,” Gelber said. “So I made the commitment to two years of traveling around the country to train with experts in various aspects of aesthetic medicine.”

Many people in the medical community warned Gelber and her husband and business partner, Matthew, that their practice would fail, that the population in Incline Village was not large enough to support such a business.

But they quickly proved the naysayers wrong.

Today, Tahoe Medical Spa’s rapid success has attracted quite a bit of attention in the high-end laser community. The best medical lasers cost upward of $300,000, and most physicians struggle to pay them off.

Because the Gelbers’ laser practice was successful from day one, it didn’t take long for Sciton, America’s premier medical laser manufacturer, to take notice.

Sciton laser customers are now routinely encouraged to travel to Lake Tahoe for training sessions with Rebecca Gelber.

Word has also spread beyond this referral source about this skilled practitioner’s pioneering approach to the art and practice of aesthetic medicine.

Over the past year, dozens of dermatologists, plastic surgeons, their staff and other laser professionals have come from as far away as Vancouver, Canada, along with numerous California locales — San Francisco, Carmel, San Jose, Monterey, Marin and Redding — for advanced training in Incline Village.

Course work at Tahoe Medical Spa’s typically three-day weekend sessions runs the gamut from demonstrating the fine points of ultra-light micro-laser peels, all the way to deep full-field laser resurfacing.

Always of special interest to trainees are Dr. Gelber’s signature strategies for combining multiple modality treatments in a single session.

“The secret to ensuring satisfied patients is to optimize results while minimizing recovery time,” she explains. “Plus, it’s the tiny details that take treatments from average to exceptional.”

To accommodate students, Tahoe Medical Spa has leased an additional office suite for classroom space directly above their current medical offices.

Is this expansion consistent with her goal of simplifying her life?

“No, but I can’t complain about the commute,” she says with a grin. “And when it comes to working with happy healthy patients, I’ve really made the grade. Plus, I’m surprised and delighted to be teaching again … especially in such a beautiful place as Lake Tahoe.”

More information about Rebecca Gelber, MD, and Tahoe Medical Spa, located at 770 Northwood Blvd. in Incline Village, may be found at www.tahoemedicalspa.com or by calling the office at 775-298-1750.


Slingshots & Lasers - Tahoe Medical Spa News December 2013

Greetings again from Matthew! 2013 has been such crazy whirlwind of a year for us. Our wonderful clients have been right there with us every day, giving us the hugs and support that have helped such wonderful things happen. So, even though I'm about to spend some time telling you how awesome and brilliant my wife is, this email is also a big thank you to everyone for being so good to us.

Mostly, 2013 was about a David & Goliath battle. Kind of like this:


On the one side? An entire army of practitioners telling people that they can choose between two kinds of laser treatments. They say you can choose a light med-spa type laser treatment that needs to be repeated over and over,  four to six times, to get a result ... or you can choose a massive resurfacing with a week or more of downtime.

On the other side? A plucky and beautiful doctor in a tiny mountain town, rereading studies on the physiology of laser and tissue interaction, and coming up with her own idea - that it's a lot more efficient  to combine multiple laser modalities in a single session to get great results with 2-4 days of healing.

Guess who won? I'll give you a hint - Dr. Gelber has been getting paid to fly around the country to lecture for the last year or so - and now she's going international, with engagements at conferences in Vancouver, Toronto, and Paris.

Also, a big thank you to our patients, many of our patients have been kind enough to share their experiences and photos as their skin underwent transformation through laser procedures, removing sun damage, broken capillaries, wrinkles and enlarged pores, all with shorter downtimes than anyone else was requiring to get these results.

Our patients have also helped us explore new ways of combining treatments to improve wrinkles in skin texture in decolletage - something most practitioners have said was impossible with either lasers or surgery. You helped us prove them wrong and that is a really big thing!

Of course, it’s the little things that have us come in to the office with a smile on our face every day - an acne patient who made it to a school dance without breakouts, the greasy post-laser hugs which keep the dry cleaner in business and getting to catch up with patients and hear how the parties, reunions, weddings and other events which we planned to have you look your best for went.

