CANDELA V BEAM PERFECTA LASER

for dilated blood vessels, rosacea, red birthmarks, sun damage, uneven discoloration, brown spots, scars, warts, and many other conditions

The Candela V beam Perfecta laser is a pulsed dye laser, which delivers an intense burst of yellow light to the skin (wavelength 595 nm). This wavelength of light is absorbed by hemoglobin, which is in red blood cells. Because blood vessels are filled with red blood cells, laser light can be specifically absorbed in these areas, to diminish or fade the vessels, with minimal damage to surrounding tissue. The blood vessels are coagulated and reabsorbed by the body. The V beam laser has a unique cooling device, which sprays a cooling mist onto the skin with each laser pulse, protecting the epidermis (the top layer of the skin), and increasing comfort. In addition to hemoglobin, melanin, the pigment in the skin, absorbs the 595 nm wavelength of light. If lasering a pigmented brown spot on the skin is desired, a special hand piece is used. This hand piece compresses the blood away from the target area, leaving only the melanin to absorb the laser energy.

Many patients have small, dilated blood vessels on the face around the nose, cheeks, and chin. The cause of this is essentially unknown. Some patients may have a condition called rosacea. Facial vessels and redness respond very well to the laser treatment. Small vessels on the chest and neck can also be treated. Benign blood vessel growths called angiomas can appear over the trunk, and look like small red dots. These can be treated with laser. Red birth marks also respond to the V beam laser. In general, dilated blood vessels on the legs (spider veins or varicose veins) do not respond as well to laser treatment. These are best treated by sclerotherapy (see separate information sheet).

Lentigos are brown spots with increased melanin in the top layer of the skin. These often occur on the face, hands, and arms in response to the sun. Another condition caused by chronic sun exposure is “poikiloderma”, mottled brown and reddish uneven pigmentation, often on the neck and chest. Many patients also complain of uneven pigmentation on the face, from sun damage. These conditions can respond to the V beam laser using the special hand piece. Optimal response may be achieved with several V beam sessions, at one to two month intervals. Moles are growths which contain mole (nevus) cells, and do not respond to the laser.

At the laser appointment, your eyes will be protected with special goggles. The laser beam is aimed at the skin. You will feel multiple “zaps” which may feel like rubber band snaps. The mist may also be sprayed onto the skin. Most of our patients tolerate this without any problems. You can ask your practitioner about using a topical anesthetic before the treatment. Sometimes, cool compresses are applied after treatment. Depending upon the number of areas affected, treatment time can take between 10 to 40 minutes. You may need several laser treatments for the best outcome. After treatment of red spots or blood vessels, you can expect post op changes ranging from minimal redness like a sunburn, or bruising (purpura), depending on the treatment selected by your practitioner. If you do not want excess bruising, your practitioner may purposefully select gentler laser settings, and you may need more overall treatment sessions. Brown spots after treatment will usually turn red then dark after a few days, and then peel away. The healing is generally a few days to 1 to 2 weeks. After treatment, you should not rub, scratch, or pick at the area. Avoid swimming, hot tubs, and contact sports if there is redness or irritation. If there is no scabbing or discoloration, your usual moisturizer, makeup, and sunscreen can be used.

Risks from V beam laser treatment are very uncommon, but can include the possibility of light or dark discoloration, or scarring. There is risk of eye injury, if eyes are not shielded properly from the laser light. Some lesions will need more than one treatment, and may not be completely faded after the first visit. We recommend avoiding sun exposure before and after treatment.. You will be asked to use sunscreen after the treatment. Self tanning products should be removed before treatment. Patients receiving Accutane treatment for acne should wait at least 6 months after completion, before laser. Tattoos should not be lasered. Let your practitioner know if you have a history of Herpes

Simplex virus (cold sores) in the target area, so that prophylactic treatment can be started before laser. Patients on blood thinning medications can develop more bruising from the laser. Topical medications should be stopped a few days before and after the appointment. Darkly pigmented skin may not be appropriate for laser treatment.

We are looking forwards to treating you with this state of the art laser system. The V beam laser can be very effective at fading and diminishing redness and hyperpigmentation, with minimal downtime.

Your practitioner will recommend the type of session (small, medium, large) and the number of sessions necessary for your treatment. For best results, multiple treatments are typically necessary.

