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The new Trusculpt iD technology from Cutera damages fat cells (adiposites) using heat. This technology has a higher patient satisfaction rate when compared to “fat freezing” technology and also tightens the skin, a claim that cannot be made with “fat freezing”.

Treatments are completed in 15 minutes with no downtime. Patients can have their treatments and go directly to the gym. Results take at least 3 months to appreciate and almost a 25% reduction is seen in a single treatment.

The highest rated fat reduction treatment on www.realself.com

INJECTABLE SKIN FILLERS

With fillers being so common today, the number of options is very high and very confusing. Which product is best for me? Who should perform the procedure? Where should I have it performed?

Let us take a look at some of the most important questions that you should be asking.

  1. Who is going to perform the procedure? How many of these procedures has the physician performed? How many times a day or week does the physician perform this exact procedure? Is the physician board-certified?
  2. What results can I expect? How long will it take to recover from the procedure? Can I see before and after pictures?
  3. What are the risks of the procedure? What happens if I have a problem? Will the doctor be available if there is a problem?
  4. Where is the procedure being performed? The procedure should always be performed in a medical center or doctor’s office, not a non-medical spa, shopping mall, or private party.
  5. Am I paying too little? If the price seems too good to be true, there is a good chance that the product could either be diluted–which would increase the risk of contamination–or purchased from an illegal source (which is much more common than one would think)
  6. Which filler is best for me? For the most part, there are two major product lines used: Juvederm and Restylane. While there are differences between the lines themselves, they are somewhat comparable with advantages and disadvantages of each and cost varies so ask. Within each line, there are products that are better for fine lines and ones that are best to add volume. No one product is best for all. Yes, there are other products such as Radiesse and Sculptra, which have a unique place in this filler arena.

Getting a filler or a neurotoxin is a medical procedure, and knowledge is power. Patients must ensure that what is being injected into their skin is legitimate and purchased form a reliable, legal, U.S. source. Patients should ensure that they are being treated by a highly trained professional. A board-certified dermatologist, plastic surgeon, or facial plastic surgeon who has been trained in the proper use of fillers and neurotoxins can help you get the results that you want and reduce the risk of complications.

Freckles on face
Freckles

Freckles are brown spots that commonly occur in sun-exposed areas on the skin that are harmless. As one gets sun exposure, the spots darken. When one avoids the sun or UV exposure, the spots lighten. The face is the most common area affected, but the arms and legs are common sites as well. It is most common for one to have many of these lesions in an area, and not one or a few.

Freckles can be confused with “age spots” or moles (nevi), which do not get darker and lighter the way that freckles do.

Any lesion that has multiple colors, is larger than 4-mm, is asymmetrical, and/or has irregular borders should be checked by a board-certified Dermatologist.

PREVENTION

As Sun-exposure, natural and/or artificial, makes them darker, avoidance is paramount. One should avoid midday Sun, wear protective clothing (i.e. wide brimmed hats and shirts), and use a broad-spectrum sunscreen that contains titanium dioxide and/or zinc oxide in high concentrations. Topical Vitamin C preparations can help prevent new spots and lighten existing spots.

We carry many sunscreens that afford superior protection. Click here to see our Sunscreens.

TREATMENT

Prescription creams can be used to lighten these spots and are extremely effective. We use a prescription that must be compounded (mixed by a pharmacist) that is extremely effective. Over-the-counter preparations containing hydroquinone, Kojic acid, and/or Vitamin C are all helpful to lighten these spots. We have two products that work well to lighten the spots:

FADE 1 2 3 which contains 2% hydroquinone and should be used until the desired color is seen. SPOT TREAT ONLY as it will lighten any skin that it is applied to

Cerum which contains Vitamin C and Ferrulic Acid, which prevents further damage and lightens brown spots. This works great to prevent darkening and helps lighten as well.

No one likes the look of dark circles under their eyes, which can make one look tired. Unfortunately, treatment of this common complaint can be difficult as several factors play a role in their appearance. 

What causes dark circles under the eyes

  • Genetics. This is the most common cause of dark circles. In darker skinned individuals, too much pigment or too much skin can cause dark circles. In lighter skinned persons, thin skin can reveal blood vessels below, giving the skin a blue-purple hue.
  • Tear trough or bulging fat pad. There is a natural transition from where the eyelid meets the cheek, which is apparent in everyone. For some this gets hollowed out and forms a deep groove. For others, the skin just below the eyelid bulges outward, thus forming a deep groove below. This occurs due to natural aging and some are more prone due their genetics. 
  • Aging. With age, the skin thins. Underlying blood vessels become apparent, the skin develops fine lines, and their is a change is texture and tone. As the skin loses its elasticity, it tends to bunch up, which makes it appear dark.
  • Seasonal Allergies. Hay fever and other allergens can result in the dilation of blood vessels under the eyes. This causes the skin to appear dark due to the increased blood flow. The released histamine can result in puffiness as well. 
  • Not enough sleep. Although, most blame a lack of sleep to having dark circles, it is not common. If one does not get enough sleep puffiness can develop under the eyes. 