Our final thing may be a little thing for you, our patients, day to day but is actually a big deal. Gina Tarantino has joined us at the front desk and as our patient care coordinator. She’ll be making your appointments, getting your tea, abusing you with pictures, but most importantly, rubbing your shoulder, making sure everything before during and after treatments goes perfectly and just plain caring. She’s wonderful at this and as you get to know her, I’m sure you’ll agree.

Anyway, as you and yours enter 2014, I hope you have your own special things, both small and large that you can embrace and give thanks for as well. Thanks to all of you for being part of ours.


Matthew (& Rebecca & Gina)

Big Positive Changes- Tahoe Medical Spa News September 2013

Well, loyal readers, with great honor, comes great competition.Everyone wants to be the top dog, even if the reward is merely an aging Milk Bone... There’s been a bit of an upheaval at Tahoe Medical Spa since the last newsletter announced my 41st consecutive turn as Employee of the Month.

A certain doctor has stepped up her game. She’s in early pushing paper. Skipping snack breaks to take pictures. She’s even been spotted making chai! She’s worked, she’s exceeded beyond our greatest hopes and she’s won this vaunted honor fair and square. It’s time to announce Dr. Rebecca Gelber as the September 2013 Employee of the Month!


Of course she has had one tiny advantage. After Sciton, the top laser company in the world, started seeing how we were combining procedures for patients, and the amazing results we were getting with only a few days downtime, they started paying attention. They’ve been flying Rebecca around the country to teach and more and more doctors are coming to Tahoe to train with us. This all really went crazy though, when they recruited me to take over their top territory - Northern CA, Northern NV and Hawaii!

This is a phenomenal opportunity for me, but also for Rebecca and the spa as well. I’ll be on the road a bit, but I will also be right smack in the middle of the loop and the latest and greatest things happening in the laser industry. I’ll still be around for all the big fun procedures, and we may be able to start offering some hot new treatments to see how you like them.

Part of the changes include the latest addition to our TMS family - Gina Tarantino. Many of you may already know her from around town. We’ve been looking for a way to bring her in for over a year. Now we have it and really think she’s going to bring a wonderful energy to the practice.

Anyway, you know we love hugs and this time they are 100% happy, no holds bars hugs, so go for it!

Matthew (& Rebecca)


Joy and Happiness - Tahoe Medical Spa News August 2013

Faithful readers, I have all kinds of good news this month. I warn you - this email gets atypically serious, but just for a little bit, and then has a happy ending.

First, I want to thank all of my fans for rooting for me. I was victorious over all of my enemies again! This engraved plaque is proof:

That's 41 months in a row. A lot of people said it couldn't be done, but I proved them wrong. Actually, make that a WE proved them wrong, faithful readers- I couldn't have done it without your support.

On to the serious part- I think most everyone in town knows, but Rebecca has had a long series of health problems stemming from traumatic internal injuries she received in a ski collision way back in April 2011. We thought she was mostly healed last year, but in late autumn she wound up with really bad nerve damage in her feet that made them hurt all the time.

She put on a happy and brave face publicly, but the fact is she was bedridden for most of the winter and spring with her feet wrapped up in electric blankets. Her doctors all told her she would never get better, and she needed to learn to live with the pain, but it was close to unbearable.

Every day was sad. After work we would go home and she would be in so much pain that she was a different person. She suffered terribly physically, and I felt like the love of my life had been stolen and replaced by a stranger.

But- good news! Over the last two months they have improved tremendously. They still bother her at night, but she feels really good at work, and recently they've improved enough that we are going out and walking 9 holes at the Mountain Course at the end of the day 4 or 5 times a week.

And every week she gets a little bit better.

I am so happy, for so many reasons. I hope everyone appreciates their health and the health of their family and friends. It sounds really trite but when health problems pop up everything else seems trivial.