Small Session

(for example, 1 or 2 spots)

Medium Session

(for example, broken blood vessels on the face,

brown spots on the hands and arms, or

small red spots on various areas of the body)

Large Session

(for example, facial, neck or chest

rejuvenation, rosacea treatment)

Candela VBEAM LASER WITH PHOTODYNAMIC THERAPY

Laser Session

Includes application of 5-aminolevulinic acid (ALA)

Many of our cosmetic services will require a deposit at the time the appointment is made. This deposit will be applied to the total charge the day of the appointment. In the event you need to cancel or reschedule your appointment, you need to provide appropriate cancellation notice to prevent the loss of your deposit.

WRINKLES AND PHOTOAGING

Condition Information
Wrinkles, when fine, are due to weakened collagen in the upper layers of skin, especially in sun-exposed areas. Deeper wrinkles are usually caused by repeated muscle action or the changing distribution of subcutaneous fat and muscle due to the effects of gravity over time. Brown spots and freckles are due to UV damage to the top layer of the skin.

Treatment Information
Vitamin A derived creams, alpha hydroxy acids, beta hydroxy acids, and antioxidants can partially reverse the fine wrinkles and photodamage. Chemical peels with TCA, glycolic, or salicylic acid can further improve skin texture. Deeper lines between the eyebrows as well as forehead lines and crow's feet can be greatly improved by injecting the areas with Botox. Deeper lines can also be improved by injection with a filler material, such as collagen or Restylane. Laser can be used to remove unwanted hair or dilated blood vessels.




CHEMICAL PEELS
for fine wrinkles, uneven pigmentation, skin rejuvenation, acne, or acne scarring

Chemical peels come in many different types and strengths, but the main action of peels is to remove the top layer of the skin, and allow the bottom layers to rejuvenate and grow in. The components of the skin from top to bottom include the stratum corneum, which is the topmost dead layer, the epidermis, which is the first living layer and the layer most visible to the eye, the dermis, which is the middle, structure-bearing layer, and the deeper subcutaneous fatty tissue. Light chemical peels usually remove the stratum corneum. Deeper peels can penetrate into the epidermis. The risk of penetrating too deeply into the dermis is possible permanent scarring. Some publications have reported that chemical peeling can actually stimulate new collagen growth in the dermis. Peeling can remove excess stratum corneum, which can appear as dry lusterless skin. Peeling can also remove excess dead skin from plugged up hair follicles. Uneven pigment in the epidermis, such as from sun damage, can be peeled away along with the epidermis, to allow a more uniform epidermis to grow in.

The following is a brief discussion of various peels offered by our practice. You should discuss with your practitioner your goals for skin improvement. Depending upon your skin type and desires, the proper treatment plan can be suggested.

Glycolic acid is an alpha-hydroxy acid derived from sugar cane. Peels can be performed with glycolic acid ranges from 20 to 70 percent. Peels are applied to the skin, and are usually left on for anywhere between 1 to 10 minutes, and patients experience mild to moderate stinging and burning. These peels can penetrate into the stratum corneum and epidermis, depending upon strength and application. Directly after the peel, there is usually light redness, and peeling skin for the next few days. Patients can usually resume their normal activities upon leaving the office. These peels generally do not achieve the desired goal after only 1 treatment. Usually, glycolic acid peels are done in a series, such as every 1 to 4 weeks, for about 6 total treatments. Your physician will discuss the appropriate plan with you. Your physician may ask you to use home products containing glycolic acid and/or hydroquinone to treat the skin before and/or after the peels. Prior to the peels, you may be asked to discontinue use of certain medications such as Retin-A. These peels can improve skin texture, skin pigment, acne, mild acne scarring, and mild sun damage.

Beta Lift peels are a brand of peel composed of salicylic acid, a beta-hydroxy acid. The peels are available in 2 strengths. The application of the peel is similar to the description of the glycolic acid peel, except that this peel is not timed. The patient experiences mild to moderate tingling and burning, which stops by itself after approximately 3 to 5 minutes. These peels can be done for the same conditions as for glycolic acid peels. Because the beta-hydroxy acid penetrates well into the hair follicles, it is useful to treat the plugged pores in acne.

