Top Weight Loss Barriers for Women

May 14th, 2012

Side GrabAs if pain in childbirth wasn’t enough, women in society today have tremendous loads to bear. Men aren’t exempt from societal pressures, however when it comes to weight loss, there’s a reason the weight loss industry is primarily targeted at women. Ironically, women are under the most pressure to be thin and fit and yet a woman’s body is less predisposed to let go of extra fat! Talk about setting you up for failure. Biologically speaking, a woman’s fat stores keep the body prepared to carry a fetus by storing nutrients for later use. The average number of children born to a family today is much smaller than it was 100 years ago, so why haven’t women’s bodies gotten the memo? There are many reasons why.

HORMONES. A woman’s body contains a complex mixture of hormones that regulate how much fat is stored. Estrogen tells your body to store fat, and testosterone tells your body to burn it. Women have more estrogen than testosterone, so naturally, estrogen wins out. Women are also more likely to have underactive thyroid glands, which regulate metabolism — too little thyroid activity can inhibit weight loss and even cause weight gain.

BODY COMPOSITION. Ever heard a man get a compliment for his hourglass figure? Not likely. Women’s bodies just naturally contain more fat than men’s bodies, giving them not only the potential nutrition for a fetus, but also creating that softer, curvier appearance that defines femininity. The normal body fat percentage for an adult woman is 21 to 31 percent, but it’s only 14 to 25 percent for men. While muscle requires more energy just to exist, fat just sits there. That’s why men, with their higher muscle mass, have an easier time burning calories.

MOM SYNDROME. Pregnancy and breastfeeding are a time to focus on your baby and the nutrition you’re providing for him or her. Even long after the pregnancy and breastfeeding ends, the life of a mother is filled with weight gain triggers. With the focus on family, work, and home, mothers often put themselves last. Stress, lack of sleep, lack of time to exercise and child-friendly meals can all contribute to weight gain.

TENDENCY TO TRY ANYTHING TO LOSE THE WEIGHT. Oh, the constant battles women face in their minds and with their bodies, trying to achieve perfection in an imperfect world. When women do decide to diet, they tend to gravitate toward “easy fix” solutions that promise quick, effortless results. Especially with summer nearly here, you’re probably looking for quick ways to trim down the fat before you bare all to the world in a bathing suit. Many crash diets just eliminate water weight, which comes back quickly once you stop the diet. As you also know, a severely low-calorie diet is not only unsustainable and emotionally draining, but sends your body into “starvation mode.” In comes that fight-or-flight mode again, causing your body to slow down your metabolism and make it more difficult for you to lose weight in the future.

WEIGHT-SHYNESS. Women tend to shy away from weight lifting because they don’t want to look like bodybuilders. The truth is, you won’t bulk up. A twice-weekly routine using weights heavy enough to complete no more than 12 reps will build lean muscle, and it can help change your body composition. The higher your muscle mass, the more calories your body will burn just existing.

While there isn’t a quick-fix for shedding a few extra pounds, there are two ways you can get beach ready for THIS SEASON, and experience healthy, long-term weight loss as well.

Exilis

After much research, Dr. Alexander Gross at Georgia Dermatology is convinced on the effectiveness of Exilis. If you’re looking for a non-surgical solution and are a good candidate, he may recommend Exilis™ for you.

Why Exilis? Exilis uses radiofrequency energy to heat the deeper tissues and to ramp up the metabolic activity of the fat cells, causing them to shrink. The patient satisfaction rate is high, with circumferential reductions ranging from 4 cm to 15 cm of volume loss after 4 treatment sessions spaced at 2 week intervals. All of this occurs in a safe, painless, and quick 20 minute office procedure with no downtime or limitations on regular activities.

Cool Laser Liposuction

You may also be a good candidate for traditional tumescent liposuction and CoolLipo™, a minimally invasive outpatient procedure that liquefies excess fat for easy removal. Cool Laser Liposuction is ideal for small fatty areas, especially for the facial, neck, and chin area. Results should be seen within a week after treatment, and skin will continue to improve months after the procedure is completed.

Contact Georgia Dermatology today to schedule a consultation that takes you one step closer to removing your unwanted fat before peak pool season.

Is Cool Laser Lipo Worth the Consideration?

