Cosmetic Dermatology

Procedures:

Micro Needle Peel

Micro Needle Peel is the latest treatment offered in our office.  We introduced this procedure on February 2012 and have since performed this procedure over 4,500 times.  I combine a new treatment, Dermapen or MicroNeedle, with a 170 year-old treatment, the TCA peel.

This procedure improves conditions such as leathery skin, wrinkles, scarring, stretch marks, and thick sebaceous type of Rosacea.  The results are achieved with a series of micro punctures of tiny needles (thickness of a hair), which creates micro-channels into the dermis leaving the epidermis relatively intact (little need to hide out at home!)   Over the next several months after each procedure, new collagen and elastic tissue factors are released, to smoothing and tightening the skin.  This works because of the following series of events occurring in the microscopic dermal layers of the skin;  needle puncture results in microscopic bleeding which floods the area with platelets (Platelet Derived Growth Factor, PDGF), numerous growth factors, cytokines, fibroblasts, elastin and proteoglycans.   A matrix of type III collagen and elastic tissue forms 3 weeks post-op and continues for 6 months, which results in thicker skin. Starting 3 months after procedure to 10 months, type III collagen converts to type I collagen. This cross-linking causes the youthful effect of skin tightening.  This entire process is augmented by applying a chemical peel immediately after needling to induce further inflammation and thus better results.

A series of 3 to 10 Micro-Needle Peels are performed monthly to achieve the desired final results.   Each treatment requires the depth of the needle to be adjusted to the area of the face treated and the depth of the problem treated.  Crows feet require a depth of only 0.5 mm, but deep acne scarring and wrinkles, especially on the lips, require up to 2.5 mm of needling.  The Dermapen easily adjusts from 0.5mm to 2.5mm and effectively treats hard-to-reach areas such as the eyelids, lips and ear lobes. Each treatment will go deeper and have a stronger acid peel applied.  The number of procedures required depends on the severity of the problem and the healing properties of each individual patient.

The procedure takes about 10 minutes.  An anesthetic cream is applied to the entire face and neck region.  The needle will be passed over the entire skin from 3 to 5 passes.  This procedure is painless, as the first pass pushes the anesthetic into the skin.  As a result, there is also no discomfort when the chemical peel is applied.  You may be pink for  1 to 24 hours.  A sunblock will be applied before you leave after which makeup can be applied.   Most people can go back to normal activity the same day.

The price is $199/ treatment and can be combined with other treatments performed at the time of your office visit.

Hyaluronic Fillers (Juvederm®, Restylane®, Perlane®) 

Juvederm ®, Restylane ®, Perlane ® are all safe, natural cosmetic fillers that provide volume, fullness and hydration to lift the skin.  These fillers are great for plumping up lips, wrinkles, hallows, and some acne scarring.  Because hyaluronic acid attracts and binds up to 5 times its weight in water, these fillers will feel soft and like part of your own natural skin.  The  hyaluronic fillers are natural, biodegradable, non-animal based gels.  No skin testing is required so a patient can receive fillers at the time of consultation.


At the time of treatment, a strong topical anesthetic cream will be applied to decrease sensitivity and bruising.  An anesthetic block will also be used if you are receiving injection in your lips.  The block will totally ware off in 15 minutes and makes the entire procedure much more comfortable.  At the end of the procedure, you will be offered a mirror to check the results and more will be added if requested by the patient.  Makeup can be applied immediately.  If you are a bruiser, avoid aspirin for 2 weeks, Advil for 2 days and buy cover-up (best one- Illuminare, extra coverage concealer, the aqua colored tube.  Porcelain color works well for most  www.illuminarecosmetics.com).

For further information on these products and before and after pictures, please refer to the websites:


Treatment areas with good results:
-Under eye circles and hallows under the eyes
-Deep and superficial nasal labial folds & Marionette lines
-Deep frown lines
-Hallow areas on the cheeks, around the mouth.
-Deep line in the cheeks and around the lips, deep horizontal lines on the
neck
-Plumping up the lips
-Shallow acne scarring
PRICES for Juvederm Plus, Restylane and Perlane – $190 to $499.   (We often have 10 % off.  Call office for the most recent specials).

