Skin

Minimally Invasive Procedures

Your skin’s appearance is affected by aging in many ways over time. Smoking habits, sun exposure, and repeated facial expressions cause lines and wrinkles which can ultimately give you a tired or sad appearance. Unfortunately no matter how well you take care of your skin, the amount of Collagen and Elastin slowly diminishes. As a result your skin becomes less elastic, like a rubber band that has been slowly stretched beyond its ability to return to its original shape. Also, the fat under your skin, which gives your face its shape and gives your skin a tight youthful appearance, slowly thins and descends with age. Many of these of these changes can be slowed by taking good care of your skin, but signs of aging inevitably occur.

Fortunately, there are many ways to look more refreshed and youthful without spending a great deal of money or time recovering. With popular minimally invasive office treatments, there are no restrictions to normal activities, and in most instances sedation and anesthesia are not required.

The most common minimally invasive procedures that I perform are Botox Cosmetic® injections, Juvederm® and Sculptra® injected fillers, and autologous fat grafting. These procedures are excellent cost effective ways to combat the obvious signs of aging, and they can leave you looking noticeably younger quickly. The trade off is that none of these procedures are capable of the dramatic results which can be achieved through surgery.

Botox Cosmetic

Botox is a natural protein that works by blocking the nerve signals to the muscles of the face. It works for dynamic wrinkles (those that appear with facial expression or movement). The most common areas are the forehead and around the eyes, but it can be used in other areas on a case by case basis.

Over the last ten years, Botox has become the world’s most popular cosmetic procedure, with millions of uses, because of its predictable effects and excellent safety profile. Treatment involves several injections with a tiny needle. Most people tolerate the injections very well, but I offer topical anesthetic in case you don’t tolerate injections well.

Cooling compresses are used to limit discomfort and bruising after the procedure. The area may be red for several minutes, but makeup can be used. You can go back to your normal activities immediately. Some patients have bruising in the injected areas, but this is rare.

The effects of the Botox are typically seen four to seven days later and last three to four months on average, though many patients report that it lasts longer after repeated use.

Injectable Fillers

Juvederm Ultra and Ultra Plus

The most commonly used fillers are made of purified molecules called hyaluronic acids. A common example is Juvederm, which can be used to fill in the lines and folds between the nose and mouth (naslabial folds) or crow’s feet that persist after Botox Cosmetic treatment. Juvederm can also be used for lip enhancement by adding volume to thin lips, creating better definition to the borders of the lips, or filling in vertical lip lines that develop with age. The results of these treatments are visible immediately and last 6-12 months.

Sculptra

Sculptra is a different kind of filler which is designed to help your body replace lost collagen over a series of treatments (usually two or three). The results can last up to two years. Scupltra is a safe material called poly-L-lactic acid, which is used to make dissolvable sutures, and is easily dissolved by the body. Once it’s injected, the body will then build collagen around it causing the tissue to thicken, filling in depressions and lines. Sculptra can improve the appearance of deep folds between the nose and mouth (nasolabial folds), sunken areas of the face such as the temples and cheeks, and even depressions on the backs of the hands.

What to expect during and after your procedure

Treatment involves several injections with a small needle. Cool compresses are applied to the areas being injected just prior to the injection to limit discomfort and bruising. I also offer topical anesthetic and nerve blocks (an injection of local anesthetic near nerves) to minimize patient discomfort. After treatment there may be some itching, redness, swelling or tenderness that is normal and temporary. If a nerve block is used, your lip will be numb and difficult to move for about 2 hours after the procedure, so you shouldn’t plan on eating until a few hours after your procedure.

Autologous Fat

Some patients may choose fill and plump up areas with their own fat, which is usually taken from the abdomen or thighs. This procedure can be done in the office using local anesthetic. The results are permanent, but it can require a few treatments to get the final result, and it does require a procedure to harvest the fat. You can read more about fat injections in the facial procedures section.

Skin resurfacing: Laser, Peels, or Dermabrasion

Over time, lines and wrinkles develop which can make you look older and even appear sad. Many things cause wrinkles, like smoking, sun exposure, facial expressions, and natural changes in your skin with age. Production of natural oils decreases, making your skin drier and appear more wrinkled. Collagen and Elastin diminish, so your skin thins and becomes less elastic. Sun damage and hormonal changes can cause blotchiness and uneven skin color.

