Micro-Lipoinjection (or Fat Microtransfer)
Micro-Lipoinjection is a form of soft tissue augmentation that uses a patient’s own fat (autologous fat) as a filler substance to “plump up” wrinkles, furrows and hollows in the face. Using local anesthesia, donor fat is taken with a small sterile cannula from troublesome fatty deposits such as buttocks or thighs, and then re-injected into the areas to be filled. Since one’s own tissue is used, there is little risk of the body’s rejecting it, which can occur when a foreign substance is used.
With the advent of the long lasting hyaluronic acid filler, Juvederm Ultra Plus XC, and “Juvederm Voluma XC”, fat transfer is now seldom needed or recommended.
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Fat Microtransfer: before and after
Soft Tissue Fillers (Dermal Fillers): “Restylane,” “Juvederm Ultra,” “Juvederm Voluma XC,” “Radiesse,” “Perlane,” “Belotero Balance”
Soft tissue fillers are injected under the skin and are commonly used to reduce marionette lines and increase lip fullness. They are also used to “plump up” or fill-in wrinkles, furrows and hollows (including undulated depressed acne scars) of the face. The current state-of-the-art durable filler is the cross-linked hyaluronic acid product Juvederm Ultra Plus XC which does not require a skin test, is relatively pain-free, and lasts about 12 months. For comfortable injections (see our Cold Air Anesthesia publication), Hughes Dermatology uses pre-op topical anesthesia combined with cold air (from our Zimmer Cryo 5 unit) and vibratory anesthesia during the injection.
Hyaluronic fillers are used as a non-surgical “nose job” for nasal depressions.
Never use a permanent filler as it will show as a linear nodule with age!
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Hyaluronic Acid Lip Volume Enhancement
For a more natural look, Dr. Hughes will add “pillows” to the lower lip when doing lip enhancement.
“Belotero Balance” is a recent (2013) hyaluronic filler that can be used in very superficial lines. We are using it with great success for undulated acne scars and fine lines around the mouth.
“Juvederm Voluma XC” is a newish FDA-approved long lasting (2 years) hyaluronic acid filler for correction of mid-face volume.
Sidney Coleman, M.D. states, “Aesthetic surgery is moving rapidly away from excision and suspension procedures to augmentation procedures for rejuvenation in particular. The primary event of facial aging is atrophy or loss of fullness. The obvious solution for atrophy is restoration of volume or fullness.” Before getting a traditional invasive face lift, consult with Dr. Hughes to see if you are a good candidate for this noninvasive more natural alternative.
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Sculptra: before and after
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Sculptra: before and after
Sculptra: before and after, 2 sessions
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Sculptra: before and after, 3 sessions
Botox Injections
“Frown lines” are produced by an overactive superficial facial muscle (the corrugator muscle) which pulls the the eyebrows together and produces a permanent fold. “Crows feet” are produced by an overactive orbicularis muscle. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, at the corners of the eyes (“frown lines,” “bunny lines,” and “crows feet”), and even around the mouth (“smokers lines”). These lines may produce an angry or sad look that detracts from a pleasant facial appearance. “Platysmal bands” are linear bands on the neck produced by overactive platysmal neck muscles.
Dr. Hughes can now improve all these lines and bands without surgery and without scars by a simple injection of botulinum toxin type A (Botox) which relaxes these overactive muscles. Please mention this concern during your next appointment.
New medical uses of Botox include the treatment of post-zoster neuralgia (persistent pain after shingles), notalgia paresthetica (unrelenting localized itching), hyperhidrosis (excessive localized sweating of the underarms or palms )and lichen simplex chronicus.
Hughes Dermatology is a Botox training facility for dermatology residents.