Botox ® 
Botox is by far the most popular indictable in the world.  Botox has been used since 1988, on hundreds of millions of patients for the treatment of wrinkles and muscle spasms, since 1988.  It dramatically reduces expression wrinkles around the eyes and mouth, over the forehead and frown lines, and on pronounced neck bands.  Botox helps the patient achieve a more happy, rested appearance. In addition, the regular use of Botox often prevents the formation of future wrinkles.  I have personally used Botox on myself since 1994.  It can take 10 years off your appearance.

A topical anesthetic is applied prior to injections.  The smallest needle is used for the injections.  Some patients do not even want or need topical anesthetic.  The results will be maximum from 2 weeks to 3 months after the injections.  At 3 months the wrinkles slowly start to come back.  Treatment every 4 months is needed to maintain optimal results. Anywhere from 20 to 60 units will be used for each treatment.  I usually recommend at least 40 units over 3 areas (the full dose is 60 units) which include the forehead, frown line and crows feet.  This will soften all the lines and achieve a younger refreshed look every where and to prevent odd facial expressions or “that Botox look”.

for further information and to see before and after pictures, see
Make sure to sign up for the Brilliant Distinctions program on the website for discounts on BotoxCosmetic, Juvederm, and Latisse.

PRICES for BotoxCosmetic are from $299 to $619.  We use always full-strength Botox and I personally administer all the injections.  (We often have 10 % off.  Call office for the most recent specials)

Treatment Areas with Good Results:
-Crows feet
-Frown lines and/or forehead lines
-Rabbit nose from a strong smile
-Over active lip lines or gummy smile
-Creased chin wrinkles
-Pronounced neck bands.

 

Injection Lipolysis

A younger face is oval in shape with a smooth tight jawline and full, high cheeks due to the fullness of the fatty layer under the skin.  As part of the aging process, we lose fat from the upper cheeks, which then become hollower and instead deposit the fat in the lower part of the face – above the nasal labial folds, along the jawline and in the upper neck.  This spoils the smooth contour of the jawline and results in a much squarer and heavier appearance to the lower part of the face which considerably ages our appearance.

There are several effective surgical techniques to effectively reduce localized pockets of subcutaneous fat on the face and neck, including facelift and liposuction.  There is now a non-surgical option that can easily be done in the office with only injections using the very smallest needle available.  Furthermore, this method not only can dissolve some of the fat, it may stimulate some skin tightening through new collagen production. This is particularly useful along the jawline where often a combination of jowl reduction and skin tightening are required to produce the best results and the most youthful appearance.  Though this treatment is not as effective as a facelift, it does provide a more youthful, less “grouchy” looking, prettier heart shaped face – less rectangular shaped face with heavy jowls plus a prettier profile –  at much lower cost without  the complications, downtime and cost of a facelift.  As I always say in my practice, it is more important to shoot for being prettier than obsess about every wrinkle.  I like this treatment so much I have already performed it twice on myself.

The first day of your treatment you will feel sore and start to swell.  Apply ice for 30 minutes if needed though not required.  All usual activities including wearing makeup and exercise can be maintained while healing.  Swelling lasts 5-10 days. the swelling means it is working. The decrease in fat and mild tightening will start in 3 weeks and continue for 8 weeks.  The next treatment is done 6-8 weeks later.  Two or more treatment sessions will be required.  Avoid aspirin 7 days prior, Ibuprofen (Advil, Motrin) and Alleve 1 day prior.  If you think you are allergic and swell from soy products, I can skin test you first.  Usually at least 3 treatments are needed with men.  They require more treatments then women.  The injections are less painful then Botox injections.

$259 1st treatment, $199 for repeat treatment in 6 weeks.


SculptraAesthetic ®

SculptraAesthetic is a volume enhancer treatment that can give you back the softness and fullness characteristic of a youthful face.  It softens the face after plastic surgery or severe weight loss and fills in the hills and valleys that begin to develop on our face as we age.

The first hollows appear in our 30s and 40s under the eyes and over the temple areas.  The cheeks and temples lose fullness over the upper face.  The face then appears to drop.  This gives the appearance that “gravity” with age has set in when in actuality, it is simply the loss of fullness and bulk in the upper face that allows nasal labial folds to appear.  As we age further, we then develop hollows over our central cheeks and around the mouth giving us a tired and harsh look.  SculptraAesthetic is the best technique to get back the fullness as the treatment encourages your skin to make its own collagen, which not only feels like your own skin but is your real skin.  This treatment is not a filler but stimulates your own collagen production.  You will get a softer, prettier look.

