#botox louisville

[elevatedaestheticspllc]

Elevated Aesthetics PLLC

Elevated Aesthetics, the epitome of refined beauty experiences. Step into a world where individuality is celebrated, and confidence is elevated through personalized cosmetic services. Our Louisville facial microneedling expert team, a harmonious blend of artists and technicians, is dedicated to unveiling your unique allure. At Elevated Aesthetics, we go beyond conventional beauty norms, offering a comprehensive array of services meticulously curated to enhance your natural features. From rejuvenating facials to precision-focused enhancements, our skilled artisans employ cutting-edge techniques and premium products to bring your vision to life. Embrace the transformative power of our treatments, where each detail is a brushstroke in your personalized masterpiece.

Our commitment to precision and innovation ensures that you not only look stunning but also feel empowered by your authentic beauty. In our sanctuary of aesthetics, every client is a canvas, and every session is an opportunity to redefine beauty. We prioritize open communication and a client-centric approach, ensuring your comfort and satisfaction throughout your journey with Elevated Aesthetics. Discover a space where artistry meets science, and where the pursuit of beauty is an ongoing collaboration between our experts and your unique vision. Elevate your confidence, embrace your individuality, and experience the art of beauty at Elevated Aesthetics – where innovation, expertise, and passion converge for an unparalleled cosmetic journey.

Business Name: Elevated Aesthetics PLLC Address: 9900 Shelbyville Road 5A Louisville, KY 40223 Phone Number: 5028081944

[generouskind]

BOTOX/ DYSPORT Treatments in Boulder and Louisville Colorado

Botox/Dysport works by blocking the nerve messages being sent to the muscles in the targeted area, keeping the muscle from contracting. Don’t worry, the effect is confined to the injection site and doesn’t go anywhere else in the body.  

It’s a quick, easy 10-15 minute service! We use a very fine needle to target the chosen area, quickly injecting small amounts of Botox/Dysport. Some people feel mild, temporary discomfort from the service. But for most, it’s fast and pain-free!

Get ready to see smoother skin and a more youthful appearance. Visible results are apparent within 3–5 days, but it can take up to 2 weeks to see full results. Good news: Botox lasts for 3-4 months!

Botox and Dysport are very safe! It’s been aggressively tested and is approved by the FDA. Come in, get that Botox/Dysport, and return to your normal day right away!

“BEAUTY IS IN THE EYE OF THE NEEDLE HOLDER”

SERVICES :

CROW’S FEET

BETWEEN EYES

FOREHEAD

NECK

BUNNY LINES

DIMPLED CHIN

HYPERHYDROSIS SWEATY ARMPITS

LIP LINES/LIP FLIP

BROW LIFT

[vitadentalfishertry]

Website Description:

"Dr. Rambert's love for sweets gives her an intimate connection to dentistry. She understands the trust and compassion it takes to receive comfortable dental care and uses her personal dental health journey to mold the attention she provides her patients. In 2007, Dr. Jabrea received her B.S. in Biology from Spelman College, followed by her Doctorate of Dental Medicine from the University of Louisville in 2011, and earned her General Practice Residency certificate from Indiana University in 2012. She is also certified by the American Academy of Facial Esthetics in Botulinum Toxin (Botox) & Dermal Filler to provide therapeutic treatments for those who suffer from TMJ, migraines, and other orofacial pain. Connecting and understanding a patient’s lifestyle helps Dr. Rambert create a treatment plan that will fit their lifestyle and help them achieve their oral health goals.

The Fort Wayne, Indiana native joined our Vita Dental family in June 2021 and is eager to infuse our dental care philosophy with her medical knowledge and personal care. Outside of her passion for dentistry, Dr. Rambert loves to travel with her husband, Cedric. Together they love to embrace and experience the culinary and music culture Indianapolis offers, spending time with family, doing yoga, and going to church."

Bussiness Address: 11630 Olio Rd #100 Fishers Indiana 46037 United States Please do visit https://vita-dental.com for more details.