I hope this was a happy newsletter? That's how I mean it to come across. Please give everyone you love a hug. And if you have any left, give one to me, its been a rough 10 months and they make me feel better.

Happily, Matthew

PS- If anyone wants to walk the 9 with us at the end of the day, let me know ... we're fun to golf with, although the squirrels in the trees along the sides of the fairways cower in fear.

Why I Hate One-Uppers; A Party Invite; &c. - Tahoe Medical Spa News June 2013

I hate One-Uppers. You know the kind of person I'm talking about - the one who always has to one-up you, no matter how good your story is.You say something like:"I made this cake from scratch!"" and she says: "I made this cheesecake from scratch, too. I even cultured my own cream cheese and grew the raspberries in my sunroom." or "Last night I saw Breathless. Richard Gere used to be so hot!" and she says "I much preferred the raw primal sensuality of Jean-Paul Belmondo in the French original, A bout de souffle." or "I just ran forty miles while being chased by a bear holding a rabid shark." and they say: "I just did a Deb Fishman pilates workout."

Do you know who is a one-upper?

My wife. She proved it today at lunch.

I was telling a hilarious story, about the party we threw at the spa last summer, the one where we planned and shopped and cooked and decorated, and made up raffle prizes and lined up wine and sodas, and then I realized a couple of days before the party that I had forgotten to invite anyone! We rush rush rushed and got the word out, and tons of people showed up and had a great time.

I concluded with a shrug and the phrase "better late than never!"

And she said:

"Well, you're about to be late. As in: The Late Matthew Gelber.

"The summer party is on Thursday and we've got everything all set up and you haven't told anyone!"

Well, she does have a point. We are having a big party on Thursday from 5:30 to 8:00. That's this Thursday, the one in two days, the 20th.

We planned and shopped and cooked and decorated, and made up raffle prizes and lined up wine and sodas, just like we did last year. And last year it was super fun and lots of fun people showed up- so this year will be, too.

Hopefully we will see you there?

Oh, the following pics are eye candy for you ladies. You might need to click on a button to tell your email program its OK to show them though.

 breathless (1)
And, just as a bonus, BECAUSE I CARE ABOUT YOUR NEEDS:
Mr_T_BA (1)


The Not Quite Late Matthew Gelber

Looking Your Best on Your Special Day - Preparing for Events

There you are on my afternoon calendar - my 2:00 pm appointment. The calendar lists your name, the word "consult", and maybe if I’m lucky, a little hint in the notes field to let me know why you are coming in to see me. The notes are different each time, but in a way each say the same thing: daughter’s wedding, class reunion, 40th birthday. Each one of them is a special event in your life, and one that you want to celebrate by feeling a bit better about yourself. And what makes it special for me? Well, you think I can help.

Our lives are scattered with special events. Most of the time we are so busy we barely notice them until they've long gone and all we have are a few pictures to remember them. There are others that are so important that we take extra time to plan for them, and maybe think about what we want to look like in those pictures we’ll look back at someday. Some events are even special enough that they make us reassess and make changes that we have been wanting to make for a long time, but would never consider undertaking if it wasn't for something special.

Not to put myself out of a job, but I’d like to start off by saying that what people will remember of you from those events is not how you look, but rather your happiness - your happiness in this special event and being able to share it with others who are important to you.

That’s all very easy to say, but for many of us, our happiness in those moments, our self-confidence and willingness to open ourselves to the experience whole-heartedly is enhanced when we feel more confident in our appearance. In fact, our happiness might be just a bit greater if we feel we are looking our very best - or looking better than we dreamed we could look.

That can come from the perfect dress, a hairstyle that makes you feel wonderful or makeup artfully applied. But if you’re coming to me, you probably have a few areas of your face and body which you would like to improve to help you feel your very best.

Some of the changes you would like to make concern areas which have taken years to develop, and may have been present for a very long time. That doesn’t mean that you have to accept them. Still, if you want to be able to make changes, it’s going to take time. So try to fit me into your calendar early - you’ll have a lot more options.