May 2nd, 2012

A New Solution for an Age-Old Problem

Cool Laser LipoPicture this: You’re lounging by the neighborhood pool on a hot summer day. You lie there in your semi-comfortable but effortless-looking lounge chair position designed to hide your backside, flatten your tummy, and make your legs longer and skinnier. You’re sipping an icy drink, and then it hits you. You’re efforts to stay hydrated are now haunting you by that ever-increasing pressure on your bladder. You wait as long as possible, until you can ward off the pain no longer.

Yep, you do it.

The dreaded walk of shame. The dreaded endless path from your chair to the bathroom across the pool. You must abandon that perfect pose for nature’s call, which means all of nature will take affect. Hello gravity. Hello muffin tops, saddle bags and three pregnancies. Hello to the 15 people you have to walk in front of to get to your destination.

While this may seem dramatic, chances are you’ve felt some angst during these skin-bearing seasons in the past, and no matter what you do, every year, the same insecurities creep up. Covering up with a towel gets old. We want our bodies to reflect our efforts in the gym and our careful diets; but sometimes our bodies just don’t respond the way we’d like.

Most of us would rather try some useless topical “smoothing” cream instead of undergoing an extensive surgical procedure or a dangerous diet. They can be expensive and risky, and some procedures require significant time for healing.

Why not consider doing something advanced and effective for this swimsuit season? For all of those who want results without extensive surgery and down time, Cool Lipo (laser-assisted lipolysis) is a new, minimally invasive technology that liquefies fat for easy removal. It is a laser-based procedure that breaks up and removes fat cells in areas such as under the chin, tummy, inner thighs and jowls or areas with loose skin such as the arms. In addition, the unique wavelength of the CoolLipo laser system directly contracts collagen and tightens the skin, an effect not seen with standard liposuction.

Cool Lipo’s Benefits• Gentle fat disruption and removal technique for small areas• Short procedure in your physician’s office• Minimal downtime post-procedure• Safe with minimal bruising and side effects• Treats areas that are difficult for conventional liposuction• Less invasive than a neck or face lift• May be performed under local anesthesia only.

So, to answer the question, yes, it’s definitely worth the consideration. Schedule a consultation with Georgia Dermatology to learn how Dr. Gross can perform a combination of cool lipo and tumescent lipo: http://www.gadermctr.com/body-contouring.php to reduce fat and sagging. So you have a busy life, and scheduling a consultation may slip your mind. You can rest assured. The dreaded walk of shame is there to remind you.

Be Done with Adult Acne!

March 26th, 2012

Adult AcneYou’re no longer sixteen anymore, but the pores on your face seem to think otherwise. If you suffer from more than the occasional breakout, (and it’s been at least a decade since attending your high school prom) chances are you’re frustrated and wondering why you are still dealing with acne as an adult. Why not determine what is causing your acne, so you can prevent future breakouts?

Acne is influenced by several factors, many of which are out of your control. The one thing you can control is how you treat your face. Knowledge is power, which means that when your done reading this, you should feel more empowered in your fight to minimize or potentially eliminate occasional acne outbreaks on your face, back, shoulders, neck, chest, limbs, or elsewhere merely by changing a few small behaviors.

1. Lower Your Stress Levels

Your body produces hormones, like cortisol, when you’re stressed. These stress hormones not only can impede weight loss, they also stimulate an overproduction of oil from the sebaceous glands in the skin. Acne then develops when the excess oil mixes with skin cells and bacteria. If you regularly suffer from stress, try to take short breaks throughout the day, exercise regularly, and get more sleep.

2. Adopt a Hands-Off Policy

Have you ever tried to eliminate a zit using your fingers, only to wake up with three more new zits who decided to join the pimple party? Or at work, do you often rest your chin or cheeks in your hands or rub your nose and forehead? Touching your face only encourages the growth of bacteria and causes infection to the areas most inflamed by adult acne. The solution to this is simple: HANDS OFF! As hard as it may be to not tamper with the problem, picking or squeezing can drive acne bacteria deeper into the skin, leading to more inflammation and possibly to permanent scarring. So try to resist the temptation to touch. If you can’t resist, clean your hands thoroughly before touching your face, and disinfect the area.

