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Bioidentical Hormone Replacement Therapy

BHRT, which is short for Bio-Identical Hormone Therapy, is a treatment that uses natural hormones to improve your health and wellbeing. It is a therapy used to restore your testosterone levels to the normal healthy levels you had in your 20's, but have declined as a result of aging and other reasons. BHRT testosterone pellets are made up of the same testosterone that's naturally occurring in your body, created from plant-based ingredients. Once the pellets are placed into the subcutaneous fat, then immediately begin releasing a continuous amount of testosterone into your bloodstream to restore balance. The procedure typically takes 10-15 minutes and you are able to go back to normal activities within a week. 

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What causes low testosterone in men?

Men experience a peak in testosterone levels in their early 30's and experience a gradual age-associated decline in their mid-30's that continues at a rate of 1-3% per year. Doctors will tell you that low testosterone is a normal part of aging, but this is a misleading statement. While aging is normal, hypogonadism or low testosterone is NOT and contributes to symptoms that negatively impact quality of life, as well as increase the risk of cardiovascular disease and cognitive disorders.  

During aging, decreased functioning of the pituitary gland (which signals the testicles to produce testosterone) or decreased responsiveness of the cells in the testicles that produce testosterone result in decreased blood levels of testosterone. Other causes of low testosterone include:

  • Unhealthy diet and obesity (increases estradiol, leptin, and adipokines)
  • Inadequate sleep
  • Undescended testis or injury to the testis
  • Pituitary disorders such as Kallman’s syndrome
  • HIV/AIDS
  • Autoimmune diseases
  • Chemotherapy and radiation therapy
  • Alcohol, opioids, and prior anabolic steroid use

What are the symptoms of low testosterone?

  • Decreased libido or sex drive
  • Decreased strength and duration of erections
  • Fatigue and decreased energy
  • Irritability
  • Decreased lean muscle mass
  • Increased fat, especially in the abdomen
  • Depression
  • Infertility
  • Difficulty concentrating or mental fog
  • Development of breast tissue (gynecomastia)
  • Loss of bone mass (osteopenia or osteoporosis)

I had my blood testosterone levels checked, how do I know if I have low testosterone?

The decision to start testosterone supplementation in men is driven by symptoms, meaning that men should only be assessed for testosterone deficiency if they have some of the symptoms above. It is not based on serum testosterone levels. There are validated questionnaires that can be used to determine if a man has symptoms of low testosterone such as the Androgen Deficiency in Aging Males (ADAM) questionnaire: 

  1. Do you have a decrease in libido (sex drive)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength and/or endurance?
  4. Have you lost height?
  5. Have you noticed a decreased "enjoyment of life"
  6. Are you sad and/or grumpy?
  7. Are your erections less strong?
  8. Have you noted a recent  deterioration in your ability to play sports?
  9. Are you falling asleep after dinner?
  10. Has there been a recent deterioration in your work performance?

If you answered "yes" to questions 1 or 7, OR "yes" to any 3 other questions, you may have low testosterone and could benefit from hormone supplementation. This is when we check and interpret lab values. 

The major problem with defining low testosterone based on lab reference ranges is that we know that the reference ranges reported with your bloodwork are inaccurate. Each lab has its own reference ranges that are often determined by a small number of random patients, for example 20 random male patients of varying ages. If a male patient has the symptoms of low testosterone, we supplement testosterone based on the blood level and reassess the patient in 6 weeks. If his symptoms are improved, we know that he has low testosterone and will benefit from supplementation. We also make sure that we don’t go above a certain level because there are health consequences of high testosterone. The goal is always to return men to the healthy testosterone levels they had in their 20's. 

Are there natural ways to increase testosterone levels?

The short answer is yes, but not enough to treat men with a diagnosis of hypogonadism or low testosterone. These are more relevant to men who do not have the symptoms of low testosterone but feel like they would benefit from slightly higher testosterone levels. The activities that have been shown to increase testosterone levels include:

  1. Exercise and lifting weights
  2. Reducing stress and cortisol levels
  3. Vitamin D supplementation if you are deficient
  4. Adequate sleep: sleeping only 5 hours a night was linked to a 10-15% reduction in testosterone levels
  5. Avoid exposure to chemicals that can affect testosterone levels such as bisphenol-A (BPA), parabens, and some chemicals found in plastic. 
  6. Limit alcohol consumption: heavy alcohol use can lead to testicular atrophy

What are the side effects of testosterone supplementation with Bio-Identical Hormone pellets?