[offerscontest]

Whas11 Great Day Live Spin The Wheel Contest

Whas11 Great Day Live Spin The Wheel Contest

Whas11 Contest – Participate in the Whas11 Great Day Live Contest at Greatdaylive.com or Whas11.com/contests or Whas11.com/great-day-live pages and you could win 2 round-trip flight vouchers from Spirit Airline, GDL Merch (t-shirt) from Dirty Tease, $100 Gift Basket from Little Mt. Lavender Co., 1 Month Gym Membership to Flex Appeal Gym, 1 Year Botox from BellaTox, Lights Under Louisville tickets…

[maysdermatology]

Dermal Fillers Can Return Your Lost Youthfulness

Every woman out there expects to retain her youthful appearance. Now, when it comes to facial rejuvenation, you don’t always have to resort to surgical interventions. Trained and certified dermatologists working with a dermatology clinic Louisville KY can enhance your facial appearance with several non-surgical methods, and dermal fillers stand atop the list.

An explanation

When people grow older, the subcutaneous fat present beneath the skin start reducing. As a result, it will lead to the formation of smile lines or crow’s feet. These happen because your facial muscles begin to appear as they work close to the skin surface after the loss of subcutaneous fat. An appropriate way to fight this age-related issue is to resort to dermal fillers.

The difference

Most folks are familiar with Botox injections. Naturally, you may be wondering why you should rely on dermal fillers instead of Botox. Well, these two treatments serve to enhance the aesthetics of your face, but they are entirely different. Botox is a neurotoxin that stops the movement of specific facial muscles and prevents the appearance of wrinkles. Dermal fillers add volume to those areas of your face that appear wrinkled or loose due to aging.

Options worth considering

If you choose to consult the best dermatologist Louisville KY, you’ll get several options. You can choose from products that contain hyaluronic acid, polylactic acid, or calcium hydroxyapatite. Hyaluronic acid is the most preferred option, and it’s a naturally occurring substance that remains under the skin of human beings and contributes to the plumpness of the skin.

Conclusive statements

It’s perfectly possible for people to regain their youthful skin, thanks to scientific advancements in the field of dermatology. If you wish to look as pretty as you were two decades ago, you should contact a certified dermatologist at the earliest. With dermal fillers, you can get rid of those early signs of aging by restoring the volume of those age-infected areas.

[perfectlydangerousarbiter]

"outer thigh workouts +will running get rid of cellulite"

“outer thigh workouts +will running get rid of cellulite”

Healthy fats (EFAs and MCFAs). Coconut and wild-caught fish contain fatty acids that promote healthy tissue. Consume 1 tablespoon daily of extra virgin coconut oil and 1 serving of wild-caught fish (or 1,000 mg of fish oil daily) for the best results.

CaloSpa Rejuvenation Center Louisville and CaloSpa Rejuvenation Center Lexington offer a wide range of medical spa treatments including BOTOX®…

[garden-of-everything]

ABIM: Gastroenterology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Esophageal disease

Gastroesophageal reflux: - Dx/Tx:  PPI --> endoscopy --> ambulatory esophageal pH monitoring with PPI - Endoscopy first if: >50yo (white male), alarm symptoms (weight loss/dysphagia), symptoms >5 years *young patient without alarm signs: test for H.pylori (urea breath test, stool Ag, serum Ab (useless to test for eradication)) and treat empirically WITHOUT endoscopy Barrett’s esophagus:  EGD Q3-5 years; if high grade dysplasia --> esophagectomy Esophageal carcinoma:  progressive solid to liquid dysphagia Esophageal dysphagia --> endoscopy vs. Oropharyngeal dysphagia (i.e., CVA, Parkinson’s, Zenker’s, MG, ALS) --> videofluoroscopy > barium swallow *Esophageal diverticula (Zenker’s) --> videofluoroscopy Achalasia:  liquid +/- solid dysphagia; associated with Chaga’s disease - Dx: barium esophagram “bird’s beak” --> manometry --> endoscopy - Tx: LES surgery / pneumatic dilation > CCB / Nitrate / Botox Medication-induced esophageal disorder: KCl, tetracyclines, bisphosphonates, iron, NSAIDs Esophageal strictures or webs: solid food dysphagia; associated with iron deficiency anemia Gastroesophageal varices: - PPx: non-selective BB (Propranolol/Nadolol) > ligation - Tx: octreotide + ligation +/- if bleeding/SBP, protein<1: FQ > TIPS/shunt Infectious esophagitis: - Candida esophagitis: Tx empirically with Fluconazole/Itraconazole --> fail?: endoscopy - HSV esophagitis: Tx with acyclovir/famciclovir --> fail?: IV foscarnet - CMV esophagitis: Tx foscarnet / ganciclovir *Viruses rarely cause oropharyngeal ulcers Mallory-Weiss syndrome: heavy EtOH + wretching/weight lifting/bulimia; Dx: endoscopy Eosinophilic esophagitis: young adult with extreme dysphagia and food impaction - Dx: esophageal Bx - Tx: steroids