3. Check Your Hair and Skin Products

Your daily efforts to look better could actually be making your skin look worse. Hair conditioners, gels, pomades, shaving products, cosmetics, moisturizers, sunscreens, and other products that contain oil can clog your pores and cause a breakout. Try switching to noncomedogenic hair and skin products. The labels should indicate whether or not they are. In addition to switching to noncomedogenic products, consider minimizing how many products you use. Too many chemicals can irritate the natural balance of your skin. Reducing the number of products you use can further reduce outbreaks. Keep in mind that even if you use noncomedogenic makeup, you should never wear it while working out, as it can still clog pores when mixed with heavy sweat. Try going natural during intense sweating sessions.

4. Don’t Let Sweat Stick Around

Be sure to shower as soon as you can after your workout. For example, when you run, your sweat and skin oils mix, trapping substances in your pores. If a quick rinse isn’t possible, dry off with a towel and put on dry clothes immediately. Sitting around in sweaty, tight, synthetic workout clothes can lead to acne on your chest, back, and other parts of the body.

5. Start with Simplicity

When it comes to skin care, simplicity is often the best solution. Most mild breakouts can be controlled with proper skin and body care. If, after a few months of proper skincare, you still don’t see changes, your dermatologist could determine another culprit. For example:

  • Medication side effects
  • Genetics
  • Allergic reactions to foods or cosmetics
  • Hormonal changes (e.g., menstrual cycle, pregnancy, or starting or stopping birth control pills)

6. Avoid Overwashing and Harsh Scrubs

Acne is not caused by dirt. Naturally, washing too often and too aggressively won’t do anything to eliminate the acne situation. In fact, it may make the situation worse by prompting excess oil production and more blemishes. Be cautious when it comes to cleansing products that claim to be formulated for acne prone skin, as these can leave healthy skin dry and irritated. Gently wash your face and pat it dry with a towel. Follow your dermatologist’s recommendations on what products to use and when.

Too often we wait too long to see a doctor for our skin problems. Some over-the-counter treatments with salicylic acid to unclog pores and benzoyl peroxide to reduce bacteria on skin could be effective. If your acne seems more serious, the experts Georgia Dermatology specialize in products that clear up your skin.

Retinoids, antibiotics, azelaic acid and birth control pills are all options usually covered by insurance. You might consider laser treatments. Severe cases are best cleared up by Accutane, which is a 5-month course that is considered the most effective treatment available. However Accutane is controversial and can lead to a host of side effects including birth defects if taken during pregnancy.

The Top Four Mistakes in Treating Dry Skin

February 20th, 2012

Folded HandsItchy, tight, flaky skin can affect more than your appearance — it can also be painful. Even if you have the best treatment intentions, you might be sabotaging your skin. What are the most common mistakes people make when treating dry skin, and what are the best ways to correct and treat dryness? Your skin is unique, and therefore you should listen to dermatologist’s recommendations for your own treatment regimen. However, below are some guidelines to begin with.

Mistake #1: Exfoliating aggressively.

What do you do when you see those dreaded dry, flaky patches on your face? You immediately grab the exfoliating scrub and sand away. The truth is, that’s not the best tactic. Scrubbing too hard can lead to irritation. Over-scrubbing can actually make skin more inflamed and cause it to produce even more skin to repair itself. Peels and harsh cleansers can have the same results.

Solution: Don’t over-exfoliate.

Using a gentle scrub once a week will do the trick. Moderation is key. Also, avoid cleansers and foaming products with sulfates; they can contain harsh detergents that strip your skin of much-needed moisture. To begin your day, use a gentle cleanser like Georgia Dermatology’s Transformation System cleanser.

Mistake #2: Not knowing if your skin is dry or dehydrated.

One of the most common mistakes people make is thinking that their skin is dry when it’s actually dehydrated. Dry skin is actually very rare. So, how can you tell the difference? Dry skin has very tiny pores and is rather tight. Dehydrated skin lacks luster and shine, and can be flaky.

Solution: See What Your Skin was Made to Do.

Over-cleansing and over-treating your skin can lead to imbalances, which then leads to chronic dry or oily skin. Georgia Dermatology’s Transformation System transforms your skin at the cellular level. Through a series of specially designed products that are also easy to use, your skin becomes efficient again at balancing its moisture levels. With proper use, you won’t even need to use a moisturizer!

Mistake #3: Using products that are too rich or heavy for your skin.