In a perfect world, here’s a schedule to consider if you want me to be able to help you best for your special day:

1 Year Before Event

  • Schedule initial consult to make aesthetic plan
  • Start any skin improvement which may require multiple sessions, such as spider veins, acne scars, brown spots, sun damage, or skin texture issues
  • Start any medically assisted weight loss
  • Start any prescription skin products to improve acne, rosacea, hyperpigmentation, or fine lines and wrinkles

 6 months Before Event

  • Undergo any laser treatment where skin tightening is the goal
  • Start Latisse for maximal eyelash enhancement

5 Months Before Event

  • Undergo first session of Botox to make sure injection pattern is perfect

1-2 Months Before Event

  • Botox and filler appointment
  • Last laser appointments

 2 Weeks Before Event

  • Last touchups to Botox and filler

Honestly, I rarely get clients who are planning a year in advance. My hope writing this is that maybe more people will think about aesthetics early, and make the experience a lot less stressful than trying to make a big change two months before an event. I’m glad to help at any stage before an event, and I’ve had many last minute calls where I did everything I could to help on very short notice - but if you really want to make some changes and turn some heads at your special event, call me sooner rather than later. We’ll have a lot of fun getting you where you want to go!

Fresh Snow, Fresh Starts - Tahoe Medical Spa News January 2013

Greetings once again from Matthew. This email should have gone out last month but the Doctor and I were busy skiing, zapping each other with our lasers, and drinking eggnog out of five-gallon plastic buckets. And procastinating. I was contemplating blowing off writing this email entirely and waiting until next month to send a newsletter, but what happened this morning got me thinking.

You know, I like things that are fresh.

Fresh snow, compared to snow that has already been skied. Fresh coffee, compared to coffee that has already been left to sit on the warmer. Fresh oats, compared to oats that have already been through a horse.

When I woke up this morning, I thought I'd have to settle for two out of three. Fresh coffee - easy! Fresh oats - easy! But fresh snow? It hasn't snowed in a week, and its been sunny and hot. I wanted to give up.

But I persevered. I had to work a bit harder to get there, but look what I found:
fresh snow fresh start

It got me thinking about a few patients we've had, who were resigned to having sun-damaged skin. "I'm too old," they say. "My skin is too far gone."

Nonsense! Its never too late for a fresh start. You might have to work a bit harder to get there, but everyone can have fresh-looking skin.

(Ha- do you see what I did there? In case you missed it, all expenses related to getting that picture are now a tax deduction.)

So, we're hoping you'll join us in a New Year's Resolution: Having nice skin. To help motivate you to make a fresh start, we're offering discounts for those who prepay for packages. We're making it simple. Our blanket recommendation for pretty much everyone is that each year they should get, at a minimum, a Zero Max℠ treatment (a combination of two laser treatments that requires zero downtime) and a Three Max℠ treatment (a combination of four laser treatments that requires three days out of the public eye).

These combination treatments will reduce brown spots and spider veins, brighten the tone of your skin, and tighten and improve the texture of your skin by stimulating collagen production. And there's good research that these treatments do more than make your skin prettier - they actually make your skin healthier and keep it that way.

So, if you prepay this month for both treatments, we'll give you 15% off. You can schedule them whenever you want. And, you can prepay for bigger packages too, if you want a bigger effect - also for 15% off.

As long as you're at it, if you pay for this year's Botox and Latisse now (at least three treatments), you can have 15% off on those, too. Cause I'm crazy!

In case you're wondering, my other New Years Resolutions include being nicer to my wife, and never leaving a task unfin

The Spanish Zamboni & Other True Tales - Tahoe Medical Spa News December 2012

Faithful readers, forgive us for our long absence from your inbox. We were gone for a while on a gluttony tour of Spain, and then had to spend a month digesting after we got back. Of course I have pictures, but only a couple, and they have stories. First, the Spanish Zamboni!