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Botox Injections – Frown lines & Crow’s Feet
Platysmal Band – treatable with Botox
Hyperhidrosis
Hyperhidrisis is excessive sweating, usually of the palms and underarms. This is an inherited condition. Although it usually responds to topical prescription medication (and this is always first-line treatment), this embarrasing malady can now be successfully treated with Botox injections if the first-line treatment fails! The good news is the results are fairly longlasting, sometimes for one year. Using topical cream anesthesia and our Zimmer Cryo 5 cold air anesthesia machine, these palm and underarm injections are made comfortable at Hughes Dermatology. (Some other offices use nerve block injections in the wrists for anesthesia which are uncomfortable and can produce serious side effects.)
Surgical procedures, especially sympathectomy, should be considered only as a very last resort, because of operative risks and the development of excessive sweating elsewhere (compensatory hyperhidrosis).
Please make an appointment with Dr. Hughes or Dr. Tichy for evaluation and treatment.
Basic skin wellness renewal regimen
This life-time fundamental regimen is always the starting point in a skin wellness anti-photoaging regimen. It consists of prescription topical retinoids, prescription topical alpha-hydroxy acids, chemical mini-peels, practicing sun safety with photostabilized sunscreens (and avoidance of tanning parlors) and oral antioxidants (an oral multiple vitamin and green tea). It is an affordable start since the cost for each visit is billed as an “office visit.” (Plus, we are not selling you products in our office!) It helps fine lines, eradicates whiteheads and blackheads, erases early liver spots and pre-malignant keratoses. The improvement develops slowly, with patients observing a nice effect after 3-6 months.
Men with pre-cancers, liver spots and sun damage will all benefit from Hughes Dermatology’s basic skin wellness regimen. It is a cost-effective solution that will improve your appearance!
There is recent evidence that these chemical peels may prevent skin cancer!
New: Hughes Dermatology is prescribing topical conjugated estrogen creams in female postmenopausal patients as adjunctive therapy to improve photo-aging, in addition to the above basic regimen. Topical estrogen is safe and free of systemic side effects.
The next “minimally invasive” additional steps may include management of wrinkling (crows feet, frown lines) in the upper third of the face with Botox, dermal fillers for marionette lines and loss of lip fullness, volumizing the lipo-atrophic face, cryosurgery to remove actinic keratoses and liver spots, improvement of rhytids around the mouth with Er:YAG laser resurfacing or superficial fillers (Belotero Balance), ablation of red vessels with the pulsed dye laser, scar management, and laser rejuvenation (collagen and ground substance production with the long-pulsed Nd:YAG laser).
Sidney Coleman, M.D. states, “Aesthetic surgery is moving rapidly away from excision and suspension procedures to augmentation procedures for rejuvenation in particular. The primary event of facial aging is atrophy or loss of fullness. The obvious solution for atrophy is restoration of volume or fullness.”
Facial Redness
This is caused by multiple tiny red vessels (telangiectasia) and is inherited or sun-induced. It may co-exist with acne rosacea. Other than prevention with early use of sunscreens (or picking different relatives!), treatment consists of laser eradication with Hughes Dermatology’s pulsed dye laser (Candela V-Beam Perfecta ). This is done without the need for any anesthesia other than the cryogen tha precedes each laser pulse.. With our new variable pulse width laser, there is generally no bruising. This is a “minimally invasive procedure” and patients can return to work without make-up. About half the time a second touch-up session is done a month or so later. Hughes Dermatology has 2 decades of experience successfully treating this problem.
A relatively new use of the pulsed dye laser is removal of bruising (senile purpura or actinic purpura) on the forearms and tops of hands.
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Pulsed Dye Laser Surgery – Facial Redness
Cynosure Photogencia V
Blue vessels of the face are safely ablated with the long-pulsed Nd:YAG laser (Laserscope Lyra-i), or sclerotherapy. The blue nasal blood vessels shown here are best treated with Hughes Dermatology’s long-pulsed Nd:YAG laser; sclerotherapy with 23.4% sodium chloride (hypertonic saline) would be an alternate option.
Sclerotherapy or Laser Rx of Superficial Varicose Veins
“Spider” veins are adnormal small superficial red or blue blood vessels on the legs or face. They are usually dominantly inherited. They can cover a large area of skin and be quite unattractive.