Tri-chloro-acetic acid (TCA) peels can range from light peels similar to glycolic acid peels, to deeper peels similar to resurfacing treatments. 20% TCA peels can be performed for skin rejuvenation, pigment irregularity, and skin roughness. At this lower strength, the peels can be similar to or slightly deeper than the glycolic acid peel. In addition to redness and peeling, there may be some superficial erosions and crusts. One way to deliver the 20% TCA peel is in a series of 3, 1 week apart. Each subsequent peel goes deeper, because of the skin removed at the prior week’s peel. Deeper TCA peels can be done at concentrations greater than 20%. The goal of the deeper peel is generally to treat moderately to severely sun damaged skin, or some acne scars. Deeper peels can also treat some early actinic keratoses (precancers). The deeper peel is usually performed once. The patient experiences moderate to intense burning during the treatment, which lasts approximately 5 minutes. Afterwards, the skin is red and has a whitish frost from the peeled skin. The patient can expect some swelling, crusting, and drainage for about 1 to 2 weeks, during which time ointment dressings are being applied. Patients generally will take some time off from their schedules for this treatment. After the skin has healed, there may be some light redness for the next few months. Patients will most likely be prescribed antibiotics to take during the healing period. Usually, prior to treating the complete area, your physician will perform some test spots first. The deeper TCA peel may not be suitable for some patients with darker skin types, due to risk of pigmentation changes.

For all types of peels, it is important not to have excessive sun exposure for a few weeks before and after the treatment. After the peel, it will be important for you to use careful daily sun protection. Be sure to discuss your current topical medicines and creams. If you are using Retin-A, Differin, or Tazorac, you may be asked to stop 1 week before the peel. Be sure to tell your physician if you have had Accutane pills in the past (a medication for severe acne), as this treatment may cause difficulty with skin healing for up to 1 year after the last pill. Also tell your physician if you have had cold sores (Herpes blisters), so that a treatment may be prescribed to prevent an outbreak after the peel.

Risks for all types of peels include light or dark discoloration (pigmentation), absence of desired effect, persistent redness, scarring, infection, and irritation to the eyes if they are exposed. Risks generally are greater for the deeper peels. Your physician will try to minimize the risks by carefully choosing the correct peel for you. Some patients with darker skin may have higher risk of pigment side effects.



CANDELA GENTLELASE PLUS LASER
for laser hair removal

The Candela GentleLASE PLUS laser is used to target and destroy unwanted hair follicles. The wavelength of light specifically emitted by this laser is absorbed by melanin, the pigment in the skin and hair. The laser light passes through the skin to be absorbed by pigmented hair in the hair follicle, where the laser energy is transformed into heat that specifically injures the hair follicle, and spares surrounding tissues.

Laser treatment is most effective on active, growing hair follicles. Since hairs constantly cycle from active to dormant stages, multiple treatments are required to achieve best results. It is expected that 4-8 treatments, at about 1-3 month intervals will be needed for significant, long-lasting hair reduction. Because there is also melanin pigment in skin cells, the laser works best on persons with light skin and dark hair. The laser does not work on grey hairs. Persons with darker skin can still be treated, but may need more treatments at lower energies.

At your consult visit, we will discuss your skin type, predicted response to laser treatment, size of area to be treated, cost, and treatment schedule. Your medical history will be reviewed. You may be given prescriptions for medications, if necessary, including a topical anesthetic to use for the day of the procedure, if desired. A laser test spot may be performed. You will be asked not to wax or tweeze, or have electrolysis, for 4-6 weeks prior to the treatment appointment (the hair root must be present in the follicle for the laser to work). Shaving or clipping the hair is acceptable. If you have darker skin, you may be asked to use a prescription bleaching cream for a few weeks prior to the laser treatment. Let your physician or nurse know if you have any tattoos or permanent makeup.

On the day of the treatment, you will be asked to mark the area of desired treatment, then shave the area. If desired, you will also put on the topical anesthetic. You should also remove any creams, perfumes, or makeup. At the laser appointment, your eyes will be protected with special goggles. During the treatment, you will feel the laser handpiece touching the skin, then a cooling spray and almost simultaneous laser pulse, which feels like a rubber band snapping. Most all persons tolerate the treatment with minimal discomfort. Depending on the area to be treated, treatment time can take between 10 to 60 minutes. Immediately after the treatment, you may experience mild redness and swelling and itching, possibly feeling like a sunburn, lasting a few hours. There may be redness for 2-3 days. If there is scabbing or blistering, you should call the office, and may be asked to return for a post-operative check. After the treatment, some of the hairs will remain in the follicles, and may even appear darker than usual. They often will fall out within the next few weeks. Hairs that regrow are usually smaller, softer, and lighter. You should then return for repeat treatment, as scheduled. You can return to normal activities after the treatment, but we ask that you make your appointments at least 1 week before major social events. If desired, you can apply makeup when comfortable, usually several hours after treatment. If necessary to remove hair after treatment, you should shave only for the 6 weeks after treatment (and avoid waxing or tweezing).