Since we are returning your testosterone to the normal healthy levels you had in your 20’s, there are no long term side effects, only benefits.  When men with low testosterone initially start hormone supplementation, there is a 3-4 period while the levels are increasing that he may experience irritability or aggressiveness as a result of the change. This is normal and will subside when the patient reaches a steady level of testosterone in the blood. We check testosterone levels again 14-16 weeks after pellet placement and plan the next placement to ensure blood levels of testosterone do not drop below the level where a man becomes symptomatic and goes through the adjustment phase again. 

Testosterone is converted into estrogen by aromatase in the body in both men and women. Some men have a relatively high level of estrogen in the body, defined as an estrogen to testosterone level greater than 3%. When this happens, men can experience symptoms of increased estrogen. We prescribe Letrozole, which is an aromatase blocker that is taken twice a month. 

There are a number of health consequences related to high testosterone, including increased blood pressure, increased risk of cardiovascular events and stroke, prostatomegaly (enlargement of the prostate gland), mood swings, aggressive behavior, insomnia (difficulty sleeping), and excessive hair growth. These DO NOT happen with testosterone supplementation using Bio-Identical Hormone pellets because we supplement to normal healthy levels. Many men who present to our practice with low testosterone symptoms have a total serum testosterone level of 300-400 ng/dL, and our initial target for total serum testosterone after pellet placement is 1000 ng/dL.

What are the benefits of testosterone supplementation in men who have low testosterone?

  • Improved libido and sexual satisfaction
  • Alleviate symptoms of erectile dysfunction
  • Increased energy and focus
  • Increased lean muscle mass
  • Decreased fat, especially in the abdomen
  • Improved mood
  • Better sleep
  • Protective against depression and cognitive disorders such as Alzheimer’s disease
  • Improved bone mineralization
  • Decreased triglycerides, low-density lipoproteins (LDLs), and cholesterol 
  • Decreased risk of cardiovascular events like heart attack

What are Bio-Identical Hormone Pellets?

Bio-Identical Hormone pellets are the size of a grain of rice and are made of the same testosterone that occurs in your body, not the synthetic forms of estrogen and testosterone that are in other preparations. Injectable forms of testosterone can cause allergic reactions because of the additives and typically result in a higher level of aromatization and estrogen-related symptoms. Moreover, injectable forms are short-acting and result in peaks and troughs during weekly injections, whereas patients who use pellets experience slow, controlled release over months. The resulting blood level of hormone is also much more predictable with the pellets, peaking at 6 weeks after pellet placing and slowly decreasing over 4-5 months. 

Should I do testosterone supplementation if we are planning on a pregnancy?

If you’re planning on pregnancy within 6-12 months, we recommend against testosterone supplementation. While testosterone is necessary for sperm production (spermatogenesis), exogenous testosterone (produced outside the body) suppresses the release of the gonadotropins from the hypothalamic-pituitary axis, which results in lower testosterone production within the testis. High testosterone levels within the testis is needed for sperm spermatogenesis. Because of this, testosterone supplementation can result in azoospermia (complete absence of spermatozoa in ejaculate) in 65% of men within 4 months of starting treatment.

For men who wish to preserve fertility, clomiphene and enclomiphene can be prescribed. These are medications that stimulate LH and FSH release from the pituitary gland, which stimulate the Leydig cells in the testicles to produce testosterone. The increased FSH increases sperm production and can improve fertility for men. 

What is the process for undergoing hormone supplementation?

  • Call us at (434) 260-1667 to schedule a consultation with on of our physicians or click on the Book Now link below
  • Complete medical intake forms using our online portal
  • Meet with one of our physicians to review your medical history, symptoms and health concerns, as well as discuss the benefits of hormone supplementation and treatment options. 
  • We use the SottPelle algorithm for dosing, which incorporates your symptoms and lab results to determine the optimal dose of hormones to bring you back to normal healthy levels
  • Pellets are placed in the office; the procedure takes 10-15 minutes.
  • You will start the feel the benefits of the hormones 3-4 weeks after pellet placement
  • Labs are obtained 6 weeks after pellet placement to ensure optimal levels. If you continue to have symptoms despite increased hormone levels, our physicians can place additional pellets. 
  • Pellets typically last 3-4 months and repeat labs are obtained 14-16 weeks after the initial pellet placement to guide subsequent doses. 
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Dr. Itri discusses the symptoms of low testosterone 

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Dr. Itri discusses hormone supplementation with bio-identical hormone pellets

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Dr. Itri describes 3 myths about testosterone supplementation

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Listen to a patient testimonial about hormone replacement with BHRT

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Mellony Harris
April 20, 2024

Dr. Segura is phenomenal!!! Super gentle with her injections, and spends quality time with her patients….definitely love it at Studio R!!

