Cosmetics

Cosmetics

I have always had a special interest in skin, and began offering aesthetic services over 10 years ago. I specialize in treatments that are effective and have minimal downtime. My staff and I regularly attend conferences and training sessions to keep up with the many new products available in the changing aesthetic medical arena.

I carry my own skin cream line, along with Obagi. I have several treatments available for rosacea (facial redness), age spots, and melasma (brown discoloration of the face). I carry several devices, including the Clarisonic. I have been performing Botox injections since early 2006, and having been injecting Xeomin since before it was launched. I have been injecting fillers like Juvederm, Radiesse and Belotero since 2008.

My staff and I are constantly evaluating new products and procedures, and add (and replace) services as new products are developed and information is published. I carefully evaluate everything before offering it to my patients. I believe in being honest with my patients and will tell you if we have not had much experience with a product I am recommending.

As cosmetic services are not covered by insurance, I do offer interest free financing for up to one year through CareCredit (click the Apply Now button on their page). Of course, I will also accept cash, MC, VISA, and Discover.

My staff and I invite you to make an appointment for a free consultation!


The Basics of Non-Surgical Cosmetic Procedures

Here are many of the non-surgical cosmetic procedures available today.

Botox – Botox is the brand name for medical grade botulinum toxin type A. It is injected into specific muscles of the face and neck to weaken and relax them. This smoothes the skin lines, and over time, can make wrinkles disappear. It is usually used to treat forehead wrinkles and crows feet, although other areas of the face and neck can also be successfully treated. It does wear off, and needs to be repeated every 3-6 months. Wrinkles can only go away permanently if the injections are done regularly. Since everyone is different, sometimes the area injected can be a little off. Since it does wear off, it is almost impossible to do permanent harm with this.

Soft Tissue Fillers – There are many of these on the market, including Juvederm, Radiesse, Belotero and Restylane. Collagen was one of the first, but has had a problem with allergic reactions. The newer agents have pretty much eliminated that problem, but are more expensive. They are injected in low spots to plump them up. Examples would be scars (typically acne ice-pick scars) and lines around the mouth. There are temporary and permanent versions. Permanent fillers eliminate the need to keep coming back, but you have to live with the results forever. Be very cautious about having permanent fillers placed!

Microdermabrasion – This procedure is almost like sandblasting the skin. A sand line abrasive is pelted at the skin and vacuumed up again. A new technology where an abrasive paddle is placed on the skin and vibrated is called VIbraderm. Microdermabrasion takes off part of the top dead layer of skin. This helps with skin surface irregularities, acne, brown spots, and allows other treatments be more effective. In addition, it is thought to stimulate the growth of collagen. Depending on the machine, there may be some mild redness to peeling and raw skin.

Peels – Acids are placed on the skin to clean off the top dead layer. Chemical peels can be anywhere from superficial to deep. The deeper peels have better efficacy, but also a longer recuperative time. A series of good superficial peels done every 3-4 weeks can show significant improvement in skin texture and coloration, with minimal downtime.

Lasers and IPL machines– In general, lasers can penetrate deeper and can be more effective. The catch is that they can also do more damage. In addition, each type of treatment requires a different wavelength, and theoretically a different laser.

Topicals – There are many skin cream lines, and individual skin creams available on the market. Most of the drug and department store lines don’t have significant effects on the skin. Many of the creams available to physicians only will make some long term changes. I have carried the Obagi line for several years now, because it appears to be the most effective in many areas. The trade off is, that it tends to be more difficult to tolerate initially. In return, it will take off that top dead layer of skin, similar to peels and microdermabrasion. I also carry several other lines that have more modest improvements, but are better tolerated.

I hope this basic overview gives you an idea what is available on the market today. Many of these modalities will commonly be combined to give maximum effect. Whatever you decide, the most important thing, is to use sunscreen daily (UVA and UVB) to maintain and protect your skin.


I’m very excited to introduce my own skin cream line! Lest you worry, I haven’t been in the basement tinkering. I found some products I really liked, and the company does private labeling, so I figured it would be fun to put my name on it. I chose high quality medical grade cosmeceuticals that are reasonably priced. I often get asked to recommend products for basic skin care, and these would be a good choice.

Ultra Gentle Cleanser is a rich, creamy product that gently cleanses and softens the skin without drying. It contains the antioxidants vitamins A, C, & E, Green Tea Extract, and Coenzyme Q10. Specially chosen to work well with the Clarisonic brush system, it is soap and fragrance free. Natural lavender extract helps to soothe the skin.

Glycolic Facial Toner is a specially formulated blend of glycolic acid, witch hazel, and selected extracts that gently cleanse, tone and refresh the skin. This toner is designed to remove oil and debris from the skin’s surface and leave the skin feeling invigorated and refreshed. Use immediately after cleansing with Ultra Gentle Cleanser.