Stomach or duodenal disease

Helicobacter pylori infection: - Dx: upper endoscopy + bx of ulcer and + (1) histologic assessment of H.pylori or (2) rapid urease test - Tx: PPI and 2 abx x2 weeks (Clarithromycin + (1)Amoxicillin or (2)Metronidazole) --> if fail: different Abx (i.e., tetracycline) + bismuth Peptic ulcer disease:  gastric ulcers need bx, but duodenal ulcers don’t unless they’re refractory to treatment or suspicious looking Stomach cancer:  Sister-Mary-Joseph nodule at umbilicus; CEA is positive and nonspecific for everything in the abdomen Non-ulcer dyspepsia: usually due to NSAIDs, Abx, Bisphosphonates, KCl; if alarm signs --> endoscopy Disorders of gastric emptying / gastroparesis: - Dx: endoscopy --> NM solid-phase gastric emptying (NOT KUB) - acute Tx: erythromycin; chronic Tx: metoclopramide Gastric outlet obstruction: - nausea/vomiting, early satiety - PEx: “succussion splash” (roll patient back and forth and hear sloshing sound in stomach) - Tx: PPI + NG tube Mentrier’s disease:  associated with gastric cancer - protein-losing enteropathy c/o epigastric pain, N/V, edema - associated with CMV, H.pylori - increased TGFalpha, huge gastric folds, significantly decreased protein/decreased albumin - Dx: endoscopy with bx - Tx: Cetuximab