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Tracy Diamond Allen
April 16, 2024

Yesterday, I had the pleasure of experiencing an exceptional facial administered by Michelle. From the moment I entered the serene ambiance of the treatment room, I was enveloped in a sense of tranquility, enhanced by the soothing background music. The attention to detail was evident as the bed was meticulously arranged to provide optimal comfort with a warm blanket, allowing me to unwind completely. Michelle's unique approach to skincare was evident from the outset. She took the time to inquire about my specific skin concerns, ensuring a tailored approach to her facial treatment. Throughout the session, she thoughtfully explained each step of the process and its benefits to address my individual needs. Michelle's skilled hands guided me into profound relaxation, evoking a meditative experience that transcended the ordinary. Notably, the facial extended beyond mere skincare, incorporating a rejuvenating massage of the chest and neck area. This holistic approach further underscored Michelle's commitment to providing a comprehensive and deeply enriching spa experience. Today, my skin feels amazing. I wholeheartedly endorse Michelle's facial treatments to anyone seeking expert skincare guidance or desiring a professional relaxation experience. I know what I want to buy my husband for his next birthday 🙂

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Paul McArtor
April 16, 2024

The two words that come to mind with Studio R is "trustworthiness" and "professional." The doctors (actual doctors), do such a great job ensuring the treatments are the correct ones to meet their patient's needs and goals with a patient-first mindset. Some medical spas feel like they are pushing treatments with profit first. If you are interested in trying out a medical spa, Studio R is the place to start. If you use another spa, you should definitely check Studio R out!

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Mallory Miracle
April 13, 2024

I had a perfect experience with everyone I interacted with during my first appointment (including other guests!) I felt very taken care of. All of my questions were answered. The music was fab. I look forward to coming back!

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Julia White
April 6, 2024

Calming and relaxing experience for being a first time toxin client. Dr. Segura walked me through the process, managed my expectations, and delivered beautiful results. The staff, especially Michelle, was helpful and provided me with great skin care recommendations.

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Isis Joens
April 3, 2024

Visited for weight loss program. Very knowledgeable and great explanation from Dr. Segura.

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Lisa Isabel
April 2, 2024

I have received services at Studio R Aesthetics since moving to the area in 2022. Dr. Segura and Dr. Itri are so very personable, professional and extremely knowledgeable about all of the services they offer. Walking through the door at Studio R Aesthetics feels like stepping into a different world! The atmosphere is very upscale and comforting. If you’ve ever wanted to invest in yourself and your well-being, call them to schedule an appointment…you won’t be disappointed!

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Nines G
April 2, 2024

Dr. Segura did my lip filler and lip flip. Definitely the best results I’ve had.

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nadia mccall
April 2, 2024

I really really love the different stuff offered here, excited to try out some of the deals. I wish I lived closer to it! They have so much holistic stuff from inner to outer health. I have a list of stuff to try out already!

I recently had a consultation at Studio R Aesthetics with Brandy to explore their services and determine what would best suit my needs. Brandy was not only easy to talk to and personable but also incredibly knowledgeable about a wide range of topics, from weight loss to daily skincare routines. I highly recommend anyone seeking services to visit her! Thank you for the exceptional experience!

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Candace Richards
March 28, 2024

I cannot say enough good things about the wonderful people at Studio R. In a world where women are not taken seriously by their healthcare providers, the team at Studio R truly cares. From the warmth and kindness of the reception, to the empathy and compassion of the physicians, I highly recommend this studio to anyone who has struggled with weight management and hormone imbalance. Every time I leave I feel better not only in my body, but with my emotional and mental health.

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alicia Xoxo
March 25, 2024

Went in for microdermabrasion, it was my first time at Stufio R Aesthetics and I will definitely be returning. Lovely atmosphere and very kind staff.

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Michelle Conner
March 24, 2024

Highly recommend Studio R if you are trying to decide if Semaglutide will be part of your health and fitness journey. Dr. Brandy Segura provided us with the best, most informative consult ever! It's reassuring to know that Studio R offers medically-supervised weight loss treatment from someone who has thoroughly done her homework and really cares about your results.

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Steve Gaines
March 21, 2024

One thing about Studio R that sets them apart from so many other similar practices is that they PRACTICE what they preach. For example, if Dr. Itri is consulting with you on their weight managment program he can speak to you from direct experience having invested much of his own time into living and working the program. So he can bring you first-hand experience when he speaks to helping accomplish your goals. They really helps Studio R stand above the crowd. I highly recommend them!