The ideal youthful looking face is more heart shaped with fullness over the temples, the lateral cheekbones and under the eyes.  Our face becomes more square or eggplant looking shape as we age with heaviness in the mouth and jaw area combined with hollowness over the mid, lateral areas of the giving us a longer face.  Usually a face lift in your 40s and early 50s will not give patients them the look that they are actually after which is a softer, prettier, more rested looking appearance.  As I always tell my patients, your goal should be to look prettier first.  The real problem is the loss of facial fullness over the upper face.  Usually 3 more treatments are needed, 1 to 2 months apart.
SculptraAesthetic is an excellent way to add fullness to thinned skin look and to remove lateral pulling lines that often appear after a face lift.  The mid and lateral cheeks are treated with 2 to 3 treatment sessions.  The sunken, hallow eye look resulting from an aggressive eye lid surgery is also an excellent area for treatment.
The procedure is performed after a strong anesthetic cream has been applied for 1 to 2 hours.  Aspirin should be avoided 2 weeks prior, Advil for 2 days prior.  Arnica (oral form) started 3 days prior also helps.  There will be puffiness over the areas treated for 3 to 5 days.  For women, makeup may be applied as needed.  The face will return to its previous state after the swelling goes down and the collagen production that will result takes 6 weeks to start to show.  It is 8 weeks after the second treatment for the results just start to show.  Collagen production continues for 6 months after each injection. This procedure requires patience.  After the third  treatment,  3 layers of collagen will be produced.  The patient will really notice significant improvement then. Most patients require 3 to 4 treatments over a 5 to 6 month period for optimal results.  Eighty-five percentage of patients are pleased 13 months after treatment, 80 % 2 years after treatment.

PRICES for SculptraAesthetic are $790 the first, $599 for each treatment after.  (We often have 10 % off.  Call office for the most recent specials).

Treatment Areas with Good Results:
-Temples, cheeks to lift the face
-Hallows under the eyes
-Crepey skin over the cheeks
-Hallows around the mouth including nasal labial lines & marionette lines.
Chemical Peels; Superficial to Medium Depth 
This is one of my favorite treatments.  Chemical peels have been in use for 130 years and have stood the test of time.  It can solve so many problems including superficial wrinkles, crepey, leathery skin texture, uneven pigmentation and acne and acne scarring.  I have been using chemical peels in my practice for 20 years.  They are affordable and can get significant results when done in a series.  Depending on the depth and the area being treated, the patient is red from 1 to 5 days, and will heal in 7 to 10 days.  Hands will take 3 weeks to peel.  Sunblock or makeup can be applied while healing takes place.  The medium depth peels will require hiding out for a week with swelling for the first 5 days and pinkness for 2 weeks.  Makeup can be applied after 1 week. A series of 3 light peels, given 1 month apart is the most commonly recommended treatment.

PRICES for Chemical Peels – Light-Jessners plus10-15%TCA ($99 to150 with face, neck & chest $95, add lower arms and hands $125), Medium Depth-Jessners plus 20-25% TCA ($200 to 250), Heavy Peel-Jessners plus 35% TCA ($650-700 with all pre-op & post-op medications and visits included).  CROSS Peel for deep acne scarring & pitting (100% TCA applied to the deep acne scarring and 15% TCA to rest of face and neck ($150).  Acne scars require from 3 to 6 treatments, monthly to remove most of the acne scarring.

Treatment Areas with Good Results:
-Superficial to medium depth wrinkles over cheeks, eyelids, mouth, chest and hands.
-Melasma and mottled colored skin from sun exposure
-Leathery skin from chronic sun exposure
-Acne scarring, most kinds.
Varilite/Iriderm Laser (532nm)
This laser is excellent at removing red and brown spots; including freckles, sun spots, superficial moles (anywhere on the body) and broken capillaries (face neck and chest).  Lasers have been used in dermatology since the 1960s. They are safe and reliable. This laser has minimal downtime, side effects and can be very effective.

A topical anesthetic will be applied.  The areas treated will look darker and redder for about 1 week after the procedure.  Sunscreen and makeup can be applied after.  There is no discomfort after the procedure.  Many spots can be treated in one session if desired by the patient.  Treatments are repeated at 1 month intervals until clear.

PRICES are $150 to 250.