Small intestine disease

Celiac disease: - Dx: small bowel biopsy OR dermatitis herpetiformis (pruritic papulovesicular rash on extensors) - associated with small bowel lymphoma, osteomalacia, iron deficiency/microcytic anemia, malabsorption (Vits ADEK)/increased PT, elevated AST Bacterial overgrowth syndrome: - diarrhea in the setting of previous abdominal surgery / small bowel diverticulosis, systemic sclerosis, Diabetes - Dx: hydrogen breath test - Tx: empiric antibiotics Short bowel syndrome: - if <100cm resection --> Tx: cholestyramine - if >200cm: nutritional supplementation Whipple’s disease: - diarrhea/steatorrhea, fever, arthralgia, oculomasticatory myorhythmia (eye movement disorders and rapid repetitive movements of facial muscles), seizures/ataxia/confusion, endocarditis - Dx: small bowel biopsy + PCR for Tropheryma whipelli - Tx: 12 mo Abx (doxycycline, PCN) Mesenteric ischemia and ischemic colitis: - bowel rest / IVF - acute Dx: selective mesenteric angiography --> Tx: surgery - chronic Dx: conventional angiography or MRA --> Tx: stent *ischemic colitis needs colonoscopy IBS:  3 months of abdominal pain with BM changes - if >50yo or severe sx: get colonoscopy and test for Celiac disease - Tx: Dicyclomine / Hyoscyamine (antispasmodic) > TCA, Paroxetine IBD:  associated with uveitis, arthritis, pyoderma gangrenosum *needs colonoscopy with bx 8 years after diagnosis and then every 1-2 years after; if dysplasia --> proctocolectomy (1) Crohn’s disease including Crohn’s colitis: ASCA>pANCA - skip lesions, involves entirety of GI but usually spares rectum - associated with fissures and crypts - mild Tx: use Budesonide if involves ileum/R colon, 5-ASA doesn’t work well - mod Tx: prednisone / MTX / AZT - refractory / fistula Tx: infliximab / adalimumab (2) Ulcerative colitis: pANCA > ASCA - continuous lesions starting from rectum; smoking relieves symptoms - associated with primary sclerosing cholangitis, ankylosing spondylitis, pyoderma gangrenosum - Dx: colonoscopy - mild Tx: 5-ASA - mod Tx: prednisone / 6MP / AT - severe Tx: IV steroid + cyclosporine / infliximab --> surgery vs. Microscopic colitis:  associated with NSAIDs; Tx: Budesonide > Loperamide / Bismuth GIB of unknown origin:  Dx: endoscopy/colonoscopy --> repeat a scope --> capsule endoscopy - Angiodysplasia: painless hematochezia and chronic anemia in elderly vs. - Meckel’s diverticulum: painless hematochezia in young with normal upper and lower endoscopy Gastric bypass complications:  macrocytic anemia, steatorrhea (1) Blind loop syndrome: loose stools + malabsorption - Tx: Abx + nutritional support (2) Dumping syndrome: abdominal cramping, nausea, loose stools 15 minutes after eating --> 90 minutes after: tachycardia, diaphoresis, lightheadedness - Tx: small frequent low carb diet Diarrhea: (1) CVID: pulmonary diseases + Giardia; Dx: Ig levels (2) Traveler’s diarrhea: FQ + Loperamide (3) C. diff: if pregnant GIVE PO VANC Gastric bypass complications: (4)  Chronic diarrhea:  stool osmolar gap = stool osm(~290) - 2(Na+K): - <50 = 5ecretory diarrhea (5higella / cholera / bacteria, 5tool 5ofteners, VIPoma, carcinoid (Dx: 24hr urinary excretion of 5HIAA)) <--nocturnal symptoms - >125 = osmotic/fatty diarrhea (1actase deficiency, 1axatives (1actulose / Mg citrate), Ce1iac, chronic pancreatitis

Colonic and anorectal disease

Colon cancer screening:  colonoscopy - Normal:  start >= 50 years old, colonoscopy Q10 years OR get a yearly fecal occult blood test +/- sigmoidoscopy Q5 years - FAP:  start at 12 years old with yearly sigmoidoscopy; colectomy by 20 years old - HNPCC:  start at 20 years old or 10 years younger than relative with youngest diagnosis, repeat Q1-2 years - IBD:  start 8-10 years after initial diagnosis of IBD, repeat with biopsy Q1-2 years - Family history of colon cancer at <60 years old:  start at 40 years old or 10 years younger than relative with youngest diagnosis, repeat Q3-5 years Surveillance: - 2-3 months if: adenocarcinoma with >=2mm margin and minimal invasion - 2-6months if: >2cm sessile polyp removed piecemeal - <3 years if: >10 adenomas - 3 years if: >3 adenomas, any adenoma >1cm, villous or high-grade dysplasia - 5 years if: 1-2 <1cm tubular adenomas - 10 years if: small hyperplastic polyps

Diverticular disease: - Dx: CT abdomen (no need for colonoscopy for initial diagnosis) - Tx: 7-10 days cipro or metro --> post-recovery colonoscopy to rule out cancer

Pancreatic disease

Acute pancreatitis: - Dx: U/S --> if severe symptoms/suspect complication or >48 hours: CT scan - labs: elevated Hct, elevated BUN/Cr, lipase > amylase - complications: necrosis / abscess (Tx: surgery); pseudocyst (Tx: Abx and usually resolves spontaneously, otherwise surgery) Autoimmune pancreatitis: - elevated IgG4 - found as a mass in the pancreas that mimics cancer - Tx: steroids Chronic pancreatitis: - associated with EtOH, DM, steatorrhea - Dx: CT abdomen shows pancreatic calcifications *if young patient, do Cystic Fibrosis genetic testing - Tx: supportive / enzyme replacement