Risks from laser hair removal are minimal, but can include the possibility of light or dark discoloration, blistering, bruising, or scarring. There is risk of eye injury, if the eyes are not shielded properly from laser light. The risks are greater on tanned skin, therefore, you should avoid tanning or sun exposure before and after the treatment. We also ask that you avoid artificial tanning creams before and after the treatment. If you have a history of Herpes virus infection (cold sores), you may be given an antiviral prescription to take, to prevent activation of Herpes infection by the laser treatment. Let your practitioner know about your medical conditions, such as warts, tendency to scar or keloid, or autoimmune diseases. Persons who have had the prescription medicine accutane within the past year should proceed cautiously.

We hope you decide to proceed with this exciting new technology. It can provide you freedom from shaving, waxing, or tweezing, and the problems that accompany these hair removal techniques, such as razor bumps, folliculitis, and cuts.


COLLAGEN INJECTION
for facial wrinkles and scars

Collagen protein can be used to improve facial wrinkles and depressed scars, by filling in sunken areas of the skin. Collagen is a protein found in many tissues of the body, and generally provides structural support. There are different collagen types in the skin, bone, cartilage, and tendon. Collagen has a fiber-like structure, and can “weave” together to form a network or framework. In the skin, it provides texture, resilience, and shape. Our practice uses Zyderm I, Zyderm II, and Zyplast brand collagens, which are purified collagens from cow skin.

Zyderm or Zyplast collagen is introduced into the affected area by injection. The purified collagen thus stays in the desired area of skin, and “fills” it in. Different conditions in which areas of skin are sunken in or depressed respond well to this treatment. Common conditions include wrinkles, such as around the cheeks, lips, frown lines, or smile lines between the upper lip and cheeks. Flattened or less defined lip borders can also be plumped up with collagen. Depressed acne scars can also be filled in. Pitted or “ice pick” acne scars do not respond well. Zyderm or Zyplast collagen treatments typically last between 2 to 6 months, before the body naturally reabsorbs the injected collagen. At that time, repeat treatment can be done, if desired.

To begin the collagen treatment, the first step is to have a skin test. There is a possibility that you will be allergic to the collagen, and the skin test is to avoid injecting allergic patients, as this could result in allergic reaction resembling a persistent insect bite, lasting 2 to 6 months. All patients must undergo the skin test. The first one is a small collagen injection, usually into the forearm, which is monitored for 1 month for any reaction or redness. The second test injection can be into the arm or hairline, and again is monitored for 1 month. If you have had prior test injections or collagen treatment without reaction, please let your practitioner know.

The actual collagen treatment involves injections with a fine needle directly into the desired areas. Topical anesthetic can be placed on the area prior to treatment, and you can ask your physician beforehand. Your practitioner will determine the type and amount of Zyderm or Zyplast collagen to be used, depending upon the defect to be treated. There may be some bruising, similar to having blood drawn. There is usually some slight swelling and lumpy appearance, lasting approximately 1 day. Other less common risks include allergic reaction (even after 2 negative test doses), formation of scab or scar, and light or dark discoloration at injection sites. There is a very remote possibility that collagen material can be injected into a blood vessel, causing blockage. There is always the possibility that you will not notice improvement. Prior to treatment, your practitioner will take a medical history, to be sure that you can proceed with treatment. If you are on certain medications, such as prednisone, your physician may wait until you are off the medication prior to treatment. Patients allergic to lidocaine (local anesthetic) should not be treated. There is controversy whether there is a link between collagen treatment and autoimmune diseases. Please discuss this with your practitioner, particularly if you or your family has any history of autoimmune diseases.

DIOLITE LASER
for dilated blood vessels

The Diolite 532 laser is used to target and remove unwanted superficial blood vessels. The wavelength of light specifically emitted by this laser is absorbed by hemoglobin, which is in red blood cells. Because blood vessels are filled with red blood cells, laser light can be specifically absorbed in these areas, to diminish or fade the vessels.