I try not to judge other people (as long as they are keeping up on their lasers & botoxes), but the ensuing events tested my cultural relativism a bit. I'll spare you the details but NO ONE, anywhere, ever, has rooted for the bull as much as I did. I was muttering, loudly enough to attract attention: "The cape is a trap! Go to the right of the cape. To the right!" Rebecca had to keep shushing me, reminding me that the bulls can't understand me since they are Spanish and I am giving them advice in English.

On a happier note, people are really pretty in Spain. Fashionistas will be interested to learn that tight trousers are in for beautiful Spanish women. As we walked I kept my head on a swivel, doing important "market research". Rebecca tried too, with less success. I saw her try to ogle a guy and she tripped over a planter, fell off the sidewalk, and yardsaled everything in her purse. Fortunately I was there to help! I chased the guy down and brought him back so I could take a picture of them together.

At the time I thought it was quite funny. But now that I peep it closer I'm confused! Why is he holding her business card?

At the Barcelona airport, you exit the country through passport control into the international terminal. Then you look around for the gate and flight information screen and can't find it... oh! There it is... on the other side of the passport control you just came through. Can you read the flight info in the picture below?

Neither could we, or anyone else, so we all lined up and trooped back through customs to check, and then came back again. I have five passport stamps from Barcelona. Why would they do it that way? I couldn't come up with a good explanation.

But, you know what I'm getting better at explaining? Lasers! I realize that we, and everyone else who does laser skin improvement, explain everything wrong. We talk about the technology: microns and ablations and fractional and this and that and people get confused.

Really, we all have the same problems - age spots, laxity, fine lines and wrinkles and those annoying spider veins in the corners of our noses and cheeks. And we mostly need the same treatments.

The fact is, if you talk to anyone who does lasers for a living, they all do treatments on themselves, and they all pick them the same way. They say: "How many days do I have to look bad?" and then they do 3-4 different treatments at the same time with a matched healing time. You can do a MicroLaserPeel with 3 days tof recovery, or a Fractional Resurfacing with 3 days of recovery - or you can do both together and still take 3 days to recover. And you can add in a BBL and a SkinTyte session and still not increase the recovery time.

Its kind of like cooking Thanksgiving dinner- you've got to be home while the turkey cooks, so you might as well chef up some cranberry sauce and mashed potatoes at the same time.

So, we're going to quit describing things with names that don't make any sense. Instead of a 4-micron peel, we'll call it a one-day peel, because that's how long you look bad. Instead of an 11%, 75 micron fractional resurfacing, we'll call it a 3-day fractional, because that's how long you look bad.

Most people are coming in and getting multiple treatments at the same time, but we're going to make it more clear - we have a One Max℠ package, which is the maximum result you can get with one day of down time, and a Two Max℠, which is the maximum you can get with two days of down time. We also have a Three Max℠, Four Max℠, and Five Max℠, but you'll have to guess what those are.

We even have a Zero Max℠ package for the maximum result you can get with no down time at all.

We have found that when we combine treatments like this people get much, much better results than any single treatment alone. They're happier, so we're happier. We're introducing the packages with a 25% discount until the end of the year. So, if you will have a few days (or no days) free and want to look nicer for the holidays, let us know, we would love to make you more ogle-able.

Have a great Holiday Season, Matthew

Hot for Teacher, Muffin Tops, &c. - Tahoe Medical Spa News September 2012

Pittsbugh, 1993. I was just a country bumpkin, lost in the Steel City. I had blundered my way into town two days before, and some of my fellow paramedic students were disgusted that I had never been to a bar. They dusted me off, picked the hayseeds out of my ears, and took me to a shady pool hall across the river.

Within a couple minutes of walking in, they introduced me to a cute little redheaded girl. I've always been a smooth-talking ladies' man, and I opened with a surefire pickup line:

"So... are you a nursing student?"

"No," she said. "I'm a doctor. They let us do that now, you know."

"This is awkward," I said.

But it got better from there, in spite of the fact that I was wearing sheepskin bedroom slippers with the sheepy part on the outside.