Even at younger ages, visible blood vessels, previous acne, chicken pox, and scars can leave unattractive blemishes on the skin. Skin rejuvenation can resurface your skin and improve the texture, clarity and overall appearance of your complexion.

Conditions that can be treated:

• Static wrinkles: These wrinkles are visible at all times and do not change in appearance with facial movements.
• Dynamic wrinkles: These are expression lines that may appear as folds when the skin is not moving, and deepen with facial movements or expressions.
• Pigmentation: Freckles, sun spots, melasma, or other dark patches of skin result mainly from sun exposure.
• Scars: As the result of acne or injury to the skin, scars may be rolling (a wavy appearance to the skin), pitted, discolored, or have raised borders.
• Vascular conditions: Small blood vessels can be visible on the surface of the skin, vascular lesions can appear as tiny blood filled blisters, or there can be a constant flush of redness to certain areas of the face.
• Loss of skin tone: Weakening of the supportive skin structure (collagen and elastin fibers) result in a loss of skin firmness or the development of cellulite.
• Excess Hair: Problem areas of hair growth can be targeted, and repeated laser treatments can be used to get rid of hair so shaving becomes less frequent or even unnecessary.

What to expect during the procedure

During the skin resurfacing procedure, laser energy or a liquid peeling agent is used to remove layers of damaged skin to leave the treated area smoother. This procedure is performed on an outpatient basis and uses local anesthesia to help minimize discomfort if needed. The entire procedure can take anywhere from 30 minute to two hours depending on the size and condition of the treated area. Sometimes more than one session is required to achieve the desired result.

Stronger lasers or peels penetrate deeper in the skin, as does dermabrasion. Dermabrasion involves using a rotating instrument to polish away the top layer of skin so that when it heals, it is refreshed and rejuvenated. These procedures are more invasive and require local anesthetic and sometimes sedation, but usually require only one session.

Recovery and Results

After your skin resurfacing procedure, you may experience mild swelling and discomfort for a few days. These symptoms can be controlled with ice packs and prescription pain medication. You will also experience redness that gradually diminishes as the skin heals. While most patients can return to work and other normal activities after a few days, redness may persist for several weeks, and some patients might experience peeling. With deeper the treatments, you will get a more dramatic result, but you will have a longer recovery.

The results of laser skin resurfacing may take months to fully appear, after all signs of redness have diminished. Although the results are long-lasting, they are not permanent. The treatment will not stop the normal aging process, but it will reset the clock, and skin will appear younger and smoother.

Risks

Although skin resurfacing is considered very safe for most patients, and complications are rare, there are risks associated with any procedure. The chance of each of these adverse reactions depends on which treatment is used, your skin coloration, and your medical history. During a consultation, I will get to know you and learn about the amount of improvement you want and the length of recovery that is acceptable to you. After we specifically review the chances of these complications, I can tell you which treatment is best for you.

• Scarring - Some scars cannot be improved, and the treatment itself can rarely cause scarring.
• Infection – You will be given antibiotics to take for deeper skin resurfacing treatments and an antiviral medication to prevent cold sores, which can even occur in a small number of patients who have never had them before
• Skin pigment changes – Dark or light areas are possible after treatment, and the risk depends on your skin coloration and which treatment is used.
• Abnormal healing – For some patients, the skin may remain red for a prolonged period of time or there may be areas of peeling and crusting that lag behind other areas that have already healed.

If you are interested in learning more about skin rejuvenation, please come talk with me in the office so we can discuss what may work best for you.

Latisse ®

This popular new eyelash enhancer is actually an eye drop used to treat glaucoma that was found to make eyelashes grow. By applying it to the base of your upper eyelashes once a day, every week you’ll watch your lashes grow thicker and longer.

Normal hairs grow for a period of time then eventually shed. Latisse works by increasing the length of the growing phase and the number of hairs growing at one time.

A few patients have had eye irritation, infection, and darkening of the eyelid skin, which is usually reversible. When the drop is placed directly into the eye as a glaucoma drop, a small number of patients had darkening of the iris (the colored part of the eye), but this has not been seen with Latisse used on the eyelids.