Most dry-skin sufferers often use creams that are extremely rich and heavy. The products have large molecules, and it’s hard for them to penetrate properly. Basically, the product just sits on the skin and can’t penetrate the pores to do any good.

Solution: Look for targeted treatments rather than heavy balms.

A good serum has smaller molecules that allow it to penetrate and add much-needed moisture ahead of your moisturizer, locking it in and creating a good layer of hydration. A product like Georgia Dermatology’s Balancer Rx is made of a special formulation of hydroquinone, alpha hydroxyl acids, and saponins. When used in conjunction with prescription strength Tretinoin, these ingredients work to improve skin’s function, diminish fine lines and wrinkles, improve elasticity, and restore your skin’s natural hydration.

Mistake #4: Finding the right skincare regimen is like taking a shot in the dark.

We’ve all done it. We go to the local grocery store or pharmacy, or even to a cosmetic counter or beauty store and do our best to figure out what products are right for our skin needs. Sure, we know if we’re prone to dry skin, breakouts, have sun damage or want brighter skin. But, unless you’re a Dermatologist, how can you be sure that you are using the best products for your skin?

Solution: Get our licensed medical technicians to recommend a skincare plan for you.

That’s why The Georgia Dermatology Center exists: To help you care for your skin exactly as it needs to be cared for. They are ready to assess your skin and its needs, and to develop a customized treatment plan, like their physician-prescribed Skin Care Formula Transformation. When used together on a regular basis, these products essentially “wake up” the skin by stimulating collagen and elastin production, balancing melanin production, and initiating increased nutrient and blood flow. Moisturizers become unnecessary as the skin relearns how to hydrate itself naturally. The skin is restored to a more youthful state, one where it works with you, not against you. The ultimate skin transformation begins at Georgia Dermatology Center.

The New ProFractional Laser: Cosmetic procedures just keep getting better

January 19th, 2012

With the Hollywood awards season in full force, dewy, wrinkle-free celebrity faces dominate the media; masterfully concealing their true age and reminding us of how far cosmetic procedures have come in delivering natural and subtle, yet dramatically good results. Here’s the good news for you: the gap between how you want to look and actually getting those results is no longer as deep and wide as the wrinkles you want to correct. With new laser treatments like the ProFractional laser, you have an extremely high chance of looking years younger with relatively easy, more affordable, and less invasive solutions.

The ProFractional laser treatment is one the most advanced procedures designed to effectively take years off your skin’s appearance without going under the knife. This laser treatment provides deeper treatment to the skin in a safer way. The ProFractional laser is usually used to refresh the face, but can also be used to treat aging and skin issues on the neck, chest, hands and other areas of the body as well.

The ProFractional laser gives new meaning to the term “baby soft skin.” Have you ever noticed how quickly a baby’s skin heals after a cut or scrape? This is due to the young skin’s incredible ability to repair itself quickly and to produce collagen more efficiently. The ProFractional laser stimulates a similar response in our skin. For example, the facial tissues beneath the skin are heated and treated by the laser because it has the ability to penetrate the skin. Collagen production also shoots up as an effect of the heat. Plus, the precision of the laser allows it to target problems in specific locations.

The procedure is simple. An anesthetic cream is first applied to the targeted skin to numb the stinging sensation caused by the laser. The process is more uncomfortable than painful. The area of skin is then treated with laser energy in rhythmic patterns. The size and the condition of the area being treated determines the duration of the process. On average, most treatments can usually be completed within only fifteen to thirty minutes. So, your busy schedule shouldn’t hinder your ability to have the procedure done. Not only that; recovery isn’t lengthy either. You can return to your daily routine within just two days.

The laser uses Fractional tissue sparing to target the skin only in specific places and at certain depths, avoiding the heavy ablation techniques associated with laser procedures of the past. Expect some reddening, swelling, and peeling in the treated area. This recovery time should subside in about two weeks, as is fairly common for most related skin procedures. Healing time can be a bit longer for some. After the procedure, the skin will be brand new, so sensitivity will increase. For this reason, sunscreen is required and other products may be recommended.

As you begin to recuperate within two to three days after the procedure, you’ll most likely already see improvements that will only become more significant within a matter weeks. Your skin looks healthier. Acne scars fade. Age lines become more smooth and evened out.