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Wendi Dass
March 20, 2024

I normally go to another spa and decided to try Studio R. Michelle did an awesome job on my lashes and brows. This will be my new go-to spa.

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LaLa Wilkins
March 18, 2024

I have visited Studio R Aesthetics on many occasions and always enjoyed wonderful experiences with the staff and Dr. Segura!! I love that everyone I speak with is knowledgeable and friendly. I will definitely continue my visits and to recommend them in the future!!⭐️⭐️⭐️⭐️⭐️

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Lois Sanders
March 16, 2024

Aesthetician was very knowledgeable and professional. Gave recommendations based on my skin type and included a relaxing neck and shoulder massage. One of the best facials I've had.

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Amy A
March 13, 2024

Nice, helpful staff in a beautifully appointed office. I was seen promptly and Dr. Segura was kind and took her time with me. Highly recommend!

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Meghan Kirby
March 12, 2024

I am so pleased with Dr. Segura and her staff! She was very friendly and extremely informative and thorough. I would highly recommend Studio R Aesthetics to all my friends and family!

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Donald Giannangeli
March 12, 2024

I just met with Dr. Jason Itri from Studio R. I was very impressed with the thoughtful, cooperative approach he took with me about my health and my options. No sales pitch. No doctor-telling-patient what's best. He listened! What a refreshing approach! Give them a call and see for yourself!

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Lyndsey Lantz
March 8, 2024

I had a wonderful experience at Studio R Aesthetics. The entire team was very welcoming and made me feel comfortable especially since I am new to the aesthetics world. I knew this was the place for me when they offered everything I was looking for....BBL...Skin Better products...medical provider as an injector. If you are looking for a medical spa in Charlottesville, look no further...Studio R Aesthetics is your place!!! 10/10 recommend!!

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Jim Ames
March 3, 2024

Medical doctors own this business and are the primary care-givers. They're concerned first and foremost about long term healthy outcomes. Furthermore, they and their team take the time and energy to ensure a friendly and relaxed client experience - their appointments last about twice as long as other providers to ensure every client gets real attention and is comfortable. Actually, a lot of their clients have come from other providers.

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Chris Parsnow
February 27, 2024

I met with Dr Itri to discuss the BBL skin treatment. I love the fact that he and his wife have tried every service they offer and can clearly explain the benefits and set real expectations. You can tell they truly care about their customers!

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Anastasiya Kalyuk
February 26, 2024

I had anxiety about getting the prp service. Instead of trying to pressure me into it, the doctor took the time to explain the process to me and understood my need to take a little more time to consider going forward. I would recommend this place to anyone based on their professionalism, patience, and ability to explain complex concepts about specific concerns to clients. Will be coming back for more services! (including prp once I get over my anxiety about it). I also got a platinum hydrafacial and it was the best one I’ve ever gotten! I will definitely be rebooking. Thank you!

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Catherine Turner
February 26, 2024

I have very sensitive skin, so I reached out to Studio R with a few questions before booking an appointment. They responded quickly and thoroughly and advised on which services would be best for my skin type. During my sugaring appointment, Michelle was very kind, patient, and friendly. She also gave me tips for how to care for my skin after the service, offering recommendations at a variety of price points. I appreciated her skill and attitude, and I will be booking again in the future!

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Ashleigh Chambers
February 24, 2024

Went here for sugaring and would definitely recommend it. Professional, relaxing, and overall great service. She was friendly and made the whole experience pleasant!

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Gabrielle Miller
February 20, 2024

I just moved to the area and came to this place based off of the recommendation of a friend and boy was she right. I have been here a few times and will definitely be coming back. Toxin service was great and doctors are very friendly. I’ve also had a facial and I have to say it was the best facial I’ve ever had.

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Erin Diehl
February 6, 2024

Great service!! Great place!

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Terrie Wood
February 3, 2024

Recently saw Michelle to do a brow lamination. She is very attentive and seeks to give you what you want. Really enjoying my brows. Lamination makes me look like I have some brows!!!

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Joanna Lehtinen
January 29, 2024

I was new to Charlottesville and Dr. Morris was so friendly and welcoming. I'd highly recommend Studio R for sugaring and other treatments!

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Allison Kirkner
January 22, 2024

Great staff, very responsive and an excellent experience!

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Vickie Hammer
January 18, 2024

I had a wonderful experience with Dr.Brandy ! Her knowledge is amazing . Her office is beautiful and very relaxing . I’m definitely looking forward to my next visit . Thank you Dr. Brandy !!