Treatment
If spider veins are unsightly or uncomfortable, they can be treated with Hughes Dermatology’s long-pulsed Nd:YAG laser (Laserscope Lyra-i), our new Vbeam Perfecta pulsed dye laser or by injection sclerotherapy (our favorite agents: hypertonic saline or aethoxysclerol) that will cause them to disappear or become much smaller. Sclerotherapy is still the preferred and most efficient method if there are large numbers of vessels. It is well-tolerated (a tiny 31 g needle is used). We recommend that graduated pressure support hose (20-30mm Hg) be worn for 2 days continuously afterwards and then another week when “on your feet.”
Dr. Hughes has had 35 years of experience successfully treating this aggravating condition and has presented lecture material on this subject at the annual meeting of the American Academy of Dermatology.
Please schedule “extra time” for this popular procedure.
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Spider veins: before and after
Laser Ablation of Unsightly Blood Vessels
Red or blue vessels of the face are safely ablated with the pulsed dye laser (if small & red), the long-pulsed Nd:YAG laser (if blue), or sclerotherapy. The blue nasal blood vessels shown here are best treated with the long-pulsed Nd:YAG laser; sclerotherapy would be an alternate option.
Some “dark circles” under the eyes are the vascular type and may respond to pulsed dye laser treatment.
Laser Hair Removal
Laser hair removal uses a low-energy laser to gently remove unwanted hair. The laser energy passes through the skin and is absorbed by the pigment in the hair follicle. In a fraction of a second, many of the treated hair follicles are injured by the heat generated by the laser and then don’t produce a new hair.
With the exception of the region close to the eye, almost any area of the body with excess black hair can be treated with lasers. The most common areas requested by patients are the face, upper lip, neck, chest, periareolar (breast region), underarms, back, abdomen, bikini line and legs.
Until recently, patients with light skin and dark hair were the only good candidates for laser hair removal. However, the use of longer wavelength lasers and skin cooling devices (Dr. Hughes’ Laserscope Lyra-i laser with its saphire contact cooling) have increased the safety of lasers used to treat patients with darker skin types who, until now, were not good candidates for laser hair removal. These skin cooling devices protect the upper layer of skin in darker skinned patients from absorbing too much laser energy, thereby reducing the risk of blistering and pigment change. Our long pulsed Nd:YAG laser can safely remove black hair in all skin types!
For female patients with “hirsutism” (thick hair in a male pattern), following a medical history and possibly a blood test, Dr. Hughes will offer topical and oral medications in addition to laser hair removal to treat this devastating problem.
Multiple treatments (typically 6) are necessary to achieve satisfactory hair reduction. A consultation visit is necessary to determine if a patient is a good candidate for laser hair removal.
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Lyra-i Laser Hair Removal
Shaving bumps(pseudofolliculitis barbae) are caused by ingrown hairs which produce a foreign body reaction in the skin. Previously, the only effective treatment was to “grow a beard.” Now, Dr. Hughes’ long-pulse Nd:YAG laser successfully treats this troublesome malady and is safe for skin of color. Contact us for evaluation and treatment.
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Nd:YAG Laser Treatment of Shaving Bumps
New: A pilonidal sinus is a congenital sinus track (usually in the buttock fold, but occasionally in the underarm) aggravated by a foreign body reaction to ingrown hairs. It has recently been discovered that these can be treated with the long-pulsed Nd:YAG laser to remove the hairs and thus improve the problem with this non-surgical method. Hughes Dermatology has had success with this new treatment.
Warts and Molluscum Contagiosum
Warts are benign contagious tumors that involve the skin, oral tissue, genital or anal areas. The etiologic agent is a double-stranded DNA virus called human papillomavirus. Warts are generally classified by their clinical features and morphology (e.g., common, flat, filiform) or by location (e.g., genital, plantar, respiratory papillomatosis). The wart on this patient’s finger was successfully treated with immunotherapy (candida and trichophytin antigens USP), a new nonscarring method. Molluscum contagiosum is another DNA viral-induced contagious tumor.
