|
Cosmetic Dermatology Dermatologists Dermal Filler Anesthesia
|
Adult DermatologyBasic skin wellness regimenThis fundamental regimen is always the starting point in an anti-photo aging regimen. It consists of FDA approved prescription topical retinoids, prescription topical alpha-hydroxy acids, chemical mini-peels, practicing sun safety with sunscreens and oral antioxidants including an oral multiple vitamin and green tea (and avoidance of tanning parlors) . It is an affordable start since the cost for each visit is billed as an "office visit." (Plus, we are not selling you products!) It helps fine lines, eradicates whiteheads and blackheads, erases early liver spots and pre-malignant keratoses. New: Hughes Dermatology is re-introducing topical conjugated estrogen creams in post-menopausal women who are not on estrogen supplements for its documented youthful effect. Studies demonstrate that topical estrogen is safe and free of any systemic 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 (Radiesse) and loss of lip fullness (Juvederm & Restylane), volumizing the lipo-atrophic face with Sculptra, cryosurgery to remove actinic keratoses and liver spots, improvement of rhytids around the mouth with Er:YAG laser resurfacing, 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 RednessThis is caused by a multitude of tiny red vessels (telangiectasia) and is generally inherited or sun-induced. It often coexists with acne rosacea. Other than prevention with early use of sunscreens (or picking different relatives!), treatment of small red vessels consists of laser eradication with our 585nm pulsed dye laser (Cynosure Photogenica V). This is done after 30 minutes of topical anesthesia (LMX5) and our new Zimmer Cryo 5 cold air machine is used during the procedure. The procedure leaves a superficial bruise that lasts 7 to 10 days and can be covered with Dermablend make-up. About half the time a second touch-up session is done a month or so later. Hughes Dermatology has had a decade of experience successfully treating this problem.
 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.Mole ManagementIf a mole is abnormal according to the ABCD rule, it should be examined by Dr. Hughes or Dr. Tichy with a dermatoscope. If it is irregular under the dermatoscope, it should be biopsied. Sadly, the most aggresive melanomas (legs in women, back in men) occur in relatively young adults, so watch your moles! Usually this biopsy can be done via a cosmetically elegant shave biopsy right at the time of the initial visit. Hughes Dermatology recommends annual whole body skin cancer checks in order to identify a malignant melanoma at an early and curable stage. If a mole is malignant (malignant melanoma) prompt surgical excision is done in our office surgery suite.  Moles that are irregular in color and shape or bigger than a pencil erasor should be promptly biopsied (malignant melanoma shown here)! New: In addition to prompt surgical excision, Aldara (imiquimod, a topical immune modulator) is used postoperatively as adjunctive treatment to destroy any residual malignant cells.Annual skin cancer exams Patients should be examined "head to toe" annually to check for suspicious moles, pre-malignant and malignant skin tumors. In most cases, a dermatoscope will be used for mole evaluation. The squamous cell carcinoma shown here represents the second most common skin cancer and it is ultraviolet-light induced. So use sunscreens, wear hats and protective clothing!Chemical Peels Chemical peeling is a technique used to improve the appearance of the skin and 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 depth of the peel is determined by the chemical agent and varies from superficial (upper epidermis to full epidermis), medium (epidermis and uppermost dermis), and medium-deep (epidermis and upper dermis).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, as when using 5-fluorouracil creams for premalignant keratosis(actinic keratoses) treatment or to enhance the penetration of Retin A. As a bonus, there is dramatic cosmetic improvement following this treatment. Chemical peels are an essential part of Hughes Dermatology's treatment of melasma ("mask of pregnancy").Soft Tissue Fillers (Dermal Fillers) "Restylane, Perlane, Juvederm, Radiesse, Sculptra" Soft tissue fillers are injected under the skin, mainly for marionette lines and loss of lip fullness. They are used to "plump up" the skin to improve contour and correct wrinkles, furrows and hollows in the face. The two current state-of-the-art hyaluronic acid fillers are Perlane and Juvederm Ultra Plus which do not require a skin test and usually lasts about 12 months. For patient comfort, Hughes Dermatology uses topical anesthesia pre-op and our new cold air anesthesia (from our Zimmer Cryo 5 unit) during the injection. Read this report in Dermatology Times. We are a dermatology resident training facility for dermal fillers. For a more natural look, Dr. Hughes and Tichy will add "pillows" to the lower lip when doing lip enhancement. Never use a permanent filler as it will show as a linear nodule with age! For this reason, we are not using Artefill, a new plastic PMMA permanent filler.
Hughes Dermatology is now offering "Sculptra" treatments as a volume filler for cheeks. This is helpful for thin, fit women or men who have lost facial cheek volume and have resultant looseness and wrinkling in this area. A recent article in Dermatology Times provides a nice overview of this treatment.