Biliary tract disease

Cholelithiasis: elective cholecystectomy Choledocholithiasis: ERCP *Mirizzi: impacted gallstones in cystic duct --> external compression of common bile duct --> obstructive jaundice --> Tx: cholecystectomy Cholecystitis: fevers, leukocytosis, pain - Tx: start broad spec Abx: (1) Amp / Gent / Metro, (2) Ceftaz / Metro, (3) Zosyn /  Unasyn + SURGERY WITHIN 48 HOURS vs. Biliary colic: no fevers, no leukocytosis, symptoms <6 hours --> Tx: NSAIDs only vs. Cholangitis: fever / RUQ pain / jaundice + SHOCK + AMS - bilirubin >4, AST/ALT > 1000 - Dx: U/S --> HIDA --> stones?: ERCP - Tx: FQ + ERCP (NOT surgery) Primary sclerosing cholangitis: - young men - associated with UC, cholangiocarcinoma, HCC, BG cancer, colon cancer - Dx: US (with increased Alk Phos) show dilated bile ducts --> ERCP “beads on a string” - Tx: liver transplant; manage symptoms with ursodeoxycholic acid Cholecystenteric fistula: SBO and air in biliary tree AIDs cholangiopathy: RUQ pain, jaundice, and diarrhea associated with Cryptosporidium (CD4<100); Tx: Ursodeoxycholic acid, stenting / sphincterotomy *IFN alpha in HIV Tx is contraindicated in cytopenias, decompensated cirrhosis, active autoimmune diseases, and major depression; associated with causing hypothyroidism vs. Fitz-Hugh-Curtis:  RUQ pain (liver capsule inflammation) 2/2 Gonorrhea/Chlamydia PID

Liver disease

Viral hepatitis: (1) Hepatitis A: - give Hep A vaccine to travelers to continents that start with A: Africa/Asia/central or south America - if traveling within 2 weeks, give Ig instead (2) Hepatitis B: - post-exposure PPx:  Hep B vaccine + HBIg - associated with membranous GN (and blood clots), PAN - Tx: Lamivudine (3)  Hepatitis C: - Dx: antiHCV Ab --> HCV RNA - HBsAb = immunity (via vaccine or past exposure); HBsAg = current infection, HBeAg = high replication - associated with porphyria cutanea tarda (blistering hyperpigmented rash with alcohol and sunlight, hypertrichosis, Tx w phlebotomy), cryoglobulinemia (cold agluttinins, cold fingers, low complement), leukocytoclastic vasculitis - Tx for genotype 2-4: peg-IFN + Ribavirin - Tx for genotype 1: PI (Boceprevir/Telaprevir) Cirrhosis and portal hypertension: - be sure to check endoscopy to rule out varices - calculate SAAG: (1) SAAG >1.1: (a) ascites protein <2.5 = cirrhosis (b) ascites >2.5 = RHF, Budd-Chiari (2) SAAG<1.1: (a) ascites protein <2.5 = nephrotic syndrome (b) ascites protein >2.5 = TB, cancer - SBP: --> Dx: ascites granulocytes > 250, albumin <1g/dL --> Tx: Cefotaxime + Albumin on day 1 and 3  *Hepatic encephalopathy Tx: Rifaximin / lactulose (NOT protein restriction) Drug-induced liver disease other than acetaminophen: amanita mushroom Autoimmune hepatitis: - young female with autoimmune disease (UC, thyroid) with transaminitis, elevated protein, decreased albumin - elevated IgG, antismooth muscle Ab, antiLKM --> Dx: liver biopsy - Tx: steroids + AZT Primary biliary cholangitis: - middle-aged lady with jaundice - Dx: antimitochondrial antibody + RUQ US + liver bx Cholestasis:  elevated bili, elevated AlkPhos>>>>AST/ALT elevation Wilson’s disease: - young patient with psych issues, transaminitis, hemolysis, and athetoid movements - Dx: serum copper, ceruloplasmin - Tx: D-Penicillamine or trientine Liver disease in pregnancy: (1) HELLP: 3rd trimester, associated with DIC, MAHA (2) AFLP (acute fatty liver of pregnancy): HELLP with hypoglycemia + AMS + elevated PT Hemochromatosis: - bronze DM, cirrhosis, 2nd and 3rd MCP joint osteoarthritis with hooked osteophytes, also affects shoulders, ankles, and elbows - significantly elevated Ferritin, elevated transferrin (if transferrin >45% --> HFE genetic testing (CY282/H63D)) - Dx: liver biopsy to confirm - Tx: phlebotomy; if cirrhosis: check alpha fetoprotein and get Q6mo US Hepatic vein thrombosis (Budd-Chiari): - SAAG >1.1, ascites protein >2.5 - associated with essential thrombocytosis / JAK2 mutation Fatty liver and nonalcoholic steatohepatitis: Dx: liver bx Alcoholic hepatitis: - severe if Maddrey >32, MELD >18, Glasgow Alcoholic Hepatitis Score (GAHS) >9, ascites or AMS - Tx severe with steroids (*CI in GIB) + pentoxyfylline Gilbert’s syndrome: elevated indirect/unconjugated bilirubin with normal AST/ALT with stress; don’t Tx Hepatocellular carcinoma: - liver nodule <1cm: f/u US in 3mo - >1cm --> MRI with contrast or 4 phase MDCT -->+ = HCC, unsure --> other image or biopsy - Tx: surgical only (no chemo)