After talking for a few hours, I told her that I better go, since I had class early in the morning. She said that she should go too, since she also had class in the morning. Unfortunately, I didn't ask her for her number since she was way too good for me and I was intimidated.

Next morning, I walked into class and the cute little redheaded girl was my teacher. True story! It was just like the start of Top Gun, but nerdier.

Unfortunately, I had to give her a negative teaching evaluation, the only one she received in 18 years of teaching medicine. It stayed in her permanent file and they read it when she left that job to move to California:

"Instructor is too short to be seen from back of room."

I tell this story because a lot of new developments have unfolded for us since my last newsletter.  Dr. Rebecca has gotten quite a reputation very rapidly and a number of companies and accrediting boards are having her do teaching and testing. Sciton (the best and most respected laser company in the world) just made her their sixth trainer in North America, and will be flying in physicians to stay with us and learn how to do laser treatments and resurfacing.

She is also lecturing nationally on botox, filler, sclerotherapy, and other aesthetic techniques, and is going to be a board-certifying examiner. She is really excited- since retiring from the medical school she has really missed teaching, and now she gets to do it again. I watched her teach a couple days in San Francisco last weekend and I see why- the doctors follow her around like little ducklings... it's cute.

What else? Oh - we'll be gone for a few weeks starting in October 3, so if you want to see us before, please schedule ASAP so we can get everything done beforehand.

Normally this is the part of the newsletter where I include a funny picture that ties into the story. Here's the picture, but the connection is a little convoluted. I'll give you a hint: I took it to commemorate out recent romantic 4 day/3 night getaway at a truckstop motel in western Pennsylvania. It was kind of like Stockton, but without the glitz and sophistication.

Also, Dr. Rebecca is doing our stem cell talk again at the eLearning Cafe on Thursday September 20th at 5:30, in case you missed it last time.

And - if you a haven't been yet, go check out IV Coffee Lab next to Bite, which Matt the FedEx Guy and his wife Allie just opened. The coffee is really good and they are super nice.

Have a great September, Matthew

Laser vs BBL / IPL For Dummies

We spend a lot of time explaining the differences  between treatment with laser and treatment with Broad Band Light (BBL, as known as Intense Pulsed Light, IPL or photofacial) treatments to our patients. Many of them have tried to figure it out on their own by researching it online, but there is so much information put out by so many manufacturers that its easy to get overwhelmed. This article is intended to provide a simplified explanation of what you can accomplish with BBL and what you can accomplish with ablative laser technology. There is a lot more to the field, but this should at least get you started. You can also just remember this and skip the rest: BBL for fixing discoloration, resurfacing lasers for fixing skin texture.

We'll start with a quick discussion of terminology and facts (don't worry - just the basics!), then talk about the conditions that are typically treated, and then come back to specific applications.

A true laser produces a pulse of energy of a single wavelength. Some lasers are very high powered, some are low powered, and some offer a range of power settings.

BBL and IPL and photofacial are three terms for a class of device that is not a true laser- it uses a flash lamp to produce light energy of many wavelengths at the same time. Just like lasers, different devices offer a wide range of power outputs. High-energy treatments create laser-like effects. BBL is Sciton's trademarked name for their IPL machine which is far more powerful and controllable than previous generation IPL devices.

With any of these devices, the higher the energy levels used, the greater the result will be. Along with this, the treatment will be more uncomfortable and the patient will have a longer recovery period afterwards, during which they can be have swelling, peeling or the need to use a vaseline-type recovery balm. There is no device that will create a substantial effect in a single treatment without a recovery period afterwards. As a general rule, the more you invest in initial discomfort and subsequent recovery, the more you will be able to accomplish in a given treatment.

People come to us for to address two basic problems - textural problems, and discoloration problems.

Textural problems include fine lines, wrinkles, acne and surgical scars, enlarged pores, bumpy or "orange peel" texture and overall looseness or laxity.

Discoloration problems include age or sun spots, spider veins, rosacea, melasma, and dark spots from old acne scars or trauma.