Sculptra before and after, 3 sessions Lasting 2 years (or more), it has been called a "liquid facelift." Injections of biodegradable Sculptra are done every 4-8 weeks with volume improvement (secondary to new collagen production) occuring slowly over 8 weeks. Typically, 3 sessions are required for optimum correction. There is no down-time other than occasional bruising. Sculptra is initially expensive but is safe, cost effective and long-lasting. Radiesse is a FDA-approved (12/06) biodegradable calcium hydroxylapatite microsphere filler that lasts longer (12-18 months) than the hyaluronic acid fillers. It is used primarily for nasolabial and marionette lines. It should not be used in lips. It is comfortably done using topical LMX5 followed with infiltration and cryoanesthesia. There is swelling that lasts a couple of hours, but then the improvement is immediate. Because it is injected deeper, it has more "lifting power." It can even be used as a non-surgical rhinoplasty ("nose job") in some patients, if part of the nose needs added volume. Our patients have been pleased with Radiesse. Radiesse and Sculptra are both being used by Hughes Dermatology to add volume to the tops of hands, creating "hand rejuvenation." We use the new "depot" technique which produces less bruising.
Evolence, a new J&J porcine-derived collagen filler, was approved by the FDA 7/1/08. Drs. Hughes and Tichy are Star-certified Evolence injectors. It is a long-lasting filler that now available in our office. It is particularly effective for ablating nasolabial folds, marionette lines and the pre-jowl sulcus.
Elevess is another new filler. This one is hyaluronic acid with a local lidocaine anesthetic, making it a more comfortable injection. It is currently the least expensive filler. 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 or Dr. Tichy to see if you are a good candidate for this noninvasive more natural alternative. 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. Hughes Dermatology can now improve all these lines and bands without surgery and without scars by a simple injection of botulinum toxin type A 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), and lichen simplex chronicus. Hughes Dermatology is a Botox training facility for dermatology residents.
Hyperhidrosis Hyperhidrisis is excessive sweating, usually of the palms and underarms. This is an inherited condition. Although it usually responds to topical prescription medication, 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).In October 2007, Dr. Hughes will appear as a medical expert in a British documentary on hyperhidrosis. Stay tuned! Please make an appointment with Dr. Hughes or Dr. Tichy for evaluation and treatment. Hughes Dermatology is a Botox training facility for dermatology residents. Laser Rejuvenation Laser rejuvenation (or non-ablative laser rsurfacing) is a new and promising minimally-invasive procedure using an FDA approved laser to reverse dermal signs of aging. It is mainly used on the face and neck, but can produce subtle improvement of loose wrinkled skin on the abdomen, knees and hands. Our new long-pulsed Nd:YAG laser (Laserscope's Lyra-i laser) stimulates collagen and ground substance production in the skin and improves facial and neck fine wrinkling, produces modest tightening and modest acne scar improvement. A series of treatments (usually 6) over the course of a year constitutes the typical treatment. Then, improvement is maintained with laser treatments every 3 to 12 months.
Laser rejuvenation: after (left) and before (right) using Hughes Dermatology's long-pulsed Nd:YAG laser. We are seeing nice results in patients with shallow facial acne scars. This is a no-downtime treatment, producing minimal redness for less than an hour. The treatment is relative inexpensive. Laser rejuvenation manages only deeper wrinkling issues and it should be combined with a surface rejuvenation regimen (topical retinoids, alpha-hydroxyacids and chemical peels) for maximum benefit. The improvement is slow with patients and physicians usually noticing the improvement after the 3rd treatment. Improvement in collagen and ground substance can be seen under the microscope; the clinical impovement can be more subtle. The majority of our patients have been satisfied with these rejuvenation treatments.
Acne scarring before (left) and after (right) laser rejuvenation with the long-pulsed Nd:YAG laser. For deep wrinkles or rhytids around the mouth, Erbium:YAG laser resurfacing (which is usually combined with chemical peeling elsewhere) is better, but this does require a 5-7 day healing time.) Hughes Dermatology is experienced with all these methods and can recommend approaches on an individual basis. Laser Hair RemovalLaser 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, hair follicles in the growing phase (anagen) are eliminated by the laser. The Lyra-i hair removal laser has a chilled saphire window which provides patient comfort. In addition, a topical anesthetic is used prior to the procedure. Our hair removal laser is safe for all skin colors. Following a consultation appointment to make sure you are a good candidate (laser hair removal is effective only for black or brown hair), laser hair removal can begin at Hughes Dermatology.
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. Sclerotherapy or Laser Rx of Superficial Varicose VeinsSpider veins are small enlarged superficial blood vessels that appear red or blue. They commonly occur on the legs, but may also occur on the face or chest. They are usually dominantly inherited. Dr. Hughes has lectured at the American Academy of Dermatology about sclerotherapy. These spider veins are successfully treated with sclerotherapy or laser ablation with Hughes Dermatology's new long-pulsed Nd:YAG laser. Please make an appointment for evaluation and then schedule treatment for these unsightly vessels!
PsoriasisPsoriasis is a persistent skin disorder in which there are red, thickened areas with silvery scales, most often
on the scalp, elbows, knees, and lower back. Some cases, of psoriasis are so mild that it only involves the fingernails. Severe psoriasis may cover large areas of the body. Pustular psoriasis can be life-threatening. Hughes Dermatology can help even the most severe cases. Please schedule an appointment. Female Baldness Hughes Dermatology 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! Stretch MarksNew red stretch marks (striae rubra) can be successfuly reduced or nearly eradicated with early 585nm pulsed dye laser treatment in conjunction with topical retinoid applications. Older white stretch marks (striae alba) are more difficult, but they can be improved as well.
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||