Many patients have small, dilated blood vessels on the face around the nose, cheeks, and chin. The cause of this is essentially unknown. Some patients may have a condition called rosacea. Facial vessels respond very well to the laser treatment. Small vessels on the chest and neck can also be treated. Benign blood vessel growths called angiomas can appear over the trunk, and look like small red dots. These can be treated with the DioLite laser. In general, dilated blood vessels on the legs (spider veins or varicose veins) do not respond as well to laser treatment. These are best treated by sclerotherapy (see separate information sheet).

At the laser appointment, your eyes will be protected with special goggles. The laser beam is aimed at the blood vessels, but does not touch your skin. You will feel multiple “zaps” which may feel like rubber band snaps. Most of our patients tolerate this without any problems. We do not usually administer topical anesthetic, because this can cause blood vessels to constrict, thereby making them more difficult to treat. Depending upon the number of areas affected, treatment time can take between 10 to 20 minutes.

Risks from DioLite laser treatment are minimal, but can include the possibility of light or dark discoloration, or scarring. There is risk of eye injury, if eyes are not shielded properly from the laser light. Some blood vessels will need more than one treatment, and may not be completely faded after the first visit. Usually, patients will notice slow blood vessel remodeling and shrinkage over the course of 1 month. Deeper and larger blood vessels may not be appropriate for the DioLite laser, thus your physician will evaluate your vessels before treatment. After the laser session, the skin is usually pink and flushed, such as after mild sunburn. Many patients feel comfortable going back to work after the treatment. There may be some slight scabs in more aggressively treated areas. We recommend that patients avoid excessive sun exposure for a few weeks before and after the treatment, to help avoid pigmentation risks (hiking, beach, all day out in the sun). You will be asked to use sunscreen after the treatment. Facial cosmetics may be applied, when comfortable, usually several hours after treatment.

PHOTODYNAMIC THERAPY
WITH LEVULON KERASTICK AND V BEAM PERFECTA LASER
for photorejuvenation, acne, sebaceous skin (oil glands), and treatment of sun damage

Photodynamic therapy (PDT) is an exciting new technology incorporating the application of a natural photosensitizing substance (Levulon, see below) to the skin, followed by activation with light. At Dermatologist Medical Group, we use the V BEAM PERFECTA laser to activate the substance. This combination produces powerful results against sun damage, acne, and photoaging.

Changes in the skin from photoaging include pigmentation changes, brown spots, broken out blood vessels, redness, wrinkles, large pores, laxity of skin, and precancers. These changes can be treated with PDT. Generally, at least 3 sessions are needed, at 2 to 4 week intervals. Acne can be treated with multiple therapies, including topical or oral antibiotics, benzoyl peroxide, topical or oral retinoids (such as retin-A or Accutane), and hormonal treatments. PDT can be used in conjunction with these standard treatments, for enhanced acne clearing. Some patients are not good candidates for standard therapies (or do not want to take oral medications). In these patients, PDT can be a great alternative to treat acne. PDT can improve some acne scars. Again, you will usually need 2 to 5 treatments, 2 to 4 weeks apart, for the best results. PDT can also treat oil gland growths (sebaceous hyperplasia), minimize pores, improve skin texture, and decrease skin oiliness, by targeting oil glands.

Levulon Kerastick is a solution of 5-aminolevulinic acid (ALA), which is applied by your practitioner in our office. ALA is a substance which occurs naturally in the body. The Levulon is swabbed onto freshly cleaned skin, and allowed to absorb for 30 minutes to a few hours, while you wait in our office. During this time, the ALA is penetrating into the skin, specifically into areas of damage, precancers, and oil glands. You may feel slight burning. In the skin cells, the ALA is converted into protoporphyrin IX, which can be activated with light. When the incubation time is over, the ALA is washed from the skin, and the area is treated with the V BEAM laser. The laser light activates the protoporphyrin IX, which then destroys the unwanted cells. During the laser portion of the treatment, your eyes will be protected with special goggles. You will feel multiple “zaps” which may feel like rubber band snaps. A cooling mist may also be sprayed onto the skin. There will be some burning. Most of our patients tolerate this without any problems. Depending upon the size of the target area, the laser treatment time can take between 10 to 40 minutes.