[shbettereveryday]

Day 279 / 280 / 281

As you can tell I am not blogging everyday. As we have started Paraquad gym (PQ) it has been making the other days busy as well since we now don’t schedule things on Tuesday and Thursdays. I look forward to days when we aren’t running to get ready and having to rush through the morning routine. Which usually results in a quicker shower then I would want. The hot water is usually great for my legs. This week has been difficult with spasticity and bladder but we are managing. I have made a new friend at PQ. He works out there and volunteers there. He’s 5 years into his injury, which is similar to mine (t 9-10). He has been great to talk to and is no nonsense. I was complaining about my bladder issues and he told me as a matter of fact that I need to get botox in the bladder, which my urologist doesn’t do, and gave me the name and number of the urologist at Wash U that many of the guys there use for their bladder management including botox. It isn’t a magic bullet, it only lasts up to 6 months and doesn’t completely eliminate problems but helps tremendously, according to them. When I recounted my issues he said Yeah we all have those times, he said you just put in pads and deal with it. When I was talking with him on Thursday we were talking about rehab, I asked where he did rehab, he said Mercy in Chesterfield and Louisville. I asked why Louisville. He said they have a place there that is suppossed to be one of the best post rehab spots in the country that concentrate on excercises trying to stimulate the muscles to encourage walking. He said he spent a couple years and way to much money ‘chasing the dream’ to walk again. He is a T9 complete and it took him years to come to terms with his injury. He told me a quad that he knows got back to his job, sort of. This person did landscaping and had a tree fall on him, causing his injury. He met him at one of his rehabs and that man started a company called Cripple Cutters lawn mowing service. That made me smile. When I asked about support groups he said there isn’t one. He mentioned the one that I went to, but there wasn’t much in the way of SCI support there. The way he got support was playing wheelchair basketball and hanging out with the guys and learning from them. He said they are from 20 - 50, all sorts of people, not all athletic. PQ is the right place to be to meet others and have people to learn from as well as get exercise. One thing funny on Thursday they were assembling and trying out a new therapy device. it is a rolling, standing harness that can be put over a treadmill or used with people who can walk but need support while they do. All the OT folks were over at the treadmill working with it and yelled over to me, Hey new guy do you want to try it? I said I was game sometime. They would put me in the harness on the treadmill and have people move my legs since it is like zero gravity. If I do, there will be pictures. The difference between Monday and the rest of the week is attitude. Still had bladder issues but with the advice of just 'pad up and get on with living' so that is what I had to do. Monday I let it get to me and that is ok but if I didn’t let that go it would have ended the week. PQ just gives me a reason to keep going. Tuesday after my bad Monday I just didn’t want to get out of bed. Didn’t want to go to work but PQ gave me a reason to get out of bed and get on with it. Somedays will be better then others but you just need a reason to get moving and be bettereveryday

[bodilouisville]

It's that time of year again: Mother's Day is fast approaching! Show your mom some love this year with a special gift and save big with our Mother's Day gift card specials. Shop now and get our exclusive discounts! Make her smile and show her how much you care!