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Leah Sampson
January 18, 2024

No one else is allowed to touch my face or brows besides Michelle !!! I trust her I love her and she’s the best 💕

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Taylor Barrett
January 10, 2024

This practice has it all! Clean office, convenient location with parking, kind and helpful ladies working the front desk, and a knowledgeable/professional/caring MD (I saw Dr. Itri). Thank you all!

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Lisa Barnes Rogers
January 9, 2024

Studio R Aesthetics in Charlottesville totally exceeded my expectations! I highly recommend giving them a call and exploring what services they have to offer!!

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Kristina Canning
January 2, 2024

The office is clean and everyone is very friendly! Michelle did my sugaring and was great!

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Shendy Smith
December 29, 2023

Friendly, professional, skilled staff. Beautiful facility.

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Anaïs Adams
December 18, 2023

Michelle was wonderful! She made me feel extremely comfortable throughout the entire waxing process.

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Kamden Pleasants
December 9, 2023

I’ve been seeing Michelle at Studio R for about 6 months now. I came to the medical spa extremely insecure about my adult cystic/hormonal acne and felt extremely defeated and misguided by other routes I had taken. With Michelles help, I started a skin care regimen that finally works, I’m getting the best facials I’ve ever had, and I was even given the opportunity to get a BBL treatment to fight residual scarring and underlying acne. Michelle’s work has truly helped boost my confidence, and my skin looks and feel the best it ever has! She is so dedicated in what she does, and her hard work never goes unnoticed. Michelle and her team at Studio R are so comforting and I truly couldn’t imagine this skincare journey without them. They’re all extremely caring and are willing to go above and beyond for each one of their patients. I am so lucky to be one of those patients.

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Jared Hardy
December 3, 2023

I asked questions and learned everything I was hoping to from the answers. Not only a highly professional and aesthetic experience, but also informative and supportive. Everyone went out of their way to ensure I received care, recommendations, and services curated to my needs. Thanks!

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Pretty J (PrettyJ_86)
December 3, 2023

The staff is great, especially Michelle my aesthetician she gives the best sugaring around

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Christina Shifflett
November 24, 2023

I recently received my first platinum hydrafacial done by Michelle and it was absolutely phenomenal! She took her time and really focused on making it an incredible experience, one of the most relaxing things I have ever done! Not to mention my skin looks and feels amazing!! I will be recommending this to everyone I know and I will absolutely be back for more!

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Jordan Stang
November 11, 2023

Today was my first Hydrafacial done by Michelle! Studio R Aesthetics exceeded my expectations. The staff was extremely nice, the office was adorable and I was very comfortable. My facial was very relaxing. Michelle was terrific, Answered all of my questions and my skin felt amazing afterward. I already can’t wait for my next experience at Studio R Aesthetics. I can not recommend them enough.

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Latasha Breckenridge
October 24, 2023

I had a brow wax and tint. Not only did my brows look AMAZING but I never had someone rub the area around my brows! It was the most calming and relaxing experience! 10/10 recommend!

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Leysa Sallie-Hall
October 21, 2023

I had a awesome experience last week with Studio R Aesthetics, first thing was just how amazing the inside of the building was, it was gorgeous and full of light, so comfortable. I was shocked when I found out about all of the services that they provide, so many! Very impressive! I was also impressed by my doctor- Dr.Segura was a delight and very professional but down-to-earth , I felt very comfortable telling her my issue's she made me feel like I was being heard when I was speaking of my problem with my hair thinning, and falling out drastically, I got a bit emotional talking about my hair and she just made me feel like she really understood what I was going through, it was an amazing experience and I definitely will be going back for a long,long time. Thank you Dr. Segura for your kindness and your compassion for me, you are very special.

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Christina Kim
October 19, 2023

Brandy was great and knowledgeable!!

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Trevor and Taylor H
October 16, 2023

Had a great experience with Dr. Segura! She is very knowledgeable and reassuring. All of the staff were friendly and professional.

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Skylar Coates
October 14, 2023

Amazing practice! Both doctors and staff are very knowledgeable and skilled at what they do! I look forward to every appointment!

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Katie Dockter
October 13, 2023

Michelle did a wonderful job! Thank you Studio R!

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Sylvia Trueman
October 10, 2023

I’ve been a patient of Dr. Segura for a year now, and I’ve had several procedures done by Brandi. Her calm and caring demeanor always brings me great comfort when she can sense my insecurities and difficulty in talking about the things I would like to improve or change. To her, I am the most important person in the world while I’m in her care, she goes into great detail of all procedures, and what they entail. She is very patient, kind and has my best interest in mind at every consultation. She is truly an artist and has given my beauty, and confidence back both inside and out. ❤️ Can’t wait for my next treatment!

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