After the PDT session, you should expect redness, swelling, and peeling for 48 to 72 hours (like a sunburn). In some patients, this post-op redness is minimal. Other patients may experience more swelling, burning, some crusting, and tightness. If you do not experience redness after the first session, you practitioner will likely increase the strength of subsequent treatments, until you develop the post-op reaction. After the PDT session, it is important for you to protect from sunlight and bright indoor light exposure for 48 hours, since remaining light-sensitizing ALA will still be in your skin. You may feel burning with exposure to any type of light, during this post-op time. You will need to use titanium dioxide or zinc oxide based sunblocks, wear a hat and sunglasses, and stay indoors. Please bring a wide brimmed hat with you to your appointment, so you can wear it as you leave the office after the session. After the treatment, you can wash your skin with soap and water, and apply moisturizer. If there is a lot of crusting or blistering, you can apply Aquaphor ointment a few times a day. You can apply ice packs, and take Tylenol, aspirin, or Advil, if necessary. Makeup and topical medications (such as topical acne medications) can be resumed after crusting has healed. Applying makeup prior to this will not damage the treatment, but may just feel irritating. If you are having PDT to treat acne, your acne may initially flare after treatments. Brown spots in the treated area may initially become darker, before they peel off. Oil gland growths may be crusted after treatment. You should avoid the sun for two weeks, and use a sunscreen with SPF of 30 or more, for at least four months after treatment. Post-op redness will gradually subside over 4-8 weeks.

Risks from PDT with V beam laser are minimal, but can include the possibility of light or dark discoloration, or scarring. The redness after treatment may be prolonged, if there is exuberant response to treatment. There is risk of eye injury, if eyes are not shielded properly from the laser light. Self tanning products should be removed before treatment. Patients receiving Accutane treatment for acne should wait at least 6 months after completion, before treatment. Tattoos should not be lasered. Let your practitioner know if you have a history of Herpes Simplex virus (cold sores) in the target area, so that prophylactic treatment can be started before laser. Patients on blood thinning medications can develop more bruising from the treatment. Topical medications should be stopped a few days before and after the appointment. Darkly pigmented skin may not be appropriate for laser treatment. Pregnant women should wait to have PDT treatment. PDT may cause permanent hair removal, thus men should be cautious in treating beard and moustache areas. As with any cosmetic procedure, there is the possibility that you may not achieve your anticipated result.

We are looking forwards to treating you with this new and powerful combination photodynamic therapy and laser treatment.

RADIESSE INJECTION
for facial wrinkles and scars

Injection of Radiesse, calcium hydroxylapatite microspheres in a water based gel carrier, can be used to improve facial wrinkles, and depressed scars, by filling in sunken areas of the skin. Calcium hydroxylapatite is a naturally occurring substance found in bones of all animals. Its function is to provide a matrix to support muscles and joints. It has been used for decades in safe clinical applications and is now FDA approved for improving the appearance of moderate to severe facial wrinkles including Nasolabial Folds.

Radiesse is introduced into the affected area by injection. The calcium hydroxyapatite forms a “scaffold” that stimulates the natural growth of the patient’s own collagen. Radiesse treatment typically lasts 9-24 months before the body naturally reabsorbs the injected calcium hydroxylapatite. At that time, repeat treatment can be done, if desired. Like Restylane, Radiesse treatment can be performed without a prior skin test. Longer lasting results are obtained if a second “top off” injection is given 2-6 weeks after the first treatment. The actual Radiesse treatment involves injections with a fine needle directly into the desired areas. Topical anesthetic can be placed on the area prior to treatment. Alternatively, at the time of treatment, a nerve block can be administered, which involves injection of a local anesthetic into the area of the gums. Your physician will determine the amount of Radiesse to be used, depending upon the defect to be treated. There may be some local bruising, similar to having blood drawn. There is usually some slight swelling and redness, lasting approximately 2-3 days. Cold compresses may be applied. Other less common risks include allergic reaction, formation of scab or scar, and light or dark discoloration at injection sites, or infection. There is a remote possibility the Radiesse can be injected into a blood vessel, causing blockage. There is always the possibility that you will not notice improvement. Prior to treatment, your physician will take a medical history, to be sure that you can proceed with treatment. You should let your physician know if you have a history of cold sores. You should avoid blood-thinning medications such as aspirin, ibuprofen, St. John’s Wort, or high doses of vitamin E, for one week prior to and after treatment. The top off touch up injection at 2-6 weeks is included in the cost of treatment. Studies have shown Radiesse to last much longer than collagen or hyaluronic acid (Restylane) when given in this manner.