[sabrinaogan-blog]

They played one other time

They played one other time, with the Wildcats racing away to a 93 63 win three years ago at Rupp Arena. This time, the Norse join Kentucky and Louisville representing the state at Indianapolis.going to get a big taste of the NCAA Tournament nfl jerseys, play against one of the premier, storied traditions in all of basketball, Louisville coach Rick Pitino said on Thursday. Going to be very exciting for them.

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[beautybydrkay]

View this post on Instagram

A post shared by Dr. Kay Durairaj, MD, FACS (@beautybydrkay)

I love the voluptuous lips on this beauty! 💋I do subtle and natural lips the majority of my day, but the trend for pouty, full lips is still thriving. And why? What is our fascination with lips?💋💋 According to an article@in BBC News, sscientists have found that the size of somebody's lips plays a key role in determining whether they are sexually attractive to other people. Basically, the bigger the better - but, in a warning to those who are thinking about opting for surgical enhancement, it is possible for somebody to have lips that are too big. This is especially true for men’s lips. Professor Michael Cunningham, a psychologist from the University of Louisville, explained his findings to the BBC Radio Four programme The Kiss. 💋His research suggests that men are looking for a sizzling combination of fullness, redness and warmth. And women who purse their lips send out a signal, subconsciously or not, that they are not really interested in a sexual advance. According to Professor Cunningham: "If a woman is holding her lips very tightly clenched, that is not a good sign." Professor Cunningham's team drew their conclusions from a series of experiments which involved making minute adjustments to parts of the face to find out how the changes altered sexual attraction. They found that good lips can make an attractive face even more attractive..."The lips can convey real warmth and receptivity," said Professor Cunningham. “Lips are so expressive, and when someone is genuinely pleased to see you, the lips flush and become fuller and darker. “They show that sensuality and warmth that we all look out for in a partner.” In general, the researchers found that a small nose, big eyes and voluptuous lips are sexually attractive both in men and women.” . 💋💋💋💋👠👠👠💃🏻💃🏻💃🏻 To see me as a client in my Los Angeles/Pasadena private practice, call me at (626) 316-7033 or email info@beautybydrkay.com. I hope to see you soon 💓 . 💧My amazing new KDskincare line is now available for purchase online. 💦Shop online for free domestic shipping at www.beautybydrkay.com/shop . #lips #lipfiller #lippies #lipinjections #lipcleavage #botox #filler #la #nyc #chicago #friyay (at Kay Durairaj, MD, FACS - beautybydrkay) https://www.instagram.com/p/B2o1gTCnZTV/?igshid=sdth8v44k0gj

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Plastic Surgeon in Louisville

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They Want It to Be Secret: How a Common Blood Test Can Cost $11 or Almost $1,000

Hospitals and insurers negotiate over healthcare prices in private, and they don’t want competitors to know about the deals they’ve been able to cut. As a result,  a metabolic blood panel test cost can range from $11 or $952. Should doctors and hospitals be required to publish negotiated prices: (1) Yes, (2) No? Why? What are the ethics underlying your decision?

It’s one of the most common tests in medicine, and it is performed millions of times a year around the country. Should a metabolic blood panel test cost $11 or $952?

Both of these are real, negotiated prices, paid by health insurance companies to laboratories in Jackson, Miss., and El Paso in 2016. New data, analyzing the health insurance claims of 34 million Americans covered by large commercial insurance companies, shows that enormous swings in price for identical services are common in health care. In just one market — Tampa, Fla. — the most expensive blood test costs 40 times as much as the least expensive one.

If you’re a patient seeking a metabolic blood panel, good luck finding out what it will cost. Although hospitals are now required to publish a list of the prices they would like patients to pay for their services, the amounts that medical providers actually agree to accept from insurance companies tend to remain closely held secrets. Some insurance companies provide consumers with tools to help steer them away from the $450 test, but in many cases you won’t know the price your insurance company agreed to until you get the bill. If you have an insurance deductible, a $400 — or even a $200 — bill for a blood test can be an unpleasant surprise.