Lets talk about textural problems first. All of these problems can be addressed by removing old damaged collagen and/or stimulating new collagen production, which also tightens skin. In the past, a number of laser frequencies were used that could theoretically penetrate down into the lowest layers in the skin and stimulate cells in the deep dermis without requiring much downtime. Unfortunately most gave modest results at best, and those improvements developed slowly after treatment.

The gold standard for addressing textural problems is to carefully and precisely remove damaged collagen and skin. When these grow back, they grow back tighter, with less wrinkles, smaller pores, improved scarring and texture. There is a huge range of treatment intensities, from very very light (one day of recovery) to intense (2 weeks of recovery).

To remove  skin cells, you use a high-energy laser with a wavelength that reacts with water. Since skin cells are 99% water, they turn into steam so fast that it is possible to remove cells with minimal transfer of heat to the cells left behind, resulting in faster recovery times. Newer lasers also allow you to add additional heat to the remaining cells for further collagen production and skin tightening, although doing so will slightly prolong healing (no pain/no gain).

With this type of treatment, the deeper you go, the greater the improvement, but also the longer the recovery time. Treatments can be further customized by the addition of fractional technology. This allows you to treat only a fraction of the skin (typically 5-30%). By doing so, you can go deep, making a real difference in scars and wrinkles (which are based deep beneath the surface), with a shorter recovery, since much of the skin is left intact to heal in more quickly.

So, to further complicate the issue, although ablative lasers will have their primary effect on texture, if you are going deeper to the extent that you remove abnormal melanin, you will have some effect on pigment as well. Still, to keep things simple, the primary effect of ablative lasers is on texture/laxity.

In contrast, the selected light waves used in BBL/IPL interact with color targets in the skin. These color targets can be brown (melanin/sun damage/hair) or red (hemoglobin/spider veins/rosacea). Different filters are used to maximize interaction with the chosen target.

BBL/IPL penetrates deeply through the layers of skin without ablating or removing skin cells. It interacts with the abnormal target, heating it up.

With abnormal melanin or brown pigment, this can result in release of melanin granules by the cells which stored them. The granules then come to the surface where they often form microcrusts and flake off or may be absorbed by the body and fade away. Either way, the result is both reduction in the visible appearance of sun damage as the actual cellular damage. Research suggests that after a series of treatments, the treated skin actually has less damage and is healthier.

With abnormal redness, broken capillaries, rosacea and reddish-purple birthmarks, a different filter is used, resulting of heating of hemoglobin and thus red blood cells in unhealthy vessels near the skin surface. When heated, these vessels can close down, resolving both the appearance of the broken vessels and the flushing and rosacea complications which result from them.

Although BBL/IPL/Photofacial treatments are often described as "no downtime" treatments, this is not necessarily a valid statement. Like any skin treatment, if you do very light BBL treatments, there will be little discomfort with the treatment, little in the way of initial swelling or pigment coming to the surface, but in the end, little results. Using higher intensities, BBL is more uncomfortable and will result in more pigment coming to the surface and can also result in mild to moderate swelling - particularly if the area under the eyes and broken capillaries are treated aggressively. The tradeoff is that more intense treatments give very impressive results.

A skilled provider using a high powered system has multiple variables which can be adjusted, so talk with your physician about what level of improvement you are looking to achieve and whether you would be able to handle looking less than perfect for a few days if it will get you more results.

Finally, just like laser, there is some overlap. Although BBL/IPL gives a primary improvement in pigment - browns and reds as we discussed, it does put heat into the deeper layers of skin. Over time this results in more collagen production. People who complete a series of BBL/IPL usually do note improvement in fine lines and mild improvement in tone and texture. Most commonly, between the collagen and pigment improvement, people note an overall glow or luminosity to the skin. That being said, deeper textural problems like deep wrinkles and scars need laser technologies for significant improvement.

So, which to do?

If your problem is mostly color, BBL is probably your best bet.  If mostly texture, then laser may offer better improvement.