RESTYLANE INJECTION
for facial wrinkles and scars

Injection of Hyaluronic acid can be used to improve facial wrinkles and depressed scars, by filling in sunken areas of the skin. Hyaluronic acid is a polysaccharide molecule naturally found in the extracellular space of all tissues in all vertebrates. Its function is usually to provide a matrix to provide volume and support to cells and tissues. Restylane is a specific brand of non-animal-produced Hyaluronic Acid, and is FDA-approved for use in facial wrinkles.

Restylane is introduced into the affected area by injection. The purified Hyaluronic acid thus stays in the desired area of skin, and “fills” it in. Water binds to the molecule, and helps provide volume. Different conditions in which areas of skin are sunken in or depressed respond well to this treatment. Common conditions include wrinkles, such as around the cheeks, lips, frown lines, or smile lines between the upper lip and cheeks. Flattened or less defined lip borders can also be plumped up with Restylane. Depressed acne scars can also be filled in. Pitted or “ice pick” acne scars do not respond well. A Restylane treatment typically lasts more than 6 months, before the body naturally reabsorbs the injected Hyaluronic acid. At that time, repeat treatment can be done, if desired. Unlike collagen injection, Restylane treatment can be performed without a prior skin test.

The actual Restylane treatment involves injections with a fine needle directly into the desired areas. Topical anesthetic can be placed on the area prior to treatment, and you can ask your physician beforehand. Alternatively, at the time of treatment, a nerve block can be administered, which involves injection of a local anesthetic into the area of the gums. Your physician will determine the amount of Restylane to be used, depending upon the defect to be treated. There may be some local bruising, similar to having blood drawn. There is usually some slight swelling and redness, lasting approximately 2-3 days. Cold compresses may be applied. Other less common risks include allergic reaction, formation of scab or scar, and light or dark discoloration at injection sites, or infection. There is a remote possibility that Restylane can be injected into a blood vessel, causing blockage. There is always the possibility that you will not notice improvement. Prior to treatment, your physician will take a medical history, to be sure that you can proceed with treatment. You should let your physician know if you have a history of cold sores. You should avoid blood thinning medications such as aspirin, ibuprofen, St. John’s Wort, or high doses of vitamin E, for one week prior to and after treatment.

ARTEFILL®

ARTEFILL is the first and only FDA-approved injectible wrinkle filler designed for the correction of smile lines that doesn't get absorbed into the body. So you can look younger, longer with a filler that truly lasts. All it requires is a simple, in-office procedure for immediate wrinkle correction that stands the test of time. And thousands of women and men who have had ArteFill® are still loving their results. If you've used temporary dermal fillers such as Restylane®, Juvederm™, Radiesse® or SculptraTM in the past, then you know that they are eventually absorbed by your body and require frequent repeat injections to maintain the results you've come to love. ArteFill® is different. The unique microsphere technology within ArteFill® is not absorbed by the body and therefore provides the permanent support your skin needs for long-lasting results. Dermatologist Medical Group uses ArteFill® to treat the deep folds between the nose and mouth and the marionette lines beneath the corners of the mouth. Because fillers aren't for everyone we are providing ArteFill® only to patients who have had, and liked, the results with other fillers. A consultation visit is required. If you and your practitioner decide that ArteFill® is a good choice for you, a test dose of the collagen used to disperse the ArteFill® will be injected. An appointment for ArteFill® injections may be made one month after your test dose has been applied.

SCLEROTHERAPY
for leg veins

Increased superficial leg veins, such as telangiectasias (spider veins), or larger varicose veins, are common. Often, there is a family tendency, and they may be worsened by hormones (including pregnancy), prolonged periods of standing or sitting, being heavy, or certain underlying diseases. While many patients have no discomfort, some have itching, burning, or aching of these leg veins, and symptoms may worsen with menstrual periods. These superficial leg veins may be removed or closed without affecting the circulatory system in the body.

Sclerotherapy is a non-surgical procedure for closing unwanted superficial leg veins. A sclerosing solution is injected into the veins using a tiny needle. The solution can be a detergent (made specifically for sclerotherapy), irritant, or hypertonic solution (such as concentrated sodium chloride). Multiple small injections will result in some temporary stinging and localized swelling of the treated veins. Immediately after the procedure, tight compression stockings are worn continuously for 3-7 days. This combination of injections and compression leads to gradual closure of the veins. We recommend 20-30 mmHg medical compression stockings (thigh-high with gripper tops, or pantyhose). If larger veins are treated, higher compression and longer wearing time may be needed. Walking for 30 minutes per day, for at least one week following the procedure, will help speed the improvement, and help with any discomfort.