Treatment
These can be treated with immunotherapy (injecting antigens or using Aldara cream topically), chemically with anti-viral agents (eg. glutaraldehyde, 5-fluorouracil), with liquid nitrogen or with laser therapy. The newest most effective Rx may be intralesional immunotherapy with MMR (measles mumps and rubella) vaccine, as reported in the July 2010 Archives of Dermatology. Pulsed dye laser therapy for molluscum contagiosum was first dicovered and published by Dr. Philip Hughes and is the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998).
With the FDA approval of the HPV vaccine (Merck’s “Gardisil” vaccine), some warts will be a thing of the past in the immunized population. The vaccine contains types 6/11 (which cause genital warts) and 16/18 (the cervical cancer and oropharyngeal oncogenic viruses).
Scar Management
Major theme: Successful scar management requires early intervention. Whether the patient has a grooved traumatic or surgical scar or an elevated hypertrophic scar, corrective measures should be carried out at one month post-scarring event. These include resurfacing (ablative laser, dermabrasion or 90% TCA) for grooved scars and pulsed dye laser or topical or intralesional steroids for red elevated scars. Treatment is inexpensive. This contrasts with the old obsolete advice of waiting a year to “see what happens.” Scars are common. If patients are aware of this urgency, they will benefit from early scar management.
Acne scars are managed in multiple ways (depending on the nature of the scarring), including laser resurfacing (Erbium:YAG), laser rejuvenation (Nd:YAG), focal acd peeling, excision and resurfacing, dermal fillers (especially Belotero Balance) and topical retinoids. Gouged-out scars are filled in with a combination of focal chemical peels (the Korean method), a long-pulsed Nd:YAG laser and Belotero Balance filler. Hughes Dermatology can improve these scars!
Dr. Philip Hughes will be course director and principal speaker on “Scar Management” at the annual American Academy of Dermatology meeting in NYC, August 2015.
New: It was recently discovered that keloids can be excised and then the site treated with imiquimod (an immune modulator)topically for 3 months to prevent recurrence. Dr. Hughes has had success with this new method.
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Surgical Scar Management – Erbium: YAG Laser Resurfacing
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The picture on the left demonstrates acne scarring treatment by Dr. Hughes using Erbium: YAG laser resurfacing. The picture on the right was taken 10 weeks after laser treatment.
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Acne scarring before (left) and after (right) laser rejuvenation with the long-pulsed Nd:YAG laser.
See an article on scar management by Dr. Philip Hughes.
Chemical Peels
Chemical peeling is a technique used to improve the appearance of the skin which is typically performed on the face, neck or hands. In this treatment, a chemical solution is applied to the skin that causes it to peel off. The intensity of Hughes Dermatology peels varies from a “mini-peel” with 10% TCA to a moderate “combined peel” (Jessner’s solution followed by 35% TCA). The new, regenerated skin is usually smoother and less wrinkled than the old skin. Chemical peeling is also done to enhance the penetration of medications into the skin when using 5-fluorouracil creams for premalignant solar spots(actinic keratoses) treatment or to enhance the penetration of Retin A. Chemical peels are an essential part of melasma (“mask of pregnancy”) treatment.
Philip Hughes, M.D. has used various peeling agents for the last 35 years and is an expert in performing multiple types of chemical peels. A thorough evaluation by Dr. Hughes is imperative before embarking upon a chemical peel.
Female Baldness
Dr. Hughes can diagnosis and treat most types of female baldness. Following a consultation appointment which will include a hair telogen count and laboratory evaluation, a specific diagnosis will be made (examples: telogen effluvium, female pattern baldness, alopecia areata, tinea capitis, psoriasis, lupus, etc.). Telogen effluvium is treated by recognition and treatment of the underlying medical cause. Pattern baldness, which is genetic, is successfully treated with 5-alpha reductase inhibitors and topical minoxidyl. Please see us for treatment of this psychologically devastating malady!