Retinol Plus Smoothing Serum contains All-trans- Retinol, which is a pure and active Vitamin A. A potent antioxidant, green tea polyphenols have a calming and soothing effect on the skin. The serum contains caffeine to enhance the antioxidant properties of the skin and hyaluronic acid to aid in skin hydration, all in a moisturizing base. It helps improve the appearance of fine lines, wrinkles, mottled pigmentation, skin texture, skin tone and hydration. It also increases exfoliation to help unclog pores.

Skin Tone Enhancement Therapy with up to 4% hydroquinone combines the botanical skin tone brightening ingredients of Kojic Acid, Arbutin, and Bearberry, along with the skin protective antioxidants silymarin, ascorbic acid, green tea polyphenols, and emblica to calm and soothe the skin. This product improves skin tone, hyperpigmentation and melasma.

5% Benzoyl Peroxide Gel is the perfect spot treatment utilizing the antibacterial properties of benzoyl peroxide. Used to treat acne, apply a thin layer daily, then gradually increase to two or three times daily.

Triple Antioxidant Cream and Serum are triple antioxidant formulations in a hyaluronic acid base. They contain the powerful antioxidants resveratrol (from red wine), 90% polyphenol isolates (the active ingredient in green tea) and caffeine (which enhances the antioxidant properties of green tea). They improve the appearance of fine lines, wrinkles, and pore size. They have a calming and cooling effect on the skin and are ideal for sensitive skin, and especially rosacea patients. They are also ideal for those concerned with photodamage. The serum is lightweight and fast absorbing, while the cream is more emollient. The serum is ideal in the summer and on oily skin (men especially like this formulation), and the cream is great in the winter or on dry skin. Use on clean skin once or twice daily.

Retinol Eye Cream has been specially formulated to contain a comprehensive system of All-trans-Retinol, peptides, chelators, antioxidants and moisturizers. You can expect a reduction in under-eye dark circles and puffiness, along with reduction in fine lines and wrinkles around the eyes. The firmness and tightness of delicate skin around the eyes will increase, and skin will have improved texture and smoothness. Use once or twice daily around eyes. Excellent product to use with the Clarisonic Opal.

Fortified Moisturizer contains Vitamins A,C & E, Green Tea, and Coenzyme Q10 to moisturize and protect against free radial induced skin damage. Delivers a smoother, softer skin with liposomal vitamins. This is a great night cream, and also the ideal moisturizer for the dry skin patient who requires a heavier, yet cosmetically elegant moisturizer.

Ultra Lite Facial Cream is similar to the fortified moisturizer, it also contains Vitamins A,C & E, Green Tea, and Coenzyme Q10 to moisturize and protect against free radial induced skin damage. This is an ideal product for the patient who would like a light moisturizer. Excellent for those who break out easily or don’t like that “greasy feel”.

Ultra Lite Moisture Dew Cream is an elegant facial moisturizer recommended for all skin types. This soft cream is made from the purest food-grade aloe vera gel which has been carefully processed and is rich in natural mucopolysaccharides. Squalane, a stabilized natural emollient found in healthy skin, and dimethicone further prevent moisture loss.

Ultra Sheer Sunscreen SPF 55 provides broad-spectrum UVA/UVB protection. This contains the latest in photo-stabilization technology to keep the sunscreen working at optimum level for longer periods of time. Enhanced with protective antioxidants, is it ultra-sheer and weightless and is especially good for those who hate using products on their face (like men with facial hair).

Green Tea Exfoliation Scrub delivers a soothing wave of heat as it gently removes dry dead skin cells, excess oils and residue to reveal healthier, younger looking skin. When combined with water it releases energy in the form of heat. Use 2-3 times per week to exfoliate the skin and deep clean pores.

Clay Mint Mask cleans and tightens pores while absorbing excess oils. It reaches deep into the skin and helps dry up blackheads.


Obagi Skin Care

Picture of Obagi ProductsPrescription skin care systems are approved by the Federal Drug Administration (FDA), which means that studies had to be performed proving a benefit to patients and that claims made by the company have been reviewed and approved by the FDA. In addition, all prescription products are monitored during manufacture to assure potency and purity.

The Obagi company offers a skin care system called Obagi Nu Derm, which is more potent than most others, which is why they require a prescription. Most skin care lines are considered cosmeceuticals. This means they are available without a prescription and their benefits are assumed, but not proven. Please keep this in mind when choosing a system. I chose to carry Obagi because the company has done scientific studies to back up its claims. Very few other companies have done that.

Both skin care systems are designed to improve the look and texture of skin, but they do act differently.

Acne Before and After Picture
ACNE

Photo Damage Before and After Picture
PHOTO DAMAGE

Hyperpigmentation Before and After Picture
HYPERPIGMENTATION

Melasma Before and After Picture
MELASMA

OBAGI NU-DERM

Nu-Derm is Obagi’s original and most effective system. The most significant ingredients are tretinoin and hydroquinone. This system will increase keratinocyte cell turnover, causing there to be less dead cells and more fresh healthy ones. It will even out the skin tone and color, giving a more even distribution of the color producing melanocytes. Fibroblasts are stimulated, increasing collagen and elastin, which makes the skin stronger and more resilient. Natural hydration is increased through increasing GAG synthesis. Therefore, additional moisturizers are not needed, even in the dry winter months. Healthy uniform cells are formed by repair of intracellular transcription. Blood flow is improved due to growth of capillaries.