How to treat dark circles under the eyes

While we cannot treat one’s genes, we can do things that reduce the appearance of dark circles.

Eye creams

Certain active ingredients in eye creams, such as retinol and peptides, increase collagan and elastin, reducing fine lines and “bunching” of the skin.  Retinol also reduces pigment, as do other ingredients such as vitamin C, kojic acid, and niacinamide. Topically applied caffeine constricts blood vessels, making dark circles appear lighter.

Dermal fillers

Restylane can be injected into the hollows or grooves under the eyes to reduce their appearance. This safe and effective procedure has results that last approximately six months or longer.

Chemical peels

Chemical peels have been used for centuries to tighten and lighten the skin. While still a good option, newer modalities have given other options, often with faster recovery, than chemical peels.

Microneedling

Microneedling is safe for all skin types, but by itself is minimally effective. When microneedling is combined with radiofrequency, significant improvement can be seen with minimal to no downtime. More than one treatment session is required for optimal results.

Fractional laser resurfacing

Laser skin resurfacing is extremely effective tool used to tighten the skin and stimulate collagen production by creating hundreds and hundreds of tiny round wounds that takes well over a week to heal. For those with fine lines and skin laxity, this is a great option for those who can have at least a week of downtime and several weeks of pinkness on the areas treated.  

How do I get the best result

For most, there is not one treatment that will work to reduce the dark circles, but several. For skin laxity and fine lines, creams containing retinol can help, while chemical peeling, laser resurfacing, or surgery may be needed for moderate to severe laxity. For hyperpigmentation, actual increased pigment that is not due to laxity can be treated with creams containing retinol, Vitamin C, kojic acid, niaciniamide, and/or caffeine. Stronger prescription agents containing hydroquinone can be used for moderate cases. For severe cases, chemical peeling and/or laser resurfacing can be used. For puffiness caused by a visible fat pad, Restylane can be injected into the tear trough, or hollow under the eye, to reduce the appearance of the “bag” or surgery can be performed to remove the bag itself in some cases. 

In short, for most creams and Restylane injections can very helpful at reducing the appearance of bags or darkness under the eyes. 

According to a study published in the Journal of the American Academy of Dermatology, patients who were treated with Mohs’ Micrographic Surgery had a higher 5-year survival rate than those treated with excision.

Despite this, many insurance carriers do not view Mohs’ surgery as “medically necessary” for the treatment of these tumors.

Revance Therapeutics Inc. said that an experimental drug RT002 [injectable daxibotulinumtoxinA] can smooth wrinkles for longer than Allergan’s Botox, according to the results of late-stage studies. The release date of this drug is not reported as it is still under investigation.

According to a report in the New York Times (5/14, Pollack, Subscription Publication), people who are prone to getting basal cell carcinoma and squamous cell carcinoma who take an inexpensive vitamin can reduce their chance of getting these common skin cancers. In a clinical trial, investigators found that “people who took two pills a day of nicotinamide, a form of vitamin B3 available as a nutritional supplement, had a 23 percent lower risk of developing non-melanoma skin cancer than those who” were given a placebo. According to the New York Times, “a summary of the results was released” yesterday “and presented…at a telephone news conference prior to the annual meeting of the American Society of Clinical Oncology.”

If you are fair-skinned or if you have a history of non-melanoma skin cancers, Dr. Bader recommends that you discuss taking this vitamin supplement with your Primary Care Physician.

We are glad to have an alternative to the once popular Contour Thread Lift. In about one hour, the mid cheeks and jowls can be lifted with the Silhouette Thread. The procedure is performed in the office under local anesthesia. A small incision is made in the hair above the sideburn. Threads are introduced into the cheek and jowls and pulled tight. The entire procedure takes less than one hour. Most patients resume most normal activities in about 3 days. This procedure was FDA approved for use in the USA in 2006 and one is performed every 15 minutes throughout the world. This is a great option for those who do not wish to undergo the more invasive facelift procedure and desire more results than Ultherapy or other completely non-invasive procedures can offer. Call our office now to find out more about this procedure.

It has been a long time coming, but Restylane Silk, the product that has been sold in Europe and Canada for over a decade under the name Restylane Fine Lines, has finally come the U.S. under the name Restylane Silk. Yes, it is another hyaluronic acid product, but it has a smaller particle size making it well-suited for the treatment of fine lines. Unfortunately, it comes with a slightly higher price tag than regular Restylane, but it is worth a try for those wishing to treat fine lines only. And yes, it comes with lidocaine to make the injections more comfortable.

According to a study published in JAMA Dermatology on Nov 5, “minimally invasive cosmetic procedures are nearly risk-free.” Such procedures included fillers, neurotoxins, and the use of laser and energy devices–performed by 23 dermatologists at eight centers across the US.

It has been well-studied that Dermatologists have an outstanding safety record with minimally-invasive and non-invasive procedures. This recent study is yet another supporting the safety claims made by Dermatologists and Dermatologic Surgeons.