Temporary bruises are common, and will fade over 1-2 weeks, followed by gradual improvement of the leg veins. Treated vessels become less defined, then gradually thinner, finer, and less apparent. Sometimes, tan color develops, and the vessels may become darker, firm, or lumpy, especially if larger veins are treated. This normal reaction will improve, though small amounts of tan pigment may occasionally persist. Fading of the veins may be noticed at 1-2 months, but gradual fading will continue for 3-6 months after injections. Multiple treatments are required for best results, usually 2-6 treatments spaced one to a few months apart. We can’t eliminate all unwanted veins, or guarantee results, but most patients improve with sclerotherapy. Usually 50-70% of veins will fade after multiple treatments. Whether treated or not, most patients will continue to develop new veins, which may be treated periodically, as desired. Continued use of support hose may help in prevention.

All medical procedures have some risks. In addition to expected reactions already discussed, a small scab or open sore may occur at an injection site. This will heal, but could leave a small scar. Please call the office if any scabs or sores are noticed. Occasionally, a network of tiny veins may develop around an injection site. This is called “matting”, and the new veins often improve without further treatment. If persistent, they may respond to additional injection or laser treatment.

Rarely, inflamed, painful veins (thrombophlebitis) may occur, and very rarely, blood clots in the deeper veins may occur, which have a remote chance of travel to the lungs. Allergic reactions to sclerosing solution are rare, but notify your doctor of any allergies before the procedure. You should also let your doctor know if you suffer from thrombophlebitis, deep vein thrombosis, poor circulation, clotting disorders, history of pulmonary embolus, or swelling of the legs or feet.

Before you schedule sclerotherapy, a vein consultation appointment is necessary. At that time, the doctor will discuss your medical history, examine your leg veins, and let you know what specific treatment is recommended in your case. In preparation for your treatment session, you should discontinue aspirin and non-steroidal anti-inflammatory medications for one week (consult your prescribing physician). You should avoid sun exposure to the legs for a few weeks before and after the session, to minimize hyperpigmentation. Wear loose clothing, and bring your compression stockings with you to the appointment. After the session, you should be able to return to normal activity. Laser treatment is also available in our office, however, only the tiny leg veins respond to laser, and most cases require additional treatment for best results. Larger varicose veins may have underlying venous reflux (abnormal blood flow), and other treatments such as surgery, endovenous laser ablation, or ultrasound-guided sclerotherapy might be recommended. These are not performed in our office, but we can refer you to appropriate physicians, if needed.

Sclerotherapy for leg veins, as performed in our office, is considered an elective, cosmetic procedure, and is not billed to insurance.

DESTRUCTION OF TAGS, BENIGN KERATOSES, AND SEBACEOUS HYPERPLASIA

Skin tags are commonly found around the neck, and in areas of skin folds, such as the underarm area. They appear to be exactly as their name describes; loose little tags of skin. Seborrheic keratoses usually look like rough, brown growths on the skin, with a “stuck on” appearance. They can be located anywhere, and are commonly found on the face, back, limbs, or the area under the breasts. Sebaceous hyperplasia refers to a benign growth of oil glands. Usually these growths look like 1-2 millimeter yellowish bumps on the face.

Multiple different destructive methods can be used to remove these benign growths. Liquid nitrogen is commonly used to freeze off the lesions. Lesions can also be cauterized off, or snipped off. Your practitioner will determine the most effective method for you. After a removal session, usually the treated areas will have some swelling and crusts, lasting approximately one week. There is also usually some discoloration of the treated sites. You should avoid tanning for at least a few weeks before and after the session, to minimize the discoloration. Sometimes, lesions cannot be completely removed without extensive scarring, and may grow back. Often, patients will return for repeat sessions as new growths appear.

Although the actual removal of these growths is very simple, the most important task your practitioner must perform is to examine your skin, and determine which growths fall into the category of tags, benign keratoses, and oil glands. Most people have multiple growths on the skin, including moles and other benign or possibly cancerous tumors. Obviously, these latter lesions should only be removed by biopsy and pathology examination. Therefore, we suggest to first have a skin examination or consultation appointment, prior to scheduling a removal session.

Because skin tags, seborrheic keratoses, and sebaceous hyperplasia are benign growths, their removal is considered an elective cosmetic procedure.