Botox® (Botulinum toxin-A)
As our skin ages, wrinkles form, starting as dynamic wrinkles which slowly develop into static or “fixed” wrinkles. These wrinkles are from repeated muscle contraction, loss of collagen and elasticity, free radical damage, and UV damage to our skin. A combination approach targeting these causes will best achieve your rejuvenation goals. We call this the 4 R’s of facial rejuvenation:
Relaxing muscle contraction can be achieved with Botox®.
Replacing volume loss can be achieved by soft tissue augmentation with dermal fillers and platelet rich plasma.
Resurfacing with chemical peels and a good skin care regimen can assist in repairing free radical and UV damage.
Redraping with plastic surgery is sometimes needed for extreme loss of collagen and elasticity.
• Facial asymmetry
• Eyelid Ptosis (drooping)
• Injection site pain
• Women who are pregnant or breastfeeding
• History of neuromuscular junction disease
• Active infection at injection site
Superficial Depth Chemical Peels
A superficial chemical peel is indicated for light resurfacing to help treat uneven pigmentation, acne, or fine lines and wrinkles. This kind of peel removes just the outer layer of the skin (epidermis) causing light exfoliation, and can result in a healthier glow. For maximum benefit, you can repeat these treatments at regular intervals to achieve your desired results. It often takes 4-6 peels to achieve the response.
Chemical peels should be combined with a skin care program including photoprotection, antioxidants, and retinoids. The degree of clinical improvement, recovery period, and risk of complications are proportionate to the depth of injury. Chemical peels are not indicated for deep wrinkles and furrows which originate in dermis. Adjunctive treatments with Botox® and filler are beneficial.
• Your face will be cleansed and de-greased using acetone.
• The chemical solution is applied to your skin and left on for a few minutes. You may feel some mild burning, stinging or itching. The depth of the peel will be proportional to the number of passes applied.
• Depending on the peel, the chemical peel may be washed off and neutralized.
• A moisturizing sun block is then applied to your skin.
• It is possible to experience some redness, stinging, skin flaking and irritation from a superficial chemical peel. After repeated treatments, these side effects will likely subside.
• Hyperpigmentation – Avoid this by always using a high factor sunscreen every day.
• Delayed healing or scarring.
• Infection is rare, but if prolonged redness, swelling, pain or oozing is present, please call your doctor immediately.
Very light chemical peel – GTZ acne peel
• Very light depth, injuring only the stratum corneum for mild exfoliation
• 15% glycolic acid, 15% Trichloroacetic acid, 2% zinc
• Cost is $35 per peel
• Peels can be done every 2 weeks
• Indications: Management of acne and post inflammatory hyperpigmentation and redness
• Speeds up medical acne treatment
• Mild stinging/burning during application. Minimal time (1-2 days) for recovery
Light chemical peels – Trichloroacetic acid 20%, Jessner’s, Salicylic Acid 30%
• Light depth injury to entire epidermis for regeneration of a new epithelium
• Cost is $125 per peel or a package is 6 total peels for $625.
• Peels can be done every 6 weeks
• Indications: Mild photoaging, epidermal lesions such as lentigines and keratoses as well as melasma and other pigmentary dyschromia
• Mild stinging/burning during application. Minimal time (7 days) for recovery
Dermal filler is a gel-like substance that is injected below the skin to replace volume loss and remodel collagen. Fillers help to soften the appearance of wrinkles. They can help under eye circles, increase volume in the cheeks, smooth deeper facial lines, and recontour the face. Other indications of filler are correction of atrophic/traumatic scars, lip augmentation, and volumization of the face in areas of fat loss.
While fillers can be a variety of different compounds, the most common is hyaluronic acid. Below is a list of the most common fillers used, location of injection, and how long it typically lasts.
Lateral cheekbones, posterior jaw – Restylane® Lyft™ (1-1.5 years)
Posterior jaw, tops of hands – Radiesse® (1-1.5 years)
Nasolabial folds, marionette lines, lips – Juvederm® Ultra™ (6 months)
Fine lines, tear trough – Belotero® (6 months), Restylane® Silk™ (6 months)
• Hypersensitivity or allergic reaction
• Granuloma formation
• Contour irregularities
• Tyndall effect (blue-gray cutaneous bead under the skin from filler placed too superficial)
• Vascular occlusion (blocked blood vessel) leading to ulceration and blindness
- Current oral herpes infection (cold sores)
- Uncontrolled diabetes
- Blood-clotting problems
Lupus or connective tissue disorders
It is best to schedule your procedure 2 weeks or more before any social event
One week before your scheduled procedure, we may ask you to stop taking medications that may increase risk of bleeding or bruising. These include aspirin for prophylactic use, NSAIDS, vitamin E, and fish oil. Please consult your doctor before stopping this.
Avoid alcohol 24-48 hours before your procedure
Avoid dental work within 2 weeks before your procedure and not to receive for 3 weeks after your procedure
Cost is $650 for 1st syringe and $550 for every additional syringe
Upon arrival, topical numbing may be applied to assist in your comfort during the procedure
Your skin will be cleansed with chlorhexidine, followed by alcohol pads
Your dermatologist will select a filler agent depending on size, depth, location of volume deficiency
The filler will be injected into dermis, subcutaneous fat, or supraperiosteal area by a variety of injection techniques chosen by your dermatologist
You may experience bruising, swelling, and pain after injection of filler. You will be provided an ice pack and are encouraged to ice on and off over the next 24 hours to help with any bruising and/or swelling
Your dermatologist may recommend topical vitamin K or arnica for bruising post procedure. Green tinted makeup works best at disguising bruises.