Your ability to fit into your schedule a period of looking less than perfect (can range from spots being more prominent to swelling, to downright scary looking redness, oozing and peeling). As a general rule, the worse you can handle looking, the more you can accomplish in a single treatment. Laser treatment will generally leave you with more downtime than BBL, although a very light laser treatment can have less downtime than a very intense BBL.

Finally, this isn't all either-or. Most people have some combination of pigment and textural issues and are bothered more by one or the other. Laser and BBL treatments can be combined both in a single session for maximal results or done at different times as a patient's budget and schedule allow.  A thorough evaluation of your skin issues and goals and a thoughtful discussion with your skin care physician will let you determine which therapies will give you your very best results.




Dr. Gelber can make your man hotter than Mr. Germany

A few weeks ago Dr. Rebecca and I went to a conference down in the Bay Area. We decided to stay in a small hotel noted for flamboyant and extravagant decor, and it didn't disappoint. The entryway, for starters, contained more carved scantily clad seraphim than the Vatican and had not one but two reproduction statues of David flanking a massive collection of nudes. I was slightly awestruck. While chatting with the pleasantly insane proprietress, an expat from Munich, I asked her which was her favorite piece of art. To which she replied:

"Ah, you must see Mister Chermany, he is magnificent- upstairs in zee dining room."

After checking in I went exploring, imagining a wildly inappropriate Aryan supermensch lording it over the loose-meat sausage and hollandaise. I found him, but he was not at all what I expectected:

No moral to this story but it does lead me into our special this month: If you come in for botox, fillers, laser or BBL, bring a man with you and he can have a free light laser peel or BBL treatment ($450 value).

The women in Incline are starting to look way too hot for their men, and we as a community need to address this imbalance.

Once a man actually tries this stuff out and realizes we aren't going to try to make him look like that Aerosmith guy (Steven Tyler?), but instead just a little bit healthier and less haggard, they usually like it and become regulars.

So- try and talk him into it. Like my wife says to me: "Shut up and put on the numbing cream. I'm the one who has to look at you."

In other news! We're doing a talk on stem cell therapy at 6:00pm on Tuesday 8/21 at The Perfect Workout, Deb Fishman's Pilates studio next to Raleys in Incline Village.  A lot of people think we just do aesthetic work, but our main interest has always been regenerative medicine - we both want to ski till we're 100. We've been performing stem cell therapy for joint injuries and arthritis for over a year now, with excellent results. I recommend learning about it- even if you don't have arthritis yet. This is definitely the future of medicine. If you do want to come please RSVP so we know how much food to make.

Have a great week, Matthew

Keep your skin beautiful and protected this July!

Summer's here and with it come Tahoe's wonderful sunny days. This makes for a beautiful hike, paddle or round of golf, but at Tahoe Medical Spa we also want you to enjoy a summer (and lifetime) with gorgeous, healthy skin. Come in during the month of July and if you mention this ad, we'll give you your choice of our one of our broad-spectrum titanium-based sunblocks for free with any service. Hope to see you soon!

Party, Party, Party!

So summer's here, and we'd like to invite all of you to come join us Tuesday for a Luau to kick the season off in style. There will be great BBQ and other food treats, wine and beverages and raffles for wonderful prizes including spa pampering and your choice of a light laser peel or IPL/BBL treatment for sun damage, rosacea, acne or facial spider veins - a $450 value. It's always a good time and a fun crowd, so we hope you can make it by the office/spa, this Tuesday, June 12 from 5-7pm.

 For Rebecca's 14th annual 29th birthday party back in March I bought her a Sciton Joule laser* and some other goodies, so we now have the most advanced tools in the Reno/Tahoe area to get your skin feeling and looking its best. If you dare, we'll be offering complementary skin analysis at the Luau to create a scientifically based personalized treatment plan for your skin. If you can't make it Tuesday, give us a call and schedule a consultation. We'd love to help you look your very best this summer!

Have a great week, Matthew

*Yes, I used her checkbook to buy the laser... she pays me in company scrip and I can't seem to pay off my debt at her company store...