In addition to getting great results through a non-invasive, quick and convenient procedure with little recovery time, your newer, younger-looking skin lasts longer than some alternative cosmetic options. While fillers like botox last from 4 to 6 months, the skin’s improvements from the ProFractional laser treatment can endure for years, depending on the aging rate of the skin. Doctors typically may recommend that patients return for three more ProFractional laser treatments in order to get the most desirable results.

The truth is that we are all aging. The other truth is that now, with the introduction of treatments like the ProFractional laser, aging is now more beautiful than ever.

A 20-Year Survey Links Tanning Booth Use to Skin Cancer

October 31st, 2011

By Amina Khan, Los Angeles Times / For the Booster Shots blog

October 25, 2011, 6:30 p.m.

The more you use a tanning bed, the higher your risk of deadly skin cancers, according to research presented at an international cancer conference this week.

Researchers from Brigham and Women’s Hospital and Harvard University in Boston followed 73,494 nurses who participated in a health study from 1989 to 2009, tracking their tanning-bed habits during high school and college, as well as between the ages of 25 and 35.

They also tracked overall average usage during those two periods in relation to basal cell carcinoma, squamous cell carcinoma and melanoma — three different skin cancers that are each named after the type of cells they affect. Of the three, melanoma is the least common but the most deadly.

For every four visits per year to a tanning booth, risk for basal and squamous cell carcinoma jumped 15% and risk for melanoma rose 11%. What’s more, the researchers found that using tanning booths in the younger age range, during high school and college, had a stronger effect on cancer risk.

The research was presented at the 10th AACR International Conference on Frontiers in Cancer Prevention Research.

Tanning beds have long been under fire for cancer risk. The American Academy of Pediatrics released a policy statement this year that supported banning tanning beds for children younger than 18. And this month, the beds were banned for use by minors in California.

Surveys show teenage girls and young women know the risks but use tanning beds anyway.

Follow me on Twitter @LAT_aminakhan.

What Are Moles?

September 29th, 2011

A mole is a small lesion in the skin, and is a collection of melanin-producing cells. Melanin is the pigment that gives skin its color. Although most moles are usually a brownish color, they can be skin-colored or much darker. Moles can be raised, flat, or rough, and are generally oval or round with a smooth edge. Moles can vary drastically in size, from as tiny as a pinhead to covering an entire arm. Generally, a mole is less than 6mm long.

Moles can change over time in number and appearance. This can happen as a response to a change in hormone levels, such as during adolescence, pregnancy, or older age. Most moles appear during the first 20 to 30 years of our lives, though some may be present from birth. People with fair skin tend to have more moles than those with dark skin. Although they may look similar, sunspots and freckles are not moles.

The average person has about 10 to 14 moles, which can be anywhere on the body, including under the nails and on the scalp. Moles that appear after age 20 should be shown to Dr. Gross, although moles may continue to appear through middle age. You should also see Dr. Gross if there is change in a mole’s appearance and/or texture, if it’s painful or oozes, or it has a burning sensation.

The majority of moles are harmless. In rare cases moles can develop into a form of skin cancer known as malignant melanoma, which is why moles should be checked regularly for changes in their appearance and/or texture.

If Dr. Gross feels the changes to the mole are mild, he may take some photographs to clinically document it and measure the dimensions of the mole to record the changes over time. The patient may be asked to come back in a few months to have the mole checked again to see if any of the dimensions have changed.

If Dr. Gross suspects the mole may be a melanoma, a form of skin cancer, or if the mole is bothersome to the patient, he will cut the mole out during an excision biopsy, attempting to surgically remove the entire mole at one time. After removing the mole, it will be sent to a lab to be reviewed for signs of cancerous cells. If the results come back with a suspected melanoma, Dr. Gross may order additional tests to determine whether the cells have spread.

If a mole is going to form, there is nothing you can do to prevent it. However, the best thing you can do to protect yourself from skin cancer, no matter how many or few moles you have or what your complexion is, is to wear sunscreen every day and limit your sun exposure.

If you have questions about moles or skin care, or would like to learn more about dermatology, please contact The Georgia Dermatology Center at (770) 781-5077.

Skin Care Tips for Fall

September 9th, 2011

The crisp air, the falling leaves: fall is right around the corner! It may be hard to remember, but just because more of your skin may be covered up during the colder months doesn’t mean you can take a break with protecting it.