Outside of health care, a swing of prices as huge as the one for blood tests in Tampa is unheard-of. Recent studies of the retail prices of ketchup and drywall, for example, showed much less variation. A bottle of Heinz ketchup in the most expensive store in a given market could cost six times as much as it would in the least expensive store. But most bottles of ketchup tended to cost around the same. And, in every case, you would know the price of your ketchup before buying it.

“It’s shocking,” said Amanda Starc, an associate professor at the Kellogg School of Management at Northwestern, who has studied the issue. “The variation in prices in health care is much greater than we see in other industries.”

In some cities, the blood test prices look more like the prices for consumer goods. Most tests in Baltimore cost around $30. Most in Portland, Ore., cost around $20. But if you live in Miami or Los Angeles, the price becomes much harder to predict.

Hospitals and insurers negotiate over prices in private, and they don’t want competitors to know about the deals they’ve been able to cut. The data in this article comes from the Health Care Cost Institute, which pools bills from three large insurance companies. (Even the institute can’t say which insurers and providers are attached to the different prices, and it has eliminated certain markets with less competition where it might be easy to guess.)

The Trump administration may eliminate this secrecy, making numbers like the ones in these charts more common and easier to find. As The Wall Street Journal has reported, the administration has asked for comments on a proposal to require doctors and hospitals to publish negotiated prices.

The institute examined several common procedures and observed two kinds of pricing differences. Prices vary considerably between markets. And, in many metro areas, they range widely between one health care provider and another.

Because these are prices paid by insurance companies, many experts say the differences between markets matter more, because they affect insurance premiums that all those with insurance in that area pay, even if they don’t get a blood test or an operation. On average, a cesarean section birth in the Bay Area costs more than three times as much as one near Louisville, Ky., according to the institute’s data.

The average hotel room in the San Francisco area last year cost only around double the average hotel room in Louisville, according to STR, which tracks the industry.

The swing within markets increasingly matters for patients, too, as the share of employer plans with sizable deductibles keeps rising. That means that choosing a provider where your insurance company has failed to strike a good deal could mean significant out-of-pocket costs.

In some cases, prices may be higher because the quality of services or the cost of doing business in a given market is higher. More influential is market power, that of either insurers or hospitals, research shows.

Sherry Glied, a health economist who is the dean of the Wagner School of Public Service at New York University, said a bigger factor was probably how many patients your insurer sent to a given hospital. Popular places are likely to offer better prices, because the insurance company negotiates a bulk discount. The most expensive providers tend to be the ones where the insurance company has little negotiating leverage — and where the service is so rarely used it doesn’t mind the higher price.

“One person buys one hamburger, and another buys 1,000,” she said. “And it completely makes sense that the guy who buys 1,000 hamburgers gets a better price.”

That sort of market power can work in the opposite direction, too. In markets where there is a dominant hospital chain, or a powerful hospital that many patients insist on using, insurers tend to face high prices, with less leverage to bargain the hospitals down. Martin Gaynor, a professor of health economics at Carnegie Mellon University, was a co-author of a recent study showing that in markets where fewer hospitals competed for patients, the hospitals tended to be paid more.

“Some of these really simple diagnostic tests — what the heck?” Mr. Gaynor said. “It does mean, in a sense, the market is broken in terms of problems with market power.”

The prices that hospitals and doctors charge to patients who are not in their insurance networks also range widely, and are typically (though not always) higher than the prices that insurers pay. The Obama administration began publishing these list prices for some of the most common medical services on a government website. The Trump administration recently began requiring hospitals to also publish a comprehensive list of prices on their own sites, though the data can be challenging to use.

For years, Jeanne Pinder, who runs the consumer-oriented website Clear Health Costs, has been collecting the cash prices for medical procedures around the country. She said the only health care services with predictable pricing were the cash-only treatments that insurance doesn’t cover, like Lasik eye surgery, Botox and tooth whitening.

“When you get into M.R.I.s, ultrasounds and blood tests, they are crazy,” she said. “The secrecy in pricing all over this marketplace encourages this behavior.”

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