Platelet Rich Plasma (PRP)
Platelet rich plasma (PRP) is an exciting treatment option for hair loss as well as facial rejuvenation. Platelet rich plasma (PRP) has been used in the medical community for many years, mainly in the specialties of orthopedic and plastic surgery, as it has shown great effectiveness in the process of wound healing and tissue rejuvenation.
How does PRP work?
PRP is an autologous platelet preparation in concentrated plasma that is prepared from a patient’s own blood. It is an enriched platelet solution that through centrifugation reverses the RBC to platelet ratio. PRP contains a high level of both cytokines and growth factors, which function to stimulate inactive stem cells within the hair follicles, promoting increased hair growth. These cytokines and growth factors can also be injected into the skin of the face to assist in collagen remodeling.
PRP Protocol: What to expect (Slight variations in protocol depending on your dermatologist and PRP system)
Eclipse PRP® System is an efficient and high-quality system for healthcare professionals to harvest and prep PRP. The procedure is designed to take about 30 minutes and only a small amount of the patient’s blood is required. We recommend three treatments, 4-6 weeks apart and maintenance treatments every 6-12 months.
The day of your visit,
1. Blood will be collected in a test tube.
2. The blood will be placed in a centrifuge to induce layered separation of whole blood. Plasma appears as a yellow serum at the top of the test tube, separated from the red blood cells at the bottom.
3. Platelet rich plasma will be injected into the target area of the scalp if being used for hair loss or into the face if being used for facial rejuvenation.
The side effect profile of PRP is relatively mild with only redness of the skin, bruising, and swelling, which usually last less than 12 hours. PRP is a natural substance derived from the patient’s whole blood, preventing the risk of developing an allergic reaction. Clean or sterile technique is often used to prevent the risk of infection. Tylenol can be taken prior to the procedure to limit discomfort.
We may not be able to treat you with PRP if you have:
A blood disorder, an autoimmune disease such as lupus, untreated thyroid disease, an active malignancy, untreated skin cancer on the scalp, rash on the scalp, untreated anemia, untreated thyroid disease, and if you have low platelets.
In summary, PRP appears to be a promising therapy for the restoration of alopecia and collagen remodeling. Schedule a consultation with your dermatologist to discuss if PRP is the right choice for you!
• Local ulceration if extravasated (“leaks”)
• Superficial phlebitis
• Post-sclerotherapy hyperpigmentation (should improve after 6-12 months)
• Telangiectatic matting (Self-resolving)
• Hypertonic saline (23.4%) will be diluted 50/50 into 1 cc syringe with 0.9% normal saline
• Approximately 4-6 one cc syringes per treatment are required for bilateral upper, lower, anterior and posterior legs.
• Injections can be painful
• Focal pressure will be applied over the treated veins with cotton balls, tape, and Coban™
• Legs will be wrapped with ACE bandages in office providing needed compression
• You will need to purchase compression stockings to wear after the procedure.
• o Compression should be worn continuously for at least 24 hours after injection and for at least 10–14 days thereafter to help the healing process and limit pain and post-inflammatory hyperpigmentation. This will also increase treatment efficacy.
• Follow up office visit will be scheduled 6-8 weeks after injection sclerotherapy
• Additional veins in other areas can be treated 1-2 weeks later, but retreatment of any single area should be delayed for 6–8 weeks to allow the treated veins to fully heal.
• Cost of sclerotherapy is $600 for a 30-minute session.
Use of Tretinoin in Cosmetics
Have you ever wondered what skin care product dermatologists use most to prevent fine lines and wrinkles? Vitamin A derivatives, called retinoids, are the secret. When applied topically, any deficiency in collagen that exists in the skin is partially improved. Topical tretinoin, commonly known as Retin-A®, is a topical retinoid that has a variety of benefits in dermatology. Prescription strength retinoids teach our skin to shed appropriately by regulating numerous transcription factors within the nucleus of cells, signaling these cells to regulate epithelial cell growth and rate of proliferation. It is like giving yourself a micro-peel every single night. In general, tretinoin is best to use at night, as sun exposure during the day can decrease the efficacy in some topical retinoid formulations.
When applied consistently, it smooths and evens skin tone from hyperpigmentation, prevents breakouts from acne, and improves appearance of pore size by keeping pores clean and small. Tretinoin tightens and brightens facial skin! With the exception of sun block, it is the miracle cream for your face. Tretinoin is the most widely used topical therapy for photo-aging. UV exposure damages the dermal matrix of the skin, leading to rapid aging. Topical tretinoin plays a role in preventing and slowing further degradation and photo-aging from UV damage. After using faithfully, your skin will achieve a beautiful, smooth, and creamy glow that you have always wanted!
In addition, tretinoin can also be used in numerous other dermatologic conditions such as psoriasis, keratosis pilaris, melasma, post-inflammatory hyperpigmentation, and even in some skin cancers like Kaposi sarcoma and cutaneous T-cell lymphoma.
Topical tretinoin is known to be irritating. Because of the way it works in normalizing follicular keratinization, irritation upon initial use is common. You may experience burning, redness, and dryness. We recommend starting slow, using only one night the first week. Tretinoin is best used in a pea size amount, dab into each quadrant of the face, and use a gentle moisturizer.
Schedule your appointment today with one of our board-certified dermatologists to discuss adding a topical retinoid to your daily skin care routine.