So before we officially need to pack away those summer clothes, here are some tips on how to keep your skin looking great during these next few months:

1.Re-evaluate Your Body Cleanser

Although it may be tempting to keep that fruity concoction that you kept in your shower this summer, consider changing to a cleanser that hydrates your skin. You want to find a body wash or bar that won’t dry your skin out when the cold, dry weather rolls around, like Eminence Organic’s Stone Crop Gel Wash or Glytone’s Exfoliating Body Wash.

2.Moisturize, Moisturize, Moisturize!

If you want to keep your skin from becoming dry and flaky, daily moisturizing is the way to go. The best time to moisturize is right after you’ve toweled off from your bath or shower, as it allows that moisture to be sealed into your skin. The Georgia Dermatology Center offers several facial moisturizer options, including The Georgia Dermatology Center’s Transformation System, Skin Medica, and Vivite. The Georgia Dermatology Center also offers body lotion choices, including Glytone’s Exfoliating Body Lotion.

3.Protect Your Lips

The skin on your lips is made of very different skin then the rest of your face. You already know from experience how hard it can be to heal extremely chapped lips! So start moisturizing early to have a gorgeous smile leading into winter. Fight the temptation to lick your lips, which will only lead to them becoming more chapped, and apply an oil-based cream or lip balm containing beeswax or petroleum, which lasts longer.

4.Skin Care

May people notice that as the season changes, so does their skin. From oily skin becoming normal skin, to normal skin becoming extremely dry, it can become a frustrating few months! Be aware of how your skin is acting as it starts to become cooler. If you notice a change, contact our medical aestheticians to help you find the best skin care regimen for you during this time of year. Lesley and Michele, The Georgia Dermatology Center’s medical aestheticians, will be more than happy to answer any skin care questions you may have.

5.Most Importantly: Don’t Forget Sunscreen!

Just because it may feel like the sun has gone on a vacation doesn’t mean that you can forget about your daily sunscreen application. You should think of sunscreen as a regular part of your daily skincare routine, year-round.

The Georgia Dermatology Center offers many sunscreen options, including Total Block and Skin Medica, and multiple brands of moisturizer with SPF, including Revision Skincare and The Georgia Dermatology Center’s Transformation System.

If you have any questions about skin care or would like to learn more about the that The Georgia Dermatology Center carries, contact our Med Spa at (678) 845-7494.

The Georgia Dermatology Center Sponsors the Live Your Legacy Summit

August 10th, 2011

The Georgia Dermatology Center is proud to be a sponsor of the Live Your Legacy Summit! This event will take place on September 10 from 8:00am–3:00pm at the Hilton Atlanta Northeast.

LYLS LogoThe goal of the summit is to inspire and teach women how they can live their best legacy, right now, no matter what obstacles may stand in their way. Hosted by Emmy Award-winning TV show host Aurea McGarry, this summit will honor Jan Smith, a prominent figure in the music industry for the past twenty years. Her clientele of over 4,000 clients, including Justin Bieber and Usher, are a tribute to the strong talent and drive of this woman.

Joanne Gross, the wife of Dr. Alex Gross, will also be honored at this event. Joanne is being honored for her philanthropic work around the metro-Atlanta area, where she has served as chairperson and organizer for such benefits as the Hospice Ball, Ballet Ball, Opera Ball and American Cancer Society Ball. Joanne has made a huge difference in the lives of thousands of Atlantans, and The Georgia Dermatology Center is honored to be able to be a part of such an extraordinary event.

Multiple speakers will be presenting at this event, from many different industries. These speakers will address strategic action plans to redirect your life to head in the direction you want now. They will teach you how to get out of a rut and begin thriving, how to achieve the results you want out of your life, and how to have better money management skills.

Lunch is included in this event, as is free parking. If you are interested in attending, individual tickets and tables are being sold now at a reduced price. Visit www.liveyourlegacysummit.com for more information or to register for this exciting event.

Georgia Dermatology Center featured as one of Atlanta’s Top Health & Beauty Experts

July 20th, 2011

Dr. Alexander Gross and the Georgia Dermatology Center were featured in the July/August issue of The Atlantan as one of the Atlanta area’s top health and beauty experts for their “innovative, effective, cutting-edge skin techniques.”

The entire staff of the Georgia Dermatology Center is extremely excited to be featured in this issue, and look forward to serving their new and existing patients.

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