What does this do for you?

This system will make your skin smoother, improve fine wrinkles, improve age spots, and improve skin texture. The skin is less dry, more elastic and firm. With continued use it can prevent future sun damage. In short, it can turn back time, reversing some of the effects of aging, and it can slow down aging in the future.

The Obagi line Nu-Derm is a system, and (with a few exceptions) no additional skin care products are required. The different aspects of the system have been carefully chosen to work together in the most effective manner. People with issues such as rosacea or severe acne may require additional medication to treat those conditions. We do, however, often add topical Vitamin C to the Nu-Derm system to decrease inflammation and augment the anti-aging effects. By the way, Obagi is also compatible with water or mineral based make-up.

What should I expect?

Nu-Derm does take some getting used to. Initially there will be redness, dryness and peeling. How much and how long depends on how aggressive the therapy is, and how sensitive your skin in. A very aggressive approach will cause more redness and peeling initially, but will be done more quickly. This initial stage lasts anywhere from 6 to 12 weeks. Over the following 6-12 weeks the skin improves, with less wrinkles, smaller pores, and improvement of uneven coloration (and of course, there is less redness and flakiness). Finally the maintenance phase is entered. This is what you have been waiting for! At this time the maintenance protocol should be followed to keep what has been gained.

Of course, results will vary, but almost everyone should expect some improvement with this system. I believe this is the most effective and most proven system on the market today. There are many skin cream lines, with many claims made. I only feel comfortable recommending those that have the best chance of helping my patients, and I believe this is one of the best.

Having said that, there are still other options, especially for people who are afraid or not willing to deal with the initial breaking in period of the Obagi Nu-Derm, or for younger women who don’t need as much improvement.

These products are prescription, and should be dispensed and monitored by a physician! For more information, consult the Obagi website at www.obagi.com. Please call for a skin consultation and we can help you decide which system would be best for you.


Botox and Xeomin Treatments

Botox, Xeomin and Dysport are trade names for a purified protein produced by the bacterium Clostridium Botulinum. There are 7 different toxins produced by the bacteria, and all three are made from toxin A. Botox and Xeomin are very similar, although Xeomin does not have protective proteins surrounding it, so in theory it is less likely to produce antibodies compared to Botox. Although Xeomin is the newest Botox alternative, I have used a significant amount of both of them, and they appear to be equal in strength and staying power. I use then interchangeably, and most of my patients have not noticed a difference or developed a preference for one over the other. Dysport, on the other hand, is a weaker toxin and requires more units to do the same job, and spreads more, so needs a different injection technique than Botox or Xeomin.

Botulinum toxins produce a temporary weakening of muscles by interfering with the release of the neurotransmitter acetylcholine. We can inject it into muscles of the face and neck to prevent their movement. If injected carefully into the proper muscles, wrinkles aren’t produced with movements (such as smiling). When done continuously over the long term, it is possible that wrinkles will never form.

When a person smiles, creases are formed at the eyes (crow’s feet), and nose. Making an angry expression will also put creases at the bridge of the nose, and raising the eyebrows will give horizontal lines on the forehead. Over a span of many years, repeating these movements will cause the creases to become permanent, which we call wrinkles. If we weaken (or paralyze) the muscles that cause these lines-while leaving all the other surrounding muscles intact-we lose the creases while still keeping the ability to have an expressive face. That is the goal and challenge of botulinum toxin therapy.

Wrinkles present at rest will not respond, these are called static lines. Dynamic lines appear with muscular effort and vanish when muscles are at rest. These will be most likely to respond.

Safety

Botulinum toxins are extremely safe, as long as some basic precautions are used. There are less expensive versions of botulinum toxin available on the internet, but Botox, Xeomin and Dysport are the only ones approved by the FDA for cosmetic use in the US. It is carefully made by the manufacturers to be pure, free from contaminants, and of consistent dosage. Before being injected, make very sure you know what you are getting.

Adverse reactions to botulinum toxins are rare, and generally mild. A mild headache that may last a few days is sometimes seen. Possible reactions at the injection site include pain, bruising, bleeding, swelling and numbness. Even when injected properly, sometimes the botulinum toxins will weaken muscles we don’t want to be weakened. When that happens there can be a droopy eyelid or brow. Fortunately, since they wears off in 3 months, this is only a temporary problem. Finally, it would take an enormous amount of Botulinum toxin to kill a person, which would be ridiculously expensive and not really worth considering as an adverse reaction.

Schedule

We can inject any muscle with Botox or Xeomin, but cosmetic botulinum toxin is used mostly in the face and neck. After injection you should avoid lying down for 4 hours. It will take up to 2 weeks for it to take effect, and I often ask my patients to come in for a quick visit at that time (at least after the first injection) to see if they are happy with their treatment, and to do any touchups that may be necessary or desired.


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